headed toward a shoulder replacement...

[jmlee]

In my day job, I'm a professor of Biomedical Engineering with a specialization in biomaterials and surgical implant design. You know, we tend to think (these days) that joint replacements have become so commonplace that, aside from the cost and availability etc., there's always a good outcome. Well, that's pretty much true of hip replacments, mostly true of knee replacements, and much less true of other joints. The shoulder, for instance, is a really unconstrained joint—not at all like the ball-and-socket of the hip's "design"—formed where the humerus, scapula, and clavicle make a really improbable connection. This is probably the case since it was a relatively late evolutionary development after we came on land. The result is that designing a good replacement, and implementing that design surgically in a degenerated joint, is really a tough job. It's not surprising that the successful outcome rate, described in various ways but mostly in terms of pain and mobility, is much lower than it is for hips and knees. Patients are therefore often wise to work through whatever other therapeutic options may be availabe to retain adequate function before commiting to shoulder joint replacement, going forward only when (i) pain and lack of function become overwhelming and (ii) continuing degradation of the joint tissue may threaten promise of a successful surgical outcome. I don't know enough about your case to know where you are relative to those two criteria, although it seems your humeral head and cartilage may be completely shot. While you still have some function, it would be wise to explore every conservative approach you can manage until the surgical outcome is threatened. Surgeons are inherently optimistic presenters of the likely outcomes of their handiwork, so do take their advice with respectful caution. Get some advice if you can from sports/rehabilitation docs (physical medicine) and from physiotherapy, and of course stay away from non-scientific alternative therapists. Shoulder degeneration is common in late life athletes—particularly hockey players who repeatedly crush shoulders going into the boards—and the sports docs often have deep experience with this sort of thing. My $0.02.

 

[lfmn16]

If you are in good health, I would get it sooner rather than later. You never know how your health may change and the better your health, the better the chance of making a full recovery.

Also, my father was looking at surgery and although he was quite a bit older than you are, we found out that as you get older, you are more prone to coming out of surgery with some degree of diminished mental capacity. Surgery and anesthesia are very hard on your body particularly as you get older.

 

[MJ_Sotti]

Bare is right. do that stuff and forget about the 300 club.

when I came out of surgery...outside of being cut and stitched up I felt better already

I said to his PA Allison..."I have less pain now than before I went under"

she said..."well, you don't have arthritis anymore"

 

[MJ_Sotti]

In my day job, I'm a professor of Biomedical Engineering with a specialization in biomaterials and surgical implant design. You know, we tend to think (these days) that joint replacements have become so commonplace that, aside from the cost and availability etc., there's always a good outcome. Well, that's pretty much true of hip replacments, mostly true of knee replacements, and much less true of other joints. The shoulder, for instance, is a really unconstrained joint—not at all like the ball-and-socket of the hip's "design"—formed where the humerus, scapula, and clavicle make a really improbable connection. This is probably the case since it was a relatively late evolutionary development after we came on land. The result is that designing a good replacement, and implementing that design surgically in a degenerated joint, is really a tough job. It's not surprising that the successful outcome rate, described in various ways but mostly in terms of pain and mobility, is much lower than it is for hips and knees. Patients are therefore often wise to work through whatever other therapeutic options may be availabe to retain adequate function before commiting to shoulder joint replacement, going forward only when (i) pain and lack of function become overwhelming and (ii) continuing degradation of the joint tissue may threaten promise of a successful surgical outcome. I don't know enough about your case to know where you are relative to those two criteria, although it seems your humeral head and cartilage may be completely shot. While you still have some function, it would be wise to explore every conservative approach you can manage until the surgical outcome is threatened. Surgeons are inherently optimistic presenters of the likely outcomes of their handiwork, so do take their advice with respectful caution. Get some advice if you can from sports/rehabilitation docs (physical medicine) and from physiotherapy, and of course stay away from non-scientific alternative therapists. Shoulder degeneration is common in late life athletes—particularly hockey players who repeatedly crush shoulders going into the boards—and the sports docs often have deep experience with this sort of thing. My $0.02.

also, the shoulder joint is much smaller than a hip or knee.

you can hammer a implant into a femur and have a lot of bone to support it. A humerus? a lot less bone.

so there's that

 

[Groove Doctor]

In my day job, I'm a professor of Biomedical Engineering with a specialization in biomaterials and surgical implant design. You know, we tend to think (these days) that joint replacements have become so commonplace that, aside from the cost and availability etc., there's always a good outcome. Well, that's pretty much true of hip replacments, mostly true of knee replacements, and much less true of other joints. The shoulder, for instance, is a really unconstrained joint—not at all like the ball-and-socket of the hip's "design"—formed where the humerus, scapula, and clavicle make a really improbable connection. This is probably the case since it was a relatively late evolutionary development after we came on land. The result is that designing a good replacement, and implementing that design surgically in a degenerated joint, is really a tough job. It's not surprising that the successful outcome rate, described in various ways but mostly in terms of pain and mobility, is much lower than it is for hips and knees. Patients are therefore often wise to work through whatever other therapeutic options may be availabe to retain adequate function before commiting to shoulder joint replacement, going forward only when (i) pain and lack of function become overwhelming and (ii) continuing degradation of the joint tissue may threaten promise of a successful surgical outcome. I don't know enough about your case to know where you are relative to those two criteria, although it seems your humeral head and cartilage may be completely shot. While you still have some function, it would be wise to explore every conservative approach you can manage until the surgical outcome is threatened. Surgeons are inherently optimistic presenters of the likely outcomes of their handiwork, so do take their advice with respectful caution. Get some advice if you can from sports/rehabilitation docs (physical medicine) and from physiotherapy, and of course stay away from non-scientific alternative therapists. Shoulder degeneration is common in late life athletes....

Brilliant advice.

 

[jharms80439]

Steve,

In the words of Larry the Cable Guy, "Get'er done". jhlee's advice is appropriate too - get checked out by a sport's Doc. Even though bass playing isn't an athletic event, they should be able to evaluate your current condition, advise you on the replacement, and give you a better outlook of life post surgery.

Football, skateboarding and Aikido took a toll on me over the years (stopped football at 29, Aikido at 42, and at almost 52, I still skate, but after a huge crash two years ago, I'm not skating that much anymore). Both shoulders have been rebuilt, both hips replaced/resurfaced (Birmingham's), right hand has some pins to hold tendons in place, most of my fingers have been broken and I'm full of arthritis. Currently, I'm ~10 years out from major shoulder reconstructions and mobility is good, but not great. Ifmn16 has a point too about anesthesia in us older patients - recovery does get worse as you age. If you choose to have the surgery, my advice is to do your best to get in really good physical condition now - exercise, strength, stretch - as all three elements are important to your recovery after surgery.

Replacement joints aren't the end-all of physical ailments. My hips still hurt if I'm hard on them - bowling after sitting all day is a bear - but I'd rather have my current mobility than the pain that I had. I currently take 3 Aleive each day and lead a pretty normal and very active life. Of course there are risks - nerve damage and painful mobility are the highest, though there are others.

Recovery time for shoulder replacements will need to be covered by others that have had it done. Do yourself a favor and thoroughly research before committing. Read the experiences of others (and take them with a grain of salt), talk with your docs - someone that really knows shoulders, up to and including talking with their shoulder replacement patients (if you can).

Again, my best advice is to do your best to get in terrific shape prior to the surgery and you will increase your odds of a successful recovery and let us know what you decide...

John

 

[Ewo]

In my day job, I'm a professor of Biomedical Engineering with a specialization in biomaterials and surgical implant design. You know, we tend to think (these days) that joint replacements have become so commonplace that, aside from the cost and availability etc., there's always a good outcome. Well, that's pretty much true of hip replacments, mostly true of knee replacements, and much less true of other joints. The shoulder, for instance, is a really unconstrained joint—not at all like the ball-and-socket of the hip's "design"—formed where the humerus, scapula, and clavicle make a really improbable connection. This is probably the case since it was a relatively late evolutionary development after we came on land. The result is that designing a good replacement, and implementing that design surgically in a degenerated joint, is really a tough job. It's not surprising that the successful outcome rate, described in various ways but mostly in terms of pain and mobility, is much lower than it is for hips and knees. Patients are therefore often wise to work through whatever other therapeutic options may be availabe to retain adequate function before commiting to shoulder joint replacement, going forward only when (i) pain and lack of function become overwhelming and (ii) continuing degradation of the joint tissue may threaten promise of a successful surgical outcome. I don't know enough about your case to know where you are relative to those two criteria, although it seems your humeral head and cartilage may be completely shot. While you still have some function, it would be wise to explore every conservative approach you can manage until the surgical outcome is threatened. Surgeons are inherently optimistic presenters of the likely outcomes of their handiwork, so do take their advice with respectful caution. Get some advice if you can from sports/rehabilitation docs (physical medicine) and from physiotherapy, and of course stay away from non-scientific alternative therapists. Shoulder degeneration is common in late life athletes—particularly hockey players who repeatedly crush shoulders going into the boards—and the sports docs often have deep experience with this sort of thing. My $0.02.

I hear this, and I'm not one to _want_ to go under the knife, but... Would be interested in your (and others') further thoughts.

There's a family history of arthritis. My paternal grandfather lived into his 80s, but was completely incapacitated for the last decade with rheumatoid arthritis and gout. I remember, as a kid in the 1950s, that he had to quit playing catch with me when his shoulder joints became too painful to throw the ball.

With me the serious shoulder degeneration set in about six or seven years ago. I started taking glucosamine/chondroitin, and I've maintained fitness--after I had to quit mountain biking because of the shoulder problem--with a Bowflex rod machine and now a Bowflex MAX at home. First diagnosis of glenohumeral arthritis was about four years ago, and I started taking Meloxicam (the NSAID) for it about a year-and-a-half ago. I had good results using Robin MacKenzie's PT moves for a creaky neck, but the method didn't provide any relief for the shoulder. Tried a cortisone shot into the joint once, but the relief only lasted about a week.

I count myself lucky it's osteoarthritis and not rheumatoid! But the pain is increasing and the mobility is decreasing.

Would appreciate folks' thoughts as to whether I've exhausted the alternatives.

 

[MJ_Sotti]

my guy said the head of my humerus was almost flat. when he took their ortho sawzall to it there wasn't much to cut off. then they get a rasp and open it up and pound the implant in there.

glue the socket in there, sew ya up and viola!

 

[HolmeBass]

I had a knee replacement and it's been great. I also know that exercise helps fight arthritic deterioration. I don't know why, but it does. The worse thing you can do is be sedentary.

So rehab, or "prehab", is the call. While it might not completely resolve your issue, it will make your surgery, if you have it, more successful.

 

[acmeseed]

I have not had shoulder surgery, but had foot surgery almost 2 years ago.

I second the recommendation of a second opinion and also would make sure you drill the doctor on what to expect when you wake up from surgery, during the recovery period and long term. In my case I was negligent in doing so, the surgeon failed to let me know what to expect and when I woke up I found out the structure of my foot had changed quite a bit; the surgery was 75% a success, but I hated not being prepared for what was coming.

Good luck, please let us know how you make out.

 

[Bare Bass]

with a Bowflex rod machine and now a Bowflex MAX at home. .

Machines/free-weight alternatives don't work as well as free weights and are unnatural to varying degrees. At best, they can supplement the basic barbell lifts. At worst, they will force your joints into awkward or partial ranges of motion or bad technique. Soooo many people get screwed up by machines, or doing silly things like upright rows or partial squats. But hey, machines are convenient and appear more advanced.

You gotta read Rippetoe. He explains it all in Hemingway-esque macho science. He's a former powerlifting with a brain and has made a study of the anatomical, physiological, and physical properties involved in strength training. He's the real deal. The basic idea is to work your prime movers or biggest muscles through full ranges of motion in natural planes with optimal leverages via compound (multi-joint) movements, and the basic barbell lifts accomplish this best. The secondary and stabilizing muscles like biceps and abs do not need direct work. They will strengthen in proportion to the strength of the prime movers.

Sorry for being pushy, but I'm completely convinced of this. I'm much more noncommital about most issues, including Fenders.

In any case, I wish you all the best!

 

[jharms80439]

Kettlebells (in both light, medium and heavy) worked for my shoulder(s) rehab. Bands only right after surgery, then 20lb'ers and worked upwards from there. Just go SLOW!

Kettlebells at first were too much - even with only 20lb, hence the bands - but after a while, 20lbs became too light. Worked progressively through 20, 35, 45, 55 and recently bought a 70 - which, by the way is still too much for me.

Mostly, I use kettlebells for swings, snatch/press and Turkish get ups. Great for keeping strength around my older broken down parts and the new(er) replacement parts.

John

 

[mikecd1]

As a member of the over 60 club I can tell you from speaking with other members (mainly bandmates and friends) that the list of aches and pains is long and distinguished. LOL, I had a neck operation in March that removed several damaged discs and installed a metal plate with screws etc. Before the operation they said six weeks for the bone graft to heal (that alone was an adventure in pain) and six months to be doing "full contact" sports. Since bass playing is my sport of choice figured I'd be well back in saddle by now. Find out exactly what's entailed in the operation and ask lots of questions about that and the rehab. All those PT guys want to stretch things out all the time when they do their deep tissue massage stuff. It can feel good at first, but in my case I think they tweaked a nerve and now my Dr's office is saying nerve regeneration can take months or even a year or longer, but this is just a bump in the road. If its the best alternative for you, go for it, but be informed and really involved. Have you tried taking Osteo Bi-flex or the chondroitin, MSM, glucosamine supplements? They might help reinforce the area and along with some B6 for the nerves help your painful shoulder. I'm doing that post-op now for the neuropathy. My bandmates say Eric Clapton has the same neuropathy that I do which isn't comforting, but is inspiring to keep playing knowing he's doing it with a lot of discomfort too. Keep playing and in good health! Best of luck and all wishes for a speedy recovery if you go for it.

 

[baileyboy]

I'd appreciate any thoughts, comments, personal stories, whatever you have to offer.

I'm an old cat (65+), still out there gigging regularly. I really dig my band and my bandmates; we work a long weekend (Friday night, Saturday night, and a Sunday matinee during the warm weather) each month at our regular club, and sometimes a one-nighter at another venue.

My right shoulder is completely shot (glenohumeral arthritis), and the range of motion has been pretty limited for the last couple years. I've been able to keep playing, but I went to an orthopedic surgeon today about it to see what my options are.

He said a complete shoulder replacement is the best course of action.

I've been pondering it, googling some stuff about the operation, and of course asked the doc about how the recovery period would affect my musical adventures.

I'd love to hear your thoughts about this. Guess I could just keep doing what I've been doing without the joint replacement, but the pain is pretty intense sometimes.

Surgery should always be a last resort. Have you given trigger point therapy a go?

 

[Ewo]

You gotta read Rippetoe.

I'm a frequent visitor to Glenn Reynolds's _Instapundit_ blog. He's often posted about Rippetoe's approach. Thanks; gonna read up on it more.

 

[Ewo]

Surgery should always be a last resort. Have you given trigger point therapy a go?

Roger that! I don't particularly want to get cut open.

Tried trigger point therapy for wrist pain, a while back. Honestly didn't do much for me.

 

[oldNewbie]

Shoulder degeneration is common in late life athletes—particularly hockey players who repeatedly crush shoulders going into the boards—and the sports docs often have deep experience with this sort of thing. My $0.02.

This. And Groove Doctor.

Whether or not you get the surgery, find a really good PT , maybe through a ports doc, and get going on therapy first . You may be able to delay it and recovery will be _much_ easier if (when) you need surgery . PT quality varies greatly and if you are getting this care through an HMO you may well be out of luck , so I'd suggest shopping around now . Wife and I both spent years being handed exercise pdfs and told "not much more I can help you with" from our well-regarded HMO PTs . We found , and pay for, a PT with considerable expertise, in this case a pilates teacher who does a lot of private work with older clients having quite deteriorated bits. Her detailed understanding of the various kinetic chains combined with her ability to provide verbal images and appropriate exercises at private lessons is crucial , And ya gotta do the exercises every day.
Good Luck

 

[Bare Bass]

I'm a frequent visitor to Glenn Reynolds's _Instapundit_ blog. He's often posted about Rippetoe's approach. Thanks; gonna read up on it more.

Cool. He's blunt and at times offensive/salty in forums/comments sections, but his books are pretty straightforward.

Of course, I'm not saying surgery won't work or isn't necessary in your case. I have no idea. I do think sometimes doctors recommend pills or surgery simply because they know most patients can't be counted on to make lifestyle changes.

In the fitness industry, like-wise, new techniques and tools may appeal more to clients' sensibilities than scientific principles, their quest for something new or easier or more convenient, or are simple branding techniques, to differentiate themselves from every other ex-jock who would like to exercise for a living, or are applied inappropriately. Kettlebells, for example, may be great for strength endurance and grip strength, but are poor substitutes for developing the kind of base strength, power, or explosiveness provided by barbells.

And don't count on medical professionals to know about any of this. A few years ago I went to see a chiropractor after I foolishly pulled a muscle doing deadlifts without a proper warmup. She asked me to do a trendy plank, to see if my trendy 'core' was strong. I had just told her I was deadlifting over 300 pounds for reps when the injury occurred. You think I have a weak core? At max load I can deadlift about two times my bodyweight but OK, so I did the damn plank. She kept waiting for me to break form. Never did. It's mind-boggling how many health/fitness/medical professionals have no idea how stabilization muscles work. You can't lift very much if your skeletal-muscular system is unstable. Just simply can't be done.

OK, sorry for the rant. Once again, all the best!

 

[acmeseed]

sometimes doctors recommend pills or surgery simply because

If you go to a shoemaker he'll find holes in your shoes, if you go to a psychiatrist he'll find holes in your head. You need to have an involvement in your care, otherwise you'll get filled with pills and other stuff with a ton of side effects.

 

[Bare Bass]

Roger that! I don't particularly want to get cut open.

Tried trigger point therapy for wrist pain, a while back. Honestly didn't do much for me.

When I used to run, trigger point therapy via self-massage helped a lot in my lower leg and feet, but I think trigger points, for me at least, tend to develop through repetitive exercise. I've never needed it for lifting. I doubt your shoulder problems are related to knots, but some self-massage techniques could be helpful. It's easy to find trigger points/knots on your own. Just dig around a bit and when you hit a painful, hard bit of flesh, that's it. Still, just maintaining a strong body with good posture seems to make most niggles disappear (for me).