I have a SLAP tear in my left shoulder, as diagnosed clinically and via MRI. For those that don’t know, that’s a form of labral tear. The joint is generally functional in that I can move it around for most daily activities. Some things, like rotating it backwards to pull on a shirt or backpack, give me a painful twinge. I’ve also got some limited range of external rotation.
Luckily I am right handed, but obviously this is still an obstacle. I’ve been in PT for a couple of months trying to get this sorted out. It’s made some progress but may have plateaued. I am trying to decide whether to have the surgery for it. That would probably involve bicep tenodesis and labral repair. (Look it up, it’s unpleasant.) Recovery requires 4 weeks with absolutely no use of the arm–it’s kept in a sling except for some light mobility work to keep it from freezing up. Full recovery takes around 6 months.
A lot of uncertainty about the decision. Some considerations:
(1) How to manage daily life, especially injecting myself several times a day and changing G7 sensors, with only one hand? I genuinely have no idea how to do this part of it. I would need someone to help me with injecting, I suspect; not a great time to be single and live alone.
(2) How to weigh the increased risk of complications and slow healing time from being T1? Tendon problems and poor recovery from rotator cuff surgery are discussed in the clinical literature, and I suspect the same problems go for this case.
(3) Will this result in less pain and mobility restriction than I have now, or just move those two things around slightly? No one can answer this one.
Ideally I would like to get back to my rather mild gym routine at some point, but I am not sure how much of that is possible either way that I go. If anyone has had this operation or has relevant experience and can weigh in, I’d appreciate it.
If you can at least use your left hand to help with changing pen needles or for holding a vial when you are loading your syringe, the injecting with one arm is not a problem. Skip the pinching of the flesh, just jab the injection with one arm.
If you are worried that the injection will go too deep without the pinch, just get shorter needles.
I think the G7 could be managed in the same way. Just use your left hand when removing the top.
If you can grip with your left hand, the G7 and the injections are manageable. Same with BG tests.
#2 I think a lot of it depends on your control. The better your control, the better your recovery.
Keep in mind, when they do these studies, they lump all diabetics together. So they say that their recovery is slower.
But you are not the same as every other person with diabetes. You are a unique individual. You are not in the same lump as they put everyone in.
You might be slower than a non-D. But you will be faster than a poorly controlled D.
A couple of things. I was just with a friend from HS who was also having some problem with the rotator cuff (maybe?) in the shoulder. He’s a couple of months behind you - just getting ready to start PT.
I developed this kind of pain during a trip in Europe - I think it was from that motion of putting on a backback. It was my right shoulder.
I see a chiropractor, and he recommended that I not exercise it at all and keep it in a sling. Then we worked on it for a while and very gradually it got better. By very gradually I mean over the course of 6-9 months.
My friend insists on exercising it - pushing it to the point where he begins to feel pain. I fear (without any expertise) that approach may be counterproductive for this kind of injury.
Have you seen a chiropractor about it? I have had very good experiences with chiropractors for a number of these kinds of problems.
I have two friends who used stem cell injections combined with PT to repair shoulder tears. They both had to pay out of pocket, insurance (Medicare) would not cover. It’s been over a year for both and they are satisfied that it was worth it to avoid surgery. Reportedly it us not a “permanent” fix but so far so good for both. I unfortunately don’t know how bad or where their shoulder tears were.
On #1, I would have use of the left hand, I just couldn’t use the arm for anything. So that does get me some of the way. But I suspect that jabbing myself in the abdomen would result in going straight into abdominal muscle, even with 4mm needles. Something I could do if absolutely necessary, but would rather not experiment with if I had the choice.
On #2, it’s true that the studies are not always good guides. At the same time, there are a surprising number of tendon problems in diabetes that aren’t caused just by high blood glucose:
Thanks for this. Rotator cuff tears and labral tears have slightly different treatment protocols, from what I gather. The work I’m doing with my PT involves scapular strengthening and stabilization, external rotators, pec strength, etc., but you never push through any sharp or high intensity pain. I haven’t visited a chiropractor for it so far. I’ve had extremely mixed results in the past seeing them for running related injuries. But if things don’t improve more with PT and I decide against surgery I might try it.
Interesting. No one has mentioned that as a possibility. I’ll see what the literature says with respect to labral tears specifically. Not being covered by insurance is a severe downside.
In SLAP repair, there are (as I understand it) three approaches. One is to just repair the labrum itself, another is to cut the biceps tendon from the labrum (tenotomy) and then repair it, and a third is to cut the biceps tendon, attach it to the humeral head with a screw (tenodesis), and then repair the labrum.
The rationale for tenotomy and tenodesis is that removing the tension of the biceps on the labrum will ensure that it heals well. The healing in tenodesis is complicated because it involves both bone and tendon, and requires the tendon to successfully attach in its new location.
While it’s the most complicated and has the longest recovery, tenodesis seems to be preferred because it has the least risk of requiring a later surgical revision. But the need for the tendon to heal well in its new location is what makes it a particular challenge for diabetic patients. I’m not sure whether the healing of the labrum itself is also slower, but I wouldn’t be surprised.
Really appreciate these references, I’ve just spent 6 weeks getting over plantar fasciitis, and maybe some of my joints and tendon issues (minor but ongoing) can be attributed to my DM.