Paddling and Shoulder Surgery

Sun - January 15, 2006

I have declared that I would be writing this blog from the perspective of a mature or "over 50" paddler, so it's time to write about some health problems.

The 2002 was the year of my first Texas Water Safari and time of a lot of paddling and training. It was when problems with my right shoulder got more serious, although, I had some symptoms earlier. I could paddle, but I had problems with loading a boat to the roof racks or with any activity with extended or overhead arms. I hadn't had any shoulder accidents. Nothing was wrong with a rotator cup. The shoulder problems were caused by some arthritis in AC joint, possibly, due to overuse. Injections didn't work for very long. Physical therapy didn't work (although it provided some benefits - a stronger shoulder and faster recovery after surgery).

So, I did some research, got encouraging responses from paddlers/racers and decided for a surgery: distal clavical resection, i.e., removing the last 1 cm or so of the colar bone.

I had my surgery in early November 2002. In January 2003 I started to paddle again but a full recovery took a longer while. In March 2003 I paddled a part of the WaterTribe Everglades Challenge, but I didn't have enough time for recovery and training for a long expedition race. In June 2003 I completed Texas Water Safari. My time was better than in the previous year. In March of 2004 I paddled the WaterTribe Everglades Challenge again and finished that time. So, I have enjoyed a full recovery and no more problems with my right shoulder.

A quote on the osteoarthritis of the AC joint from Acromioclavicular Joint Injuries article by Robert J. Johnson, MD, THE PHYSICIAN AND SPORTSMEDICINE - vol 29 - no.11 - November 2001:

Osteoarthritis of the AC joint may be traumatic or atraumatic, but its true incidence is unknown. Fractures of the distal clavicle and AC dislocations may predispose this joint to osteoarthritis. Repetitive upper-extremity activity can cause mechanical wear of the articular cartilage. Also, age-related deterioration of the articular disk has been associated with osteophyte development at the acromion and bony changes of the distal clavicle. Narrowing of the joint space by about 50% appears to be a part of the normal aging process.
Radiographic changes have been observed in 10% to 23.4% of the nondominant arms of those who do not use their upper extremities excessively. Changes are noted in almost 62% of the dominant arms of those who participate in occupations and sports that require extensive shoulder use. Fortunately, despite the frequency of degenerative changes, few people become symptomatic.
Common clinical complaints of those who have AC arthritis are diffuse, lateral shoulder pain and/or local AC-joint pain. Nocturnal exacerbation is common. Upper-extremity activity and activities of daily living involving the shoulder aggravate the symptoms. The physical exam commonly reveals local tenderness to palpation of the involved joint. Active and passive range of motion of the shoulder may intensify symptoms. Crossed-arm adduction of the involved shoulder with additional passive adduction by the examiner also aggravates pain. X-rays of the painful shoulder demonstrate typical degenerative changes of bony sclerosis, subchondral cysts, osteophytes, and joint-space narrowing.
Treatment of osteoarthritis of the AC joint parallels that for other degenerative joints. Common recommendations include activity modification, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs) or other analgesics, and corticosteroid injections. Although not widely investigated, corticosteroid injections of the AC joint provide symptom relief for 20 days to 3 months.
When conservative therapy fails, options include arthroscopic or open excision of the distal clavicle.

Early this year, after some weight training and paddling shallow South Platte River in preparation for the Ultimate Florida Challenge, I started to feel the same problems in my left shoulder. It is very upsetting, although, not completely unexpected.

A rest period didn't help much. Paddling doesn't make the pain much worse. I am applying biofreeze and taking aspirin. Because of my trip to Europe I cannot see my orthopedist any sooner than February 20th but I know what to expect from my experience with the right shoulder.

In the next couple of days I have to decide if I am racing the Ultimate Florida Challenge in March. I am sure I can do several days of paddling. However, I would have to paddle 1200 miles within 4 weeks in Florida, i.e., more than 40 miles per day, day after day.