Anterior shoulder dislocation recovery process

This thread was really helpful to me as I went through the injury / diagnosis / decision / recovery process. Without restating what everyone has said before, here's my story for anyone in the same position.

Background -- male, 26 y/o, climbing 5 yrs, mostly rock / alpine, history of loose shoulders but no previous pain / problems.

Spring 2015 -- back of shoulder starts to hurt, stop climbing because I figure it's just some inflammation. No real trauma, just started hurting one day at the gym. A few weeks later, pain is still there all over the shoulder in everyday movements and the joint feels gross. After navigating doctors and referrals, I end up at PT and I get a routine going.

Fall 2015 -- A few months go by, no climbing, lots of PT, moderate persisting everyday pain, but the joint starts to feel more stable. Then one day my girlfriend hugs me, I have a momentary "slip" of the joint and I'm back to square one.

I got an arthogram which showed signs of significant looseness (not much of the contrast agent stayed where it should have) and damage to the posterior labrum. At this stage it's been six months of no climbing and little to no forward progress. PT helped some of the symptoms, but obviously didn't solve the underlying issues. Surgery was the clear option.

end of October 2015 -- arthroscopic surgery to repair the posterior labrum and tighten the capsule to stabilize the joint.

First week post-op was a valium blur. Not terrible, but definitely a stay at home and sleep affair. I was in a sling full-time for 4.5 weeks then started to wane off. Getting dressed and sleeping was the hardest part of this phase. Having a live-in partner made a world of difference in this regard.

PT started around 5 weeks, mostly ROM. I didn't find this too difficult or painful. By two and a half months out I had "by the books" regained full ROM and was completely out of the sling for sleeping. I did some winter backpacking at this point. Extended trekking pole use and sleeping on the ground gave me some trouble, but nothing that a few days of rest didn't solve.

PT progressed into more serious strength training at three months, which continued until six months. I worked with a great sports-focused therapist who tailored the program to get me back on rock -- not just able to do the dishes or open doors. Throughout this phase (and still) sleeping is the only occasion where I sometimes have trouble.

At 5.5 months post-op I started climbing again. Things don't feel totally normal, but there's very little pain. One caveat is that textbook ROM is not the same as the ROM expected by a 5.11 climber. There's still some work to be done in that regard, be it more stretching or changing climbing tactics, knowing what I can and can't do. This weekend I had my first day of outdoor climbing in a year and it felt incredible. I'm not where I used to be in strength or in my mental game, but at least I'm climbing and not worried about my shoulder.

Hopefully this adds to the knowledge base here, like I said this thread was tremendously helpful as I went through this. PM w/ any questions.

Hi Kurt,

For me, it felt off up to 9 months after the operation. Right now, about a year, I don't even think of it.

Take it easy, you'll be fine.

Hey guys, its been a while since Ive posted but its good to see that the threa lives on. Echoing what Paul said, the shoulder just feels strange for a while, but at 14 months it feels totally normal. I still have a bit of ROM loss, but its steadily improving.

Super happy to see that this dialogue has informed other climbers! I hope we continue to develop the thread as a resource for others who are unfortunately faced with similar problems to what we have faced in the recovery and shoulder surgery decision process.

I'll add my experience too, 12 months post-op. I don't really think about my should when I climb, though consciously I now avoid most gastons unless it's very static. Also, I'm much less likely to reach as far up as I can with my affected shoulder because that was the position that led to the injury, and instead I rely on finding better feet. That's probably made me better.

I still do 20 min of shoulder stuff on both sides 2-3 times a week and plan on keeping that up for as long as I climb.

I reached my current ROM after 5 months or so, with minor improvements I'm sure since then. Although I still have some restrictions, it hasn't really mattered.

I guess I lucked out...my surgery was two weeks ago. The doc went in and said that the tear he saw on the MRI was not one that required an anchor. It was a "static" tear that just created a "flap", which he trimmed off. I was out of the sling after a few days, and while the shoulder is still sore, and my ROM isn't 100%, he's expecting that I can start easy climbing in six weeks, and be back to 100% in six months. I start PT tomorrow and consider myself really lucky. Hope that all goes well for anyone else considering this surgery!

Michael

I'm 11 weeks out from having arthroscopic SLAP and Bankhart repairs on my left shoulder. The SLAP has been the more restrictive of the two repairs. Week 9 was a big week for the recovery, I was able to start running regularly and start working toward full ROM. My PT told me to start testing it out for climbing this week, which is awesome. Did a lap on Kindergarten crack at donner summit for my first day back, so nice to touch some rock!

8 months post op: cascadeclimbers.com/forum/u…

It's interesting when people ask me about my shoulder now. It's obviously highly functioning and I'm asking as much of it as I ever have, but I think it now requires a lot of work (as others have said) to maintain that level of functionality. Doing shoulder PT/strengthening 2-3x per week is going to be my new norm for basically ever.

Try several swim strokes...i switch to a backstroke sometimes and even breast stroke a bit. I think it gives the shoulder a different range of motion.

hotlum wrote:So I got my results back from an MRI of my left shoulder and I do have a small tear to the labrum from a posterior dislocation about three months ago. The dislocation was probably a partial dislocation and my shoulder was only out for a second. The first doctor I saw at the emergency clinic the day of the accident said I was fine and classified it as a severe sprain. I started PT a few days later and was doing push ups and assisted pull ups within two weeks of the injury. Fast forward three months.... I am still having range of motion issues and some pain. I work in the woods and haven't been slowed down too much and have climbed a few easy trad routes without any issues. I swim when I can get it in. Since I have hit my out of pocket max with my insurance and my wifes friend is a shoulder specialist I decided to find out the extent of the damage. Small tear in the labrum, cartilage looks great, tendons look great, all in all she said not too bad but I have developed a frozen shoulder and will need a steroid shot and more PT..... I just moved back to central Oregon and am looking to take some time off of work this winter to do some smith rock sport climbing which is crimpy, techy, and vertical. Hopefully I can work through this frozen shoulder thing and really push myself again... Anyone else out there have any similar stories??

Hi Hotlum. What you report is a bit odd: frozen shoulder from a minor tear to the labrum is news to me. I am not a doctor, I've "learned about shoulders" dealing with my own (same for knees). I managed a non-surgical recovery of a torn labrum, for 10 years, until a second injury required the operation. During the non-surgical treatment of my first injury, I did something similar to you: I took up swimming. But I never ever forced it. To my knowledge, a "frozen shoulder" should be managed by a professional PT and you really need to have an MD look at it. Muscling your way through a frozen shoulder can cause additional damage that you really rather do without.

I can share my experience with you. I torn the labrum significantly in 2004. The doctor said "we operate, or you try conservative treatment". I took the second, I became an ok swimmer in 5 years of daily routine and became serious about the weight room. My best rock climbing was done during this period. Then I aged, took up traditional climbing and classical mountaineering, and a subluxation happened in 2014. The labrum was really torn, and the supra spinal tendon. So I went under the knife, it took me 9 months to feel ok, now I feel like new. No need to pack the shoulder with muscle to keep it stable: that's convenient for someone who loses weight and muscle in long periods of mountaineering. I only have pain now after long walks with a heavy backpack: apparently it's the supra spinal tendon.

To my knowledge, "frozen shoulder" is fixable, but is no joke. If you force it incorrectly, you can further damage other soft tissues that can only be repaired from inside. So, in your shoes, I'd see an MD and ask for a referral to a PT. Once your shoulder behave normally, even with some pain, then the pool is all yours.

Just my opinion: not an official medical advice.

The advice in this thread has been really helpful! I don't think I'm the only shoulder repair patient who just wants to know if they are normal. Seems like normal is all relative. I haven't spoken to two people who had the same recovery--and in many cases, it's a wildly divergent timeline. Figured I'd pay it forward and share my timeline for anyone else lucky enough to undergo surgery:

Pre-surgery

• August, 2016 - Came down from a powerful layback crack and notice a sharp pain from 80-100 degrees of my ROM when my left arm was reach across my body.
• September 2016 - Got a (non-contrast) MRI which showed no damage but saw an ortho who felt it may be a small labral tear. My lack of pain and healthy ROM didn't give us any reason to operate or cease activities. Did some PT.
• October 2016 - January 2017 - Took three big climbing trips. No huge decrease in physical performance. Returned from Patagonia with pain in a much great range of my ROM.
• January 2017 - Saw my PT, therapy made me worse. Saw my ortho, told me that operating would be the best course if I wanted to continue climbing at the same frequency and level.
• February 17, 2017 - Surgery day...super easy! Got the nerve block and felt great. Two anchors for a SLAP tear and an AC joint debridement.

Post-surgery

• Week 1 - Felt great. Used the cryocuff, didn't need painkillers, graduated from the recliner on Day 3.
• Week 2 - Had my post-op and surgeon told me I could go slingless. The only restriction he gave me was not to lift heavy objects. Immediately went home to force 180 degree ROM and regretted it. Saw my PT who chastised me. Cue the next month of worry that I'd ruined my surgery.
• Week 3-4 - Kept myself in a sling, tried to inhibit movement. Worried constantly that I'd ruined something in week 1. My PT shared the concern and we were very conservative, moving only passively.
• Week 5-6 - New concern: I am behind. My ROM is no good, I have pain with almost all motion. What does this mean??
• Week 7-8 - Bit of a breakthrough revelation...pain doesn't mean that I'm re-injuring myself. Now doing more aggressive strength building exercises and getting close to full ROM. Varying levels of pain at all times. Discussed with ortho who feels this inflammation is a little abnormal, likely due to the dual surgery. Suggest 2 weeks of anti-inflammatories, potentially followed by oral steroids and/or a cortisone shot.
• Week 8-11 - Continuing to take anti-inflammatories daily but shying away from steroid/cortisone for now. Pain is still present but primarily only when I am fully stretched. PT is continuing with bands and light weights but still not at full ROM. I climbed a children's slab wall at the gym (the holds were shaped like alphabet letters, neat-o!) in tennis shoes and it actually felt great to weight the outstretched arm a bit. Hopefully this is a sign of progress!
• Week 12-13 - Continuing to take anti-inflammatories. ROM below the plane of my shoulder is nearly pain-free, but still have continuing pain as I lift my arm. Particularly sore under the AC joint (where is was debrided). PT is incorporating heavier weights, weighted rows, and lat pull-downs. Marked increase in soreness after each session. Went to the gym and led a 5.6/5.7/5.8. It felt natural and pretty easy to move again, and I even clipped once or twice off the bad arm outstretched. 
• Week 13 - 15 - No longer taking anti-inflammatories. Shoulder movement has a marked decrease in pain when stretched overhead. Most soreness occurs when I try to sleep on the surgical side (not there yet). I went to the Gunks and dipped my toe in the water leading a 5.3 then progressed to a few 5.6's. The most noticeable thing is now weakness, particularly when I need to pull up my weight on a slight overhang. I'm starting a climbing gym routine again this week and am continuing with twice-per-week PT.
• Week 15-17 - Progressing well. Shoulder pain feels generally superficial with no deep aches like pre-surgery or post-op. General climbing fitness is very low and ability to pull up from the injured side is limited. That said, I am leading 5.10 in the gym (as long as it isn't too overhung or shoulder intensive) and even topdogged a technical 5.12. Seems like finger strength hasn't been affected much by the downtime. Still going to PT twice a week.

EDIT: updating as I progress

Alissa Doherty wrote:

The advice in this thread has been really helpful! I don't think I'm the only shoulder repair patient who just wants to know if they are normal. Seems like normal is all relative. I haven't spoken to two people who had the same recovery--and in many cases, it's a wildly divergent timeline. Figured I'd pay it forward and share my timeline for anyone else lucky enough to undergo surgery:

There is a wide variety of problems/surgeries in this thread.  The only thing they have in common is the shoulder and, of course, everyone is different ( age, sex, height, weight, etc..)

I had a bi-directional dislocation which is quite different than your problem.   I actually ended up with my arm almost 1 inch shorter :-) 

I like the way you broke down your process in a list.  Good luck to you in your recovery.

Hey sDawg, great to hear! Did you go to weekly PT for years to work on regaining strength or just for upkeep? I always assumed that I'd be dismissed within 6-9 months, but I've actually never asked my surgeon or PT how long they foresee rehab going.

Its been over 2 years since I had the repair, and the shoulder is doing just fine - i kept up with the ROM and the strengthening exercises as maintenance and I really think it helps with continued stability and shoulder health. 

wow, what an informative thread! I am in this decision process now, after 15 years of shoulder instability and a full dislocation 10 years ago. Over the years I was diagnosed with generalized ligament laxity and/or multi directional instability and just advised to do PT. No one ever did an MRI. I self-maintained with PT and exercise and was generally strong enough to keep up with yoga and climbing. I often got close to dislocating but always caught it in time. Now I'm 31, and last year in May i had a pretty significant sublexation at the climbing gym (via a high five of all things), and since then I've had more sublexations along with pain and general instability.

I finally found out about my Bankart lesion last month with an MRI, and am trying to schedule a surgery. I've heard from my PT and others about a combination of bankart repair + Capsular shift/repair. The surgeon I talked to says he doesn't believe there is any long term benefit to the capsular shift and won't do it. He is supposedly very reputable (Slocum I'm in Eugene OR which deals with a lot of athletes at the UO). I'm wondering if people have found research one way or another, or have experience to share on the matter? I expected there to be differing opinions on whether to go the PT route vs. surgery, but not that there is more than one way to deal with a torn labrum. To clarify, my question is whether you all would go for it with the surgeon I've talked to, or try to research the benefit of a capsular shift? Even if I talk to another surgeon, then I still just have to decide who i trust more in the end. 

this is also my first time posting on a forum, not sure if I'm supposed to start a new thread instead of commenting on an old one. any help appreciated!

Hi Mandy.   You can go either way...start fresh or resurrect an old thread (and get slagged either way in the process).   I prefer the resurrect route so you don’t have to reinvent the wheel.

Anyway, I have torn the crap (multiple dislocations both posterior and anterior, separations etc) out of both shoulders (between climbing, kayaking, and parachuting, hockey, and yes, softball).    No surgery.  So far PT and getting back at it as quick as possible has worked fine.
in my experience, surgery is a last resort.

Keep posted here on your further research and findings though.  I’m interested. 

thanks Mark! I am in the decision making process now and will post an update when I've figured some things out.

I am not sure what "Capsule Shift" exactly means. I had a lot of capsule repair though with my arthroscopic labrum repairs and that was essential to my recovery. I had the first one done and was so happy with it that I did not delay at all getting the second one done (other shoulder) just 11 months later (after a new injury). My shoulders were naturally lax and also had capsule damage as a consequence of the dislocations. In any case, I can't recommend specific surgical options but I definitely recommend a second opinion. Your surgeon should not mind recommending someone and if you're still not sure, ask for a third opinion or more. It's a big decision and a big commitment and you want to feel like you were sure about it as you are recovering.

I realize I'm a bit late to the revival of this thread, but why not add to what's here...
I had the bankart repair + capsular shift done when I had my shoulder done around 6 years ago. The shift is independent of the bankart repair itself - the shift essentially tightens the joint capsule (ligaments, I believe) by folding them back on themselves. I think this can be done in very bad cases since the joint capsule gradually gets stretched after repeated dislocations. My surgeon described it as adding another small bump (probably a percent or so) to the success rate of the surgery.
My understanding is that from a recovery perspective it does not affect the timeline, though it does boost the invasiveness and possible pain of the surgery (I didn't care - I just wanted the dislocations to stop). I was given the impression that the capsular shift could not be done arthoscopically and requires an open procedure. Apart from a much larger scar, this means that the subscapularis has to be severed to gain access to the joint (can contribute to the overall pain of the procedure) and the likelihood of infection probably goes up a bit.
While I obviously can't say whether the capsular shift (capsular tightening as I've also heard it called) added anything useful to the bankart repair itself, I've been very pleased with the result!

Funny how these things go... I'm 6 weeks out from my second bankart repair and remembered this thread, so I thought post a few things that changed in 10 years of medical progress in case anyone finds this buried in the MP archives. 

The last repair has been awesome - no issues to speak of other than a few degrees less ROM. But my other shoulder, which hadn't dislocated for 20+ years, finally popped out while doing an overhead reach at the gym a few months ago. Now it did have many dislocations all that time ago, and while it stabilized again much of the labrum damage probably never healed right if at all... So I walked out of the gym, cancelled my membership, and had an appointment with a surgeon a few days later to get the whole process started again. 

The recovery timeline I was given this time is much more aggressive - 4 months until I start climbing again instead of 6, and my experience so far is in line with a much faster recovery. This time it was with all arthroscopic with capsular shift, and I felt much less wrecked from the anesthesia and surgery. The few weeks with the sling (and the pillow!!!) still sucked, but it was clear that I could do more with the hand this time, and by 6 weeks out I am closer to where I was 8-9 weeks out last time around... so this bodes well. 

Sure, you can tell there is a huge spread between doctors just by reading through this thread, but I assume a lot has changed over the last 10 years too. It seems the general trend for surgery has been to try and accelerate recovery and shorten down-time, which seems to be the case here. It's probably also the case that surgical procedures and the tools available are improving at a good clip too.