What are the major stages of blunt trauma?

Rotator cuff surgery without physiotherapy is incomplete!

How to properly plan for your post-op physiotherapy?

Stages of Rotator Cuff Trauma

Rotator cuff injury is one of the severe consequences of blunt shoulder traumas. There are four stages for every blunt force shoulder trauma. Each stage includes its own peculiarities and challenges.

For me it all began with a slip and fall on the clear ice. When did it happen? On Jan 9!  What stage of my rotator cuff trauma  began  immediately after that incident? The ‘discovery stage’! What do I mean by the ‘discovery stage’,  and what does it entail? I’ll tell you… the jazzy term for the intent of this stage is the ‘diagnostic stage’. It’s the period that begins immediately after the incidence and ends with proper identification of the nature and extent of the incurred damages. During this stage we seek answers to questions such as these: What did truly happen; should we leave our injured shoulders alone and try to cope with our injuries without medical interventions; or should we restore part or most of our lost functions with the help of an expert orthopedic surgeon?  These are just a few of the questions that must be properly addressed in this phase. Can you guess what are the top two radiologic modalities that are employed at this stage to elucidate the extent of our physical damages? The answer is… X-ray and magnetic resonance imaging (MRI)! The next phase after proper diagnosis, is the ‘what-can-be-done’ phase, that in most rotator cuff tear scenarios, point to orthopedic surgery. During this period, we seek answers to several important  concerns of ours, and in particular to the following six important questions: (1) who is the right surgeon for me; (2) what does s/he think is the best course of action for me; (3) how am I going to finance the whole process, and what part of it is covered by my health insurance; (4) when can my surgeon perform surgery on my shoulder;  (5) what do I need to do to prepare for my surgery; and (6) what should I do to maximally facilitate my post-surgical recovery? In my case and given my ‘terrible rotator cuff tetrad’ that included three total tears and one elective tendon detachment, I needed a minimum of 5-6 weeks for optimal post-surgical healings. As you can tell, the post-surgical-doing-practically-nothing-with-my-left-arm-and-shoulder phase is now almost over for me, and I am about to begin my  next stage. The next stage is by far another important stage of the whole ordeal, and at times it may take a long time to complete.  Can you guess what this stage is? If you’ve guessed ‘rehab and physiotherapy’, you’ve answered correctly.

Anticipating Your Rehab Phase

Those who plan out management of their rotator cuff injuries meticulously are the ones who anticipate their rehab and physiotherapy  alongside their rotator cuff surgeries. As far I’m concerned, my upcoming challenging milestone is how to excel at my prolonged physiotherapy. This phase begins with picking the right physiotherapist. If you think it’s easy to do, I have to tell you… think again! Why? Because it’s an art to pick the right physiotherapist. Why? Because you have to walk along his or her side for so many days or months of your life. Did I read your mind correctly that you would like to know how I have planned for this after the reality of my rotator cuff injury settled in! Truthfully, I have already started the process of selecting my physiotherapist, and by the time that I will post this blog, I might have even completed my  first few sessions as well. Originally, I had two physiotherapy centers as my top two preferred facilities. However, if you like to call it pure coincidence, or it-was-meant-to-be, I picked a Rehab and Physical Therapy facility that is within a very short driving distance from my house.

Why do I believe that securing the right physiotherapist at the most convenient location is an art that anyone who desires to optimally regain his shoulder functions after massive rotator cuff injury  should master? Why do I believe that this is by far the most crucial post-rotator cuff surgical phase? Your physiotherapist is the one who will team up with you with one shared goal in mind… helping you to achieve your post-surgical shoulder joint potentials.

Was it a sign that I didn’t miss this time or did I plan it?

I underwent my rotator cuff surgery on February 24. It was a detailed surgical procedure that included biceps long tendon tenodesis and anchoring three of my totally torn rotator cuff tendons; namely, supraspinatus, infraspinatus, and subscapularis, via drilling 7 tunnels into the head of my left humerus. In the recovery room, I woke up with a totally paralyzed left arm and shoulder as a result of my cervical nerve block. The block that targeted my cervical nerve roots 5 and 6 (C5 and C6) normally prevents pain perceptions from 16 to 36 hours in most patients. On the day of my surgery and as I was getting ready to be discharged, the assigned nurse placed my shoulder in a special and pretty complicated brace (i.e., shoulder abduction sling with pillow) and instructed the partially-conscious-me and my wife on how to use an ice machine intermittently during my first several post-surgery days.  In particular, I recall that she mentioned that it may take some time to learn how to assemble or put-on the  brace,  as it is a little more complicated than meets the eye. I remember that she even emphasized  that it would be wise if I do not detach and disassemble various components of it. Despite all those warnings, about 25 hours later, at about 530 PM on Friday February  25, I took off my ice machine pads and opened up my brace to allow more circulation to my shoulder. As we were about to put all the parts back together my wife and I became  perplexed by the difficulty of it.  In particular, given the partial numbness of my left arm, I was concerned that I may adjust the brace improperly and it may place inadvertent tensions on the tendons that were surgically placed on the head of my humerus. We entertained two options, checking it on the web and on YouTube, or stopping at the nearest rehab and physiotherapy outlet and asking for help. My wife called the closest one that was a short driving distance from our house. The physiotherapist in charge of that shift told her that she would love to help us, and even though she is about to wrap up her daily shift, she will wait for us until we make it there.

I Was Sold on the Spot…

Soon after that call we hopped in the car, and before we knew it, we were by the door of the rehab center.  Guess what? The physiotherapist  courteously received us, and she gave it her best  to fix and adjust my brace to ensure optimal shoulder immobility.  I must emphasize  that adjusting these universal braces to properly embrace the arm and shoulder of the post-op patients is an art that is not that easy to master. Why? Because no two post-shoulder-op patient braces custom fit equally. Well, as it turned out, she placed  the brace around my arm and adjusted all the straps to minimize mobility of my shoulder joint. Upon completion, we offered to reimburse her time and expertise,  but she courteously declined. As we were driving back home, I said to my wife: “was it an awesome coincidence or what”? We just solved the next important puzzle of my rotator cuff story. What I originally thought may take much longer to solve was resolved in less than 60 minutes! A caring physiotherapist like her suggests that her supervising mentor must also be an awesome role model on matters of this nature. In short, that day we identified my preferred physiotherapy center, and the physiotherapists that I felt comfortable to share the next phase of my post-op management with. In my opinion, when it comes to selecting a healthcare professional, nothing matters more than the care part of healthCARE … and it’s no wonder why we refer to them all as the “HealthCARE professionals”. Before I leave this topic, do you recall what I said earlier about the other overriding reason for selecting my physiotherapist? Two words: convenience and accessibility.

Well, this has been the starting point of my rehab stage. In the upcoming weeks I will take you with me through the next phase, and as I plan to excel at it. I understand that my physiotherapy begins with passive activities and then gradually progresses to the active ones. I just hope that my physiotherapists, as I progressively tend to know them better, will be inquisitive individuals  who desire to learn more about my case with every passing day along the way. I just hope that they are caring enough to consider my case as a lifelong opportunity to learn more about the art of physiotherapy for someone with terrible rotator cuff tetrad! 

Epilogue

On Wednesday, March 23, I had my first physiotherapy session. It was mainly all about reviewing my case and getting to know my physiotherapist, who’s the guy who runs the show out there. What in my opinion was the highlight of the session was the measurements that he made on the range of motion of my right (non-surgical) arm, shoulder, and elbow joints. Why did he make those measurements? Because if all goes well, my left arm should progressively be able to perform what my right arm does for me! Of course, realistically-speaking this appears to be a lifelong struggle for me. How happy was I with my first meeting? I’ll tell you, it was a … good beginning!

One final point if you don’t mind! Do you know what’s the 4^th stage of traumatic rotator cuff injury? Trying to excel at those physical activities that you’ve always been passionate about!

Catch you all healthily later!