Shoulder to Shoulder

Swimmers, goals, and the most powerful force on earth—friendly peer pressure—go well together.

A few years ago, some swim buddies and I made a pact to compete in the 2040 Senior Games when I’m 83. Despite my last year, the goal remains.

On Nov. 15, 2011 I underwent surgery on my left shoulder, just 14 months after massive rotator cuff and bicep tendon surgery on my right one. Though it’s only been six weeks since my second surgery, I was ready for it. Maybe my story will help others who are suffering from shoulder problems.

I’m not a doctor; I’m a patient. My experience is not universal. So if you’ve got a nagging shoulder, or want to avoid it, start by reviewing all the great information provided in USMS publications (a list of articles I found helpful are linked below). Work and time may help you avoid my journey.

Yet if you find yourself as I did about two years ago, with year-long chronic, unending shoulder pain that no amount of ice, ibuprofen, massage, physical therapy, chiropractic, cortisone or rest could control, here’s an outline of what to expect. It’s a long road, but keep this in mind: my right shoulder surgery went so well, I did it on my left. Full recovery can happen.

As background, I’m a regular guy who’s been mostly active my whole life. Although I’ve been swimming consistently since my mid-20s, it wasn’t until joining the Minnesota Masters Swim Club in 2000 that I got serious with interval workouts, averaging 3500 yards, three mornings a week. On non-pool days my activity included other cardio and weights.

But it wasn’t the swimming alone that landed me in two operating rooms.

It turns out that a portion of the population develops a too-narrow space under the acromion (the bony top part at the end of the shoulder) for the proper movement of the tendons of the supraspinatus muscle. This muscle runs horizontally on the top of the scapula (shoulder blade) and under the arch of the scapula (acromion), joining with the other muscles of the shoulder blade to form a common tendon called the rotator cuff. When this muscle contracts it pulls on the tendons, which help lift the arm.

The narrow-space condition, known as rotator cuff impingement syndrome, can lead to somewhat common tendon tears. In fact, the Wall Street Journal recently reported that more than 50 percent of people older than 60 have partial or complete rotator cuff tears.  The chances are most folks don’t know they have the problem because they don’t do what we do. Yet those with the impingement who rotate their arms under resistance, say 4,200 times a week for 10-plus years, will likely suffer sometime.

Even before seeing the surgeon I had an MRI, which showed a 90-percent rotator cuff tear, along with a frayed bicep tendon—a common condition in the dominant arm for a tear of this size. What I learned at my first visit was that surgery was my only real option. Tendons simply do not heal without help and even if I gave up swimming, I’d likely lose full use of my right arm.

There are two basic approaches to this surgery: open and arthroscopic. I’ve had them both.

The large tendon tear on my right shoulder required a three-inch incision, running front to back, at the end of my shoulder above the upper arm. Through this opening the surgeon was able to sew together the torn supraspinatus tendon and reposition the frayed bicep tendon. Also, to prevent a later repeat tear of the supraspinatus tendon, the surgeon performed a subacromial decompression—essentially shaving the underside of the acromial bone to allow freer movement of the muscle.

With identical symptoms on my left shoulder, an MRI a year after the first surgery revealed a rotator cuff tear about half the size of the one on the right with no bicep tendon deterioration. This smaller tear allowed for less invasive, but technically tough arthroscopic surgery, requiring five small incisions to allow the instruments access for tendon repair and the subacromial decompression.

Though the surgeries are different, the pre- and post-op conditions are similar.

A general anesthetic caused a deep sleep for the 90+ minute surgery, after which I awoke heavily medicated with a narcotic, along with an anti-inflammatory and ice. A pain pump was also installed attached to a small tube placed under the skin leading to the surgery area to provide a self-controlled local anesthetic over the next two days.

The 24-72 hours post-op was the toughest because of limited mobility, narcotics and a new, short-lived lifestyle.

Pain management is a balancing act that’s different for everyone. For me, the narcotic provided miraculous pain relief but also slowed down other bodily systems, if you know what I mean. So after 36 hours I stopped the narcotics and switched to over-the-counter pain reducers to eliminate side effects.

During the first week post-op I found myself sleeping more, likely because of the trauma and need for energy to repair tissue. Sleeping in a partially reclined position with pillows under my arm/shoulder made things more comfortable, but it still wasn’t easy.

In the days, weeks, and months after surgery, the right shoulder rehab took a lot of time and patience – something that’s difficult for active folks. Though progress was literally measured in millimeters, every day saw improvement as I followed the medical professional’s directions religiously. 

My right arm was in a sling for six weeks to ensure initial adequate healing, while the left was only four weeks because it was less invasive and did not require bicep tendon repair. In both cases, there were lifestyle changes and more time needed to do almost everything. Putting on a sock with one hand, and other things, take concentration but are not impossible. Little things like an electric razor and those harp-like dental floss things helped a lot, but the best thing was having support at home.

Let’s face it; most swimmers are accustomed to a daily dose of activity. Unfortunately the first months of recovery meant less upper body action to ensure proper healing and avoid the risk of injury. But there’s no excuse to be entirely inactive. The mental and physical benefits of responsible activity count as much after surgery as they do normally. So two days after surgery I walked for an hour, following the next day with careful lower body cardio to get my heart rate up, and never looked back.

Professionally directed physical therapy was critical to the full recovery of my right shoulder. It began soon after the sling came off and lasted about six months, with shorter interval appointments in the beginning and a month between the last two sessions. The initial work involved passively and incrementally moving my arm and shoulder, using my good arm to assist. This evolved to an unaided increase in the range of motion, measuring and recording progress in millimeters along the way. As full range of motion came back, I began a series of strength training exercises specifically designed for the complex of muscles surrounding the shoulder.

With progress and doctor approval, I got back in the pool five weeks after surgery simply to allow my arm to float. Just being in the water and smelling chlorine was a lift and there’s little better than water therapy for any injury.

At about four months, workouts were solely kicking (arms at the side) just to regain the feel of the water. Six months post-op and as strength came back, so did sculling, kicking with arms outreached, followed by breaststroke, backstroke and finally, freestyle.  Nine months after surgery, I was back to swimming 2,500 yards, two to three days a week and at 10 months had completed several 1- and 2-mile open water swims.

Chances are most Masters swimmers occasionally experience shoulder problems. If or when it happens, it’s likely conservative treatment can keep it in check. But if surgery is on the horizon, it’s good to know what to expect. Success will come with good information, experienced professional help, patience, encouragement from fellow swimmers and goal setting.

Additional reading:

Getting Started with a Healthy Shoulder

When Shoulder Hypermobility is a Problem for the Swimmer

What To Do When 'Simple' Solutions Do Not Resolve Shoulder Hypermobility Problems for the Swimmer

Shoulder Pain - When to have an MRI

The MRI Shows A Rotator Cuff Tear ... What Now?

Rotator Cuff Tears: Frequency of Tears 

Stitching Up Shoulders