Shoulder Hell

shoulder_painFirst I turned 40, then I had my first knee surgery to replace a torn ACL after landing wrong my right foot and hyper-extending the knee during an indoor soccer game. Three years later, almost to the day, I had my second knee surgery, after another soccer incident, tearing my meniscus in my left knee. Last year at age 44 it was my left shoulder. Why the cause of the shredded bicep tendon is still unknown to to point, I can only assume it was from lifting weights. That soreness I experienced in my shoulder that was mistaken as “tightness” was probably tendonitis and stretching the shoulder out and continuing to lift only aggravated the injury. I feel as if I have been in shoulder hell the last year or so.

On Tuesday I returned to physical therapy to receive treatment for my left shoulder. The pain I had prior to surgery has return with no decrease of intensity (7-8 on pain scale of 10) on a daily basis. I know I did too much, too soon last year after the initial surgery in October and caused added pain at times, but I don’t believe that accounts for the pain I am experiencing now.

The physician assistant I met a few weeks back opened with, “So what do you want me to do?” That statement allowed cause frustration and concern that I was just going through the motions. She offered up Cortisone, which I refuse to have injected into my shoulder a second time. While it can relieve the inflammation, I don’t believe it had any positive results on relieving the pain I have been in. She countered with ultrasound and while not as involved as an MRI, it did give her a look inside my shoulder to see if there was anything going on. It did reveal some tendonitis, in the shoulder joint, as well as inflammation of the shoulder capsule.

She provided a single exercise and nothing more for my $15 office visit and “call our office again, if the pain persists.” Wow! It wasn’t but 2 days later I was frustrated and called and requested a referral for physical therapy. The othropedic’s office still believes there is nothing going on in my shoulder. They believe the original problem was the only problem, a shredded bicep tendon, which has been reattched and is now problem free. The ongoing pain they cannot account for.

Talking to the therapist, a gal I had for my first knee surgery sees the shoulder pain in a completely different light than the orthopedic’s office. After the initial session, she was not going to rule out a tear in the labrum, which could result in surgery. In the meantime, she is giving me 3 weeks (6 therapy session) to see if the pain and inflammation can be reduced. Motion of the left arm is very limited, not being able to scratch my back bring it across my chest.

While I had been lifting weights training for Tough Mudder, moving a barbell has been put on hold. No weight training until further notice. I can however do some modified rows, in order to strengthen back muscles to relieve some of the pain in the shoulder. I am still able to run, so there were no restrictions on staying active. Even if I am not lifting weights, working around the house is still a challenge. Lifting, pushing, pulling and moving things in my daily life cause varying levels of pain. One thing is for certain, I won’t miss Tough Mudder. It might mean I won’t be able to compete in all the obstacles, but I will be participating and supporting my team.

“Knee-d” More Information

As of today it will have been 4 sessions with the physical therapist encompassing 2 weeks. To date, I have been provided with electric stimulation, ice, ultrasound and a series of strengthening exercises for my left knee. To date, the pain still exists and while the muscles around the knee (quad,hamstring, calf) will eventually get stronger, the cause of the pain still exists. The therapists has mentioned it a few times that she doesn’t believe the underlying cause is osteoarthritis of the left knee.

While the day to day pain has subsided, there is still a pain and terrible popping noise when I walk, this is especially noticeable when climbing stairs. Even sitting with the knee in a bent position or lying down with my legs straight out will eventually increase the severity of pain. While the therapist cannot come out and tell the orthopedic surgeon how to do his job, she does recommend I push for an MRI of the left knee.

On the recommendation of a user at the McDougall Forums, I picked up a book by Pete Egoscue called Pain Free: A Revolutionary Method for Stopping Chronic Pain. This book attempts to get to the root cause of the pain through a series of exercises and stretching routines called “E-cises.” Only a few chapters in and one comments from the author stood out. “The musculoskeletal system’s worst enemy…is the x-ray machine. With one stroke of technological genius, we went from observing the body from the outside with sharp eyes to scrutinizing it with a specialized instrument from inside.” This rings true with my trip to the orthopedic surgeon. A quick 3-4 minute discussion while looking at the x-ray and I was on my way. Never did his hands or eyes feel or see my knee, except via the x-ray.

I won’t take the orthopedic up on his recommendation for a series of injections that may or may not work. That would (if successful) only provide a stop gap and not get to the root cause of the problem, must like Pete Egoscue stresses in his book. Therapy has gone about as far as it can, progress isn’t being made and the therapist recommends “further work up” as she called it. Reading between the lines, she wants to see an MRI.

Physical Therapy Begins

Let the physical therapy begin! It’s a day shy of a month since I injured my left knee playing soccer…yeah I know dear, you told me so…today was day the start of another physical therapy session in order to resolve the pain and strengthen the muscles around the knee. Depending on the injury, as I am quite confident it’s NOT osteoarthritis in the knee, I might end up back at the orthopedics’s office inside of 10 days.

I passed on the story and timeline of the injury and the subsequent doctor visits and the fact that no one touched my knee for more than about 60 seconds in the three different office visits I had. Today, the therapist pushed, poked and prodded for a go 30 minutes and is convinced there IS a problem, but to what extent I will have to wait and see. Part of the problem is continued swelling on the knee. Ice, heat, elevation and an anti-inflammatory are the prescribed remedy for the swell, but that won’t account for the pain and discomfort I am still in.

As we talked during our session, I made mention that the orthopedic surgeon spent no more than 5 minutes with me, never touching me knee and based only on X-rays diagnosed me with osteoarthritis. She had a good laugh and disagreed with his diagnosis. I went into more detail about how this injury feels the same as my 2009 ACL injury in my right knee, but the orthopedic seems to be dismissing any pain or swelling. Then again I am quickly losing faith in our medical system IF this turns out to be something more severe.

After about 45 minutes I was given a list of exercises in order to strengthen muscles around the knee. Most of the exercises caused pain to the knee (interior portion), but she told me to do a few sets of ten, if possible. I will be returning on Friday for another session. I am already having my doubts, not about the therapy but about how this entire process is playing out. The therapist said she would have liked to see an MRI, but I told her none were requested by the orthopedic, which only called his opinion into further question.

While I wasn’t happy with the orthopedics’s diagnosis, I think the therapist is siding with me that there IS a problem and hopefully her notes and input will help me get the situation the sort of resolution I am looking for.

Coincidence?: Part IV – The Bullshit

My wife continues to tell me it’s due to insurance reasons, but I have my doubts. I called the physical therapy office today about 90 minutes later they returned my phone call, took some basic information and started the process to schedule some appointments. The first available appointment, April 3! That is three weeks away, what am I supposed to do in the meantime with a knee that continues to be a problem as described yesterday in Coincidence?: Part 3?

The moment after hanging up the phone with the PT office, I dialed the doctor’s office. I explained my situation and how the knee was doing. I explained that it would be next month before I could get in for physical therapy and if there was someone available to see me today. Unfortunately, maybe I should have pushed a bit more, the nurse practitioner, wasn’t available, but they would not have the doctor see me. Huh?

The reason was because the doctor was not the original physician to “treat” (which they didn’t) me last Monday. All I am trying to get out of this visit is an MRI and a referral to an orthopedic surgeon, someone who knows more about the true problem other than hearing “it’s a sprain, ice, heat and you’ll be fine in 6 weeks.” My body is telling me otherwise, yet nothing I have said or done seems to strike a chord with this doctor’s office.

I am set up with an unnecessary appointment (that will cost me $15) with the nurse practitioner, who will probably spend less than 5 minutes with me (again) and not provide me with additional information that I already don’t know. I would venture to guess they will be quick to prescribe medication. Way to go! Big Pharma to the rescue again. Pfft…not. Regardless of the outcome, I won’t get a definite answer on my knee until AFTER we get back from vacation (which starts Sunday). It includes a roadtrip to SoCal with stops at Disneyland and San Diego scheduled. That is one less week to recuperate IF surgery is needed to resolve the MCL issue. Unfortunately time on the books is not something I have a lot of. So the saga continues…

Back to Work

It has been 12 days and I am back to work again after taking more time off because of post operation problems with my right knee. Actually, the knee is healing well and physical therapy has been great. The flexibility is almost back to normal, minus some lingering pain that still exists. The strength is slowly coming back with continued exercise, I might actually connect the Wii back up since WiiFit, as I was told by my PT is a great way to strengthen the knee. Hmmm…who would have thunk it?

The problem still resides in my foot, where the tingling persists on a 24/7 basis. The pain is much worse at night when I go to bed, but is with me all day. If I have been on my feet all day or walking, sitting with knee bent (like today at work) I know by the time my punch out time rolls around I am going to be in more pain.

I posted a message on another message board (Teton Gravity) under their “Gimp” section pertaining to my ACL tear and surgery. Someone mentioned to find a homeopathic ointment call Trauma Oil. I have not been able to find it locally, but do see it sold on the Internet. Trauma Oil consists of Calendula flower, Arnica flower and St. John’s Wort in a small 1 oz. bottle. As described, “Indicated in injuries, strains and inflammations of muscles, ligaments, tendons and joints: fractures and dislocations, sprains, bruises, contusions, arthritic joints and rheumatic pains.” Can’t hurt to give it shot since the numbness on the right side of my knee is not going away either.

I have 2-3 months of possible FMLA/Short Term Disability available to use, IF needed. Hopefully I won’t miss any more time at work, but if needed it is there. The chance for a second surgery is still there, but not for at least a month of so. I return to the orthopedic surgeon on May 20th, for a two month follow up. We will see what he says at that time, as it stands now I don’t see any improvement in the sensation.