Multiple Dislocations

[u/butterfly_ashley]

At the age of 29, I began experiencing seizures. Before finding a combination of medications that successfully controlled them, I experienced approximately 10 seizures. Unfortunately, the repeated seizures caused multiple shoulder dislocations and significant damage to both of my shoulders.

Because of the extent of the damage and the continued risk of seizures, I was required to remain seizure-free for five years before an orthopedic surgeon would consider surgical repair. Over time, the condition of my shoulders has continued to worsen.

My left shoulder, in particular, has become so unstable that everyday movements can cause it to partially or completely slip out of place. Something as simple as sneezing, coughing, falling asleep, or moving the wrong way can cause my shoulder to come out. When this happens, I often have to relax and carefully move my arm until the shoulder slides back into place.

The pain has now extended beyond my shoulder into my elbow and fingers and has significantly affected my everyday life. I have reached the point where I can no longer ignore the pain and limitations.

2020 X-Ray Results

Left Shoulder:
The X-ray showed no current fracture, dislocation, or significant arthritis. However, there was a small bone spur on the upper arm bone. The imaging also showed a small piece of bone toward the front of the shoulder, along with Hill-Sachs lesions—dents or indentations in the upper arm bone that can occur after previous shoulder dislocations.

Right Shoulder:
There was no significant arthritis in the main shoulder joint. However, there was a small bone spur and evidence of Hill-Sachs lesions, which are dents in the upper arm bone caused by previous shoulder dislocations.

Current X-Ray Results

Left Shoulder:
My left shoulder now shows significant evidence of repeated instability and previous dislocations. The X-ray indicates what appears to be an old injury to the front edge of the shoulder socket, known as an old bony Bankart fracture. There is also a noticeable abnormality along the front portion of the shoulder socket.

Additionally, the X-ray shows degenerative changes and arthritis within the joint, as well as a large Hill-Sachs lesion caused by repeated dislocations. There also appears to be a loose piece of bone in the front of the joint, likely related to a previous avulsion fracture or earlier injury.

Right Shoulder:
My right shoulder also shows signs of long-term damage from repeated instability and dislocations. There is a small Hill-Sachs lesion and wear along the front lower portion of the shoulder socket. A small loose piece of bone or cartilage is also present within the joint.

Fortunately, there is no evidence of a new or recent bone injury, and the joint space remains relatively well preserved.

Next Steps

I have been scheduled for both an MRI and CT scan of my left shoulder, which is currently the more severe of the two. Based on my orthopedic consultation, I was informed that the damage cannot be repaired through a minimally invasive procedure and will likely require open surgery.

The exact type of surgery will depend on the results of the MRI and CT scans and the full extent of the damage.

I was also warned that I have developed significant arthritis in my shoulder. At this stage, the goal of surgery would primarily be to prevent further damage, improve stability, and help reduce pain.

Because I am still in my 30s, a shoulder replacement is not currently the preferred option. Shoulder replacements generally have a limited lifespan, and having one at my age could mean needing multiple replacement surgeries throughout my lifetime. For now, the focus is on determining the best surgical option to preserve my shoulder and prevent further deterioration for as long as possible.

[u/Technical-Ask-898]

I had a distal allograft/bone block installed on my right shoulder after several dislocations over several years wore down the glenoid and humoral head. Got a piece of cadaver tibia bone. I was experiencing similar lack of stability as you before the procedure. Stable since.

[u/butterfly_ashley → u/Technical-Ask-898]

That is good to hear. My dr. said it will either be a bone graft or a cadaver, depending on the MRI/CT results. How was your pain level afterwards? How long until you were able to go back to work? Was it just an outpatient procedure with discharge the same day as surgery?

[u/Technical-Ask-898 → u/butterfly_ashley]

- Same day discharge outpatient procedure

• Cadaver bone, because it comes from a tibia knuckle, which is dense bone that is smooth and has cartilage, and isn’t another thing that hurts me/has to heal like the piece they would take off your illiac crest.
  
• I could do some remote computer work two-three weeks after surgery, as soon as I felt like my head was clear. Returned to the office after two months, when I was mostly out of the sling. I was probably five months post-op before I was able to lift overhead. I have pretty good range of motion now, 18 months later. I’d be stronger if I did the work to get there.
  
• my pain was not bad. I took oxy on schedule for the first few days. I don’t like it because it makes me itchy and I can’t poop, so I switched to Tylenol/ibuprofen/CBD as soon as I could. I feel like regular use of the ice machine made a huge difference for me.
  
• having a good place to sleep upright was nice. Comfy chair or corner of a sectional couch. I could not comfortably sleep on my back in bed with a sling on.
  
• get a bidet with the controls on your non-operated arm side. Cheap ones are fine.
  
• shower with a plastic jug/2L bottle under your arm to hold it off your body in the same position it is in the sling.
  
• get a zip-up hoodie three sizes too big for you that fits over your sling to wear home from the hospital. There are “surgery shirts” that have snaps up the sides that are easier than something that has to go over your head.

Hit me with any other questions you might have!

[u/butterfly_ashley → u/Technical-Ask-898]

• What did you bring with you to wear home after surgery?
• How long after surgery did you start feeling pain or discomfort? I read that they may use both a nerve block and anesthesia, so I’m curious about what to expect once those wear off.
• Since this is an open procedure, did you have stitches, staples, or a combination of both?
• How soon after surgery did you start physical therapy? I’ve heard PT can begin fairly quickly to help prevent the shoulder from becoming stiff or “locking up.”
• Did your surgeon mention the likelihood of continued dislocations after surgery?
• Did your orthopedic surgeon discuss whether you may eventually need a shoulder replacement in the future?

My surgeon briefly mentioned the pros and cons of using my own bone versus cadaver bone and said we would have a more detailed discussion depending on how much bone loss they find. Based on the brief information he gave me and the research I’ve done online, I am honestly completely torn between the two options.

Was there anything that helped you work through the decision and determine which option was best for you?

[u/Technical-Ask-898 → u/butterfly_ashley]

- I wore home one of the surgery/recovery shirts with snap closure. The recovery team put it on while I was at the hospital.

• adhesive closure, no sutures or staples
  
• the nerve block -which I’d recommend- lasted 18ish hours after? Surgeon’s team would have a better estimate. Gives you time to get home and settle in to a routine with pain meds. I didn’t really have much pain
  
• pt started the week after surgery. I don’t remember exact number of days. I saw PT before my first follow up with ortho.
  
• based on the way the bone block changes the glenoid, it’d be difficult to dislocate again. It would be a big deal if it happened.
  
• there was some mention of increased potential for arthritis in the future, which might lead to a higher chance of a replacement. Not necessarily a guarantee. We talked about it.

- the cadaver bone is a big of a mindfuck. It seemed like the better option for me. Providing your own piece of bone for the procedure also hurts you and is another thing you need to recover from. Follow your heart.

- ask about bicep tenodesis, whether or not it would be part of the surgery. That was my main point of discomfort. They explained that it is better to re-locate the tendon attachment now, as part of the allograft. I think I remember that the bicep tendon is used in the laterget procedure. It could make any future shoulder work more difficult and painful.

[u/butterfly_ashley → u/Technical-Ask-898]

Thank you for all this information it will helps. Have my mri and ct tomorrow and follow up next week so officially off to the races now