Discussions By Condition: I cannot get a diagnosis.

Cartilage degeneration at 28yrs old

Posted In: I cannot get a diagnosis. 1 Replies
  • Posted By: disposableairman
  • December 23, 2008
  • 01:30 AM

Ok this is long so I will keep it short here on top and go into greater detail below. I am 28 and have severe shoulder pain. Both shoulders for about 8 years (increasing about 1 pain level per year and is about always 7 now). My humeral head of both arms has severe cartilage degeneration. The pictures actually look like the cartilage was wiped away with fine sand paper over the long term. No chunks gone, but down to the bone in several spots. I am supposed to have bilateral hemiarthroplasty starting with the right next month. No stem, just capped in order to save bone. Glenoid is fine. Cartilage in my right ankle is fine, (scoped this year) but all my joints hurt.

Why is this happening? I have seen 4 ortho doctors over this who all states this is strange (my favorite diagnosis) and I appear to have my grandpa’s shoulders.

Brief summary:

No HS sports, but did do rigorous infantry training in early 20’s.
I hate vegetables so have ate very little of them.
All joints hurt but right ankle cartilage is fine. (hips, wrists, knees)
Both shoulders have severe cartilage degeneration and osteoarthritis. Right worse than left.
Scapulas point away from back on certain arm movements.
Popping clicking and catch points in many ranges of arm movement.
4-5 trips to physical therapy have never helped.
Diagnosed with bursitis, impingement and finally cartilage degeneration without cause.
Side sleeper on tempur-pedic mattress.

Ok the long story. It is boring, but I want to include it in the random chance it sparks the interest of someone who can help.

History. Born 1980 in S. California and lived there until 5 yrs old. Moved to N. Arizona for 2 years. Lived in Las Vegas since then. No high school sports. I don’t eat vegetables. I ate a lot of fast food growing up and still do a few times per week. I joined the US Marines at 18 and the problems started soon after that. I was in great shape and was an infantryman. I could do over 50 pushups anytime I wanted and did 20 pull-ups on every fitness test. I could run 3 miles in under 23 minutes for the 4 years I served. I could also do 80-100 crunches in the allotted time. So I was strong but my shoulders were always my weak link. I did my first 2 years in Camp Pendleton S. California and deployed on a US Navy ship to the entire western pacific for 6 months. I stopped in Australia, Hawaii, Hong Kong, Thailand, Bahrain, Kuwait and Qatar. Maybe a few others but since my pain really started the previous year, I don’t believe this could have been a factor. On this deployment I did however work out a lot. I gained about 20 pounds of muscle but really nothing on my shoulders. Whenever I move my arms I have catch points in certain movements. My shoulders hurt a lot, but these catch points are unbearable. I can feel a lot of grinding and clicking in most other movements as well. Another thing that caused pain was uncomfortable mattresses and even more sleeping on the ground. Whenever it was cold I also felt more flair ups of pain. I had seen doctors a few times by then and was given Motrin or naproxen and told to ice it up when I could (couldn’t find ice most of the time in the infantry). I also took Aleve at times which nothing really helped besides just letting my arms rest and not moving them. I was diagnosed a few times with bursitis.

My last 2 years in the Marines, I was in 29 palms CA near Palm Springs. Same game, infantry and one deployment to Okinawa Japan for 6 months. I was still able to do all the physical requirements, but by this time both my knees were hurting also. In Japan I rolled my ankle with all of my weight while hopping down a four foot cliff. I had to hike several miles back to our base camp but was forced to stay the rest of the week in the field and our corpsman just wrapped it up extra tight for me. This was x-rayed the following week and I was told I was ok. I had to wear an ankle support the rest of my remaining 8 months until I was separated. Just before I was honorably discharged I pulled a muscle (maybe) in my middle back that hurts every couple of days and worse if I twist just right (or is that just wrong).

When I left the Marines, I filed for VA compensation and was initially denied (I love the games). The VA gave me x-rays which was inconclusive. They gave me MRI’s and x-rays of both shoulders and I was told were inconclusive. (Last year 6 years after those were done I found they did show minor spacing issues and some minor tearing of the rotator cuff, so they were lying to me). I also Joined the Air Force reserve and have been living in Las Vegas since (June of 2002) The next few years were not too bad. I was a Realtor and didn’t do too much to aggravate my body. And at the time the AF reserves did not require running. Just a 3 mile walk once a year. So the hardest thing I would do to my body was snowboard a few times a month in the winter. The boots had good support so it didn’t bother my ankle too bad, but it smoked my knees. In 2004 my back and shoulders had bothered me enough into buying a tempur-pedic mattress to alleviate some pain. It helped to a point but no miracles.

In 2005 the Air Force decided we needed to be in better shape and we had to run a mile and a half do pushups and crunches. So I would also occasionally run on my own besides the once a month on base. Then In 2006 the real estate market tanked (like I had to tell you all that) and I took a job in private security. This job made me workout 3 days per week on the clock and I had to be able to run 1 mile in 8.5 minutes. So I was back to having to stay in shape again. This didn’t bother my shoulders too much, but they hurt on their own without any help from me. This did however bother my knees and ankle. I would use the elliptical machine or walk on the treadmill for most of it, but I still had to keep my real running skills up also.

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  • In early 2007 my shoulders were finally to the point of being unbearable. I saw a rheumatologist at the VA who did a workup on me. She prescribed hydrocodone 5/500 + sulindac and did bilateral cortisone/lidocaine injections. The 5/500’s didn’t do anything and the injections provided minimal relief for about a day. I was then bumped up to 10/650s 4-6 per day. My results came back very low on the arthritis scale and was told I was fine. I was activated by the Air Force in March. We did a month of combat training and then went overseas. My job is a heavy equipment operator/laborer. We do all our own labor and it was 6 months of 12 hours a day 6 days a week (which is short compared to the Army, they have it way worse). I made my 1 month prescription of the hydrocodone last 3 months despite the heavy workload. I feared addiction and also didn’t want to be out of it since I operate machinery and we carried our rifles everywhere we went. When I ran out of 10/650’s I had to go to another base that had a hospital and was given a one week refill that lasted me 2, then when I went back, I came across a Dr. who wanted to send me home since apparently I wasn’t supposed to be on those meds there. I was able to be sent to Qatar and seen by an Ortho there (I didn’t want to go home early with my unit still there). I was given x-rays and was told I had bilateral shoulder impingement because of Type II Acromion’s. She was so sure she said all other doctors so far were dumb for not discovering this. I was also diagnosed with Patello-femoral Pain Syndrome (runner’s knee). I was kept in Qatar for 3 months and did physical therapy for both shoulders and both knees while I was there. My shoulders only got worse to the amazement of the physical therapist. My knees started to feel better while I was restricted from running; until I ran again then it was back to normal. Ok so when I got home the real fun started. This was now October 2007. I had MRI/X-rays done. This showed some minor tearing of the rotator cuffs and I was told I did not have shoulder impingement. In December I had the right shoulder scoped. That’s when the Dr. found that in addition to the rotator cuff tear the cartilage on my humeral head was severely deteriorated. He went as far as to call in every available Dr. at the hospital to come take a gander and guess at what is causing it. Post op pain was so great I went on MScontin 15mg every 12 then 30 mg every 8 hours. The pain went down after a week and I decreased to 30mg twice daily. I was in a sling for 6 weeks. In March of 2008 I did the same on the left shoulder except the cuff was fine and he cleaned up some minor fraying of the labrum while he was in their. The left was not as bad as the right but the humeral head was still very much damaged. It wasn’t traumatic and just appeared to be slowly eroded. Post op for the left shoulder wasn’t bad and I was out of the sling in 2 days. In May while waiting to be medically discharged I figured I would have them check out my ankle since I was getting so used to surgery. The ankle felt kind of like the shoulder. It clicked and popped but didn’t hurt every day. Only if I walked maybe more than a couple hundred yards or ran on it. So after weeks of physical therapy Ortho went in again and trimmed some tissue that may have been slipping in the joint. No dice. It still hurts now 8 months later. It was worth a shot and I discovered the outstanding fact that the cartilage in my ankle was normal. So normal It made my shoulders feel worse by comparison since until then, I had not really seen what cartilage was supposed to look like. I saw Ortho in September about my knees and was told runners knee again and I just need to stretch 8 times a day and I will be fine. (I guess all that physical therapy wasn’t any good). So now it has been a year since my first shoulder surgery. My case manager for my medical board told me last year I couldn’t have the recommended bilateral hemiarthroplasty I felt I desperately needed since I was being discharged and they couldn’t justify me being around the year it would take to recover. I should have fought back then. I did just recently start pulling the BS flag since I am still waiting on a discharge. I stopped asking, and started demanding and it looks like I might get it soon. I am stuck in an awkward position. It is very early in life to voluntarily get shoulders replaced. But my security postion on my waiting civilian job won’t let me be on pain medications and carry a gun. I am up to 4-6 10/325s a day and fentanyl 25mcg/h patch. I can’t take the pain anymore and soon I won’t be able to medicate either. Plus, my attitude isn’t great with all the medication problems. About the time that I started the hydrocodone in the first place I started having sleeping problems. It has progressively gotten worse. It started probably because of the itching and now some nights I just don’t feel I am getting any sleep. After 2 months of the itching, I started taking 2 Benadryl at bedtime to stop the itching. 6 months later I couldn’t sleep even with lots of hydrocodone and some morphine and Benadryl. I tried promethazine instead of Benadryl and no help. Then Doxepin/morphine/hydrocodone. Even with the itching mostly under control I had a sleep study done. No sleep apnea, but I only got 4% of the 4 hours of sleep was stage 3 (REM). This would explain why I am always tired. I try not to drive too much, but I still have to report to the military base every day and I fall asleep on the 20 mile drive like 4 times each way. One other thing about my physiology that may contribute to this but no other Dr. has made a statement about. In certain positions when I move my arms, my scapula seems to flair out. This makes it so my back is no longer flat and it looks like a dinosaur or something. In physical therapy they tried to help me tighten the muscles up. No Dr. has told me whether this would or could cause my shoulders to grind away but it is the only thing I can think of besides bad genes. If this would cause the problem with the shoulders, is there anything surgically (like shortening tendons, ligaments or muscle) to correct this and would it be beneficial to prevent further damage (glenoid)
    disposableairman 1 Replies
    • December 26, 2008
    • 10:31 AM
    • 0
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