The rest of my shoulder repair episode

The rest of my shoulder episode.

My shoulder just after the rotator cuff repair operation

My shoulder just after the rotator cuff repair operation

This is what my shoulder looked like soon after the surgery.

For the first few weeks I was on a gradually decreasing intake of painkillers, as I built up my shoulder flexibility with physiotherapy. I could neither drive nor cycle, and there aren’t many buses near where I live, so I walked a lot more than I usually do.

A large pustule of Propionibacterium Acnes

A large pustule of Propionibacterium Acnes

After about four weeks, an obvious abcess appeared on one of the incision sites. This looks alarming, but in the long run was a blessing in disguise, as the type of infection I had normally festers asymptomatically inside the joint for a couple of years, then manifests as arthritis; so I’m glad that it presented in such an obvious form.

The abcess looking even worse

The abcess looking even worse

It swelled rapidly, and I went round to the local GP, who sent me in to Accident and Emergency, who sent me on to Orthopaedics, where the surgeon who did the original operation took a look at it, and booked me in for revision surgery the next day.

The second surgery was to wash the wound out (“lavage”; the surgeon said he put 14 litres of fluid through it) and inspect it. Fortunately, the infection appeared to be superficial.

The hole in my shoulder, after the lavage operation, when I and the hospital realized it wasn't healing properly

The hole in my shoulder, after the lavage operation, when I and the hospital realized it wasn’t healing properly

However, the wound took a long time to heal, leaving a hole like this, and a couple of weeks after the revision surgery, a lab culture came through showing infection with Propionibacterium Acnes, the bacterium that causes acne. In about 3% of male shoulder surgery patients, and about 1% of female patients, matter from a sebaceous gland gets pushed into the body by a surgical incision, and causes an infection.

The time they told me this I was expecting it to be just a checkup, but the hospital kept me in a for a week of intravenous vancomycin, followed by five weeks of intravenous teicoplanin. This was mostly a precaution, in case the infection had got into the shoulder capsule, where it can cause arthritis; however, in the lavage operation, the surgeon observed it appeared to be more superficial.

A Peripherally Inserted Central Catheter in my arm

A Peripherally Inserted Central Catheter in my arm

The first few doses were given through a normal cannula into an arm vein, but for the longer treatment, they put a PICC line into me: a Peripherally Inserted Central Catheter. This ran from my arm, through the veins, to just above my heart. This way, the drugs (which could cause irritation to the vein linings) are mixed into the circulation as widely as possible.

My teicoplanin setup: one day's supply

My teicoplanin setup: one day’s supply

I didn’t have to stay in hospital for the whole six weeks of treatment; I was taught to prepare and connect a daily teicoplanin drip myself. It was slightly scary, knowing that I was handling stuff going straight into my circulation; so I was very systematic about the hygeine. In fact, it was all quite straightforward, and became very routine.

The hole, getting smaller

The hole, getting smaller

The wound healed rather gradually, so for many weeks I was applying iodinized dressings.

The hole almost closed over

The hole almost closed over


Eventually, it closed up.

Continued healing

Continued healing

Almost fully healed

Almost fully healed

The invagination (groove) suddenly changed, in two days or less, to a hypertrophic (protruding) scar, which I gather will eventually disappear but it could take a year or so.

The scar eventually became hypertrophic

The scar eventually became hypertrophic


Now the basic healing is done, and it’s a matter of rebuilding strength, trying to do it steadily. Of course, in practice I tend to alternate between bursts of enthusiasm and having to take it more cautiously. I’ve been given a second set of exercises by a physio, and I think I should eventually be able to return to doing Krav Maga, perhaps this summer or autumn. I think most of my restriction now is from the scar tissue from the infection, rather than from the original tendon repair.

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