On November 10th I had shoulder surgery. I, by the way, am Neely Quinn, one of the founders of TrainingBeta. My bio is here. If you’ve been following the podcast or my blog posts, you’ll know by my incessant whining that my shoulder pain kept me from climbing since early May of this year, which sucked.
Why Am I Telling You This?
The reason I’m writing this is, first of all, because I wasn’t able to find the kind of information I wanted from climbers about shoulder injuries when I was researching it. I know a ton of us have had shoulder injuries and surgery, but I couldn’t find details about the kind of pain people feel, what warrants surgery, what people have recovered from without surgery, what surgery is really like, what kinds of different surgeries there are, and what the recovery process is like.
I wanted photos and videos and first hand accounts from my community, and it was lacking, so this is my contribution. I’ve also gotten a ton of questions from readers and podcast listeners who want answers to their own shoulder problems, so this is for you guys, too.
The Back Story
When I first started experiencing the pain, I thought it was just a tweak like so many others I’ve had over the years, and that it would go away. I sought out my normal practitioners for help: rolfers, acupuncturists, massage therapists, and chiropractors. They can usually fix me up.
Dry needling by my chiropractor, Brent Apgar, took away a lot of the pain that was shooting down my triceps, biceps and up my neck, so that was cool. Rolfing, acupuncture, and massage seemed to do nothing, unfortunately.
Description of the Pain
From the very beginning, what I felt was an instability in my shoulder. There was a big “catch” when I tried to lift my arm up from my side. So much so that I’d have to move my arm around it to get it above my head, and sometimes I couldn’t get it above my head.
There were other motions that would cause the catch, too, like bringing my arm back toward my body after it was out in front of me, or moving it to the outside of my body, as if to toss your keys on the counter in a quick motion (I learned that the hard way). Climbing was hard because I couldn’t fully weight it without intense pain, and any sort of lock-off was pretty much impossible because of pain and instability.
It kept “subluxating”, too, which means it was continually falling subtly out of the joint capsule, which caused a lot of pain and more instability.
How I Did It
Perplexingly, I didn’t “injure” my shoulder in the typical sense. I wasn’t climbing one day and felt a tweak. We’d been living on the road climbing 3-4 days a week for the past 9 months happily without injury. I was working on a 5.13c with shouldery cruxes (The Cross at the Wailing Wall in Nevada) with no problem. Then I took a 3 week break from climbing and sat on our couch doing a work project (in the Paleo nutrition world) on my laptop.It was an extremely stressful time, and I was working about 100 hours a week (sometimes not sleeping at all for days). My posture was terrible. When I went back to climbing, it hurt and never stopped. That’s it.
Moral of the story? I stand while I work now, I take lots of breaks, and I try not to get so stressed out. I’m more aware of my posture all the time, and I do shoulder exercises (rotator cuff strengthening and general shoulder exercises) with my other shoulder. I’ll continue to do these for the rest of my life. I hope you do, too.
Road To Surgery
After 3 months of seeing all of my alternative practitioners, I finally went to see an orthopedic doctor – a PA actually – for further testing. I wish I’d gone a lot sooner.
After doing her manual tests (press down this way, push up this way, does that hurt?, etc.), she didn’t think there was anything very wrong with me. She thought it was just a little bit of biceps tendonitis and impingement – that it would go away.
I wasn’t convinced, and I’m stubborn, so I insisted on an MRI. She compromised at an x-ray, which showed that my shoulder was sitting higher in the capsule than normal, which could mean something was torn. The x-ray also suggested a slight hint of the beginnings of a bone spur, but nothing to worry about, she said. She agreed to the MRI.
The MRI showed that my labrum was torn and they suggested surgery. I was absolutely terrified of surgery, so I got a second opinion from one of the best shoulder surgeons in the country (world?), Dr. Tom Hackett at the Steadman Clinic in Vail, CO. He thought I could do without surgery, but after 6 weeks of PT that he prescribed (with no pain relief), he gave me a cortisone shot in the shoulder capsule.
That made the pain go away a little bit – enough so that I could climb up to 5.10 on good days, but not without pain. So after 5 weeks of that, I got surgery.
They can’t tell you exactly what procedures you’re going to end up needing until they’re actually inside your shoulder. I ended up getting a subpectoral biceps tenodesis and a subacromial decompression with partial acromioplasty (bone spur). I didn’t know any of those words until after my surgery, either. Here’s what it means.
If your surgeon is willing and able to do a biceps tenodesis, that is fantastic news. It means you have a knowledgable doctor who doesn’t fall back on repairing all labral tears, which often doesn’t take care of the pain and inflammation. The recovery time is about 5-10 times longer, too. Meaning 8-10 months instead of 6 weeks (like mine).
This right here is one of the MAIN reasons I’m writing this whole boring thing out for you. If you’re going to get shoulder surgery, ask your surgeon if he/she is going to consider tenodesis, or if they will only repair the labrum with anchors. If they say yes to the latter, get a different doctor. Or go to Tom Hackett, even if it means you have to fly to Vail to see him and have him do the surgery.
Here’s what tenodesis means. And just for the record, I am by no means a doctor. If I mis-speak here, please let me know in the comments and I’ll correct it. I’m not trying to be a know-it-all at all – just trying to warn my fellow climbers 🙂
Ok, so if you have a torn labrum, it’s often caused by your biceps tendon. Your labrum is like a golf tee for your shoulder. It’s a bunch of cartilage that gently cups your shoulder to keep it all in place. The labrum is connected to the biceps tendon, and since we use that tendon a lot as climbers, it gets pulled and inflamed and can tear holes in the labrum – or tear it right in half.
So some doctors will go in and just tack the hole back together with anchors and hope it doesn’t tear again. My doctor (and according to my doctor, all good shoulder surgeons) will at least consider biceps tenodesis, which is removing your biceps tendon from your labrum altogether and attaching it to your arm bone.
That’s what mine did.
Tenodesis removes the possibility that you’ll ever have impingement (of your biceps tendon going under your shoulder) again, or that your biceps tendon will tear your labrum further. So they drilled a hole in my arm bone, threaded my newly cut tendon through the hole, and anchored it with some sort of rod on the back side of my bone and a plastic plug inside the bone (I think).
But I don’t have to wait for anchors to affix themselves to my labrum, and I didn’t have to be in a sling for 5 weeks, and I’ll be climbing 6 weeks after my surgery, and I feel incredibly fortunate.
Now, if my labrum had been more severely torn, he would’ve put anchors in it – not sure if he would’ve also done the tenodesis. Anyway…
Subacromial decompression with partial acromioplasty is apparently the fancy name for removing a bone spur. I had a level 3 bone spur in my shoulder (the biggest kind), which was basically making it impossible to NOT impinge my biceps tendon and cause all kinds of other pain every time I moved the wrong way. It also damaged a section of my biceps tendon. Good thing they tore that sucker off…
They just go in with a shaver tool, shave off all the fascia on the bone spur and then shave down the spur and call it good.
So my doc thinks most of my pain was coming from the bone spur, which, if you recall, my orthopedic PA said had maybe a possibility of existing when she looked at the X-ray.
Here are some before and after photos they took during the surgery. See that thing that looks like the moon in the top picture? That’s my bone spur and the little black area below it is the minimal space my tendon and everything had to move around. Below it Dr. Hackett drew a little line showing the space that now exists because of the bone spur removal.
The Actual Surgery Process
To be honest, I have always been absolutely terrified of general anesthesia. I assumed I would die if I underwent this kind of procedure (I’m a glass half-empty kind of girl sometimes), and dying was the only possible downside of the surgery that consumed my thoughts leading up to it.
So if you have a similar fear, here’s what I experienced in the hospital.
I arrived at 10:30am. They quickly ushered me into a room where I got into my robe and put me in compression socks to avoid blood clots (I had to wear them for 2 weeks afterward, too). They took my vitals, talked to me about what was going to happen, the risks I was taking, the fact that MOST people don’t die due to anesthesia, and asked me about 100 times which shoulder I was having worked on.
Then they shot my neck area with the nerve block, which numbs your arm down to your hand and makes it so that you have to have less anesthesia and less narcotics afterward. Then he gave me valium, which made me very happy. I liked that.
Then they started wheeling me into the surgery theater while I was talking to my old climbing friend, Dave, who also happened to be my anesthesiologist, about how amazing my husband is at climbing… and I don’t remember one thing after that until I woke up.
I woke up a couple hours later to Seth (my husband) sitting next to me, at which point I apparently repeated the same 4 sentences 10 times (“What time is it?”, “I’m so glad you’re here”, “I can’t feel my arm”, “Did you get something to eat?”). Then I ate a sandwich (they make sure you can eat and go to the bathroom before you can leave), got dressed, and walked down to our car.
The nerve block wore off that night, unfortunately, and that’s when I discovered my love of narcotic drugs. I haven’t done drugs since I was 17 years old, and I’ve had a lot of bad experiences with them, so I was scared to take anything. I told them I didn’t need a heavy narcotic, so they just gave me Vicodin.
The pain was excruciating. I asked them for oxycodone, and after 14 hours of the most nauseating, life-altering pain I’ve ever experienced, it finally started to work and the next week is a faint memory – lots of sleeping.
On day 2, I was told to swing my arm around passively, dangling it below me. Or have Seth move it for me. I cried every time he moved it for the first week. It was rough. I also had really bad nerve pain in my hand and arm on my surgical side, which I’ve since learned can happen to people with neck injuries (I have 2 bulging disks in my neck), so I had to stay on the drugs for longer than I would’ve otherwise. I got off of them on day 6.
During week 2, things started to rapidly improve. I started to cry less during PT, I could almost lift my hand to my head, Seth didn’t have to do everything for me, walking wasn’t so treacherous.
Week 3 I could do my own hair, wash my hair with both hands, drive less dangerously, my range of motion started coming back quite a bit, I was okayed to start working with bands, and I started thinking about working again.
This week (Week 4), I have a lot of range of motion back, but still a lot of pain with certain movements. I can straighten my arm out to my side and bring it all the way up to my head, like this…
But I can’t get it as far back as I’d like…
That’ll come. It’s just stiff and sore for now.
Using my biceps has been the most challenging part, since the bone is still recovering from having a hole drilled through it and the tendon was cut off of its home of the past 36 years. So no biceps curls for me for another week or so, but I can lift things now. I can even lift my 40-lb dog out of the car (she’s gimpy right now, too).
Mostly I just stretch my arm and shoulder, work with the bands, do range of motion drills passively or actively (using a pulley system, a wall, my hand, a stick, or my muscles). I look like an idiot in the gym just lying on a mat with a stick for an hour, but whatever.
I can do some yoga, I could run (if I wanted to, that is), and I’m looking forward to getting the ok to climb before Christmas. We’re going back to Vegas in January (on the road again – woohoo!!), and I’m psyched to do tons of moderates that I’ve never taken the time to do before.
My Physical Therapist
If you’re in the Boulder, CO area, I HIGHLY recommend Seneca Webb for any physical therapy needs you have. She’s at North Boulder Physical Therapy, and after having gone to 2 other physical therapists before I could get back in with her, I can hands down say that she is the best, smartest, most compassionate and skilled physical therapist I have ever seen.
The prognosis for my shoulder is that I should be climbing 6-8 weeks after the surgery, and potentially be climbing at my peak 3 to 5 months out. That’s typical for this surgery, according to other climbers I’ve talked to and my surgeon. I was previously looking at not really climbing at all until 6-8 months post surgery before I knew about the tenodesis, which was really depressing to me. I have a lot of respect for those of you who’ve gone through that and kept your spirits high.
My muscle mass has decreased a LOT – I lost about 10 pounds through all of this – all of my muscle is gone. So I’m looking forward to not looking like a child-sized weakling anymore.
Anyway, I just hope that this post gives those of you with impending shoulder surgery some info and perspective.
All in all, it’s been a surprisingly quick and relatively easy experience. My shoulder has come a long way in a short amount of time.
If you’re interested, I’ll update you again in a couple months. Please let me know if you have any questions in the comment section – I’m happy to answer them! And thank you so much to everyone who’s emailed or FB’ed with support and encouragement through this. It means a lot!
Top Photo Credit
Photo by Brian Suntay of me on Vision Thing in Rifle. I hope to be back to my old self there this summer!