Resolved question:
Hi
I had an arthroscopic bankart repair 4 months ago, and things have not been going smoothly for me. Getting my surgeon to listen to this has been proving difficult. I'm not sure how to progress now and would love to get a fresh perspective on my situation. Here's how my recovery has gone:
- week 1 - in sling full time - felt great, completely stable and no pain at all.
- week 2 - physical therapist says to only wear the sling if going out - I'm off work for 3 weeks so sling barely gets used from this point on. Old pain coming back, but no pain from surgery itself.
- end of week 2 - told I can take sling off to sleep. 2 nights later I wake up with excruciating pain, muscle spasms and whole arm is limp. That's the first time I believe I dislocated. I had my first post-op appointment a few days later and tell surgeon what happened. He said I wouldn't have dislocated - shoulder is fixed. I've only ever had these symptoms after a dislocation, but I take the surgeon's word for it that I have just annoyed my shoulder.
- week 5 - same thing happens during the night. I am not getting these symptoms any other time, I believe now that I am moving awkwardly during the night and am dislocating. Between weeks 2 and 5 I also notice a sensation that my shoulder is slipping when I roll over, and when using the pulling and doing certain exercises I have been given. I see my surgeon and he once again dismisses it and says my shoulder is fixed.
- between weeks 6 and 12 my shoulder is feeling increasingly unstable. I feel like I'm subluxing again. I keep telling my PT that the exercises are making me feel worse and I feel that I'm subluxing again - he tells me to forget about my shoulder and have a glass of wine. I decide to have a break off PT at this point to see if that helps.
- week 12 - time for another follow up with surgeon. I tell him I feel like I'm subluxing and the pain is back to what it was before surgery - once again he says my shoulder is fixed. I feel like he thinks I'm doubting his skills and he is pretty annoyed by this - I feel uncomfortable at this stage, but he was great when I didn't question anything.
- week 12 and 13 - I decide to change PT's to see if I can make some progress with someone else. She tells me my shoulder is a massive mess and can't believe the rehab protocol I was given - she believes I shouldn't have been allowed out of the sling for 6 weeks as it takes that long for the cartilage to heal to the bone. I tell her about the issues I've been having and all doesn't sound right to her. We decide to give it a month and see if I make any progress, otherwise I might need a second opinion from another surgeon if my current one isn't listening to my concerns.
- week 14 - I am vacuuming and the cord gets stuck. I tug on it with my bad side and it dislodges suddenly and my arm flings back overhead. It all happened in a blur, I thought I must have fallen back against the wall and hit my head because I feel like I'm going to pass out, but I suddenly registered the excruciating pain in my shoulder and grab at it - at that point I feel it pop back into place. After that the pain settles but severe muscle spasms set it and my palm and fingers are tingling.
- A few days later I'm still in a lot of pain and my shoulder has completely ceased up. I have a visit with my PT and she tells me I have to get a second opinion - but also warns me that surgeons generally don't like fixing the work of other surgeons, great!
- I decide to visit my GP to see what she thinks and get a referral to another surgeon. She believed the repair has failed due to poor rehab protocol.
- My GP sends me for an x ray and in the meantime calls my surgeon to discuss what has happened. My xray results reveal a bankart lesion, although she doesn't know if that will always show from the surgery. The surgeon wants me to go back and see him, she says he sounds disappointed with what has happened and genuinely concerned, which makes me feel a bit better. We decide that I should go and see him, but if he doesn't do anything I have a referral for another surgeon and I can make an appointment for a second opinion if necessary.
So I'm just looking for another perspective on this before I head back to the surgeon in a couple of days.
- Does it seem reasonable to assume that the repair as failed? And what usually causes this? I feel the rehab was too intense, but I also felt all along that I have another problem at the back of my shoulder that was never addressed - something I had raised with my surgeon but was also dismissed.
- Who takes the blame for this? I mean, am I expected to pay for another surgery in this circumstance? I followed all the instructions I was given, I don't feel that I should be up for more expense, especially as it's only been 4 months since the first surgery.
- Is it normal for bankart repairs to fail this easily? I wasn't told that this could happen.
- Is it too soon to have surgery again?
- Am I silly to go back to the same surgeon if the repair has failed? I really don't want to have to start all over again with someone else but will if that's the best course of action.
- Am I just being impatient? Is it reasonable to expect that 4 months after surgery that my shoulder should feel stable and not subluxing/dislocating regularly? My shoulder feels significantly more unstable than it did before surgery, not to mention the constant pain. I just want to get back to some sense of normality! I expected a long rehab process, I expected that I would have stiffness and pain, but I didn't expect the outcome I have.
Any input would be appreciated, I need to know I'm not crazy for expecting that this shouldn't be happening!
Submitted:
4 Days
Category:
Orthopedic Surgeon
Hello,
Thank you for your query at DoctorSpring.com
I have read your question with diligence.It looks from your details that you have failed bankart's repair.Although it is too early have this failure.In post operative phase most of surgeon keep the affected limb from 3-6 weeks in sling.The strenuous activities are gradually allowed after 6 -8 weeks.At my end i can not blame any one neither your surgeon nor your physio.
But you should have this surgery again as you are having features of subluxation.In my opinion an open discussion with your surgeon who has operated upon you will be better for you.Your surgeon will be more cautious with you now & if he is doing these surgeries frequently then it should not be his fault.Failures in surgery are common & written in books & other literature even in best hands.
Hope this all will help you.
Thank you for your reply. I just have a couple more questions.
1. When you say it's too early for this failure do you mean it doesn't normally happen so early? I'm really struggling to understand how this has happened so early myself given that I have limited range of motion. If I have to have this surgery again I want to know what I did wrong the first time as I did exactly as instructed. I fear that if this repair has come unstuck so easily then I may just end up in the same situation second time around.
2. Is it possible to dislocate/sublux and not actually do any damage, and therefore physio may help if I keep persisting?
3. My recent xray report says I have a bankart lesion. Is it possible that this could be from the surgery or should it be healed up by now? My pre-surgery xrays didn't show the bankart lesion so I'm wondering if this is significant or just an after effect of surgery.
4. Can a second surgery be done by arthroscope or I'm I looked at a more complex surgery?
Hello,
Your bankart lesion was present before surgery & as you have told the surgery was done for this (Bankart repair).The most probable reason was an early movement of the shoulder. Keep your limb in sling for at least 3-4 weeks.Second surgery can be done safely by arthroscope in good hands.
With best wishes.