The first thing you do is you ignore it because you just played through the pain.
When you were younger you wake up the next morning and it was feeling better. It was feeling better after I took a couple of ibuprofen and the older that I got but after a while I knew there was probably something wrong with it.
He was struggling with the ability to throw, and he was having increasing pain, and had told me that he really wanted to try and get back to some of his more active lifestyle.
I just didn't want to give up playing baseball. Part of it was internal that hey, if somebody tells you that your shoulder's really messed up, you might not be playing anymore and I wasn't ready to hang up the spike, so to speak.
Eric had a labral tear in his shoulder and the labrum is a piece of cartilage in the shoulder that acts as a buffer. That acts as space for the shoulder and also shock absorption.
After a couple of months of doing physical therapy at the Sports Medicine Center, it started to feel a little bit better, so I kind of went back to doing my own thing again, working out and what have you. After a while, the pain came back again.
Any patient who has shoulder pain that limiting their function, in other words, they can't lift their arm overhead without pain, they can't do activities that they would like to do. Like one the things he referred to was I can't throw the ball with my kids in the backyard because it's just too painful and then I pay for it. We try to promote things that allow them to do that. But, sometimes people have underlying issues, underlying pathology in their shoulder that nothing we can do conservatively. So surgery ends up being the only option at that point.
The interesting thing with Eric is he's so active, and his demands are really pretty high, and what he wanted to do with his shoulder was at a higher level, athletically than a lot of people who are more sedentary, so he makes a choice with me, and we have a discussion regarding what his treatment might look like if we went down a surgical route, and what he can expect. I think the discussion really ended up with the decision to have surgery because he really wasn't happy with where he was at.
I basically said, "I've had enough. Let's get this taken care of," he goes, "Okay, first and foremost, when would you like to have the surgery?" I appreciated that because we were at the beginning of summer at that time, and I really didn't feel like ruining my summer having my arm in a sling. We decided that we were going to do it sometime in the fall, and it ended up being in October. And basically, he said, "Hey, let's go ahead and get it scheduled. We'll go through all of the proper paperwork. We'll get it taken care of in October, and hopefully by next spring, you're starting to do your slow throwing again, and we'll get you back into the gym at some point depending upon what I find more once I get in there.”
I guess Dr. Herbenick, in recovery, came in and talked to my wife, Laurie, I don't remember any of this, but at the end of the day, it turned out that it was a lot worse than what the MRI showed because not only was there a small tear in the rotator cuff, that wasn't his main concern. My labrum was pretty ripped.
When we have to do revision procedures of the top part of the labrum, a lot of the times we'll have to do something with the biceps tendon rather than just repair the labrum, and so the biceps tendon, in his scenario, was taken out of the shoulder itself, and had to be placed in another location. It's a procedure called a biceps tenodesis. That is something for a heavy weight lifter, or somebody who works out quite a bit, that is reproducible, and gets rid of the ability of the biceps to pull on the labrum, and then disrupt it. We know from plenty of research studies that people over the age of 35 don't do very well with revision labral repairs in that particular area, and so that's why we chose that particular procedure for him, and it is a little different than say somebody who's 21 with a labral tear.
After the surgery, for those first couple of days it was ice and non-stop getting the pain down to a manageable level, and then we started the recovery process with some physical therapy knowing that I was going to bend that arm, bend that shoulder, and do those exercises to whatever degree Jamie told me. Again, one of the things that they cautioned against is if you say do it four times, in my psyche I think six is better, so I would always push it a little bit further than I wanted to.
If a patient's injured and comes to the Sports Medicine Center at Miami Valley Hospital South, they have the opportunity to see sports medicine physicians, they have the opportunity to see orthopedic surgeons, they have the opportunity to see physical therapists and athletic trainers and it's a situation where because everything's all under one roof that it's very convenient for them to have everything taken care of.
Eric was an enjoyable patient. He has a lot of energy. He has a lot of charisma. He was a patient that I had to pull the reigns on quite a bit because he consistently wanted to do more than I wanted him to do while his injury was healing. But, he basically made optimal progress in an optimal amount of time, and had met all his therapy and all his personal goals in the quickest time possible.
It's a great case of somebody who has some complicated types of situations and problems within their shoulder, and what you can do to maximize somebody's recovery with some real challenging pathology. In any revision setting, the challenges are greater in order to normalize somebody's anatomy. Anytime somebody has some elements of arthritis, as well, that sort of clouds the picture and it makes it more challenging to get people back to everything they want to get back to, but once again, I think that largely we do the best job we can of trying to recreate the anatomy and normalize things. It's the patient like Eric who does exceptionally well.
I would not have changed a thing. I am very happy that I went through with it. I feel that my normal day to day activities are back exactly where they were before I started feeling all the pain, and as far as throwing and the ability to coach my son and daughter, that hasn't deterred me at all.
