My shoulder update – surgery January 2017

If you have attended my yoga classes in recent months, you would have noticed that I have been dealing with a nagging problem in my right shoulder for some time now. In a previous update on my shoulder, I wrote about the re-tear of the rotator cuff muscles after the surgery in October 2013. As a result of that tear, I have had a limited range of motion (ROM) as well as limited strength in the right arm/shoulder. However, despite the tear and some limitations, for almost three years after the surgery I was able to raise my arm to a full vertical position without any significant pain. That level of ROM allowed me to practice sequences like Surya Namaskar and asanas like up/down dog etc. without much problem. I was, in fact, able to practice almost 75-80% of all the asanas in my usual routine. You can view a sample of the movements in this video on the Sun Salutation sequence which is from August, 2016. I was perfectly happy with this level of functionality in my shoulder and had no desire or intention to get any further treatment done to the shoulder. Of course, I have vivid memories of the painful experience after all three previous shoulder surgeries. For those who are not aware of it, I had my first shoulder surgery on the right shoulder back in 2002. That surgery was quite successful and I was back to normal functionality. Soon after, in 2005, I had to have the same surgery on my left shoulder as well.

Then, about four months ago, suddenly I began to feel a big change in my shoulder’s condition. In a span of a few days, I found that I was unable to lift my arm above my shoulder level. I was no more able to do positions like the plank pose, upward facing dog etc. without significant discomfort. I could not put my finger on anything that I might have done to cause this change. However, the situation with my shoulder began to deteriorate gradually and I started feeling increased pain in various movements.

At this point, I decided to see a shoulder specialist to explore possible options for fixing the tear in the rotator cuff. About two months ago, I saw a specialist at Duke Raleigh. After looking at the X-ray and learning about my history of two previous surgeries on the same shoulder, he told me that the shoulder had deteriorated beyond any reasonable repair. He strongly advised me to learn to live with the situation. He also recommended that I get a steroid injection right away which would give me pain relief and better ROM for at least one year. However, to my great disappointment, after getting the injection I experienced no pain relief whatsoever.

I was aware of a relatively new procedure wherein they use a graft patch of some external tissue (most commonly taken from a pig) to augment the torn rotator cuff and then do the surgery. In fact, the doctor at UNC Hospital who did the surgery in 2013 was planning to use that technique. However, during the surgery he decided to go without the patch as he was able to bring the muscle back to the bone without having to add the patch. Unfortunately, the surgery did not hold and the muscle was torn again, possibly due to the weakness of the muscle.

On doing some more research on the internet I found that more successful cuff surgeries have been done using the graft patch in recent months/years. During this online study I also noted that the name of Dr. Alison Toth at Duke Hospital was associated with some of the research in the same field. So, I decided to seek a second opinion with her to see if something could be done to fix my shoulder. In my meeting with her, she talked about the same procedure of using a graft patch. However, she told me that the pig skin patch may not be strong enough for my situation. She would rather use an even more recent procedure wherein they use a patch made from human skin. The technical term for this technique is "Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears using Acellular human dermal allograft" and the brand name for the product is Arthroflex.

After some thought, I decided to go for this surgery which took place on January 5. As per the doctor, the surgery went well. Because of the nature of the surgery, the doctor anticipates a long recovery period, possibly up to one year before full recovery. However, with regular physical therapy and my yoga practice as therapy, I should be able to get back to normal yoga activity within six months or so.

Shoulder in sling

The doctor also seems to have done a good job of pain management this time. In my previous surgeries, I suffered severe shoulder pain for several days after the surgery. In fact, I had to be on strong narcotics for at least a week. A highly undesirable side-effect of the narcotics was there I suffered severe constipation as well as trouble emptying the bladder. After this recent surgery, due to some effective pain management, I have not had to use any strong narcotic medicine. The pain has been completely bearable with the use of over the counter drugs like Tylenol and Ibuprofen. I am required to wear a sling to support my right arm all the time for three weeks. After that I need to wear the sling only when I am in public places for up to eight weeks. I am also not supposed to drive for at least three weeks.

Despite having to wear the sling even at night, I have been sleeping quite well. Since the pain is minimal and am able to sleep well, I have started practicing my yoga routine on a daily basis. Obviously, I am unable to do any of the asanas that require use of the arm/shoulder. On the other hand I am able to spend more time to work on my toes, legs, knees, thighs, hips, spine, core etc. This should help me stay relatively limber despite limited arm and shoulder movement. I am currently going for physical therapy twice a week and may continue this schedule for about 3 to 4 months.

I am grateful for all the good wishes that I have received from family, friends and yoga students. It is this support and encouragement that gives me additional strength to deal with the situation and get back to normal activity levels soon.