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Old Aug 23rd, 2013, 02:45 PM   #277
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Re: US Open 2013: hashtag slam number 5

Originally Posted by Serfpova View Post
It just seems all too surreal and sudden. I still don't have a clue about what's going to happen, and we need not hold our breath for solid info from Team Pova.

So I've read up on it, bursitis in itself is not so bad. It can be treated and cured with rehab, however there will always be limits to what the patient can do with their shoulder or it will flare up ie. for a tennis player like Maria where the shoulder will be under constant stress and pressure - it's not going away. However, it can easily be cured surgically. This would seem the be the best and only option for Maria. It only takes a few weeks to recover from too and have full motion of the shoulder restored.

BUT. The symptoms of bursitis and impingement are the same and often the two are suffered together, so she could have impingement syndrome too. This is a bit more serious, but again not as serious as a rotator cuff tear although untreated it leads to it. She'll need a bit of her acromion (small part of shoulder blade) ground off. This can easily be done at the same time as the removal off the bursa, so the whole thing is decompressed and there is no friction.

Basically, you have to have been suffering the symptoms for 3-6 months (which she has) before surgery is considered, also the cortisone injections are pretty much the last non-surgical result. So all things considered, I think the subacromial decompression surgery is what's going to happen.

Rehab: typically 2-4 months. Maybe up to a year but that's very very worst case scenario.

This surgery shouldn't have as much affect on her as the rotator cuff isn't torn, once rehab is complete she should be fit to go through all the motions painlessly whereas last time she had to teach her shoulder how to do those motions again, wait for her shoulder to strengthen so she could do them painlessly and then the whole muscle-memory thing so that she would be fit to to do motions consistently.

It certainly doesn't seem like it will be such a long and grueling process.
My only fear is that her stubborn self will hear 'shoulder surgery' and think the worst despite the two being completely different things and theoretically a much quicker time to return to high form. I hope she doesn't think she can just rehab this away, this summer alone proves that false never mind past experiences. Although I think given what her work involves on the shoulder, and the ineffective rehab and cortisone these past few weeks that the doctor's will tell her as much.

Basically if the surgery is done soon she should be fit to start practicing in Jan/Feb. So IMO I think a Nadal circa 2013 approach is even off the cards. She won't be at either of IW or Miami IMO. Clay season at the very earliest though very unrealistic. She should be fit to serve etc without pain once the rehab is done, I guess it's just a matter of her getting match fit. I'm not sure how long that will take but it could be a post Wimbledon comeback. Similar to Clijster's 09 schedule IMO. Clijster's practiced and trained for 7 months before returning. I'm not sure what will happen if she isn't ready for the USO. Although I would rather her miss it than flop and affect her confidence.

Perhaps rehab will get the job done, although based on what we know I think what I've just posted is the much more likely scenario. It's not as serious as shoulder surgery 1.0 but the timeframe for 2.0 could likely be the same IMO.

EDIT: Just to stress, rehab may get her back for the AO. But like I said, I'm not so sure of it's long term effects.
Very interesting. Are you sure that this type of surgery WOULDN'T result in her losing all feel and muscle memory like the one last one did? Because as you say, that was the main stumbling-block last time, that even after she'd largely recovered from the immediate after-effects of the surgery, her arm had basically "forgotten" how to hit her serve and forehand (she said it really felt like she had a new shoulder). If that wouldn't happen this time, then yes, I agree that sounds like it shouldn't be too bad, if once she gets through rehab her shoulder/arm will be pretty much back to how it was before (even if that means months off the tour).

Still, the main worry for me is that this is more than bursitis. Especially after what we've heard about her having cortisone shots. I've definitely read that having regular cortisone shots can really weaken the shoulder and make you very vulnerable to tearing the rotator cuff or another tendon (I think she was having them like monthly or something in 2007-08), so hopefully she only got them once or twice this time.

I think I'll go and research what all of Tommy Haas's various shoulder surgeries were, because with some he was out for ages and with others he wasn't out for anywhere near as long.
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