I have had trouble with my right shoulder for fourteen years.
I had fallen in college and ended up with a tiny fracture in my right wrist. At some point a few years later, my right shoulder starting popping and grinding. I went to the Kaiser Permanente medical center, where the general practitioner referred me THE ONE orthopedist. The orthopedist did some testing, told me I had a torn piece of cartilage hanging down in the shoulder joint from the fall, and needed surgery to repair it. The orthopedist then referred me to THE ONE orthopedic surgeon.
Before I proceed further, I should explain that I'm not making some kind of odd Frodo, M.D. commentary. I don't know if they still work this way but, a decade ago, Kaiser had a single medical building in my city of residence, in which they housed their medical staff and equipment. If you got sick, you went to that office and saw one of several randomly assigned general practitioners.That general practitioner would conduct a basic review and testing and, if they felt it appropriate, they would send you to see a specialist. Oops, I mean, "the" specialist, because they only had one specialist in any particular category.
So, I was shuttled off to Kaiser's ONE orthopedic surgeon. He came in, read the written MRI report, and then proclaimed without any kind of physical inspection of my shoulder or review of the MRI images, that I could not possibly have this particular injury because it was only found in little old ladies or people who had fallen. He wouldn't listen to anything I said. All he wanted to do was give me an injection. I asked what the injection was, and then he rolled his eyes and said that he would use the needle to inject "medicine" into my shoulder. When pressed for details, he started talking about "walking the needle along the bone." I bailed, not only because he was incredibly demeaning to me, but because I found the idea of "walking the needle along the bone" in my shoulder to be terrifying.
I followed-up once with the referring orthopedist who apologized and said that the surgeon was a jerk, but that he was literally the ONLY ONE at Kaiser who could perform the surgery. I gave up on treating my shoulder. I couldn't bear the thought of going back to the jerk doctor, and couldn't afford to go out of network. I subsequently ignored my shoulder for fourteen years.
This year, as a part of a general clean-up of my life, I decided to address all of my unresolved physical ailments and therefore sought treatment for my shoulder. It had degraded to the point that I had notably reduced mobility and constant pain. I could barely lift my elbow above my shoulder line and my shoulder would pop and cause shooting pain in my arm if I extended my arm to the side or picked up anything heavy.
I had new, non-Kaiser insurance and selected a new orthopedist based on positive Yelp reviews. He ordered an MRI with contrast which, as far warning to any of you out there on the interwebs going down this same path, is not your typical MRI experience. I have had a good number of MRIs - brain, ankle, spine, kidneys, etc. - and usually contrast involves injection through an IV in the arm or hand. For a shoulder, the injection is made directly into the joint.
First, we had a little snafu where the imaging center had booked my appointment with the MRI technician but had forgotten to book any time with the radiologist. This meant that I had to wait around for two hours while they tried to fit me in. They said that I could come back on another day, but I had already taken the time off of work and didn't want to have to do so again.
I was then shuttled off to the radiology department where I got to put on a typical hospital gown. The radiologist suited up in his lead armor and his assistant then pulled out a tray filled with GIGANTIC NEEDLES. If you are needle shy - like me - for goodness sakes, don't look around the room, and close your eyes as soon as you get on the table. Once I saw the needles, I turned away and started crying, and continued crying for the entirety of this stage of the test.
I had to lay on a table, very slightly on my left side. They shoved a small angled pillow under my right shoulder. The radiologist said that this position helped separate the shoulder joint and make it easier to get the needle between the bones. While this information would be helpful to a normal person, for me all I could think was, "OMG HE IS THREADING A NEEDLE BETWEEN TWO BONES OMG OMG OMG OMG!!!"
Once I was in position, the radiologist injected a local anesthetic into my shoulder using a small needle, which was not so bad. It was several injections in different areas. Next, he put a very, very long needle deep in my shoulder, where it remained for about 5 minutes. This process takes a while because the radiologist is trying to position the needle so that the contrast material gets inside the joint, and reaches all of the tissues around the rotator cuff, including the labrum. This involves moving the needle a little bit, taking an x-ray and checking the position, moving the needle a little more, taking another x-ray and checking the position, etc. While not overtly painful, it was uncomfortable pressure. I also happened to be wigging out at the gigantic needle protruding from my body, which I could see in my peripheral vision.
This contrast injection process, for me, was truly horrible. I would say that 10% of the unpleasantness was discomfort (not pain), and 90% was my being utterly terrified of needles and freaked out at the gigantic needle protruding from my body for an extended period of time.
Once the injection was made, they took me off to the MRI wing. The walk down the hallway felt exceptionally long, partially because I was emotionally exhausted after all of the needles, and partially because I was concerned that the gown was insufficient to cover my tush. The MRI itself was easy. They give you earplugs, hand you a panic button in case you freak out or need to pee, and stuff you in a narrow tube that makes lots of loud noise. At various points, they told me to inhale or exhale and then hold my breath.
Once the test was over and I met my husband in the waiting room, got a hug, and then proceeded to cry off and on for the next hour, while I decompressed from the terrifying needling I had received.
The MRI showed wear to the rotator cuff, pockets of inflammation, and a type III acromion, i.e., a little piece of bone in my shoulder was curved down and poking into my rotator cuff. The orthopedic surgeon said that surgery was necessary to clean up the joint and perform an acromioplasty, i.e., shave down that piece of bone so that it stopped chafing my shoulder tissues. He said that if surgery was not convenient in the immediate future, that I could delay and try physical therapy. He warned me that physical therapy was only a short term solution to reduce pain and improve mobility, but that surgery would be required to correct the problem. I chose to do the surgery immediately.
My next post will discuss the entire surgical procedure and recovery, including photos of the incisions and bruising, for any prospective acromioplasty recipients who want a very forthright idea of what to expect!
