Shoulder Surgery

[Griz]

I have been for an MRI at Bangkok Hospital. I have a torn tendon in my shoulder that needs keyhole surgery to repair and they have quoted me 270K - 300K baht. As I don't have insurance I am now also in shock! Has anybody had similar surgery and can anyone recommend a good but cheaper hospital. Thanks.

[Sheryl]

Try either or Bangkok Christian Hospital or Saint Louis Hospital, both are not for profit and substantially less expensive.

www.saintlouis.or.th

www.bkkchristianhosp.th.com

Standard of care is good but number of specialists on staff much fewer, be sure to ask if the orthopedic surgeon has experience with this specific procedure. English speaking will be better than at a government hospital but still a bit limited among the nurses.

If you are in the Pattaya area (or don't mind traveling) a number of members have been pleased with results of orthopedic surgery at the Queen Sirikit Naval Hospital in Sattahip. However somewhat similiar to a government hospital in terms of initial long waits/red tape. Like the two above, English speaking by nurses will be limited.

A government Hospital would be another option but frankly I don't think would be much less expensive than the places mentioned above and a lot more delay/red tape.

[Rimmer]

I have had many torn tendons in knees, ankles and shoulders over ten years of mountain biking and they all grow back again in time. If it's not that bad get some more opinions.

It's not your rotator cuff is it? that would require keyhole surgery.

Be very careful that the muscle does not atrophy through lack of use in the meantime.

[Griz]

I have had many torn tendons in knees, ankles and shoulders over ten years of mountain biking and they all grow back again in time. If it's not that bad get some more opinions.

It's not your rotator cuff is it? that would require keyhole surgery.

Be very careful that the muscle does not atrophy through lack of use in the meantime.

[Griz]

I have had many torn tendons in knees, ankles and shoulders over ten years of mountain biking and they all grow back again in time. If it's not that bad get some more opinions.

It's not your rotator cuff is it? that would require keyhole surgery.

Be very careful that the muscle does not atrophy through lack of use in the meantime.

It is a rotator cuff injury specifically the infraspinatous has detached from the bone and there is a small tear to the supraspinaous. Looking at the MRI I am pretty sure it won't heal itself and as you said the Doctor warned me about atrophy over time making it difficult to pull back to the correct position for re-fixing.

[ericg1953]

I am not sure if the price will be any less but you can check with a Dr. Mason at Bumrungrad. He has a fellowship from Harvard in sports injuries and is a shoulder surgery specialist. I saw him for a tennis elbow problem and found him to be very good as far as diagnosis and treatment. You can check him out on their website...very good credentials.

[onomataho]

I'd suggest seeing Dr. Panya at Bumrungrad. He's performed two surgeries (knee, shoulder) on me and I'm very happy with the results.

[imthai]

I am Thai and as I work in Ortho. field, may I say something naka

Yes,we also have some nice gov. hospitals for ortho. such as Leardsin Hos., PraMongkut Hos., Ramathibodi Hos., Siriraj Hos. and Chula Hos. If it was myself, I may start with some experienced orthopaedists in these hos. then I will see how they say.

But for you, an expat patient, queuing up for a few hrs maybe not fun. My opition for you is asking your orthopedist whether he works in any other cheaper hospitals. Nowaday as financial crisis's all over so..if you try a bit more, your cost maybe/could be a half less ..

Good luck for you.

[robblok]

I am Thai and as I work in Ortho. field, may I say something naka

Yes,we also have some nice gov. hospitals for ortho. such as Leardsin Hos., PraMongkut Hos., Ramathibodi Hos., Siriraj Hos. and Chula Hos. If it was myself, I may start with some experienced orthopaedists in these hos. then I will see how they say.

But for you, an expat patient, queuing up for a few hrs maybe not fun. My opition for you is asking your orthopedist whether he works in any other cheaper hospitals. Nowaday as financial crisis's all over so..if you try a bit more, your cost maybe/could be a half less ..

Good luck for you.

Nice to have friendly Thais frequenting the board and giving good advice. I hope you wont be deterred by some of the crazier types here.

[jetjock]

I am currently 8 months post op from rotator cuff surgery so have leaned something about the surgery that I will pass onto you for what it is worth. I have been an athlete all my life so have had about every joint in my body operated on due to athletic injuries. Rotator cuff surgery has a fairly high failure rate as surgeries go so it is important to choose your surgeon very carefully. Proper post op care and rehab is critical to increasing the chance of a succesful result (my doctor restricted what I could do and should do for the first 6 months post op as he considers resuming heavy use of the shoulder too early to be one of several things that can lead to an unsuccessful result). The doctor has now returned me to normal activities involving my shoulder including weight training (no heavy weights yet) and said I could return to my sports like tennis and beach VB that involve heavy shoulder use at the 9 to 12 month point. I did specific rehab exercises for the first 6 months with a sports therapist . The surgery was a piece of cake, but the rehab was the longest and most difficult of all my injuries. I chose my doctor with great care as he is considered one of the best knee and shoulder surgeons in the US and has operated on hundreds of famous athletes. Now that I know how more about rotator cuff surgery, I am very happy that I took my time to find the right surgeon. Good luck.

[spacefruit]

I too am an athlete, in a right shoulder intensive sport.

I have had shoulder problems for three years, which I have managed with non-surgical techniques. Last year I went to Samitivej and saw a surgeon who said I had a torn tendon which would not heal without surgery.

Not once in my sport have I met a player with a successful shoulder repair - all regretted the surgery.

So I am working with a trainer daily, resting from the sport until June. Also acupuncture and Reiki.

If that doesn't work I am off to New York to the top shoulder surgeon and a mortgage. I wouldn't dare work with a surgeon who is not sports EXCLUSIVE. Specialist is not good enough. I need someone at the cutting edge, working with young active patients who's livelihood depends on their shoulder.

[FBN]

Any injury to ligaments or tendons tend to respond poorly to surgical treatment. This is partly due to the poor blood supply to these structures and the healing process that involves the formation of scar tissue rather than "normal" connective tissue.

Scar tissue will never be as strong as the original structure and utmost care must be taken with the rehab process as "jetjock" indicated above. This is extremely important and will determine the outcome of any such surgical intervention.

Rotator cuff surgery has a high failure rate made even more so by inappropriate rehab and too early return to activities which put the structure under stress.

Most difficult to convince keen athletes to go through a tedious rehab process but it is the key.

[donna]

i had a tear in a ligament and a tendon in my left shoulder. i went under the knife with Dr Panya at Bumrungrad just before the Tsunami.

i found Dr Panya to be a nice man and a good surgeon, but i have to tell you that i have not fully recovered from the operation. my physio told me that most people never regain full use of their shoulders after surgery (depending on the surgery of course).

for me, the after effects of the operation was a fair bit of pain. i started physio the day after and continued for a year or more.

if someone were to ask me if i recommend shoulder surgery, i would recommend it only as a last resort.

[fearless1]

I see some posts related to the do's and don'ts in relation to rotator cuff surgery and some references to shoulder surgery in the USA or in the past, but I'm wondering if anyone has had rotator cuff specific surgery here in Thailand fairly recently. If so, I am curious where your surgery was performed, who the surgeon was, how much it cost, what the actual procedure was, and how satisfied you are.

I had rotator cuff surgery in India 3 years ago and I need the same surgery on my other shoulder. Rehab without surgery will not work for me since I need to have significant shaving of the bone to fix the problem. The surgery in India was successful and cost about 1500 US dollars. The post operative care was less than satisfactory though and I do not want to return to India to have the surgery again. I really want to have the surgery here in Thailand since I live here now and I do not have health insurance back in the US. Unfortunately, I am finding it next to impossible to get any definitive specific information about rotaor cuff surgery here in Thailand.

I'm mainly posting to keep this thread alive so eventually someone can provide concrete information.

Thanks,

[camerata]

i found Dr Panya to be a nice man and a good surgeon, but i have to tell you that i have not fully recovered from the operation. my physio told me that most people never regain full use of their shoulders after surgery (depending on the surgery of course).

for me, the after effects of the operation was a fair bit of pain. i started physio the day after and continued for a year or more.

This sounds depressing. I mentioned it to my doc and she sort of rolled her eyes and said rehab was normally 3 months. Then I asked if she knew of a totally successful case of keyhole surgery. She did, but only one that she mentioned.

[OriginalPoster]

i found Dr Panya to be a nice man and a good surgeon, but i have to tell you that i have not fully recovered from the operation. my physio told me that most people never regain full use of their shoulders after surgery (depending on the surgery of course).

One of the reasons for that is that that's the expectation of most patients - most will be happy just to stabilize the situation and don't expect to ever be able to throw a 96 mph fastball again. Even if you're not an athlete and your only goal is for your shoulder not to dislocate when you go down to the pub, what you really want is a surgeon who has done a sports medicine internship at somewhere good and has about 10 years of experience (but not a whole lot more than 10 years or the risk increases that he might not be up to date on current techniques).

Edited April 15, 2009 by OriginalPoster

[ironhut]

I've had surgery on both shoulders (one has a 2" screw and the other a metal pin and both with restructuring to keep things in place) from major dislocations. Shoulder surgery is not only painful, but the rehab is long and intense. Rarely will shoulders become what they once were. I suffered a dislocation on one of my previously operated on shoulders 8 weeks ago (it was out for nearly 3 hours before being finally set back in place at Bumrungrad under GA). It was something I don't want to go through again.

I now need to decide upon another surgery and will likely use Dr. Mason if I go through with it. However, what I am considering is if I can get by without the surgery. Sure, it's horrible sleeping sometimes and even worse knowing something else could happen...but surgery is a commitment that has other consequences with no real guarantee of improvement.

I read where many above are/were athletes (weren't we all?). Interesting since basically this comes down to a realization that sports with high impact to the shoulders are over (also a factor of age). Once it happens, we'll never be the same again. If it's possible to manage without the surgery, it's usually the best option.

[Griz]

Thanks for all the comments here is my update which may be of interest to some.

I did shop around a little but the quotes were mostly in the same range. In the end as I wasn't buying a second hand lawnmower I decided to stick with Bangkok Hospital. Dr Pornthep Manamee was my surgeon, he is listed as an orthopedic surgeon specialising in sports injuries some of his training having been done in the USA. Dr Pornthep was very professional and helpful going to some lengths to explain the injury and the surgery even showing me a film of a previous operation he had done (he did ask me first if I wanted to see it). He called in a second specialist to examine me and confirm his diagnosis. Anyway on with the op. All the staff at Bangkok Hospital were excellent, the orthopedic nursing staff who carried out a battery of tests to make sure I was fit to undergo surgery, the anaethetist who explained how he was going to knock me out (don't think I ever saw a hammer that big!), the nursing staff who took care of me for one (very painful) post op night and even the concierge department who took my passport to immigration for a ninety day visa registration and delivered it to my hotel.

The operation was a little more involved than first anticipated, I went in at 12.30 and was in recovery at 4pm. They cleaned up the bone spurs and screwed three titatnium anchors into my humerus (not funny) and used these to suture the tendon back into place they also repaired a 6 cm tear in another tendon which they believed to have been a result of an old injury (I have had a lot of problems with this shoulder in the past).

I have had my arm in a sling day and night for 2 weeks, 4 more to go. I have been started on passive range of motion exercises, that is when you relax the muscle completely and somebody else moves the arm.

I guess I won't know for many months whether it was money well spent , I am 47 years old have played sports all my life, these days its all been weight training and golf. Dr Pornthep said I could be golfing in 4-5 months but I won't be lifting any heavy weights for a few months after that. I know with all the sport I have played and injuries I have had that it was never going to repair itself. Time will tell just how effective the surgery has been but Bangkok Hospital was excellent.

[Sheryl]

Many thanks for the update and feedback, much appreciated.

We all wish you the best in terms of regained function.

If you think of it, drop a line after recovery is complete and let us know the final outcome

[Ave]

I've just been given the go-ahead by the (in)famous Bangkok-Pattaya hospital for an operation on a dislocated shoulder with torn legaments. I've read this thread twice to convince myself that surgery is not necessary like Memorial and the Camillians' hospitals advised. However, next week I have to go to work somehow and I don't like the idea of riding a motorbike with damaged legaments and a bone pushing up my shoulder. The total cost would be around 130,000 Baht with an excess of 22,000 B but I've managed to negotiate it down to 10,000 B plus 5,000 B for an extra night if not well enough to leave. Unfortunately I'm not in a position to travel/shop around from hospital to hospital as I'm drugged up/in pain most of the time. I have to take the nearest option.

Any piece of advice anyone? I'm feeling a bit nervous about being in the hands of a place where their common practice seems to be 'the wallet biopsy'..

[fearless1]

Thanks for all the comments here is my update which may be of interest to some.

I did shop around a little but the quotes were mostly in the same range. In the end as I wasn't buying a second hand lawnmower I decided to stick with Bangkok Hospital. Dr Pornthep Manamee was my surgeon, he is listed as an orthopedic surgeon specialising in sports injuries some of his training having been done in the USA. Dr Pornthep was very professional and helpful going to some lengths to explain the injury and the surgery even showing me a film of a previous operation he had done (he did ask me first if I wanted to see it). He called in a second specialist to examine me and confirm his diagnosis. Anyway on with the op. All the staff at Bangkok Hospital were excellent, the orthopedic nursing staff who carried out a battery of tests to make sure I was fit to undergo surgery, the anaethetist who explained how he was going to knock me out (don't think I ever saw a hammer that big!), the nursing staff who took care of me for one (very painful) post op night and even the concierge department who took my passport to immigration for a ninety day visa registration and delivered it to my hotel.

The operation was a little more involved than first anticipated, I went in at 12.30 and was in recovery at 4pm. They cleaned up the bone spurs and screwed three titatnium anchors into my humerus (not funny) and used these to suture the tendon back into place they also repaired a 6 cm tear in another tendon which they believed to have been a result of an old injury (I have had a lot of problems with this shoulder in the past).

I have had my arm in a sling day and night for 2 weeks, 4 more to go. I have been started on passive range of motion exercises, that is when you relax the muscle completely and somebody else moves the arm.

I guess I won't know for many months whether it was money well spent , I am 47 years old have played sports all my life, these days its all been weight training and golf. Dr Pornthep said I could be golfing in 4-5 months but I won't be lifting any heavy weights for a few months after that. I know with all the sport I have played and injuries I have had that it was never going to repair itself. Time will tell just how effective the surgery has been but Bangkok Hospital was excellent.

Griz,

I tried an internet search for Dr. Pornthep Manamee but I cannot find anything. You said you had the surgery at Bangkok Hospital. Is that the exact name of the hospital or did you mean Bangkok Pattaya Hospital? I'm really looking forward to your answer because as I posted earlier, I am having a hard time getting any up-to-date concrete information.

How much did the operation end up costing?

Hope you are doing well.

Thanks,

[Sheryl]

Griz,

I tried an internet search for Dr. Pornthep Manamee but I cannot find anything. You said you had the surgery at Bangkok Hospital. Is that the exact name of the hospital or did you mean Bangkok Pattaya Hospital? I'm really looking forward to your answer because as I posted earlier, I am having a hard time getting any up-to-date concrete information.

How much did the operation end up costing?

Hope you are doing well.

Thanks,

It is Bangkok Hosp in Bangkok, here is the link:

http://www.bangkokhospital.com/App/doctorp...&Lang=en-US

[Griz]

Thanks for all the comments here is my update which may be of interest to some.

I did shop around a little but the quotes were mostly in the same range. In the end as I wasn't buying a second hand lawnmower I decided to stick with Bangkok Hospital. Dr Pornthep Manamee was my surgeon, he is listed as an orthopedic surgeon specialising in sports injuries some of his training having been done in the USA. Dr Pornthep was very professional and helpful going to some lengths to explain the injury and the surgery even showing me a film of a previous operation he had done (he did ask me first if I wanted to see it). He called in a second specialist to examine me and confirm his diagnosis. Anyway on with the op. All the staff at Bangkok Hospital were excellent, the orthopedic nursing staff who carried out a battery of tests to make sure I was fit to undergo surgery, the anaethetist who explained how he was going to knock me out (don't think I ever saw a hammer that big!), the nursing staff who took care of me for one (very painful) post op night and even the concierge department who took my passport to immigration for a ninety day visa registration and delivered it to my hotel.

The operation was a little more involved than first anticipated, I went in at 12.30 and was in recovery at 4pm. They cleaned up the bone spurs and screwed three titatnium anchors into my humerus (not funny) and used these to suture the tendon back into place they also repaired a 6 cm tear in another tendon which they believed to have been a result of an old injury (I have had a lot of problems with this shoulder in the past).

I have had my arm in a sling day and night for 2 weeks, 4 more to go. I have been started on passive range of motion exercises, that is when you relax the muscle completely and somebody else moves the arm.

I guess I won't know for many months whether it was money well spent , I am 47 years old have played sports all my life, these days its all been weight training and golf. Dr Pornthep said I could be golfing in 4-5 months but I won't be lifting any heavy weights for a few months after that. I know with all the sport I have played and injuries I have had that it was never going to repair itself. Time will tell just how effective the surgery has been but Bangkok Hospital was excellent.

Griz,

I tried an internet search for Dr. Pornthep Manamee but I cannot find anything. You said you had the surgery at Bangkok Hospital. Is that the exact name of the hospital or did you mean Bangkok Pattaya Hospital? I'm really looking forward to your answer because as I posted earlier, I am having a hard time getting any up-to-date concrete information.

How much did the operation end up costing?

Hope you are doing well.

Thanks,

It was Bangkok Hospital on New Petchburi Rd. Bangkok

Email: bangkokhospital.com

Final bill was 272K but will have some ongoing physio bills at Bangkok Samui Hospital.

Sling comes off in another 2 1/2 weeks then the real fun starts!!

Good luck for you

[Ave]

I've just been given the go-ahead by the (in)famous Bangkok-Pattaya hospital for an operation on a dislocated shoulder with torn legaments. I've read this thread twice to convince myself that surgery is not necessary like Memorial and the Camillians' hospitals advised. However, next week I have to go to work somehow and I don't like the idea of riding a motorbike with damaged legaments and a bone pushing up my shoulder. The total cost would be around 130,000 Baht with an excess of 22,000 B but I've managed to negotiate it down to 10,000 B plus 5,000 B for an extra night if not well enough to leave. Unfortunately I'm not in a position to travel/shop around from hospital to hospital as I'm drugged up/in pain most of the time. I have to take the nearest option.

Any piece of advice anyone? I'm feeling a bit nervous about being in the hands of a place where their common practice seems to be 'the wallet biopsy'..

Well, I was well impressed with the whole experience. Excellent doctors and nurses. Great service, very professional and caring staff. I went in with a smile and came out with everyone smiling including me, despite the pain. I paid 10,000B and got nearly 5000 on my way out. awsome!

[bonobo]

I would be very cautious about jumping into shoulder surgery.  Really weight the pros and cons, first.

While I was in Iraq, I suffered a minor shoulder injury.  Back in the US, before they demobilized me, they did an MRI and told me I had a rotator cuff injury, and I needed surgery.  I delayed my return to Thailand, had the surgery, and went through therapy.  My shoulder did not respond well, though it didn't get too much worse.  The surgeon then suggested a Mumford Procedure, where they cut of the end of the clavicle.  He assured me that this would take care of the lingering pain.

My shoulder is much, much worse for it.  I can no longer do most of the sports I played, and my fitness is limited to weights and bikes (I can do some weights, but not the same repertoire.)  I am now in the process of getting medically retired from the Marine reserves.  Even sleeping can be bothersome as I tend to move around, and if I put my arm in the wrong position, the pain will wake me up.

Shoulders are not great candidates for surgery.  If you are going to get it, fine, but just make an informed decision.  And I would agree with the posters who have opined that getting the most experienced and skilled surgeon is vital.  Do not accept a lesser degree of competence just to save a few baht.

[OriginalPoster]

I would be very cautious about jumping into shoulder surgery. Really weight the pros and cons, first.

While I was in Iraq, I suffered a minor shoulder injury. Back in the US, before they demobilized me, they did an MRI and told me I had a rotator cuff injury, and I needed surgery. I delayed my return to Thailand, had the surgery, and went through therapy. My shoulder did not respond well, though it didn't get too much worse. The surgeon then suggested a Mumford Procedure, where they cut of the end of the clavicle. He assured me that this would take care of the lingering pain.

My shoulder is much, much worse for it. I can no longer do most of the sports I played, and my fitness is limited to weights and bikes (I can do some weights, but not the same repertoire.) I am now in the process of getting medically retired from the Marine reserves. Even sleeping can be bothersome as I tend to move around, and if I put my arm in the wrong position, the pain will wake me up.

Shoulders are not great candidates for surgery. If you are going to get it, fine, but just make an informed decision. And I would agree with the posters who have opined that getting the most experienced and skilled surgeon is vital. Do not accept a lesser degree of competence just to save a few baht.

That's pretty much the story that I hear from most people who had shoulder surgery. In my case, what you describe is basically the outcome that I had from my first surgery back around 1982. About a year ago I had a second surgery, this time from a hotshot shoulder specialist at Columbia University, and now the shoulder seems almost normal. What puzzles me though is that while shoulder surgery is often the death knell for a major league baseball pitcher, there also are quite a few that make comebacks and go back to throwing 90+ mph fastballs. Just can't understand how they do it. In my case thought the original injury was severe enough that I really didn't have a choice about whether to have surgery or not.

[camerata]

Even sleeping can be bothersome as I tend to move around, and if I put my arm in the wrong position, the pain will wake me up.

Yes, I consider this a major drop in the "quality of life."