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Guitarhero

Shoulder Replacement Surgery.

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Hi,

Has anyone had this procedure done? I know Dave Palumbo has had both sides done but I can't seem to find out much after his ops in the terms of training after etc.

I've been told last week I need this done as mine are beyond repair the right side more than the left..

After 32 years of training some competing I started to develop issues back in 2013 at the age of 44,  Specialist said it's down to poor posture, lack of flexibility/mobility, weak supporting muscles and just being unlucky..

I've had a little look on here and I can see a lot suffer from impingement which I started out with, I really wish I could turn back time and do things differently..

A lot of newcomers to this sport need to take this seriously as I'm seeing the younger generation developing issues in their late 20's and early 30's! 

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No but I know a bit about the different techniques and about the shoulder in general.

Firstly I'm sorry to hear you've ended up with this.

Dave palumbo had bilateral reverse tsr. This is basically an end of road procedure to get shoulder function back when the rotator cuff has completely failed. Dave left it way too long and must have trained through the pain of shredding his rotator cuffs....or his surgeon copped out a bit (unlikely). It's not meant for weightlifting (no mainstream tsr is) and you're only meant to do day to day stuff with the arm. Exercise wise swimming might be ok.

The specialist is fairly on the mark re causation. The factors which lead to impingement will also overtime unbalance the joint and cause point loading of the articular cartilage. Over time what usually happens is the ball starts to wear a secondary socket towards the back of the socket, a so-called biconcavity. Most end up with the ball migrated to this pathological socket and unable to externally rotate.

What people need to remember is the shoulder is a small joint with a small point of contact. As such people would be well advised to build well balanced shoulders (lots of rotator cuff work and 3x as much pulling as pushing) with higher reps . If each of your arms is pushing an average adults bodyweight you may run into trouble. They are arms, not legs lol.

I would advise you to check out a group on FB called ream and run support. It will tell you everything you need to know.

If you want to have unrestricted activity you need either a ream and run or glenoid inlay procedure. All other procedures rely too heavily on a plastic socket cemented into the bone (a narrow bone at that without much support for such an implant) which either works loose, wears out or both.

Can I ask how your symptoms developed/ progressed?

Can you hang off a bar? If so...keep it up.

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Hi charlysays,

Apologies for the late reply as I've not been on for few months.

I've not heard of the ream and run but will look it up thank you..

It started when my weight went up to 102kg at a height of 5"6 , I soon found out I was struggling as lack of flexibility then one day it just struck me, Went for a ultrasound to find out I had a Bursitis and Calcific Tendonitis in my right shoulder which then I was told I had impingement, my gp told me it was the effect of gear while a specialist told me lack of flexibility, poor posture and weak inner supporting muscles..

I can hang off a bar but it's a bit painful , I'd be grateful if you could give me some more advice if you know of anything..

 

Thank you.

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On 31/03/2021 at 8:50 PM, Guitarhero said:

Hi charlysays,

Apologies for the late reply as I've not been on for few months.

I've not heard of the ream and run but will look it up thank you..

It started when my weight went up to 102kg at a height of 5"6 , I soon found out I was struggling as lack of flexibility then one day it just struck me, Went for a ultrasound to find out I had a Bursitis and Calcific Tendonitis in my right shoulder which then I was told I had impingement, my gp told me it was the effect of gear while a specialist told me lack of flexibility, poor posture and weak inner supporting muscles..

I can hang off a bar but it's a bit painful , I'd be grateful if you could give me some more advice if you know of anything..

 

Thank you.

Do check it out. I think there may be some surgeons doing it in the UK now too as I did see posts from one or two guys in the UK who had a partial shoulder replacement like or much like the r&r.

The FB group is called ream and run support.

Good thing about a glenoid inlay or ream and run is you have the option of revision to a total tsr. If you go with a tsr or god forbid reverse tsr that is end of the road... You're on a one way trip to further surgeries and inevitably a failed plastic glenoid component.

It's fair to say gear use without being careful about how much weight you're pushing is responsible for a lot of joint and tendon problems in weight lifters. Some tendon ruptures are seen almost exclusively in roiders. Unless you're a competitive power lifter then the risks aren't worth it... Push more reps and sets. You'll still grow.

Most people should be hanging off a bar most days (I do 2x 30 seconds usually) and doing rotator cuff band work (innies and outies as some call them).

The key with the bar hang is to really relax into it and focus on letting all muscle tension go apart from your grip. It will be a bit painful initially but it's highly likely that your shoulder issues will begin to improve doing these.

The key with rotator cuff strengthening are slow controlled movements. We're looking for a tired feeling not total failure. Use bands. If you still have tendonitis, e.g in your right supraspinatus then only train a slow eccentric for now as this will consolidate the tendon and calm it down. You might have to rig up a pulley and a rope to pull your bad arm up to horizontal holding a light weight (thumbs up position, basically a lateral raise) then slowly lower it down to eccentrically load the injured supraspinatus.

Eccentrics are very effective. I had tennis elbow last year and could barely pick up my rucksack, 3wks of eccentric exercises daily whilst watching TV and it's been good ever since.

It's really important that you maintain ROM in an arthritic joint and keep the rotator cuff strength/ endurance good.... Or you could end up like Dave palumbo with two reverse tsr and severely limited ability to train and a high likelihood of further problems.

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Hi, I appreciate your time in writing this information which I didn't have any idea of, I'm not on Facebook but I've just joined up so I can join this group for some information.

Most of my training consisted of high reps 20-100 on sets, I was never into 1 rep max's  or low reps tbh but I felt so tight and solid at my heavy weight which didn't help.

I cut down on a lot of the stretching for the upper body as I wasn't sure whether I was doing more damage than good as at the time I wasn't aware of my issue as not been able to get into my doctors.

I have access to our own home gym and have a pretty good set up so I can get some of what you have mentioned done in the form of strengthening etc..

I will try and find a UK surgeon to talk to but failing that I will have to raise some money and maybe go over to the states to this dr for surgery..

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On 09/04/2021 at 9:38 PM, Guitarhero said:

Hi, I appreciate your time in writing this information which I didn't have any idea of, I'm not on Facebook but I've just joined up so I can join this group for some information.

Most of my training consisted of high reps 20-100 on sets, I was never into 1 rep max's  or low reps tbh but I felt so tight and solid at my heavy weight which didn't help.

I cut down on a lot of the stretching for the upper body as I wasn't sure whether I was doing more damage than good as at the time I wasn't aware of my issue as not been able to get into my doctors.

I have access to our own home gym and have a pretty good set up so I can get some of what you have mentioned done in the form of strengthening etc..

I will try and find a UK surgeon to talk to but failing that I will have to raise some money and maybe go over to the states to this dr for surgery..

No worries. It's important that people know what's out there and what's possible.

Good job on growing without low reps. I liken it to cyclists vs weight lifters. You can get pretty hench legs from cycling, especially hill climbs even though youre doing thousands of reps per ride. Muscle overload is the key requirement for growth and than can be achieved with various rep ranges. Somewhat surprisingly research also shows that as the muscle grows from high reps, its 1rm also increases despite it not being trained.

Flexibility seems to be something which is at least partly genetic. Some of us have to work at it, that would definitely be me.

Stretching the upper body is a little bit of a minefield I agree. For a long time people were advocating standing in a door way and putting your elbows against the frame and leaning forward to stretch the pecs for example but we now know this will also stretch the anterior capsule of the shoulder which isn't always a good thing for many people. As such its best to stretch one pec at a time against a door frame or similar and concentrate on sticking your chest out and sliding that scapula in towards the spine to elicit a stretch on the pecks.

IMO, all you really need to do stretch wise for upperbody is bar hanging (lots of it), peck stretches, rear shoulder stretches and perhaps some foam roller work on the mid back between the shoulder blades to improve thoracic extension as this is an issue for lots of people and is a major contributing factor to impingement.

I'm 99% sure there are surgeons in the UK who could offer the glenoid inlay procedure if not the R&R. The inlay in some ways looks like the safest bet to have one surgery and be done and recovered. It does use a plastic socket but it's recessed into the glenoid, so its surrounded by bone and can't really work loose. The R&R itself looks like something you would want to travel to the US for to see Brad Carofino or Dr Matsens team as it's highly specialist and skilled.

all the best

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All this puts me in a positive state of mind, would love to get it done to last then recover and get back to some sort of normality ..

I've just got back on fbook and have joined the ream and run support group, hopefully someone can advise me of a UK surgeon to perform the glenoid inlay procedure or ream and run...

As for hanging off a bar I find this very painful so I'm starting to let my body take the weight slowly to aid stretching and hopefully take all my weight soon.. 

I will see what I can find out then post an update on here..

Thanks again charlysays...

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On 19/04/2021 at 9:06 PM, Guitarhero said:

All this puts me in a positive state of mind, would love to get it done to last then recover and get back to some sort of normality ..

I've just got back on fbook and have joined the ream and run support group, hopefully someone can advise me of a UK surgeon to perform the glenoid inlay procedure or ream and run...

As for hanging off a bar I find this very painful so I'm starting to let my body take the weight slowly to aid stretching and hopefully take all my weight soon.. 

I will see what I can find out then post an update on here..

Thanks again charlysays...

There are definitely lots of options and hope if your rotator cuff is still working! Until you get surgery I would focus on keeping the rotator cuff strong with gentle, slow innies and outies a few times a week. Rig up that pulley system and do partial lateral raises in thumbs up position so you can haul the bad arm up to just below shoulder height or wherever is comfortable, then use the injured rotator cuff to really slowly lower the weight down to your side. In time hopefully you'll be able to do the concentric bit as well after the eccentrics have had time to consolidate the thickened inflamed tendon. You don't need to do full ROM to keep tendons like the RC healthy, partials are fine. Its time under tension , slow reps , slow eccentrics and slow movements which consolidate tendons.

Use the search function on R&R support, just search "UK" or something as there was definitely a guy on there in the last year in the UK who had been offered a partial replacement (probably a hemi cap which was the precursor to the arthrosurface glenoid inlay).

Yes, do build up really gradually to bar hanging. I found it a bit uncomfortable for a month or so and would have to ease into each hang and my shoulders are basically OK. Now I can hop on the bar any time any day and hang comfortably. So expect some pain when doing it, afterwards though you should be OK. Obviously if it starts making it worse overall stop or go even more gently. It's possible there are bone spurs in there. If any are sub acromial then it could impinge the rotator cuff although in theory if you can get fully overhead, the RC should be tucked away inboard of the acromium anyway. In RC tendonitis we usually see a "painful arc" scenario where there is pain when the arm is around shoulder height but OK nearer the side and OK right overhead. Obviously your glenohumeral arthritis might cause its own issues when the arm is fully overhead. The better ROM and stronger RC you can have now, the longer you can avoid surgery and when you do get surgery the better the outcome will be,

Here's a good article on bar hanging. Basically its natural function of our shoulders dating back to when we hung out in trees. Kids hang and swing off everything and have surprisingly good grip to weight ratio, then as we get older most us just stop doing it unless we're gymnasts, then the shoulder pain starts. There's increasing thought in the surgical and physiotherapy community that bar hanging prevents and treats the majority of shoulder pain.

https://www.physio-network.com/blog/hanging-for-shoulder-health-and-function/

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