To get shoulder surgery or not.... Dilema I'm facing (1 Viewer)

[top dog]

Last saturday I separated dislocated my shoulder in a mishap. Felt it pop out and back in. Needless to say it hurt like hell when it happened.

Monday I went to the orthopedic walk in clinic at a large practice here in the area. My wife had her shoulder surgery there just over a year ago. Doc does an x-ray and is like "Damn... You broke your socket." You need to see a shoulder specialist. They scheduled me for a CT scan and made an appointment with one of the docs there, but not the one who did my wife's shoulder. The doc I ended up with a much younger doc than my wife's doc. My wife's surgeon is one of the main guys in the practice with a lot more experience.

Wednesday I see my doc and he says "you need surgery to fix the socket or you will always have shoulder instability. But regardless, that shoulder will probably never be the same again." So we schedule a MRI for Thursday and surgery for next week 3/16 so we are on the books pending the MRI verifying everything. After fitting for the post-op brace I asked the doc how many of these surgeries he's done. He assures me he has done a bunch of them. He has been a surgeon for 6 years in this field but if I want a 2nd opinion he totally understands. I tell him that the other doc is my wife's surgeon and I just want to double check with him and see what his thoughts are. "No problem" says my doc. Tells the receptionist to get me an appointment and she gets me in for 9:45 Friday (TODAY)

Today I see my wife's surgeon. He says "My advice is to NOT do the surgery". He recommends to let it heal up on it's own, scar up and see what happens. That I will have some instability in that shoulder but the benefits of the surgery do NOT outweigh the risks. He says there is about an 80% chance that letting it heal up on it's own will result in me being pretty good. Because of my age (49), there is about a 50% chance they do the surgery and I end up with permanent stiffness in the shoulder. I ask him about the prospects of the instability. He says yes, I will be more likely to dislocate my shoulder in the future but at least I won't get stuck not being able to lift my arm over my head again. Also says that if I went and saw 10 orthopedics I'd probably get 5 who say do the surgery and 5 that say don't. I asked him what happens if I'm one of the edge cases and letting it heal and PT don't fix it? Surgery is still an option down the road he said. It's harder on the surgeon doing it because of the scar tissue but the recovery for me whether we do it now or 6 months from now is similar.

I'm probably 75 / 25 leaning towards not doing the surgery but I'm torn. Anybody ever go through a similar thing? Basically when the shoulder separated dislocated the ball sheared off a piece of the bone of the "socket".

 

[Doug B]

Doc does an x-ray and is like "Damn... You broke your socket." ... Basically when the shoulder separated the ball sheared off a piece of the bone of the "socket".

I don't have any experience with this, but I wanted to get something clarified for those that do. It looks like you basically answered it once I got to the end of your OP:


Your shoulder socket ... imagine a bowl or tea-cup shape. Your socket basically has a chunk broken off along the edge, kind of like a large chip on the rim of a tea cup?

 

[top dog]

Doc does an x-ray and is like "Damn... You broke your socket." ... Basically when the shoulder separated the ball sheared off a piece of the bone of the "socket".

I don't have any experience with this, but I wanted to get something clarified for those that do. It looks like you basically answered it once I got to the end of your OP:


Your shoulder socket ... imagine a bowl or tea-cup shape. Your socket basically has a chunk broken off along the edge, kind of like a large chip on the rim of a tea cup?

Yes. That basically is it.

 

[Doug B]

Also ... where is the "chip" in the socket? If your ear is at 12 o'clock, your chest at 3 o'clock, your feet at 6 o'clock, and your back at 9 o'clock, where about would you say your socket "chip" is?

 

[top dog]

Here is the results of my MRI:

FINDINGS:
Posttraumatic changes of recent anterior glenohumeral dislocation
noted. There is a slightly displaced bony Bankart lesion which is
better visualized on the CT measuring approximally 1 cm in size. A
small amount of step-off of the anterior glenoid articular surface
noted with a globular morphology of the anterior labrum consistent
with a component of labral Bankart as well.

Hill-Sachs deformity of the humeral head with marrow edema seen.

There is no evidence of rotator cuff tear. The rotator cuff tendons
have a normal signal and morphology. There is a small amount of
feathery edema of the subscapularis at the muscular belly adjacent to
the scapula likely related to the trauma. The subscapularis tendon
normal.

No large effusion.

Biceps intact.

Mild acromioclavicular osteoarthritis. This causes some mass effect
on the supraspinatus myotendinous junction.

No evidence of other fracture.

No other marrow replacement lesion.

No evidence of a soft tissue mass.


IMPRESSION:
Posttraumatic changes of anterior glenohumeral dislocation with bony
and labral Bankart of the anterior inferior glenoid rim and humeral
head Hill-Sachs deformity.

Mild muscular injury of the subscapularis muscle belly.

Mild acromioclavicular osteoarthritis.

 

[top dog]

Also ... where is the "chip" in the socket? If your ear is at 12 o'clock, your chest at 3 o'clock, your feet at 6 o'clock, and your back at 9 o'clock, where about would you say your socket "chip" is?

On the bottom. 6 o'clock

 

[Steve Tasker]

I'm not a doctor but I've had 3 progressively-more-serious shoulder surgeries so I've seen a lot of these questions.

Your terminology is a little confusing. If you know the actual medical terms for what you have been diagnosed with, it may be easier for me to explain my complications / experience.

Shoulder separation and dislocation are two different things; the terms often get confused. What you have described sounds like a dislocation rather than a separation, but you've used the term separation twice in the post so I am not sure. It sounds like you had a bony Bankhart, which I had as well, but again I'm not sure.

edit - you've posted the medical findings before my response went through.

 

[top dog]

I'm not a doctor but I've had 3 progressively-more-serious shoulder surgeries so I've seen a lot of these questions.

Your terminology is a little confusing. If you know the actual medical terms for what you have been diagnosed with, it may be easier for me to explain my complications / experience.

Shoulder separation and dislocation are two different things; the terms often get confused. What you have described sounds like a dislocation rather than a separation, but you've used the term separation twice in the post so I am not sure. It sounds like you had a bony Bankhart, which I had as well, but again I'm not sure.

I obviously am NOT a doc as well. Dislocation is probably more accurate. And the MRI calls out the "bony Bankhart"

 

[otb2huffing]

Tor Eckman down?

 

[Doug B]

The chip was around 3 o'clock, then, with an anterior dislocation. EDIT: That's why I'm not a doctor -- six o'clock it is.

Others who have been through such an injury, described as in the bolded above, will be able to share their experiences.

 

[Doug B]

And the MRI calls out the "bony Bankhart"

The Bankart lesion is a break in the cartilage on the edge of your shoulder socket. And cartilage doesn't heal as readily as solid bone does.

 

[gianmarco]

While not knowledgeable with the specifics of the surgery to repair this, anytime non-surgical approach is an option, I would recommend that route. As he stated, you can always get the surgery later with little downside to waiting. He clearly outlined some risks with getting the surgery done.

Until there's a clear reason/indication for surgery, I would hold off. I'm glad you got a 2nd opinion. It also doesn't mean the first surgeon you saw is incorrect (basically the 2nd surgeon told you that opinions may vary on best course).

If anything, you can help yourself feel at ease and get one more opinion from a shoulder specialist at another practice. But, personally, I would hold off on surgery for sure.

 

[Steve Tasker]

Here is the results of my MRI:

FINDINGS:
Posttraumatic changes of recent anterior glenohumeral dislocation
noted. There is a slightly displaced bony Bankart lesion which is
better visualized on the CT measuring approximally 1 cm in size. A
small amount of step-off of the anterior glenoid articular surface
noted with a globular morphology of the anterior labrum consistent
with a component of labral Bankart as well.

Hill-Sachs deformity of the humeral head with marrow edema seen.

This is helpful - I have had a very similar diagnosis.

The bony Bankart lesion is basically how you've described it, a small fracture of the shoulder socket, basically. My limited understanding is that it's a "bony" Bankart if the fracture has any bone present, rather than just pure cartilage. Hill-Sachs means you've basically dented the head of the humerus, most likely when the shoulder was popped back in. I also have had both of these.

I opted for surgery. First surgery was an arthroscopic labrum repair. Basically clean up and sew up the cartilage to try to make the shoulder socket intact, get rid of the bony Bankart issue. I was told by my doctor that this holds for the vast majority of patients. It lasted about 1 year before I began dislocating again, and frequently. I lost no range of motion or strength, but I also never gained back the stability.

Second surgery was a "capsular shift", where they basically give up on repairing the labrum and instead try to "tighten up" your shoulder socket using muscle, rotator cuff etc. This was an open surgery, large incision from about my armpit almost to the top of my shoulder. This held for about 8 years before I suffered a dislocation while playing soccer. Afterward, I began experiencing frequent dislocations yet again. Again, before this dislocation I had lost no range of motion or strength, and this time I had felt much more stable in the shoulder compared to the first surgery. The second surgery was a lot more serious, but it had much better results.

Third surgery was a Latarjet procedure. It was described to me as yet another more serious procedure but a last-step before pursuing a shoulder replacement. Basically they cut a small bone (coracoid process is the bone) and screw it into the front of your shoulder socket, so you now have a bone for shoulder socket instead of cartilage. I have two screws in my shoulder and there's a long thread about it somewhere in this forum. As of now, knock on wood, it feels better than ever. I have lost the slightest bit of range of motion but my daily life is back to normal and the shoulder feels very stable.

I will note that I was younger than you during the course of all of these surgeries (approx 19, 21, and 29-30 when I had them) so recovery was much different. I also took the recovery very seriously, never missed physical therapy, did my exercises at home, etc. None of us here can give you any better advice than your doctors, but this has been my experience. I am certainly not a doctor and this is not medical advice. Happy to answer any questions.

 

[top dog]

Here is the results of my MRI:

FINDINGS:
Posttraumatic changes of recent anterior glenohumeral dislocation
noted. There is a slightly displaced bony Bankart lesion which is
better visualized on the CT measuring approximally 1 cm in size. A
small amount of step-off of the anterior glenoid articular surface
noted with a globular morphology of the anterior labrum consistent
with a component of labral Bankart as well.

Hill-Sachs deformity of the humeral head with marrow edema seen.

This is helpful - I have had a very similar diagnosis.

The bony Bankart lesion is basically how you've described it, a small fracture of the shoulder socket, basically. My limited understanding is that it's a "bony" Bankart if the fracture has any bone present, rather than just pure cartilage. Hill-Sachs means you've basically dented the head of the humerus, most likely when the shoulder was popped back in. I also have had both of these.

I opted for surgery. First surgery was an arthroscopic labrum repair. Basically clean up and sew up the cartilage to try to make the shoulder socket intact, get rid of the bony Bankart issue. I was told by my doctor that this holds for the vast majority of patients. It lasted about 1 year before I began dislocating again, and frequently. I lost no range of motion or strength, but I also never gained back the stability.

Second surgery was a "capsular shift", where they basically give up on repairing the labrum and instead try to "tighten up" your shoulder socket using muscle, rotator cuff etc. This was an open surgery, large incision from about my armpit almost to the top of my shoulder. This held for about 8 years before I suffered a dislocation while playing soccer. Afterward, I began experiencing frequent dislocations yet again. Again, before this dislocation I had lost no range of motion or strength, and this time I had felt much more stable in the shoulder compared to the first surgery. The second surgery was a lot more serious, but it had much better results.

Third surgery was a Latarjet procedure. It was described to me as yet another more serious procedure but a last-step before pursuing a shoulder replacement. Basically they cut a small bone (coracoid process is the bone) and screw it into the front of your shoulder socket, so you now have a bone for shoulder socket instead of cartilage. I have two screws in my shoulder and there's a long thread about it somewhere in this forum. As of now, knock on wood, it feels better than ever. I have lost the slightest bit of range of motion but my daily life is back to normal and the shoulder feels very stable.

I will note that I was younger than you during the course of all of these surgeries (approx 19, 21, and 29-30 when I had them) so recovery was much different. I also took the recovery very seriously, never missed physical therapy, did my exercises at home, etc. None of us here can give you any better advice than your doctors, but this has been my experience. I am certainly not a doctor and this is not medical advice. Happy to answer any questions.

Thanks for your insight. All of that just made my shoulder hurt more! That sounds horrible.

I do like the 1st doc but his is pretty new. Has been in practice since 2022. The 2nd opinion doc has been in practice since 2003 and has been a team physician for the Los Angeles Lakers, Dodgers, Sparks, Galaxy and Kings, as well as the Anaheim Angels and Mighty Ducks. He is also the division chief in orthopedics here. It's hard to dismiss his advice when he says "If it were MY shoulder, I would not do the surgery at your age. 30 and under? We do the surgery every single instance. 49? Very high chance of frozen shoulder"

 

[top dog]

While not knowledgeable with the specifics of the surgery to repair this, anytime non-surgical approach is an option, I would recommend that route. As he stated, you can always get the surgery later with little downside to waiting. He clearly outlined some risks with getting the surgery done.

Until there's a clear reason/indication for surgery, I would hold off. I'm glad you got a 2nd opinion. It also doesn't mean the first surgeon you saw is incorrect (basically the 2nd surgeon told you that opinions may vary on best course).

If anything, you can help yourself feel at ease and get one more opinion from a shoulder specialist at another practice. But, personally, I would hold off on surgery for sure.

That is kind of where I'm at. I'm not going to make the decision 100% until I've had a chance to think it through the weekend and of course get my advice from my favorite message board.

And the 2nd doc said as much about the option of surgery. He didn't say it was the wrong choice, just not advised because of my age and risks. May end up having to do it in 6 months, but maybe not.

 

[fruity pebbles]

I’d hold off on surgery and see how the recovery goes. You can always have surgery down the road if it keeps popping out. Anecdotal I know but a friend of mine, after years of mountain bike riding, had both shoulders popping out on a somewhat regular basis. He had one shoulder done then the other. The recovery was so long and tedious, he said he’d have just lived with it. Personally, I’d never opt for surgery unless there was no other option.

 

[Gally]

What do you plan to do in the future that may or may not need your shoulder? By that I mean, do you play mens baseball or coach baseball where you need to throw with that shoulder? Do you rock climb, play basketball or tennis that will make you need overhead movement and strength from your shoulder?

If you don't do any of those things and are just a typical old guy that doesn't need shoulder strength/range of motion extremes then you probably can get away with no surgery and then just deal with the limitations as you grow older. If you need your shoulder for things you plan to do as a quality of life then getting the surgery while younger and stabilizing it is probably the right answer.

I did a similar thing to my shoulder many, many years ago. They couldn't find any issues beyond the separation and then going back in on it's own. I was prescribed PT and did that. But I coached baseball at the time. Once healed I went back to throwing which included batting practice for the team so I would throw 150 times every couple days during practice. My shoulder was never "right". I always had some level of pain. That went on for about 10 years when the pain became too much to bear. So I had more imaging done and it turned out I had an impingement on the rotator cuff so they did surgery. Once they were into the surgery it turned out I also had a torn labrum so they repaired that as well. It was likely my pain was mostly from the torn labrum which based on the way it was torn it wasn't able to be seen via MRI.

All in all shoulder issues suck.

 

[Hawks64]

Here is the results of my MRI:

FINDINGS:
Posttraumatic changes of recent anterior glenohumeral dislocation
noted. There is a slightly displaced bony Bankart lesion which is
better visualized on the CT measuring approximally 1 cm in size. A
small amount of step-off of the anterior glenoid articular surface
noted with a globular morphology of the anterior labrum consistent
with a component of labral Bankart as well.

Hill-Sachs deformity of the humeral head with marrow edema seen.

This is helpful - I have had a very similar diagnosis.

The bony Bankart lesion is basically how you've described it, a small fracture of the shoulder socket, basically. My limited understanding is that it's a "bony" Bankart if the fracture has any bone present, rather than just pure cartilage. Hill-Sachs means you've basically dented the head of the humerus, most likely when the shoulder was popped back in. I also have had both of these.

I opted for surgery. First surgery was an arthroscopic labrum repair. Basically clean up and sew up the cartilage to try to make the shoulder socket intact, get rid of the bony Bankart issue. I was told by my doctor that this holds for the vast majority of patients. It lasted about 1 year before I began dislocating again, and frequently. I lost no range of motion or strength, but I also never gained back the stability.

Second surgery was a "capsular shift", where they basically give up on repairing the labrum and instead try to "tighten up" your shoulder socket using muscle, rotator cuff etc. This was an open surgery, large incision from about my armpit almost to the top of my shoulder. This held for about 8 years before I suffered a dislocation while playing soccer. Afterward, I began experiencing frequent dislocations yet again. Again, before this dislocation I had lost no range of motion or strength, and this time I had felt much more stable in the shoulder compared to the first surgery. The second surgery was a lot more serious, but it had much better results.

Third surgery was a Latarjet procedure. It was described to me as yet another more serious procedure but a last-step before pursuing a shoulder replacement. Basically they cut a small bone (coracoid process is the bone) and screw it into the front of your shoulder socket, so you now have a bone for shoulder socket instead of cartilage. I have two screws in my shoulder and there's a long thread about it somewhere in this forum. As of now, knock on wood, it feels better than ever. I have lost the slightest bit of range of motion but my daily life is back to normal and the shoulder feels very stable.

I will note that I was younger than you during the course of all of these surgeries (approx 19, 21, and 29-30 when I had them) so recovery was much different. I also took the recovery very seriously, never missed physical therapy, did my exercises at home, etc. None of us here can give you any better advice than your doctors, but this has been my experience. I am certainly not a doctor and this is not medical advice. Happy to answer any questions.

Thanks for your insight. All of that just made my shoulder hurt more! That sounds horrible.

I do like the 1st doc but his is pretty new. Has been in practice since 2022. The 2nd opinion doc has been in practice since 2003 and has been a team physician for the Los Angeles Lakers, Dodgers, Sparks, Galaxy and Kings, as well as the Anaheim Angels and Mighty Ducks. He is also the division chief in orthopedics here. It's hard to dismiss his advice when he says "If it were MY shoulder, I would not do the surgery at your age. 30 and under? We do the surgery every single instance. 49? Very high chance of frozen shoulder"

Those two things make it very easy IMO. No surgery. He has significantly more experience than the other doc and he has very valid reasons for his decision. I would heal up and see how it progresses over time.

 

[DocHolliday]

I’d hold off on surgery and see how the recovery goes. You can always have surgery down the road if it keeps popping out. Anecdotal I know but a friend of mine, after years of mountain bike riding, had both shoulders popping out on a somewhat regular basis. He had one shoulder done then the other. The recovery was so long and tedious, he said he’d have just lived with it. Personally, I’d never opt for surgery unless there was no other option.

This. Let the shoulder heal and see how it feels and functions.

 

[top dog]

What do you plan to do in the future that may or may not need your shoulder? By that I mean, do you play mens baseball or coach baseball where you need to throw with that shoulder? Do you rock climb, play basketball or tennis that will make you need overhead movement and strength from your shoulder?

If you don't do any of those things and are just a typical old guy that doesn't need shoulder strength/range of motion extremes then you probably can get away with no surgery and then just deal with the limitations as you grow older. If you need your shoulder for things you plan to do as a quality of life then getting the surgery while younger and stabilizing it is probably the right answer.

I did a similar thing to my shoulder many, many years ago. They couldn't find any issues beyond the separation and then going back in on it's own. I was prescribed PT and did that. But I coached baseball at the time. Once healed I went back to throwing which included batting practice for the team so I would throw 150 times every couple days during practice. My shoulder was never "right". I always had some level of pain. That went on for about 10 years when the pain became too much to bear. So I had more imaging done and it turned out I had an impingement on the rotator cuff so they did surgery. Once they were into the surgery it turned out I also had a torn labrum so they repaired that as well. It was likely my pain was mostly from the torn labrum which based on the way it was torn it wasn't able to be seen via MRI.

All in all shoulder issues suck.

Great points as well. I'm right handed so I can still throw a baseball to my grandkids if needed. I'm a typical old guy with a bad knee and now a bad shoulder. My ideal vacation is drinking too much gambling in vegas with the wife. Maybe laying on a beach.