Partial Rotator Cuff Tear on Lymphedema Side

https://community.breastcancer.org/forum/64/topics/816905?page=2#top

Here is one thread about getting a cortisone shot in the affected arm.

katiejane, I had rotator cuff repair seven months ago, but on my non-LE side, so I cannot comment much on related LE issues. I do know that despite being my non-LE side, I had crazy full-arm swelling, especially when I went to Florida a few weeks post-surgery and found myself in unaccustomed heat. I actually got a second set of night-time compression gear and wore that for quite a while until things settled down. My take-away there was that LE is a systemic disease, and the surgery altered the lymph balance, so to speak, and so my non-affected arm was affected. Massage helped, as did compression, and my greatest fear--two LE arms--did not materialize.

What I can tell you is not to put off the surgery, because despite the LE concerns, you sure need to use that arm. I also had a tear in my hip joint, and regrettably I put off dealing with that one so long that the tissue was not repairable, so I have issues remaining and will probably face a hip replacement some day. I had the shoulder taken care of within a short time of realizing that the limitations and pain were not temporary, and the outcome was much, much better. Mine too had no obvious cause, and in fact in my shoulder I had not only a rotator cuff tear at 90% detachment, I also had a labrum tear on the other side of the joint. I've since read that much of the population has degenerative shoulder tears, which come simply as we age, so you have lots of company.

The surgery is straight-forward, and then you have a resting period where you ice your shoulder and use momentum only to move the joint. They'll have you bend at the waist and use your torso to gently rock your hanging arm in a circle, the idea being to get more blood supply to the repair via movement of the joint, but without actually using your repaired muscle/tendon to initiate the movement. Gradually you'll start passive-range-of-motion exercises, where among other techniques, you use your other hand, or you grasp a stick and physically move the healthy arm or the stick (using the healthy arm's hand) to make your recovering arm/shoulder move. And eventually, you do start using your recovering limb by itself, slowly regaining lost range of motion and strength. Severity of your tear will dictate how long you're immobilized and how quickly you can start the therapy exercises. I was in a sling for 8 loooooong weeks, but a good friend who had her rotator cuff repaired quite recently only needed to be immobilized for two weeks. And the good news is that it's amazing what you can do with only one hand and arm!

On the bright side, I read a long time ago that it's quite healthy for the brain, and may help ward off cognitive decline, if we change things up a lot--how we do tasks, where we put things, etc. So I choose to believe that the obligatory re-assignment of all kinds of tasks to my non-dominant hand may have been inconvenient, but it added life to my brain!

My surgery was August 24 and today I have nearly full range of motion, although my surgery side is not nearly as strong as my healthy side, and I really notice that when I pick things up or put items in a high cupboard. So I continue to do my strength training exercises. I cannot recall if you are an avid gym or workout person. One potential concern with doing strength training on a lymphedema arm is that after post-surgical inactivity, you risk triggering some added lymph if you stress the arm by hefting too much, i.e. unaccustomed, weight. The good news however is that the therapy protocol will definitely have you adding resistance and weight in just the manner that the PAL Protocol established for safe weight training for those with, or at risk of LE: slow, steady progression using small resistance increments. I do believe that the post-surgical therapy routine will be LE-safe for you.

You'll want to chat with your surgery team in advance about the possibility of using compression on your arm and hand during and after surgery, with thought given to wrapping, considering how long you will be in surgery, and then during your initial inactivity during the very early recovery period. I'm sure you have good resources to check with on this, thinking of your LE surgical team.

Before my surgery and recovery, I could not even reach the garage door opener clipped to the passenger visor in my car. OK, there's a work-around for that: I moved it to my own visor. But more important, I could not paddle my kayak, and even grocery shopping-type reaching had become a two-armed gymnastics event. For the same reasons you've been doggedly determined to put your LE in its place--you want your life back--I'm sure you want the same for your shoulder and arm. I am so very happy I did the surgery, even as I continue to work toward getting the life back because I'm not as strong as I want to be. But now I see my old life coming along on the horizon, and the desired strength is a happy goal.

Good luck!!

Carol

I sure hope so, Glennie! We were in Key West for New Year's, and we went on a night-time kayaking tour. It was just a few hours, and not strenuous (and spectacular!!). I had no issues, so I'm super hopeful for this coming spring.

Paddling is peaceful, that's for sure. Glennie, I'm so glad you're able to enjoy that!

That is a bummer, Katie, my first thought was - maybe she didn't get your message? Did you only try once?

When is your appointment with the shoulder specialist, soon?

Oh, Katiejane, NO ONE should have to be put through the runaround you've received from Marja Massey. She cannot do a node transfer and then simply leave you to puzzle through how to handle life's damage to the limb and joint. One thought--can you provide her contact details to your shoulder specialist, and ask that surgeon to get in touch with her? If he is to formulate a plan for you, whether it is surgical or some kind of therapy plan, he needs the full picture of your anatomy and your LE surgery. It's extremely unlikely that he has ever given node transfer more than a passing thought, or even that it's ever landed on his radar screen. And...orthopedic surgery differs from breast/recon/lymphatic surgeries, so I would trust that he will have insights Dr Massey may not have, and if he learns what he can from her about node transfer, and especially your case, he will be better equipped to develop a strategy for you. At a minimum, her office must respond to a request for a printout of her operative report and office notes. But I hope that the two surgeons will talk, with your shoulder specialist advocating on your behalf for a solution.

As for orthopedic surgeons never operating on patients with LE, I'm left speechless on that. Candidly, I am not willing to be certain that you got the full response from the surgeon(s) Dr. Massey spoke with. With the tears you have, you need some intervention. My understanding as a two-shoulder-tear person is that many rotator cuff tears are asymptomatic, so it is possible to function with some degree of tearing. But you've got serious impairments, and you are in pain, and you've been doing the therapy already. So while it's possible that more physical therapy might help, I would not be surprised if the shoulder specialist tells you that your limitations will resolve only with surgery.

I have a couple of thoughts about surgery on your LE side. First, pain draws lymph, so unless you resolve what's causing the pain, you're probably aggravating your LE. Second, we know that muscle movement is key to moving lymph through our lymphatic pathways, so to help your LE, I think you want to restore all the movement and function that you can. Third, more and more studies are hinting at physical activity/exercise as being remedial for LE. I'm not holding my breath to hear that physical activity, whether cardio or strength training, will 'cure' LE, but I do think that common sense says that if our arms are fit enough to hold a 25-lb dumbbell, then lifting a 25 pound baby is not likely to trigger a lymphedema flare. If I can lift a 40 lb barbell, I can lift my suitcase into the overhead bin without having my lymph come to the rescue, because that lift is not stressful. Which is to say that even if you think you can relinquish use of your dominant arm, can you really? You will use it, inevitably, but you will be particularly vulnerable in your LE, because that usage will provoke pain, and your arm will be weak, both of which will invite the body to produce lymph and send it to the site in distress.

Your history of infection is scary, yes. No wonder you're gun shy about surgery! But I hope you will open your heart to the shoulder specialist's perspective on that.

Finally, although not on my LE side, I can report a great outcome from surgery 13 months ago to repair my supraspinatus tear, my type II SLAP tear (the labrum), and subacromial compression. It was a slow recovery, with aches that lasted well into nine or ten months, and it felt like I was in PT forever. But the pain and inconvenience were nothing compared to my pain and loss of mobility prior to the surgery. I'm back to normal and very glad that I opted for the surgery. I feel for you on the LE complication, and I wish you the absolute best of luck in your meeting with the shoulder specialist on Wednesday. I SO want you to find a pathway to success on this.

You ARE golden, Katiejane! Even if this aging business is a, uh, challenge. Not for the wimpy. But then, only the stout of heart are chosen by the LE fairies to be part of the this "Swell" Sisterhood in the first place.

REALLY good that this doctor was knowledgeable about LE--very reassuring surprise. May the pain not raise its ugly head.

Okay, keeping you in my thoughts for the lumbar spine issues next month. Be well, y'hear?! Onward!
Binney

Hi Everyone,

Just reading these posts as I was recently dx with calcific tendonitis on my non BC side. It has been a full 2 wks of very little sleep and some of the worst pain in my life. I'm determined to keep this shoulder moving and it is but now my BC side shoulder is hurting..I'm assuming from over use. I'm doing pt and eating Advil. Any advice??

I had a partial Rotator Cuff tear too on the side they wreaked. It doesn't sound as bad as what you got, but it upset me and bugged me every time I lifted my arm away from my side more than a little. That went on for several months. I got Low Level Laser therapy (LLLT). The pain stopped almost that day. It was a HUGE improvement. I had a couple of treatments done at Bastyr University's Naturopathic Clinic. I went in and got the LLLT because I tried PT and it didn't help. Then I read up on it, and figured I had nothing to lose. I also read some studies that said that it was just a placebo effect. It seems to be almost equal in terms of saying yea/nay. So who knows? I don't care if it was a placebo effect or not, I just know my pain with lifting my arm sideways from my body went away (called abduction)

30 patients with supraspinatus or bicipital tendonitis were randomly allocated to active infrared laser therapy at 904 nm three times weekly for 2 weeks, dummy laser or drug treatment for 2 weeks. Objectively maximum active extension, flexion and abduction of the shoulder, and subjectively pain stiffness movement and function were measured at 0 and 2 weeks. Significant improvement of active over dummy laser was noted for all seven assessments. Active laser therapy produced significant improvement over drug therapy for all three objective measures and pain. Naproxen sodium significantly improved only movement and function compared to dummy laser. These results demonstrate the effectiveness of laser therapy in tendonitis of the shoulder.

Key Words: laser, shoulder, tendonitis

In July, 2016, I had a double mastectomy with lymph node removed on left side. I have had lymphedema in that left arm ever since, in which nothing seems to help for very long. I have had pain in both shoulders ever since the surgery. The Drs have dismissed my complaints as inconsequential by telling me it will get better eventually, or some people have pain for a long, long, time and/or by throwing more drugs at it, like Lyrica. Physical therapy and lymph massage made the pain worse, so I stopped doing it.

The pain kept getting worse, so last week I went to an orthopedic surgeon. He ordered a bilateral MRI. The DX came back as bilateral bone spurs and rotator cuff tears! I never had this problem before the surgery and I elected not to do chemo and radiation, so, I can only conclude that these injuries happened during the surgery! A nurse friend confirmed that sometimes your arm can be hyper extended during the surgery. I have tried to research the topic but have not found much. I am told that the arthroscopic surgery required can be at a higher risk because of the Lyphedema.

I would appreciate any and all information anyone might have on this to help me navigate through this stormy sea! Medicare seems to limit my options, but I am still pushing.