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Living with Psoriatic Arthritis (PsA)

Shoulder Replacement

#1

Hi Everyone,

I am looking at a shoulder replacement in near future and would like to hear from those who have already had one how the did post op?
I would be having it 6 weeks before my son’s wedding, can I do it?
Otherwise I would have to wait till fall and I am at the point where steroids no longer help. Just walking with my arm down is painful…
Thank you!

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#2

Hi Krim.

Six years ago, I was where you are. I had my left shoulder replaced on August 23, 2013. My post-op was not “normal” because when the doc was reaming out everything for the implant, my humerus shattered. I have a cerclage holding it together.

That meant when I started PT in early September (maybe 10 days after surgery), we moved muuuuch slower–only four exercises, two with support under my arm and two without. That went on until late October. I was finally able to get both hands on the keyboard sometime in November. I was in PT until sometime in the spring of 2014.

I can’t remember how long I was on pain meds. I know I moved from one every six hours to one every eight or ten, and then a half every 12 hours, I think.

At six weeks, I was still wearing my shoulder brace–can’t remember if it was 24/7 or while I was awake. Also at six weeks, I had finally begun to feel better–I didn’t drop off to sleep at the drop of a hat. I had more energy than I’d had for a while.

While successful in doing away with 24/7 pain, it was not as successful as it could have been in part because I have cervical spine involvement and in part because the damage had gone on too long before the surgery.

Lamb, I think, has also had a shoulder replaced.

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#3

Thank you sixcatlawyer, all good to know!

#4

Well I have had two and they were different as night and day. The first one was done the old fashioned way. Nerve block and lots of pain meds. I was trussed up likea pig with a sling and in a LOT of pain (but then I only take pain meds day one EVER) Slept in a recliner for a week and was an unhappy camper for about 3 mos.

The second one was done by a new out of residency Hot Shot with the NEW method. No nerve block (the evidence is clear they aren’t much help other than getting you out of the hospital quicker and less nursing care while you are there and the new guys refuse to use them)

I was out of recovery at 11:30 I understand they did give me one dose of pain meds while in recovery. I never saw them again and was not given a take home prescription. I did recieve some torodal (3 doses max) and was on IV Tylenol and oral Ibuprofen. NO SLING. PT arrive for their first Session at 1:00 pm and apologized for being late. I was in the hospital 3 days and saw PT 3 Times a day and had one Session with OT to learn how to take a shower… I won’t say I didn’t have pain but at NO TIME did it ever reach the oh CHIT level

Resumed normal activities immediately (except for weight etc) and had 60% rotation with in 3 weeks and full rotation within 8 weeks. Never looked back…

Its all in the surgeon. If he a general Ortho shop some more There aren’t many of those guys left. The whole field is now specialized. Make SURE he has done an upper Limb FELLOWSHIP and is not just the guy who does all the shoulders in the practice. I traveled a long ways to get one. WORTH IT. He also if he is worth a tinkers damn will schedule around your biologic dosing so you miss as few doses or in my case a delay of only 2 weeks… If he can’t won’t move on.

Nerve blocks and pain meds dramatically increase healing time so make sure they discuss in detail with you their plan. Most medical centers will have a pain management pharmacist as part of the the ortho surgery staff wh will visit with you and develop a minimal (or no) narcotic plan.

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#5

Thank you tntlamb, I will definitely ask for that!

#6

I have a ton more questions to ask my new shoulder guy. Thanks, Lamb.

Krim: I can’t prove it because of the cspine issues, but I have often wondered in the last six years just how much my old surgeon’s lack of attention/skill (discovered AFTER the damn surgery) had to do with the lack of use I still have (I can mostly dress myself but I can’t fasten anything on my back and sometimes, pulling my hair back is an issue). Like I said, I’m out of 24/7 pain but use is questionable day-to-day.

THEN last year, my old shoulder guy was suspended from practice because he was high doing some sort of ortho surgery. Turns out he likes Ambien and Oxycodone. Can’t prove this either, but I have to wonder when his addiction started.

#7

Heres what the anesthesiologists are saying (rebound pain being more significant than post op pain :

https://www.asra.com/asra-news/article/37/rebound-pain-after-a-nerve-block-wears-o

The main issue is many if not most Orthos (in the USA anyway) own their own Surgi centers and are doing day surgeries that SHOULD be done in the hospital. Even if they don’t own surgi centers there is a hug advantage in that the can do TWICE as many procedures in a day. There is a reason that Ortho is now one of if not the highest income specialty.

The orthos will persist that the nerve blocks are for the patient UNTIL you look them square in the eye and say "BUT Local anesthetics are widely known to be neurotoxic and may be the source of neuronal damage. If not why are are gabapentin, and dextromethorphan being used postoperativley with nerve blocks??

FWIW umpublished (but its coming i promise) research has pretty much confirmed that rebound and longer term pain is far MORE significant in shoulder surgeries following nerve blocks. Other research also confirms that Opiod Hyperalgesia (super sensitivity) can be created with JUST The opiods used during the procedure when a nerve block has been done.

BTW I have had nerve blocks that make sebnse. I have had several nerve entrapment surgeries. The blocks sorta make sense there…

Anyway I’ll step off my soap box now…