QUESTION: Hey there, I have had surgery on my left shoulder 3 times. The first for a grossly torn posterior labrum with multi-directional instability, the second was a anterior capsular shift, the third was for SADC and DCR.
I have been having alot of biceps, deltoid, posterior pain with and without motion. Feeling of crunching and poping when dropping my arm from over head and I feel unstable when trying to reach behind my back or behind my head. I have also been waking up at night with intense pain when rolling on the shoulder with a sensation that it has shifted forward and is nearly dislocating, but when I slowly roll off of it, I can feel it reduce and the pain goes away.
During my last arthroscopy the pics in the ball and socket joint showed several glenoid lesions and a spot that looked like the surface was peeling off toward the anterior labrum, the labrum is fraying all along the anterior side and at the biceps anchor. The biceps itself is also fraying and the posterior inferior labrum is all chunky and bulky with fraying all over. I asked my ortho about it and asked him if that stuff was normal and he said that I dont need to worry about it and that the cause of my pain was from the AC joint that he chopped out.
Well here I am almost 2 years later and my symptoms remain and are accelerating. Ill attach the scope pics, I know you cant comment on them specifically, but I just need to know if I need to find a new doctor and get this treated. I am 40 years old and very active, I initially injured the Labrum with a car accident in 2000 and had 40 or 50 dislocations in 2 years before I had it fixed in 2003. The ball part appears to be OK, the rotator cuff appears to be OK. I have no strength probs and my range of motion is pretty much complete accept for the few movements that feel unstable. Im wondering if the glenoid is toast and if I should look into a ream and run proceedure
ANSWER: You have been through a lot on this shoulder, and it will never be Normal as you probably know. The whole shoulder multi-directional instability thing seems to continually change over the years as to what is the best treatment, Thermocapsulary was big at one time can google.
You are young for a total shoulder replacement, and if in cont'd pain/instability I would try and get a second opinion from a shoulder specialist,one who does at least 75% shoulders. You have had the usual "treatments" that one has-but unfortunately the outcomes vary a great deal. The labrum fraying is probably not a huge factor unless you are having catching,clunking type sensation with shoulder rotation..ie making a circle with your arm. I'm sure you have tried PT although not mentioned, it is one of the best things to do and to keep doing as home exercise program.
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QUESTION: Are there treatments for dealing with Glenoid lesions alone? I know that there is a ream and run proceedure that resurfaces the glenoid, but the humeral head needs to be replaced too. My humeral head seems to be ok (at least last time we were in there) but the glenoid is jacked up. Are there things that can be done to buy me time with the glenoid without a shoulder replacement?
Thanks for your help.....I do appreciate your time. You dont have to volunteer for this, but you do.....and I am thankful for that!
Yeah thats a partial shoulder replacement basically-Typically The ream and run is done when you have severe arthritis of the joint,so I don't know if you would be candidate for that? it's a major surgery relative to scoping. They have done procedures called Microfracture of chondral lesions for the glenohumeral joint, these are things I've heard of at conferences etc but no first hand knowledge.