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Thread: shoulder imbalance, pain in shoulder and some random q

  1. #1
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    shoulder imbalance, pain in shoulder and some random q

    Hey,
    I am a male with 30 years old. I have been submitted to scoliosis surgery and I will hit my 4th month threshold very soon. I am fused from T3 to T10.

    My surgery went very well or so they told me.
    I do have a little bit of shoulder imbalance. I did have my 1 month follow-up with my surgeon and he told me to look myself in the mirror and to try to correct my posture. He says the inner ear and the vestibular system has to adapt to my new body shape and sense of perception. Although it might be the case, I think it is a side effect of surgery like this http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230354/
    My movements kind of remain similar to the pre-op times, That is, some muscle memory still lingers and the muscles are having a hard time at settling down into new position.

    But I am writing in the forum to hear your answers to this questions:

    1) Did you feel crooked just after surgery? I did, my scoliosis was well hidden in the thoracic spine but right after surgery I thought surgery could not achieve a good correction. When I looked at the post op x- ray I was both surprised and happy. The correction of the bones was instantaneous but the muscular imbalances take time to subside. That might have been the cause to the crooked feeling.

    2) On my post-op x ray I had a little neck tilt. This was just a confirmation because when I stand up the first time and I saw myself on the mirror I was able to check this. Do you remember the sensation of your body standing up the first time? Did your posture changed 1 year after surgery for the better?

    3) On the last weeks my shoulder imbalance has improved but I still think something just not rest as it should. I still have to think how to put my clavicles, and my shoulder blades into a normal resting position (mainly the right one). But it does not come naturally. Did you struggle with this?

    4) what was you schedule of recovery? when did your doctor lift the restrictions to have the normal range of movements and flexibility so you could just forget to have precautions with your back? Like have a normal life and pick up things from the floor and stuff? Do you still log-roll? I mean, when did you start to have confidence to live a normal life without being aware of the major surgery you went through, like stop obsessing over your movements so you don't break the hardware/instrumentation?

    5) when was the month or week in the recovery that you started to feel really better?
    I numbered my questions to make it easier for you to answer.

    thanks in advance

  2. #2
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    Hi and I will comment on some of the issues. You are young but healing takes time. Don't be discouraged but at least a year. You get better slowly.
    I will encourage you to pay close attention to your shoulder problem. Work with your PT to encourage proper movement of the scapula. You can look up my posts and read in my signature the problems that may be there. In a few words my ribs were deformed right where the scapula needed to move. It has been a big challenge. It took years to find the problems and it wasn't until my shoulder got trapped down that any doctor I saw took the problems seriously.
    If yours continues I encourage you to see an upper extremity specialist in a major teaching hospital. I had two unusual surgeries. I am open to questions. Jackie
    T10-pelvis fusion 12/08
    Fractured t-9 six days out of surgery
    C5,6,7 fusion 9/10
    PJK at t-9
    T2--T10 fusion 2/11
    Removal of left side t6-t10. 8/14
    C 4-5 fusion 11/14
    Right scapulectomy 6/15
    Right pectoralis major muscle transfer to scapula
    To replace the action of Serratus Anterior muscle 3/16

  3. #3
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    Welcome to the forum

    I didn’t feel crooked, it was the opposite, I felt straight and tall.....My shoulders were or seemed overcorrected, instead of my left shoulder hanging down, it was slightly higher probably for around a year. I would say they are quite even now. Your shoulder imbalance and your thoughts of surgery will eventually diminish in time.....it takes a year or so to heal physically and mentally. Its quite a distressing, disturbing thing that we go through, amazing actually that we can endure such a procedure. Healing happens!

    I was never actually released per say, but ordered to go skiing at 15 months. I guess that counts as a release. (smiley face) The bending over process was something that I took seriously, so didn’t do it till around the 8 month mark. At that point, I started LIGHT hanging stretches with one leg up on a stool. That went on for around 6 months till I limbered up some more. That was done so I could finally reach my feet to tie my shoes. Since many books will state that it takes 12 months for fusion to occur, that stood out in my mind.

    Log rolling is the easiest way to get out of bed. After a year or so, I realized that I didn’t need to do this and can sit up if need be, but it takes more effort.

    Some surgeons will order PT for scoliosis surgery and some will not. I didn’t do a scoliosis therapy program but my arm and shoulder were broken when I did do my spine surgeries. When I did my “shoulder therapy” I discovered that the arm bike was beneficial for the paraspinal’s and soft tissue that run over the screw heads in the thoracic. Pedaling with my arms helped with toughening up the 4 inch wide surgical zone in the thoracic area. I used no resistance doing this, and I was around 9 months post. You can emulate this arm pedaling motion without any machinery. I would pedal forward and backward in 12 inch circles. Much of this was done standing up straight staring straight ahead.

    Walking is our therapy.....its actually amazing how valuable this is. Outdoors is much better....

    Do try to eat well.....I have found that when I break dietary rules, it has an affect on things...

    Hang in there

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  4. #4
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    I think I may have found the cause for my shoulder imbalance post-op.

    My left shoulder was higher on the pre-op xray.
    I was fused from T3 to T10.

    According to what I have looked up online, the surgeon should have planned the surgery as this for the upper instrumented vertebrae:
    "T2 for preoperative left shoulder elevation, T3 for preoperative level shoulders, T4 for pre- operative left shoulder depression" according to http://upload.orthobullets.com/journ...3_23996983.pdf

    I should have been fused from T2, instead of T3, because I had not preoperative level shoulders. I had preoperative left shoulder elevation.
    I will rule out another possible cause for this with a shoulder specialist. If he tells me everything is fine, the cause should be the one I mentioned above.


    This applies to almost everyone(read the article to match the pre-op curve of your case to the ones standardized), so those who have shoulder imbalance post-op may find this info useful.

    In my case the shoulder imbalance was aggravated on the post-op x ray when compared to pre-op x ray.

    The take-way message from this seems to be: surgery planning is crucial for a successful outcome.
    Last edited by richardis; 06-28-2016 at 07:34 AM.

  5. #5
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    I may be wrong but I think the degree of correction is also related to the shoulder leveling. I asked the surgeon why he didn't hyper-correct my second daughter like he did the first. He said her T curve was different than the first kid's T curve and couldn't be hyper-corrected without leaving her with a high left shoulder.

    Both their fusions start at T4.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  6. #6
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    I am not sure. Some very severe scoliosis have shoulders leveled.

    Anyway, in my case the correction is very good so that is not the cause.
    Last edited by richardis; 06-28-2016 at 05:44 PM.

  7. #7
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    Quote Originally Posted by richardis View Post
    I am not sure. Some very severe scoliosis have shoulders leveled.

    Anyway, in my case the correction is very good so so that is not the cause.
    I don't think I was clear. I am saying over correction can cause high left shoulder. Sometimes the surgeon does not correct the curve as much as possible so the shoulders will be level.

    It is a trade off... more correction producing uneven shoulders versus less correction and even shoulders.

    You say your correction is very good. I am saying that may be linked to the uneven shoulders. My one daughter could have been corrected more but the surgeon didn't do it and left some curve because if he corrected it more she would have a high left shoulder.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  8. #8
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    Quote Originally Posted by Pooka1 View Post
    I don't think I was clear. I am saying over correction can cause high left shoulder. Sometimes the surgeon does not correct the curve as much as possible so the shoulders will be level.

    It is a trade off... more correction producing uneven shoulders versus less correction and even shoulders.

    You say your correction is very good. I am saying that may be linked to the uneven shoulders. My one daughter could have been corrected more but the surgeon didn't do it and left some curve because if he corrected it more she would have a high left shoulder.
    good point. It has crossed my mind too.



    So, what of the following is correct:

    "overcorrection " = correction so good that the curve now leans to the other side

    or

    overcorrection = corrects a thing at a greater cost for other imbalances

    ?
    Last edited by richardis; 06-28-2016 at 05:43 PM.

  9. #9
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    Quote Originally Posted by richardis View Post
    good point. It has crossed my mind too.



    So, what of the following is correct:

    "overcorrection " = correction so good that the curve now leans to the other side

    or

    overcorrection = corrects a thing at a greater cost for other imbalances

    ?
    The second one. I am not sure anyone is ever corrected past zero.

    Can you post your x-rays?
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  10. #10
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    I will send you my x rays via PM.

    Is there any difference between overcorrection vs hyper-correction?


    I think I have seen a picture of pre and post x ray somewhere on a scientific article, where they measured the curves like 45º (pre) and -15º (post-op).

    Thanks for your collaboration.

  11. #11
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    Quote Originally Posted by richardis View Post
    I will send you my x rays via PM.

    Is there any difference between overcorrection vs hyper-correction?


    I think I have seen a picture of pre and post x ray somewhere on a scientific article, where they measured the curves like 45º (pre) and -15º (post-op).

    Thanks for your collaboration.
    I don't know any official definitions but I think hyper-correction is when you take a large curve and bring it very close to straight.

    Over-correction can happen in a growing child when you staple or tether the spine. Also, curves can be over-corrected temporarily in braces I think.

    I have never heard of over-correction in an adult. Maybe Linda can comment.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  12. #12
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    Here is my before and after of my twin girls.

    http://www.scoliosis.org/forum/showt...792#post135792

    I would say Thing 1 was hyper-corrected because she went from 58* down to no residual scoliosis. Her shoulders are even now but were uneven before surgery. She fretted a lot for several months until they came even.

    Thing 2 was not hyper-corrected and the surgeon left a residual curve. It is 20* there but increased a bit to abut 25* on her last x-ray. I think she had a false double curve which looks like two curves but the lower one bent out and so is only compensatory. I have read that you can't hyper-correct this type of T curve or else you will have a high left shoulder. Her shoulders are even because she was not hyper-corrected as far as I know. She would have had a high left shoulder had she been hyper-corrected as far as I know.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  13. #13
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    @Pooka1 please get some space out of your PM inbox. Cannot send you a message because it is full.

  14. #14
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    Quote Originally Posted by Pooka1 View Post
    Here is my before and after of my twin girls.

    http://www.scoliosis.org/forum/showt...792#post135792

    I would say Thing 1 was hyper-corrected because she went from 58* down to no residual scoliosis. Her shoulders are even now but were uneven before surgery. She fretted a lot for several months until they came even.

    Thing 2 was not hyper-corrected and the surgeon left a residual curve. It is 20* there but increased a bit to abut 25* on her last x-ray. I think she had a false double curve which looks like two curves but the lower one bent out and so is only compensatory. I have read that you can't hyper-correct this type of T curve or else you will have a high left shoulder. Her shoulders are even because she was not hyper-corrected as far as I know. She would have had a high left shoulder had she been hyper-corrected as far as I know.
    your Pm inbox is full. get your box cleared of some space so that I can send you my 20 yrs x -ray again.

  15. #15
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    Hi. I just cleared it. So sorry.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

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