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  1. #1
    Join Date
    Mar 2016
    Posts
    153

    new surgery to correct shoulder balance

    Hi,

    I have been fused from T3 to T10 on the beginning of this year.
    A good correction was achieved but shoulder imbalance was aggravated.

    I have talked with another ortho MD who told me I should have been fused from T2 instead of T3 to correct shoulder imbalance.
    What do you guys think about the possibility of losing one more level above T3 of my spine and possibly one or two under T10 to get shoulder balance?

    Did anyone got revision surgery to correct shoulder imbalance? If so, how apart were the surgeries? And, was it worth it?

    It really does bother me this new greater imbalance. Before surgery I could compensate the imbalance with the mobility of my spine that I have now lost. And it does cause pain on my job because I have to be all day on a desk working with a mouse with this imbalance. Shoulder specialist have told me that the imbalance may be the root of pain and is certainly the root of discomfort on my new posture on activities that require shoulder symmetry,e.g. holding a book, typing on pc, etc

    Thanks in advance.
    Last edited by richardis; 07-13-2016 at 03:23 PM.

  2. #2
    Join Date
    Dec 2008
    Location
    illinois
    Posts
    766
    Hi I have answered you posts before. Before you add another level on your fusion try to go into a big medical center that deals with more unique problems. I agree that it is hard to live with and pulls on a balanced spine. I could not pick up where you live but I have had a problem for last 5 years. I don't know if it the same but my scapula was always getting caught. It ends up it was caught on 3ribs that were deformed because of scoliosis. I will direct you to my signature for time line.
    Have someone do a Ct scan because fusing another level of the spine may not make any difference and it may be the way the scapula sits over the rib cage. I will be glad to answer your 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
    Join Date
    Jan 2008
    Location
    Oregon
    Posts
    1,162
    Hi there,

    I hear your concern and frustration, although please keep in mind you are really early days still and things will likely adjust if given adequate time.

    What does your original surgeon say about your current shoulder imbalance? Hopefully you have asked him, and will give things a chance to readjust.

    Hang in there. Nothing happens quickly in recovery from scoliosis surgery!
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

  4. #4
    Join Date
    Mar 2016
    Posts
    153
    Thanks for your support.

    The thing is, every day that passes since surgery , nor the pain in shoulder improves which is much worse than before surgery as of now, nor the shoulder balance. Shoulder balance was not ok before surgery but it seems worse to me now.

    My surgeon told me that the shoulders would even out with time, but the shoulder specialist I consult told me not to be overoptimistic about the symmetry, it may well end up like it is now. And if symmetry is not achieved pain will settle as an effect.
    Although, the shoulder specialist I consult did not order any imaging tests. He simply did the shoulder movements tests and told me to work my subscapularis muscles and my pecs and to do external rotation of shoulder and internal rotation of shoulder to ease the pain and masquerade the imbalance.

    Truth be told, when I am standing in with my muscles relaxed the clavicles do have a tilt ( right clavicle hangs further down, left clavicle moves further up), left shoulder blade protudes back in the saggital plane ( is retracted) and is higher in coronal plane, and right shoulder is protracted and depressed in coronal plane. It may be because of muscle imbalances that remain or because I am afraid to do much movement in the area of the fusion to correct my posture. I do think that my right razor back ribs http://link.springer.com/article/10....586-014-3619-x may contribute to this. Frontal part of left ribs stick out and upper to the front of my chest and the back part of ribs of the right are much farther away from my my right arm . I do have a very slight T1 tilt.

    I am not sure if shoulder deformities are ruled out.

    This Friday I will go to another ortho MD and I will ask a full CT scan of both my shoulders and full thoracic spine with 3D reconstruction. What do you guys think? what other imaging studies/tests may I require? An MRI? An x-ray of both shoulders? But the ortho I consult redirect me to my surgeon.
    I am afraid to confront my surgeon with this because he was so nice...but I have to tell him the truth. In the next follow-up appt I have to ask him this and show him the imaging studies (which he did not ask).

    What bothers me the most is the pain, which keeps getting worse, as the asymmetry is not that bad.

    I am not that mad about my surgeon but if it would end up like this I would prefer that he would have told me the truth right after surgery. My expectations have been ruined and it is harder to accept it now. And surgery may not have been worth it. I mean, sitting is much much more comfortable, but if arm movements are required then the pain drives me crazy.

    Thank you for your understanding,
    Last edited by richardis; 07-14-2016 at 11:37 AM.

  5. #5
    Join Date
    Dec 2008
    Location
    illinois
    Posts
    766
    I think the Ct scan may show something. Something you did not mention is if there is any snapping or catching in the shoulder blade. It is very difficult to see under the shoulder blade. My 3d Ct scan showed the rib deformity. It is not a shoulder deformity but a rib deformity. It looks like speed bumps under the shoulder blade. You did not mention a walking balance problem. That was my main problem. If the scapula is trapped it is impossible to move the arm in all movement.
    Do not be afraid to c to ask your surgeon. Bring your tests results and get a copy of images on a CD. A lot of surgeons like to see the actual images. A shoulder MRI will show if the problem is in the shoulder itself.
    Do remember you are early in recovery. If you have to hold your shoulder up in order to stay balanced is one issue and pain and movement is another.
    My doctor that finally figured it out is in Chicago. But he is available worldwide and travels to lecture .so your surgeon can reach him.
    Last edited by jackieg412; 07-15-2016 at 05:14 PM.
    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

  6. #6
    Join Date
    Mar 2016
    Posts
    153
    Quote Originally Posted by jackieg412 View Post
    I think the Ct scan may show something. Something you did not mention is if there is any snapping or catching in the shoulder blade. It is very difficult to see under the shoulder blade. My 3d Ct scan showed the crib deformity. It is not a shoulder deformity but a rib deformity. It looks like speed bumps under the shoulder blade. You did not mention a walking balance problem. That was my main problem. If the scapula is trapped it is impossible to move the arm in all movement.
    Do not be afraid to c to ask your surgeon. Bring your tests results and get a copy of images on a CD. A lot of surgeons like to see the actual images. A shoulder MRI will show if the problem is in the shoulder itself.
    Do remember you are early in recovery. If you have to hold your shoulder up in order to stay balanced is one issue and pain and movement is another.
    My doctor that finally figured it out is in Chicago. But he is available worldwide and travels to lecture .so your surgeon can reach him.
    it snaps a little, and makes the shoulder blade travel a different path at making some movements.


    Did you have any thoracoplasty done? If so, how many ribs?

    Who is your doctor? put the website here pls

    your right shoulder was up or down before scapulectomy?

  7. #7
    Join Date
    Dec 2008
    Location
    illinois
    Posts
    766
    The shoulder blade may be showing signs of dyskinesis. You can look that up and see if it describes what you are feeling. It is difficult to describe but I say it is like the shoulder blade has a mind of its own.It goes where ever it wants.
    I did not have a thoracoplasty. It should have been done but everyone agreed it was too risky. It should have been done for 3 ribs.
    The doctor that finally figured it is Dr Daniel Mass at the university of Chicago. The email is dmass@surgery.bed.Chicago.edu.
    You can look him up at the University of Chicago medicine.
    His address is The University of Chicago,5841 S.Maryland Avenue, Chicago,Illinois 60637.
    Phone 773-834-3531.
    I hope this helps.
    Please feel free to ask anything.
    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

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