Game’s up

Brilliant news at the hospital today in that the Os Acromiale has healed and the screws can come back out.

There is a bit of a wait to actually get the operation, as there are many children who need surgery, we’ll wait ’til April, so we can fit the operation in between GCSE Mock and the actual GCSE exams in May/June.

The after-effect of the metal-revoval operation will be much less severe than putting them in. At least it’s the left shoulder and Madison is right-handed.

Whilst we try to overcome the effect of the school closing at the end of the year and look for Sixth Form places elsehwere, we find that the actual conclusion of the shoulder problem will take a lot of weight off our shoulders.

At least the backstroke will be possible again and Madison looks forward to getting into the pool more often from the summer, once the GCSE exams are done.

Dashed hopes

It appears that this shoulder operation didn’t work. In fact we are glad we didn’t book a holiday this year because at the moment, Madison can’t even stand up without being in pain.

Lee Valley Wildlife Centre

Yesterday we only went for a relaxing walk, so I thought, but then in the evening just standing up was extremely painful for Madison. It is of course the screws in her shoulder are causing pain.

A lake in Walthamstow Wetlands

Of course whilst Madison can’t do the swimming training because she still can’t rotate her arm around we – at least – want to keep the legs moving and doing 10.000 steps per day is a minimum requirement for fitness.

We went to the Lee Valley Wildlife centre and then onto Walthamstow Wetlands. A mere walk, which didn’t involve any strain onto the shoulders but in the evening and still today the shoulder hurts when just standing up.

Screws were inserted into the shoulder to fuse the joint together

Those screws in the shoulder are causing a lot of debilitating pain and we are going to ask the doctors to take those screws out.

Before and after

To show to you interested swimmers what treatment for Os Acromiale looks like these days, here it is. Os acromiale is a failure of fusion of the acromial process. It is usually asymptomatic and discovered by chance. When it is painful a differential diagnosis must be made in relation to the subacromial impingement syndrome.

  • This is the plain shoulder x-ray prior to the operation.
  • This is the shoulder after the screws have been inserted to close the gap between the shoulder blade and the arm bone
  • This is the side view of the screws and elastic keeping the tension to tighten the gap

Unfortuantely because two boys pushed each other in the dinner queue and Madison was pushed violently against the wall in the dinner hall the healing process has been disturbed. As Madison had bone fragment taken from her hip bone and inserted it into her shoulder to close the gap, that bone craft had been disturbed by those silly boys.

But Madison can return to some training, e.g. kicking but cannot rotate her arm but only do granny breaststroke. It will get back to normal eventually.

Madison will help out at Regionals.

The recovery

Thanks to Hackney Aquatics for the many good wishes from swimmers, parents and coaches and of course all others who made the hospital stay bearable. The hospital staff were marvellous too.

Making it worst before it gets better is the phrase the consultant used and that is what it literally is.

Getting out of bed on the same day of the surgery on Thursday in day-care was impossible. Madison had nerve blocks on the left shoulder and general anaesthetic. The surgeons took bone fragments from the right hip and transferred this to close the gap on top of the left shoulder, which is held in place with 2 screws and elastic band.

royal-london-nightWe kind of thought, it’s just a matter of waking up and going home after a while like it was after the injection Madison previously had but not so.

The pain was immense and all the morphine given did have a bad effect on Madison. It added nausea to everything else. So on Thursday evening Madison was supposed to go home it was necessary to get a transfer to a children’s ward to stay the night.

There is a breathtaking view onto Tower Hamlets’ south-side from the seventh floor of the building at night and reflections also show in the big glass window.

The next day looked quite dreary, it was decided to stop the morphine and concentrate on getting mobile. The physio taught Madison how to use a crutch, so we could vacate the bed and continue the recovery at home.

royal-london-dayIt is quite disabling to have a crutch for the right leg and a sling for the left arm. There will be no school for the next two weeks and we’ll get work to do from home. With the hip pain Madison could not move around the school and she is also not able to sit up. The screws in the shoulder are only protected by a slight bandage and the arm is kept in a sling.

Yet it is very good that the surgeons did it that way because if they had taken the bone fragments from the left hip for the left shoulder it would be more awkward to move on one side only. It would have disabled one side of the body completely.

Once the Morphine has worn off, it is possible to manage the pain with just Ibuprofen and Paracetamol. What is most important now is to wait for the hip pain to settle so that walking becomes easier.  Once the shoulder is fused together there is less chance of disturbing the positive effect of the fusion by accident. So keeping it safe for the next 2 weeks is most important. But obviously we do not want to occupy a hospital bed for 2 weeks when there are so many other desperately sick children in need of it.

Madison can’t wait to get back to swimming once everything is healed up.


The operation

There will now be coming a big break in Madison’s performance career and we have opted to not insure for the performance category with Swim England.

The oncoming operation for Os Acromiale will mean that surgeons want to close the gap in the shoulder bones to fuse the bone together at the top.

Normally the shoulder bone should fuse naturally at the end of the growth period but as Madison cannot turn her arm at all at the moment, it is the only option to get her arm flexible again.

Obviously this operation is unavoidable and necessary. It will mean however no swimming for several months.

That should not be a hindrance to continue with the sport. Madison is very keen to return to performance swimming next season and will keep herself busy by coaching her peers in the meantime. Swimmers love to have Madison as coach.

Obviously there are ways to keep fit in the meantime and any type of exercise that is possible will be explored.

We’ll stay fresh with the sport, whilst I continue my officiating career Madison will work with swimmers as a volunteer.

Having enquired about the possibility to compete as Para swimmer whilst we wait for the shoulder to heal naturally over several years, which is not guaranteed, I have learned that one cannot be a temporary Para swimmer. It takes 2 years to get certified as such and then that is not reversible. A swimmer cannot temporarily opt in and opt out of para swimming.

And anyhow why should a young person have to put up with an inflexible shoulder if the problem can be fixed.

The new hope

It’s now been over a week since that steroid injection and so far nothing has returned to normal.

Madison’s pains have gradually disappeared through the week but the swimming is not yet what it used to be.

The steroids injected merely acted as anti-inflammatory agent, they are not like anabolic steroids some athletes use.

When the shoulder bones do not fuse, then the friction causes inflammation of the area. The steroids merely counteract on that inflammation.

So far the pain has gotten better but no more than 15 minutes of breaststroke can be swum.

It is remarkable that still no freestyle or backstroke can be done. Well, that means back to the drawing board and to see what the doctors can come up with. But till then there is still time to try. I reckon the diagnosis of OS Acromiale remains the same.

Normally it takes about a week for the injection to take effect. It has been only 7 days since. Let’s wait and see.





























OS Acromiale

It’s where there is a fusion failure of the anterior acromial apophysis. In a case-report published on the internet, there was a successful solution via taking anti-inflammatory drugs, resting the shoulder, e.g. no swimming for 2 months and doing gentle stretch-band exercise.

We did all that and Madison hasn’t been swimming using her shoulder since 3 months and the problem still exists.

Further medical invention will have to take place.

Here is another interesting article on surgical intervention.

When I suggested to give up swimming instead, the look I got in return could have frozen an iceberg.