I'm six months post-op for the repair of a complete tear of the supraspinatus. Our situations are somewhat similar in that I'm a vet, too, and my procedure was funded by the VA. However, it wasn't the VA who did mine.
In case you aren't aware, the VA has a program to pay for getting you treated by an outside (civilian) physician.
Veteran's Choice is supposed to help vets get access to health care all the sooner. It does a piss-poor job of that, and it can be a pain in the ass because it subjects you to an additional new level of beauracracy (versus 'regular' VA care), but it does give you the option to pick your own (civilian) doctor. If you're not familiar with Veteran's Coice and want more details, let me know.
The surgery itself should be painless. My new favorite pain killer is fentanyl, because this surgery was the first time I'd had it. It's 200x stronger than heroin! Good shit, Maynard! Unfortunately (or fortunately, depending on your point of view) there's no euphoria from fentanyl like there is with heroin, just ten tons of "I don't give a fuck-ness."
My repair was arthroscopic. The waiver I signed before the surgery included a clause that authorized them to go old-school if they found problems making it necessary once they got inside, but they didn't see the need to go that route. I had five separate incisions, each less than an inch long. The scars are barely noticeable. My doctor described them as looking like "chicken scratchings," and that's about the size of it.
My suprapinatus tendon was completely severed. Tendons are notoriously slow to heal, so in my case they didn't even bother to try. Instead they stretched the remaining supraspinatus muscle down to the arm bone and attached it mechanically to the bone. In time, the bone and muscle will fuse and function just as the old tendon did.
They also shaved a bit off the bottom of my subacromial arch because growths that tend to accumulate on it with age can impinge on the underlying muscle, even wear clean through it. So I also had to spend a couple of months guarding against damaging the surgically weakened bone structure there.
Post-op pain is highly individual but the mechanics of re-attaching a muscle to bone to re-route a torn tendon involves stuff that causes most people considerable post-op pain. In most cases like mine, they would have used an electronic nerve block device to get me through the first few days. However, one of the complications of me using Veteran's Choice is that the VA wouldn't spring for the extra $350 for the nerve block device because a $10 bottle of oxycodone (pain killer) is cheaper. Whether that also means the VA doesn't use nerve blocks for post-op pain when they do the surgery, I couldn't tell you.
I had no post-op pain at all, but then I never do. I have an extensive orthopedic history, and I just don't do post-op pain. It's not that I have a high pain threshold, because I prefer to be heavily medicated, even when I'm having my teeth cleaned. There's just something odd about me that I don't feel pain when I come out of anesthesia.
But the real misery isn't the post-op pain, it's staying trussed up like a rack of lamb for weeks on end. It's not that the immobilization device itself is uncomfortable, it's the simple fact of keeping that limb in the same position for so long. At times it's maddening.
In my case, for a month, all movement of the affected arm
had to be "passive," meaning the only time I was allowed to move that arm was when the other arm was moving it. I also spent that month wearing a
DonJoy shoulder cradle essentially all the time.
The function of the DonJoy (or other shoulder immobilizing device) is to keep the joint aligned into the position that optimizes healing, as well as preventing re-injury to the healing tissues from accidental bumps and whatnot. So they'll want you to stay in it as much as possible, but you obviously can't change clothes when you're wearing this thing, or bathe.
Having the one arm immobilized complicates caring for yourself but doesn't make it impossible. I live alone and was able to get by. For me, the biggest complication was bathing. You shouldn't get the DonJoy wet (or probably any similar deice) so be sure you've got a simple sling that can be got wet beforehand to wear in the bath/shower. Something with velcro or fastex closures than can be put on and removed one-handed.
Bathing generally is more complicated than showering for the simple fact that it can be hard to get into and out of a bath tub without the use of one arm. It's worse if the outside arm (when you're sitting in the tub) also is on the affected side.
In either case, even the passive range of motion of the affected shoulder will be so limited for the first few weeks that it will be difficult to keep that armpit as clean and as deodorized as you might prefer.
Lack of mobility also means that that armpit will get less than normal ventilation, so it will tend to stay damp. If you can dust it with baby powder after every bath, that will help prevent "diaper rash," and at least you'll smell like a baby's ass instead of an old pair of sweat socks.
Also consider how you eat, and stock your kitchen accordingly. It would have been impossible for me to use a mechanical can opener for that first month, and I don't own an electric one. If I couldn't get by that long without some canned food or other, I'd have had to get one. As it was, I'm a pizza junkie, and I make homemade pizzas. You can't do much of a job kneading bread with just one arm, so the day before the surgery I made and froze a bunch of pizza crust dough balls, enough to get me through the first six weeks or so. Consider how you eat and think ahead what you'll need to buy and what changes to your preparations you'll need to make, particularly for that first month.
For the first week or so I was expected to sleep in a recliner, sort of sitting up. The point was that this position would let the cradle control the position of my shoulder. If I had been lying in bed, flat of my back, the mattress would have pushed the shoulder joint around any way it wanted, putting unnecessary strain on healing tissues.
But I absolutely cannot sleep sitting up, not without chemical assistance, and I only got through this with the help of Ambien. After the first week, I was allowed to sleep in bed but I still had to wear the damned cradle. My sleep resembles a trout that some fisherman has caught and tossed up on the bank, so even once I was out of the immobilizer, sleep was my biggest challenge.
I was in the cradle for six weeks, transitioning out of it and into a sling for the next four weeks. Then I was a month transitioning out of the sling. Toward the end of that month, it mostly was used as a visual indicator to others that there was something wrong with that arm and it shouldn't be messed with.
About four months out I was allowed to resume my passion, bicycling, but only very cautiously, and under a number or specific restrictions. If I'd crashed or just fallen over, and had reached out to catch my fall with the wrong arm, it would have meant the waste of a lot of pain and suffering.
I'm six months out now, the VA won't pay for any more therapy but I'm still far from 100%. Still doing the same exercises I was in therapy, but only with slightly heavier weights. I'm sure my age has some impact (I'm 60) but I won't be fully "released" by the surgeon probably until I'm nine months or so post-op.
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Originally Posted by Proximal
