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Other/Mixed Rotator Cuff Surgery Sucks

Other strength modalities (e.g., Clubs), mixed strength modalities (e.g., combined kettlebell and barbell), other goals (flexibility)
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Steve W.

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I haven't posted about this because it falls under the second line in my signature, but I'm almost two weeks post surgery to repair a torn rotator cuff (supraspinatus tendon). I tore it playing basketball in September, but wanted to see how it responded without surgery before committing to a surgical repair.

I've been able to do alot of productive training in the interim. KB swings, mace swings, crawling, KB hack squats, inverted rows, many clubbell and band exercises, wheel rollouts/ring fallouts, and LSD on the NordicTrack skier were all well-tolerated, and I was able to continue to play basketball, albeit hampered.

I was not able to snatch, press, clean, do anything holding a KB in the rack or goblet position, do pullups or get ups (which I rarely do anyway), or do many clubbell exercises. Sleeping and many daily activities were also hampered to varying degrees.

Although I was able to maintain a reasonable degree of function (after seeing the MRI and then examining me, all the doctors I consulted were shocked at the degree of functionality I had), and the general trend over time was positive, it became clear to me that surgery was ultimately necessary and should not be put off any longer.

Due to the degree of the tear, my doctors are being very conservative about starting physical therapy, but optimistic about my overall long term prognosis.

So I'll be wearing a sling, sleeping (or at least trying to sleep) in a chair, and not driving for probably another month and a half. The overall rehab period will be several months longer than that.

I plan to scrupulously follow the rehab program and other training guidelines prescribed by my doctors and physical therapists, and then intelligently ramp up my training as I am cleared to do so.

Hopefully, in the long run the result will be positive.
 
I've had one shoulder done & really need the other one done too, but I've been able to manage it up until recently. I had well over 100 dislocations before I committed to surgery, so mine was fairly messed up before the op too.

It's not much fun being in a sling, but it's amazing what you can adapt to and learn to do with one hand. When I had mine done I had my hand resting on the opposite shoulder and had a bandage around my torso to keep it fully isolated for the first month. The sling didn't go onto about week 5

Take it easy with the physio and you should come back better than before.

I hope you have a speedy recovery Steve.
 
Tarzan said:
I've had one shoulder done & really need the other one done too, but I've been able to manage it up until recently. I had well over 100 dislocations before I committed to surgery, so mine was fairly messed up before the op too.

It's not much fun being in a sling, but it's amazing what you can adapt to and learn to do with one hand. When I had mine done I had my hand resting on the opposite shoulder and had a bandage around my torso to keep it fully isolated for the first month. The sling didn't go onto about week 5

Take it easy with the physio and you should come back better than before.

I hope you have a speedy recovery Steve.
Click to expand...

Thanks for the kind wishes.

I talked to a woman today who had been injured in a car accident and was in a sling for six months afterward, so everything is relative.
 
@Steve W.
All the best. You have the right attitude. Don't rush the healing, do what your physio's and doc tell you. There are no shortcuts. I had my right labrum repaired a few years back. It was a full 8 months before I could climb again. A full year until I didn't 'notice' my shoulder. And probably 18 months before I really felt strong again.

I am getting ready to get the other one done.

Take care...
 
Steve W's super buyer's guide to arm slings:

Part 1:
If you have to live in an arm sling for weeks and months on end, even small differences in comfort add up to big differences in tolerability over time. I've actually tried 5 different slings since injuring my shoulder, so the following observations may help anyone out there facing substantial sling time. This is based on wearing these slings for two weeks and subject to revision with further use.

Wearing a sling is very uncomfortable above and beyond any pain from the injury/surgery itself. Having your arm immobilized is just a very uncomfortable feeling on it's own. Then there is pressure against the injured arm from resting in the sling, and pressure on the neck/opposite shoulder from the strap/harness.

In my opinion, an essential feature of a tolerable sling is an offloading harness with a second underarm strap to pull the main strap away from your neck, direct the load more vertically onto the uninjured shoulder, and distribute some of the load under the arm of the uninjured side. It does take some experimentaton to get the lengths of the different straps right for a comfortable fit, but it's definitely worth the trouble.

A couple of other general points:

If you are near the border between sizes, using the manufacturer's sizing charts and measuring instructions, I recommend going with the smaller size. I find it very uncomfortable to have my hand buried in a sling that is too long. I was exactly on the border between sizes on the Donjoy chart and went with the smaller size (also on the advice of Donjoy customer service) and it was the correct call. Coincidentally, the other Donjoy sling provided by my doctor was also the smaller size. I was near the bottom of the size large range on the Breg chart, but probably would have done better with a medium. I was near the top of the size regular/medium range on the Ossur chart and that size fit well.

All the slings came with very long straps. In most cases straps have a lot of adjustment range, and a lot of them are made so you can cut them shorter and reattach the velcro closure to the end of the cut strap. Personally, I have an aversion to cutting the straps and am paranoid that I will trim them too short and render them useless. I'm about 5'9" and some of the straps needed to be tightened to the end of their adjustment range to fit -- in some cases even beyond their seemingly intended adjustment range by overlapping the closures in creative ways. If you are shorter than me and/or slightly built, you will probably have to do some cutting.

15 degree abduction pillows seem to be standard for rotator cuff surgery. After the first week, my doctor told me I could remove the pillow if it was more comfortable without it, but I find using the pillow much more comfortable than not using it.

Note that all the slings I've used were conventional slings with shoulder straps/harnesses. There are other styles that support the arm from underneath with a rigid support that straps to the waist, but these seem to be much more expensive and not commonly used for rotator cuff repairs.
 
Steve W's super buyer's guide to arm slings:

Part 2:

Here are the slings I've used and my observations:

Procare cloth sling:
Generic cloth sling. Picture "arm sling" in your mind and you know exactly what this looks like. This sling was given to me at the immediate care orthopedic clinic I went to right after my injuy. To say that I would rather have my arm amputated than wear this sling for a whole day qualifies as hyperbole by only the smallest of margins.

Donjoy Ultrasling III:
This is the sling I was outfitted with at the hospital after my surgery. The actual sling part where your arm sits is nicely designed and comfortable, with a good balance of breathability, padding, flexibility and rigidity (the right degree of rigidity make the sling much easier to get in and out of, and supports the arm without squeezing it too much).

I like that strap attachment point near the wrist is further up the forearm than other slings, and the area around the hand is somewhat cut away around the top. Having the sling pull against the forearm, rather than directly against the wrist or hand is much more comfortable, and the cutaway allows good freedom of movement for the hand.

The thumb loop is easily positioned so it gives you some security that you arm won't slide too far forward, but without being tight, and you can easily slide your thumb out of it when you want.

The abduction pillow has rounded ends, a concave contour against the body, and a convex curvature against the arm. The front is thicker than the back, which I found put my arm at a more comfortable angle. The rounded end at the front works well with the strap placement on the forearm since is gives the hand a little more freedom of movement. However, the convex curvature against the arm felt weird. My forearm, which is not curved, does not lie flat against the pillow, so the apex of the curve puts a subtle pressure against the arm which is noticeably annoying for long wear. The rounded front end of the pillow did not work well when used with other brands of sling that have strap attachments nearer the wrist end of the sling. With other brands of sling, the straps tended to pull at an angle over the curve that put uncomfortable pressure on the wrist.

The Utrasling III has a terrible single strap that cranks on your neck, and the sliding pad attached to it tends to slide out from under the strap, so the bare strap is against your body.

Donjoy Ultrasling IV:
This sling is very similar the Ultrasling III. The sling itself looks superficially identical to the Ultrasling III, but the lining is less meshy, and more solid, and doesn't breath as well. It also has a couple of additonal strap anchor points on the sides of the wrist that don't seem to serve any purpose.

The main difference between the Ultrasling III and IV is that the IV has an offloading harness instead of a single strap. However, the design of the harness is poor. The window between the shoulder strap and the underarm strap is uncomfortably small, and there is an additional length of strap between the ring where the two straps come together in front and the buckles that attach the harness to the sling. The other brands of slings that use the offloading harness design (described below) do not have this extra length of strap. It's a problem because it puts the ring up higher on the chest where it presses uncomfortably against the body. With the other brands that don't have the extra strap, the ring is lower and rides away from the body. However, the Ultrasling IV harness is still much more comfortable than the single strap of the Ultrasling III.

The Ultrasling IV also has a slighty different shaped abduction pillow that is equally thick at both ends instead of tapered in the back like the Ultrasling III.
 
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Steve W's super buyer's guide to arm slings:

Part 3:

Breg Slingshot 3:
The Breg Slingshot 3 has the best, most comfortable harness of any of the slings I've used. Instead of straps with seperate sliding pads, the padding is integrated into the straps themselves, more like padded backpack straps (not exactly, but the same idea). Not only is this more comfortable and distributes the load better, but the straps tend to twist and tangle less, making the sling easier to put on. One drawback of the integrated strap/pad design is that the adjusment range is more limited, although it fit me fine.

Another thing that makes the Slingshot 3 easy to put on is the buckle that attaches the harness to the sling (the last thing you close when donning the sling). The Slingshot 3 has a single buckle, where the Donjoy and Ossur slings have two buckles. The buckle is also smartly designed with a finger hole in it that makes it easy to squeeze the buckle closed with one hand. The buckles on the other brands are much more fiddly to line up right and squeeze closed.

The sling part of the sling is very light, meshy, and breathable, and has an adjustment flap/strap at the elbow designed to take pressure off the ulnar nerve, but which I found more useful to adjust the depth of the back of the sling.

This sling is very comfortable when you first put it on, but has a few drawbacks that make it annoying to put on and fatiguing to wear for long periods. Since the sling is very light and unstructured it tends to flop around and fold in on itself instead of standing open and making it easy to slide your arm in.

Also since it is so soft and unstructured, it tends to hug and squeeze your arm more than a more structured sling -- more like lying in a hammock than lying on a mattress. It feels fine at first, but become fatiguing over time.

Finally, the buckles are right at the end of the sling, meaning that the strap pulls uncomfortably against the side of your hand, instead of your wrist or forearm. It also means your hand has less freedom of movement, unless you scooch your arm forward in the sling so you whole hand is outside the front opening.

The abduction pillow of the Slingshot 3 is also somewhat annoying. Instead of one piece, it consists of two wedges velcroed together. The idea is that the wedges can be configured to provide 15 degrees of abduction, a neutral position, or a neutral position with external rotation. In practice, I only use the 15 degrees abducted configuration, and the two velcroed wedges tend to flop around instead of staying solidly together and really functioning like one unit.

The thumb loop of the Slingshot 3 is not as easy to position comfortably as the thumb loop of the Donjoy Ultraslings.

BTW, I tried attaching the Breg harness to the Donjoy sling. It was easy enough to make the attachments, but the dimensions of the two didn't quite seem to work together and I couldn't adjust the combination for a comfortable fit.

Ossur Form Fit Shoulder Brace:
This seems to be a new model by Ossur. Most online supply sites seem not to stock it yet, and have the older Ossur SmartSling model instead. The big difference between them is that the Form Fit has an offloading harness and the SmartSling has only the traditional single strap. I found a dealer on Ebay that had the Form Fit, and for a much better price than other vendors had the older SmartSling -- and a lower price than any of the other slings (other than the generic cloth sling) for that matter.

The Ossur Form Fit harness works well. It has flat straps with sliding pads that aren't quite as comfortable as the Breg straps, but the pads stay in place well. The straps are made of a thinner material than on the other brands. It seems strong enough and isn't uncomfortable, but the straps tend to flop and twist more than other brands, making the Form Fit a little harder to put on.

The sling part of the Form Fit is very well-padded and holds it's shape well. This makes it very easy to slide your arm in, and distributes pressure well. The downside to this padding is that the sling tends to be hot. Like the Donjoy slings, the harness attachment is not at the end of the sling, and the end of the sling is cut away on top. This places the pull of the strap in a more comfortable place and gives the hand more freedom of movement.

Another nice touch of the Form Fit is that the velcro closure on top of the forearm is integrated into the sling and not a separated strap. It looks nicer and seems less prone to accidentally getting stuck in the wrong place and getting in the way when putting the sling on. However, since the closure is attached on the left side of the sling and velcros to the right, it looks like it might not work as well if wearing the sling on the left arm. Wearing the sling on the right, the closure fastens on the outside of the arm. Wearing the sling on the left, the closure would fasten on the inside, in between the sling and the abduction pillow.

The arm pocket in the Ossur Form Fit is shallower than the other slings. This makes it easier to get into, and my arm fits in it fine, but if you have really huge arms or wanted to wear a thick fleece or sweater inside the sling, it might be a problem.

The Form Fit comes with a removable elbow cushion that fits inside the sling. I find it more comfortable without the cushion. The thumb loop of the Form Fit is uncomfortable to the point of uselessnes. I attached the Donjoy thumb loop to the Ossur sling and it works perfectly.

The abduction pillow of the Form Fit works fine. It has symmetrical ends, a concave curvature against the body, and a flat surface against the arm. The velcro strip that connect the sling to the pillow is smaller than on the other brands, but this has it's advantages. It's big enough to hold the parts together, but it's a little easier to position. All these slings are covered in velcro everywhere, and straps and parts are always getting accidentally stuck together where you don't want them to.

Overall, the Ossur Form Fit is my overall favorite and the sling I wear the most. I still change into the Breg Slingshot 3 or a combination of the Donjoy Ultrasling IV harness with the Ultrasling III sling on a regular basis. None of the slings is perfectly comfortable, and it's nice to be able to be uncomfortable in a different way occasionally instead of in the same way all the time.

Hopefully this post might help someone. Buying and trying these different slings was a little expensive and perhaps overkill. But I think ultimately worth it to me, both from the standpoint of minimizing discomfort, and giving me a bit of a sense of control in a situation where I don't have as much control as I'd like.
 
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Steve W. said:
I haven't posted about this because it falls under the second line in my signature, but I'm almost two weeks post surgery to repair a torn rotator cuff (supraspinatus tendon). I tore it playing basketball in September, but wanted to see how it responded without surgery before committing to a surgical repair.

I've been able to do alot of productive training in the interim. KB swings, mace swings, crawling, KB hack squats, inverted rows, many clubbell and band exercises, wheel rollouts/ring fallouts, and LSD on the NordicTrack skier were all well-tolerated, and I was able to continue to play basketball, albeit hampered.

I was not able to snatch, press, clean, do anything holding a KB in the rack or goblet position, do pullups or get ups (which I rarely do anyway), or do many clubbell exercises. Sleeping and many daily activities were also hampered to varying degrees.

Although I was able to maintain a reasonable degree of function (after seeing the MRI and then examining me, all the doctors I consulted were shocked at the degree of functionality I had), and the general trend over time was positive, it became clear to me that surgery was ultimately necessary and should not be put off any longer.

Due to the degree of the tear, my doctors are being very conservative about starting physical therapy, but optimistic about my overall long term prognosis.

So I'll be wearing a sling, sleeping (or at least trying to sleep) in a chair, and not driving for probably another month and a half. The overall rehab period will be several months longer than that.

I plan to scrupulously follow the rehab program and other training guidelines prescribed by my doctors and physical therapists, and then intelligently ramp up my training as I am cleared to do so.

Hopefully, in the long run the result will be positive.
Click to expand...
Hi Steve, best of luck in your recovery! I was going to say the board will miss your sage advice because I assumed you wouldn't be typing for a while, but then I saw your lengthy posts describing different slings and it's apparent that you can still type with the best of them.

After reading a post in the Kettlebell forum regarding recovery from ACL surgery, I have to say these joint/connective tissue surgeries and recoveries sound awful. I've broken four bones and lacerated my forearm but those were all "easy" compared to these. You hear pro athletes tearing their ACL's or rotator cuffs all the time and you don't see them again for a year, typically. But what you don't hear is what they went through to get back. Last year my wife was diagnosed (without an MRI) with a torn or ruptured tendon in her foot and they prescribed a custom orthotic for her shoe to try to head off a possible surgery. The surgery/recovery sounded brutal to us, but overall not much different than what I'm hearing with these other injuries. I got her started doing kettlebell swings and KB deadlifts to, if not fix her foot, at least get her stronger ahead of time in case we have to go the surgery route. As of now, she's getting around just fine with the orthotic and her foot doesn't appear to be doing any worse, no pain either.

Hope your recovery is smooth!
 
Baron von Raschke said:
Hi Steve, best of luck in your recovery! I was going to say the board will miss your sage advice because I assumed you wouldn't be typing for a while, but then I saw your lengthy posts describing different slings and it's apparent that you can still type with the best of them.

After reading a post in the Kettlebell forum regarding recovery from ACL surgery, I have to say these joint/connective tissue surgeries and recoveries sound awful. I've broken four bones and lacerated my forearm but those were all "easy" compared to these. You hear pro athletes tearing their ACL's or rotator cuffs all the time and you don't see them again for a year, typically. But what you don't hear is what they went through to get back. Last year my wife was diagnosed (without an MRI) with a torn or ruptured tendon in her foot and they prescribed a custom orthotic for her shoe to try to head off a possible surgery. The surgery/recovery sounded brutal to us, but overall not much different than what I'm hearing with these other injuries. I got her started doing kettlebell swings and KB deadlifts to, if not fix her foot, at least get her stronger ahead of time in case we have to go the surgery route. As of now, she's getting around just fine with the orthotic and her foot doesn't appear to be doing any worse, no pain either.

Hope your recovery is smooth!
Click to expand...

Thanks for the good wishes. I can now type if I position the keyboard the right way, although it is a little uncomfortable.

My philosophy is to avoid surgery if at all possible. Dan John once joked, "I think I have another surgery in me, but not another recovery." Plus, in many cases, the relationship between pain, dysfunction, and structural damage that shows up in imaging tests is not necessarily clear. In my current case, given how I felt, all the information I had, and the medical advice I received, I reluctantly decided that surgery was the right choice at this time.

I hope your wife continues to do well.
 
Hoping to for speedy and thorough recovery, Steve! That's quite a buyers guide to slings you've written, there. I hope to never need it but I sure know where to look if I do.
 
@Steve W. hope you recover quickly and well. And, despite being out of action, hope too that you will continue to contribute to the forum with your insightful advice and knowledge. Good luck
 
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