The shoulder is connected to the latissimus dorsim the latissimus dorsims is connected to rib bones, the ….

I really thought I handled pain, other than needles, as well as the next person. I’ve spent years dealing with migraines, not that I had much of a choice when one hits. With my open abdominal hysterectomy, the recovery wasn’t too bad at all,  it wasn’t that much worse than the monthly pain with endometriosis. I’d gotten my hopes up that an arthroscopic shoulder surgery with its small incisions would go even better than a big abdominal incision that required my guts to be set aside, parts removed, and then put back together.  I was wrong.

It has not gone like I’d hoped. I’m not sure how much of that was affected by the too early use of resistance bands or my rib and back pain that wasn’t really addressed.

We watch crime, court, thriller and action movies. Whenever someone is in injured, you always hear them say, that the “person is a fighter”. I don’t recall someone ever saying, something like,  “well so-and-so is a big wuss and if anyone can’t pull through this it will be them”.

Not that anyone really wants details when they ask how you’re doing- I wrote it out anyway, mostly for my memory but thought anyone else going thru shoulder surgery might benefit. The previous post have more detail thru week 6 post-op.

In summary, the first week, even after the nerve block wore off I was thinking it wasn’t that bad. Then on March 22nd, day 8 post-op doing the prescribed resistance band physical therapy, it all went downhill from there.

On April 16th (1 month 2 days post) after starting back the resistant band physical therapy for the 2nd time, as instructed, the pain again felt like I was going the wrong way. The pain from the band exercises the second go’round was not as bad as the first try on day 8 post surgery but it was still pretty terrible.  For me, it was either a do the band PT prescribed by the surgeon or do some daily activities – but not both.

After not hearing about anyone else out there that was told to do what I was with the bands,  I decided to listen to my body and stop the bands. I wish I’d thought about going from no movement to resistance bands more before doing it. I told the surgeon and he referred me to a physical therapist. In hindsight, I should’ve done that right off the bat like everyone else who has shoulder surgery. Apparently, my insurance doesn’t get that  PT after shoulder surgery is pretty much expected.

My lower right rib went out again just before 7 weeks post surgery and boy did I want to be able to put my thumbs in my back and pop it. Since my arm can’t go anywhere close to that, I immediately went to the chiropractor. He was able to get it back in on the first visit this time. Yeah! The residual rib pain is nowhere close to when the rib head is actually out of place. I know without a doubt that the shoulder, shoulder blade, and my rib are all connected. There were several days I couldn’t do the shoulder movements because of my rib pain as moving my arm isn’t doable when my rib is out. On my rib the chiro said there are exercises I can do to strengthen the muscles that should keep it in place but not until my shoulder can do them. Sure would’ve been nice to know that before my surgery. The pain subsided enough on my rib to keep my appointment.


At my first, and only,  PT appointment I wanted to see if I was where I should be at 7 weeks and 2 days post-op. He gave me two movements to add to what I’m doing from the online instructions I found. He said basically my ache pain is more than most at 7 weeks but the sharp shooting pains usually take at least 12 weeks to go away- if I hadn’t had to the 2 setbacks from doing PT with the bands. He felt my movement ability was on par accept I can’t lay on my right side, and can’t take my bent arm back to past 45 degrees to my side. He seemed impressed I could raise my arm over my head – but then again I could do that before surgery too but now there is pain. He was a little concerned with my guardedness when he had my arm in his hands to trust him not to move it wrong and send a sharp stabbing pain. In my defense- this visit was after the attempts with band PT that made it so much worse. 

Turns out doing PT with bands on day 8 after shoulder surgery is reserved for pro-athletes and even they do just movements before even they add resistance- definitely not typical instructions for a normal 40 something non-athlete like me.

It truly makes me wonder what my journey would’ve been like had I followed surgery, the way most people do, with PT with a physical therapist, starting with just movement.

I can’t recall but I bet when I broke my collarbone it hurt for more than 7 weeks and the doctor took part of my clavicle off during my shoulder surgery. The therapist said it shouldn’t hurt to do the exercises and it is mobility before strengthening and if it does hurt or the aching pain is way worse afterward that I did too much too soon. yep- check check. 

He said he thought my collarbone area was still swollen. I think my right bicep at the elbow is swollen. He said since it hurt a year before having the surgery that would make the recovery take longer than if my mind hadn’t been ‘protecting’ that arm/shoulder from pain for so long, plus the muscles had gotten weak from not using it like normal for such a long time.

He said after I can do 3 sets of 15 of a movement without pain for a week then I can add a lightweight or the bands but not before. If it gets way worse back off to just the movements. When I can do that w.o pain for a week, add a little more weight. He said adding the bands both times too soon, and the fact that I waited so long to get it fixed probably set me back and he guessed it’d be closer to 6 months before I could do things I used to could do before the damage.

He did agree on the two movements I was told not to do yet (arm past 90 degrees or behind me) because the humerus puts too much pressure on the labrum. He suggested I listen to my body and said to be patient (easier said than done), that shoulder surgeries are hard because of how complex the joint is and take time even in a best-case scenario. 

I wish I would’ve gone to PT right afterward like most people do instead of trying to follow the surgeon’s instructions at home. The physical therapist didn’t say anything about my bicep still hurting, it now hurting past my elbow, my shoulder blade pain, my lower right rib or back pain. He just talked about my shoulder itself. Oh other than he says I can’t look up as much as most but the chiropractor already told me that.

Both sides now have issues. The week of 2 months post-surgery I had the second time my left shoulder felt like it almost had a charlie horse at the top front of my shoulder. It is also starting to be pretty uncomfortable laying on my left side now too. I guess I shouldn’t be surprised since my left arm has been doing the work for two arms for 16 months. Now, for the first time,  my lower left rib, across from the painful lower right rib, is causing pain in a straight painful line across my whole back. Auggh.

The ache hurts worse than before surgery but not as bad as a migraine or a displaced rib head. I also now understand that if someone has never had a rib head displace, topped off by muscle spasms they have no idea that it really does hurt to just breathe. The simple pressure of air in your lungs shoots stabbing pains through your torso from the back clear through to the front. My surgeon, the PT guy and most people who’ve never experienced a rib out of place don’t know how excruciating that is until the rib is back where it goes.

A tip on shirts. I’ve been able to add back most of the shirts I was wearing before surgery.  I put on one that was a little tighter fit with the arms cut off to work in the yard and my farmer tan. After sweating in it I forgot it’s always harder to get a wet shirt off than a dry one and it still hurts if you have to really wiggle, pull and tug. The bras going on like they used to is going to be an issue for awhile because I still have to fasten in the front and slide the back to the back, around my stomach, then pull it up where it goes. Hope I can get my arm back there soon before I ruin all my bras

I have not added any weight to the movement exercises because just doing them still hurts. Even though I’ve been given no instructions to really push my arm to extend to 90 degrees (but not passed) out from my body- I can’t do it. I can do it with my elbow off of my body but can only go about 45 degrees if I keep my elbow at my side.

Just this week (about 7 weeks post) I have my first bit of good news or improvement… it doesn’t hurt as horribly bad for my right arm to make the empty can pour. Still hurts with the weight of emptying the coffee carafe into the pot. My right shoulder, shoulder blade, right rib, right bicep and top of my arm to just past my elbow all still hurt more than before surgery, as does my left shoulder and left lower rib too.

At 2 months post surgery, I can not do these things that I could do before surgery: Hook my own bra in the back, put my hand on my hip, put something in my back pocket, use my right hand for bathroom stuff, pass something to someone on my right, and put my arm out 90 degrees if my elbow is at my body and I haven’t even tried my photography backpack. I’m really pretty disgusted at still being worse than before surgery. My range of motion is so much less than before surgery. I can’t touch my left shoulder with my right hand (like to pull up a bra strap) without pain. That hurt before surgery but I could still do it.  I used to could lay on my right side to sleep. It hurt to get there but once I was there I could sleep on that side. Now I can’t lay on my right side at all and my left shoulder now hurts to lay on my left side.


Today at 2 months 8 days post I had the follow up with the surgeon the first one since the stitches came out on day 7 post surgery.  My arm, except for the ability to turn my thumb down, hurts in all the same places, some worse, plus new places and has less mobility than before surgery. I waited the 2 months for my follow up the appointment to talk about this.

It was 30 minutes past my appointment. Not as bad as last time but still a wait then I felt rushed through and left with more questions than I went with- as some things seemed like contractions.

Not that I thought he would agree so this, so it was no surprise, but he still felt doing resistance bands after on day 8 post, following no movement was the thing to do even though at the one PT appointment I was told no one does those that quick. They just want movement and I get that so you don’t end up with frozen shoulder. The surgeon did not look at the printed off PT movements I was doing along with the 2 their own facility physical therapist recommended. In fact, it was almost like he didn’t hear that I did go to them. As far as the surgery he said he would do it again the same way and that if in 2 months my bicep, front and back of my shoulder still hurts or I still can’t move my arm we’ll do another MRI then… Really wishing they’d looked at everything that hurt before surgery. I waited a long time to go and I really don’t want to waste time, money or more needles going through another surgery and recovery. I read somewhere that MRIs don’t show as much, as clear after a surgery either. I know I told him on more than one occasion and even right before surgery to fix everything he saw because I was only doing this once.

He said at my follow up when the stitches were removed that the bicep wasn’t involved. Today when I asked what photo showed the top of my bicep in the photos, he pointed to the one he had told me at that same follow up was my labrum. I said that, and he said it was where the bicep attached to the labrum. He said part of the tightness was because of the shortening of the tendon, but earlier he had said he saw nothing wrong with my bicep that still hurts and that he didn’t do anything to it. As far as I know, the only thing shortened was my clavicle for the impingement.

I asked if the pain in the back of my shoulder was from the rotator cuff tear that he didn’t stitch and he said it was probably referred pain. That is what he said my bicep pain probably was too. It’s in the same stabbing place it was before the surgery. He did say the rotator cuff tear was indeed a high-grade tear at not quite 50%. I asked if it wasn’t easier to sew a small tear instead of a gaping hole and he said the bone spur was removed under the tear, and he’d do it the same way again.

He said my shoulder shouldn’t be catching. It wasn’t until after surgery. He said the short head of the bicep couldn’t be viewed only the long head.

He asked if I was lifting anything. When I just looked at him, he said it’s okay if you are. My mind just couldn’t come up with an appropriate response. Yes to the hair dryer and my camera. No to a gallon of milk or my cat. I’m lifting what I can without pain.

He was surprised I still had the aching pain. He was surprised I still had stabbing pain in the same places when I  moved it wrong. He was surprised that, that even though he told me not to take it back like to fasten my bra or past 90 out to my side that I couldn’t do those movements. He said the other movements I could do were good for 2 months – but everything except the thumb down movement that I can do now – I could do before surgery.

He said he did view my labrum all the way around and it only had the one tear in the front bottom that he stitched so that wasn’t what the pain in the back of my shoulder was from. Before my surgery, he said he didn’t stitch labrum tears, that they move the bicep to quit pulling on it as the stiches there caused more harm. Then he said he stitched it because it was a tear lower than a SLAP tear.

He agreed the shoulder, and ribs are all connected. He didn’t comment about my left shoulder degrading but at this point you couldn’t pay me to ‘fix’ it until my right shoulder is better off than before surgery.

He said I should go to physical therapy instead of doing the exercises I found online when I quit his band therapy.

Then 10- 15 min later he left the room to do something with ordering physical therapy. A gal came in with my discharge paper. At check out he’d crossed PT back off.  My head was getting worse so I just said to call me about the PT. I have been and will continue to do the PT I printed offline with the ones the physical therapist added and I really don’t see the benefit in someone watching me do them. I’m already doing it daily and to the full extent that I am able to do each exercise.

Right Shoulder 3-14-18 (1)-labrum-smRight Shoulder 3-14-18 (2)-rc-sm

So since I’ve been told both, I still don’t really know if my darn bicep was involved or not. The chiropractors thought it sounded like bicep tendonitis all along. I also don’t know if the surgeon did everything right during surgery and it got messed up from the bands being too much too soon or if this is normal, or if something is wrong.

I’m just going to push the stretching and use even if hurts like you know what, see where I am in 2 more months and decide what I’m doing from there. I don’t see keeping another appointment like today just to schedule another MRI to look at the same stuff that has been hurting for a year and since I’m doing the PT the physical therapist said to do I don’t see starting to go to one regular at this point.

Now all the medical bills are starting to show up too.  1st visit $330.14. MRI 1247.75. 2nd visit $199.14. Hospital $20,101.15. Anesthesia $2210.00. Imaging Center $429.00. EmergeOrth fee on surgery day $9789.90. First Assistant surgical team $6805.00 3rd visit for stitches out $266.10 and then there is one PT and today’s visit. I sure don’t feel like I have new $42 grand shoulder!


My doctor’s office has a portal where you can read the notes from today. Good thing because it gives me more info than being there. It said he knew I was frustrated at where I was at this point and am still in pain. He wrote “She did point out that she felt doing the therapy bands is early she did was quite painful. However, she did not go to formal physical therapy and I do believe if she would have gone it moving early she be stiffer than she has now..” I bet it was voice recorded so not sure what he means. If I wouldn’t have got it moving early I’d be even stiffer now? I did get it moving but I still think the strengthening bands on day 8 were too much too soon and that I should’ve concentrated on movement instead of strength resistance first. I’ve been moving it daily since day 8 with the PT I found online, then adding the 2 their PT guy told me to add everyday unless my rib wouldn’t let me. It says the Plan: is “They will now start formal physical therapy. They may begin a light strengthening program. They should still avoid overhead reaching and lifting. I realize Kim is frustrated. However, her range of motion is actually quite good. Not his good as the left shoulder but probably in my estimation better than most people at this point in time. These labral repairs can tighten up the shoulder quite a bit initially. I would recommend that she start again a formal physical therapy program. If it isn’t helpful then she should quit and let me know.” so I guess they were supposed to schedule the crossed out PT, but they’ll have to get approval from my insurance first. I didn’t know I wasn’t supposed to avoid overhead reaching or lifting. I was sure he told me there was only 2 things I couldn’t do movement wise and they were cleared to do today – if I could actually move my arm that far. In face on my 1st follow up appt when he gave me the bands and sheet of exercises I noticed nothing was overhead and asked the nurse to go ask him and she came back and said to yes, stretch overhead. At least he got I was frustrated and in pain.


It is just hard not to get discouraged, especially after being in pain for so darn long. When you add on to the ongoing pain some of the other stuff in my life that all happened within a short time I can see how easy it would be to fall into a bit of depression. I’m thankful I have family, friends and faith and know that there is a season for everything.

Thanks for reading if you made it this far. Maybe just maybe my post about my shoulder surgery will help at least one person.

For my past shoulder post simply type shoulder in the search bar on the first page or click the tag for “shoulder”.

 

2 thoughts on “The shoulder is connected to the latissimus dorsim the latissimus dorsims is connected to rib bones, the ….

  1. Bill Ramsey

    What a mess. I read it all and toward the end was having sympathy pains. It will get better for you in time. How much better remains to be learned. You are a tough cookie. Bill

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    1. KiM Post author

      Bet you were bored out of your mind too. I just wish I had read some more real-life stories with follow up because I would’ve done some things differently. I really expect to be better after a surgery than before it. I guess I’ll just hope the PT guy was right and my recovery was delayed from too much too soon. I sure don’t feel like a tough cookie when I’m still not back to the old me.

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