Patient Experiences

RELEVANT LINKS:
The Shoulder Joint
Shoulder Instability (Bankart) Repair Rehabilitation
Common Shoulder Injuries Among Athletes


M.L. was an energetic 16-year old when he first came to The Stone Clinic in April 2001. He is a talented athlete with aspirations of playing baseball in college and perhaps beyond, as well as eventually becoming a firefighter.  He hurt his left shoulder in October 2000 while playing football.  At that time, he recalls hitting another player and rolling backwards over his arm.  He heard a "pop" and then his arm went numb and was quite painful.  After a course of physical therapy He was feeling better.  However, he says, " My shoulder started to pop out everywhere.  It got so bad, it would happen in my sleep!"  He also describes a feeling of having a "dead arm," which is typical of a person whose arm is as unstable as his was.

Dr. Stone examined him and reviewed his MRI with him.  The MRI confirmed what his symptoms indicated.  He had torn the ring of fibro cartilage in the shoulder joint known as the labrum, which is an essential part of keeping the shoulder in it's socket.  This injury is known as a bankart lesion and typically occurs from a traumatic dislocation of the shoulder joint.  In addition, his shoulder bone (humerus) had signs of a Hill-Sachs lesion.  This occurs when the surface of the bone is impacted and injured because of the force and trauma associated with a dislocation of the arm.

He and his parents decided to have the surgery that would stabilize his shoulder in August 2001.   Dr. Stone used arthroscopic instruments to look inside the shoulder as well as to repair the damage.

Dr. Stone saw and removed both some damaged and inflamed tissue (hemorrhagic synovitis) and a loose body (a floating piece of cartilage).  The rotator cuff, which is the group of muscles that help control the mechanics of the shoulder, was intact and the Hill-Sachs lesion was observed and left to heal on it's own.

Dr. Stone then needed to assess the damage to the labrum and repair it accordingly.  The labrum was significantly torn and detached from its place on the glenoid rim.  The labrum is a piece of fibro-cartilage that lines the glenoid rim and helps to hold the shoulder in place.  The glenoid rim is the part of the scapula (shoulder blade) where the humerus fits to create the shoulder joint.   

The first step to repair this was to use an arthroscopic pick to bloody the glenoid rim and create an area with fresh blood to stimulate a healing response within the shoulder.  A nylon suture was placed through the labrum and used to draw it back into place.  A Mitek super anchor with a Panacryl stitch was placed into the glenoid and this was used to further secure the labral tissue onto the rim of bone.  Another series of sutures and an anchor was placed in the capsule of the shoulder and the labrum in two other sections of the joint at the glenoid region.  Dr. Stone then re-evaluated the shoulder to assure that stability was attained.



NOW THE REAL WORK BEGINS

With Dr. Stone's part of the job finished, M.L.'s work had only just begun.  He said that his friends and family gave him a lot of encouragement and support when he was feeling like a "big baby" during the early stages of his recovery.  "My friends harassed me for missing football this year, but they also pushed me and supported me during rehabilitation."

He began physical therapy at The Stone Clinic the day after his surgery.  He was given a small ball to keep with him throughout the day to squeeze, told to take his arm out of the sling frequently in order to straighten the elbow and wrist, he was reminded which movements to be cautious of, and he was taught the importance of good posture throughout the healing process.  He was also put on the stationary bike in order to get a solid "sweat workout."  Over the next four weeks the emphasis in rehabilitation was on keeping the muscles and joints around his shoulder flexible and strong.  He began each session with a massage of his neck, arm and shoulder region followed by neck stretches and shoulder blade exercises.  The rest of the session was a workout emphasizing cardiovascular fitness, legs and especially abdominal exercises.  "I never knew there were so many different ways you could work your stomach muscles!"

At four weeks, he began gradual range of motion exercises.  He was given specific exercises for range of motion to do 3-4 times per day.  At The Stone Clinic, his physical therapist would move the joint and stretch the capsule surrounding the joint.  Slowly at first but more aggressively as the weeks went on.  He was apprehensive at first to move the shoulder.  "The hardest thing about rehabilitation," says M.L., "was the level of attention I needed to give my shoulder daily and the occasional pain associated with it."

He soon saw how the work would pay off as he regained more motion.  His favorite part of physical therapy was "getting out the goniometer (a measuring device) and measuring my shoulder range of motion for progress."  The competition against the "goni" really got him motivated.  He also kept progressing on his overall fitness workouts.  Six weeks after surgery he began light resistive exercises with a theraband in small ranges of motion.  At eight weeks after surgery, he pranced into the clinic and with a big grin on his face and said, "Now I'm ready to get serious!"  He was no longer afraid to move the shoulder and wanted to get his strength back.  He was given a group of new exercises and continued working on his range of motion.

Twelve weeks post-operatively he had 95% of his motion back and was doing a full workout with free weights in the gym.  In physical therapy, the mechanics of his shoulder were refined and he did plyometric exercises (throwing a weighted ball in specific ways), and was taught the "do and don'ts" of weight training.

He is now playing baseball and being actively recruited by local colleges.  Also, he has spent afternoons with the fire department hauling equipment and helping out where he can.  "All the sweat and tears were worth it.  I did a ton of rehabilitation and have come back more powerful than before my injury."  His advice to those who may have this procedure is that going through surgery and rehabilitation can be frustrating at times, but with patience and work, it will pay off.