new surgery to correct shoulder balance

[richardis]

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.

[jackieg412]

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

[leahdragonfly]

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!

[richardis]

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,

[jackieg412]

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.

[richardis]

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?

[jackieg412]

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.

[jackieg412]

I forgot to answer but my shoulder was trapped down. I could lift it but it wouldn't stay unless I held it up. It caused me to have difficulty walking. I couldn't keep my balance.

[richardis]

Ok, turns out the doctor I went today has another opinion.

He said shoulder balance will come. He was not sure if some curve will form under the fusion to compensate for this.

So there are two options according to this doctor:

- shoulder balance will come but a distal curve will compensate for this

- shoulder balance will come with no impact on spine alignment ( no scoliosis distal add-on curve will appear)



He said I should wait to assess if pain is due to another condition. Right now, pain is expectable as a result of the imbalance and I am still in recovery (so pain is justifiable). He denied to order a CT scan.


Anyone being through this? What are your thoughts on this?

[jackieg412]

Yes I have. Many opinions but it is indeed early in recovery. There isn't any harm in waiting and watching. If you can walk balanced it may be ok. So waiting is the right thing. Be aware of your posture . Have some guidelines in keeping the 17 muscles that hold the shoulder blade working together in the right way. Find a good PT team and faithfully do the proper exercises. Pain is expected but should get better even if it is slowly.
Now if the shoulder or shoulder blade starts snapping or catching on movement continue to look for the answer.
It took 4years of this to permanently trap my shoulder blade. Don't wait that long if you continue to have these symptoms.
I hope this helps

[rohrer01]

Richard,

I have not had surgery, but do have a pretty large rib deformity under my left scapula. I also know people who have had surgery.

Just something to remember; you don't have that much movement in your T-spine when it's healthy, so it's unlikely that you were correcting your shoulders prior to surgery using this portion of your spine especially since that is where your deformity was at its greatest. I can't move my T-spine at all. Any adjustments you were making were most likely in your L-spine since that is where the majority of your flexibility is. It may be that you are still nursing surgical pain and are afraid to adjust the same way that you did pre-surgery.

I can't understand why they didn't do a thoracoplasty if you needed one, IF that is the problem. I'm still reeling at the fact that they didn't do one in Jackie and felt it was better to remove part of the scapula. Ask her about that because if I recall, they needed to do further surgery to reroute muscles in order for the scapula to have any function. I realize she explained that they thought it was too risky at the time, maybe complications? She's been through a lot, and like she said, ask her.

But as far as you go, they didn't even fuse ALL of your thoracic vertebrae and maybe they should have? Your ROM shouldn't be affected by what they fused. My DIL is fused from T2-L1 and hasn't lost ROM, although they scared her out of doing things by not explaining that it was just for the recovery period when her spine was fusing. But at her last visit, the surgeon told her she could do anything. Her surgery was 10 years ago. She has remnants of a high shoulder as well. Her upper trapezius muscle is still larger on her left than it is on the right and she has a bit of curve left going into her neck on x-ray, but it's minimal. Sometimes our expectations exceed surgical capability.

I hope you find this helpful and not critical. I don't mean to be, but sometimes I come off that way.

I wish you all the best in your recovery. I hope things normalize and you don't need anything else done. Let's just hope your shoulder pain is a result of your body adjusting to its new configuration.

Just a side point; I had terrible left arm pain after my first round of botox in and between my neck and shoulder region. The doctor said it was because it allowed my left shoulder to drop a bit and my other muscles were being pulled a bit and that it would go away. It did after a few months. Your whole torso has been reconfigured. You have reconfigurement pain (things being pulled where they weren't before and less tension in other areas) AND surgical pain. I don't know how old you are. If you are young, you can expect six months to a year. If you are older you can expect upwards of two years of surgical pain. It would be good to ask Linda Racine. She works with scoliosis patients and is very knowledgeable with things like that.

Again, I wish you all the best!
Rohrer01

[jackieg412]

Yes those are very good points. Not everything can be corrected. For me the shoulder had to come up because I couldn't walk without great difficulty because my spine was balanced but the arm down pulled very hard on the fused spine. I would get tired easier and loose my balance. For me it was a huge problem because I walk a lot. According to the doctor in Chicago I was left with a high degree of kyphosis. It does have an effect on the cervical. But not everything can be corrected and I can function like this.
It was decided not to remove the ribs but to remove part of scapula. That worked for 5 months and then the Serratus Anterior muscle failed and in March I had a muscle transfer for stability of the scapula. So for it is working but it is early. I am optimistic but guarded. A lot of retraining but while the shoulder is up it isn't even with the other and may never be. Still working on it.

[richardis]

Just something to remember; you don't have that much movement in your T-spine when it's healthy, so it's unlikely that you were correcting your shoulders prior to surgery using this portion of your spine especially since that is where your deformity was at its greatest. I can't move my T-spine at all. Any adjustments you were making were most likely in your L-spine since that is where the majority of your flexibility is.
Rohrer01

Thanks for the contribution. My understanding may be erroneous, but I truly believe I could compensate it. I know that t-spine has very limited flexion and extension ability but it has indeed great rotation ability.https://youtu.be/xonZvWOt670 . Plus, by rotating the spine, the rib hump would change position as well as all the rib cage. And do not forget that by rotating the rib hump one shoulder would come down and the other would sit on top of the smashed rib hump.

Since I was a little kid I do remember putting my thumbs against my deformed vertebrae trying to ease the pain and to put in place what seemed to be a bad positioned bone. Ever since then, I used to rotate and derotate the torso and flex laterally my spine to both sides, bend and extend because I knew something was wrong and I wanted to fix it or find relief. Plus, the focal pain in the apex vertebrae was horrendous and by doing this I was decompressing some nerves ( I can only understand this now as you can imagine).The downside of this is that I may have contributed to the arthritis of the spine on that area by doing that. Of course I had not a mobility of a normal person, but I was very mobile. No position I could chosen to sit seemed to be comfortable, so to sit still for me has always been a nightmare. I kind of miss that after fusion, but sitting now is such a relief! Now, I can tell I was a 24/7 equilibrist. My bones are now more aligned so they can rest after a +20 years performance as equilibrist performers.

And sometimes the most comfortable position before fusion was identical to an odd position of a contortionist.


Though, I may be wrong. I don't care if I am wrong or right about this, I only want to know the truth. The truth is what helps medicine as a science to develop and advance to contribute for the well-being of all of us.

And you made a very interesting point when you said "you don't have that much movement in your T-spine when it's healthy", but a scoliosis spine is not a normal spine. My curve was very pointy, as you can tell by the length of my fusion ( shorter than the standard). It was like a sharp bend on the road which rapidly corrects its path. I had one or two wedged vertebraes, so it kind of functioned as an articulation point. But I do admit that the more long curves may be stiffer. Each case is unique.

I am very grateful for your insightful info.

[richardis]

How reliable is this : Mobility-of-the-spine.png
is this trustworthy?

Anyone with more detailed info?