Two week Post op check for shoulder surgery – subacromial decompression

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I saw my surgeon today for the two week post op check for my shoulder arthroscopic surgery (subacromial decompression).

She was amazed. And thrilled.  I showed her my range of motion and told her the shoulder was already so much better than before.

She couldn’t believe how well I am moving it. I told her I have been doing my physio exercises religiously. I have been moving it as much as possible, as per her recommendation, even though it does hurt. And I have been using my pain meds as directed, and icing the shoulder often.

She told me I was an exceptional patient and she wished all her patients did so well!  She told me most people can barely raise their arm at this point.  And in fact, I am doing better than most people she sees at their six week check-up.  She felt there isn’t even a need for me to come back at six weeks, unless I want to.

I’m pretty darn pleased with all of this.  I think it’s a testament to the fact that she’s a brilliant surgeon – she did her job very well.  And I’m also taking some credit myself.  I can work through considerable pain (years of experience) and for me it’s worth experiencing more short term pain, for a quicker and successful recovery.

She told me to keep the shoulder moving at all costs. The biggest risk of the surgery was adhesive capsulitis (frozen shoulder).  To avoid that she wanted my shoulder OUT of a sling and moving as normally as possible.  And as much as possible.

Within 24 hours I was doing everything around the house on my own. I don’t have any help, so maybe having to do it all was an advantage.  I cooked, cleaned, did dishes.  And I did my physio exercises.  And yes, it all hurts a lot.  Really quite a lot sometimes.  But this is pain with a purpose. For rehabilitation. For the greater good.

Unlike inflammatory arthritis pain which is just good for nothing!

She also took me through some photos of the inside of my shoulder joint.  Showed me what an inflamed bursa looks like.  And the inflamed synovium.   Clear signs of active RA.  Proof positive that I have uncontrolled RA.  She even told me to show it to my rheumatologist or anyone who doubted that my pain is due to active, aggressive disease (blood tests be damned).

She showed me the bone spur that she filed away. She said it was as thick as a pen and she had trouble getting her instruments into the space to clear it away.  She said she really wondered how in the world I was moving my shoulder at all with all that crap in there!

She said I must be pretty tough.

It’s really nice to hear that from a doctor.  Usually I get ‘the look’. The one that says ‘are you sure your pain is THAT bad?’

My surgeon was the opposite.   I could see that she had a lot of respect for me.  For the pain that I was in prior to the surgery.  And for the way I was managing my recovery.  I could also feel a lot more empathy at this follow up appointment. I think it’s because she had seen with her own eyes, and cleaned out my inflamed tissues with her own hands, the damage that my RA is causing.  And she knows that what’s going on in my shoulder is indicative of what’s going on elsewhere in my body.

And what she saw was active inflammation.  Lots of it.  The labral tear was the type that is only caused by a shoulder dislocation.  So I managed to dislocate my shoulder without noticing.  I’m so used to pain, I just thought it was another level of shoulder flare.

And the other thing? I have no biceps long head tendon. At some point it tore completely.  It’s not necessary for shoulder function and in fact she often surgically snips this tendon rather than repairing it.  But mine was completely gone.  So I tore my tendon completely and didn’t notice that either.

All of that combined told her a lot about the kind of pain that I live with.  And she gave me a lot of respect and extra kindness.  She said ‘It’s a horrible disease.  I wish more people understood how much damage it can do.’  I would have to agree!

I know I am blowing my own horn a lot here. But I am so used to people telling me that I have a low pain tolerance, which I do not believe to be true. It shouldn’t bother me that people think that, but it really does.  My surgeon gave me validation.  The surgery put my daily pain into perspective.  Within 48 hours the post op pain was less than my daily arthritis pain.

Looking at the pictures of my shoulder told me that I have been pushing my body too hard.  That I do have to stop or slow down when I feel pain.  Because sometimes I am actually doing extra damage by ignoring the pain.  But it’s tough – how do I tell which pain is damaging pain, something tearing, something being injured, or what’s RA pain?

I don’t know.  But I am going to take it slower in the gym. Take it easier.  Even for me, seeing the inside of my shoulder showed me that I have some pretty serious disease going on.  Sometimes fighting is resting.  Although the hardest thing in the world for me to do is nothing at all.

So it really was a great appointment.   My shoulder is already less painful than it used to be.  I’m expecting it to improve to be the same as my left shoulder. Probably better, because the left is deteriorating. I won’t wait so long to get an arthroscopic clean out on the left.  I waited far too long on the right shoulder.  I have been living with that pain for more than four years.  Because I had no idea that surgery would improve it so much.  And because I was afraid of surgery. Of opening that door. I felt like once I started down that road, it would never stop.

And it won’t.   My surgeon gave me the names of the best hip surgeon in town and the only spine guy she would go to.  I trust her recommendations, and I know I will need these people at some point down the track.

Surgery is a treatment of last resort for RA these days.  Its supposed to be rarely required, because the treatments are so good these days.  But in my case, I am there in various joints.  Even if Orencia suddenly puts me into remission, there is damage done.  But it is hugely cheering to me to know that surgery is an option and potentially can relieve a lot of pain.

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