Hello,
My mother was diagnosed with Multiple Myeloma stage III a few days ago. We found out because of a pathological fracture on the shoulder (proximal humerus) and later found a very big plasmacytoma mass, surrounding the hip bone. Her marrow test revealed 90% plasma cells. At the moment she is on 24- hour morphine in the hospital and yesterday she started therapy (Velcade, Endoxan [cyclophosphamide], Dexaton [dexamethasone], and Zometa) .
My question is about her shoulder fracture. The doctors said that it will probably heal itself with the medication. Two orthopedics at the hospital said that, in the meantime, she could keep her arm on a simple shoulder immobilizer sling and that, while she's in bed, she can move it as much as her pain allows. Another orthopedic (who happens to be a shoulder expert) said that he believes it will need surgery, but if it's going to heal by itself it is very important to keep it in a special angle and keep it completely immobile for the next few weeks/months. Otherwise it will not heal properly.
I'm trying to figure out what is right because I fear that if it is not done properly now, this can cause her a great deal of pain later on. We're really hoping that the shoulder will heal quickly, as my mother already has a difficulty standing and walking so she is bedridden. Not being able to use her right arm has significantly lowered her quality of life.
Any advice/opinion would be very appreciated.
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10 posts
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knoulp - Who do you know with myeloma?: My mother
- When were you/they diagnosed?: November 2013
- Age at diagnosis: 66
Re: Shoulder fracture - best way to help heal right?
I had a pathologic fracture of my humerus a few years ago which led to my starting treatment. I was treated with Revlimid, Dexamethasone and Zometa infusions. My orthopedic surgeon, who only treats shoulder problems, said that once I started treatment that the pain would begin to lessen. I had been given a sling in the ER the night before I saw the orthopedist. He didn't want me to use the sling because he was concerned that my shoulder would freeze by limiting use of my arm. I had to use the sling against his recommendation because any jostling of my arm caused excruciating pain. He also was pessimistic that my arm would heal, but wanted to give it time before he would do surgery to put a rod in my humerus.
Within a couple of weeks of starting treatment the pain began to subside and the x-ray done of the humerus 6 weeks after the fracture showed that the bone was healing. Once the pain subsided I stopped wearing the sling and was able to use my arm without loss of motion. I had to be careful of not lifting things with that arm and not doing anything that caused a rotation of my upper arm.
My last visit with the orthopedic surgeon 5 months after the fracture showed that the bone was almost completely healed. It didn't heal completely straight, but close enough to be ok. 4 1/2 years later my arm is good most of the time. I occasionally have discomfort in the fracture site when I overuse the arm, lift something too heavy or am over tired.
I think that you probably will get a different view from each orthopedic surgeon that gives you an opinion. If your mother can tolerate surgery, it might be good to consider it since the arm will be quite stable afterwards and might heal more quickly. If your mother has mobility problems and is at risk of falling, the surgery might also be good so that she is at less risk of fracturing that arm if she should fall.
So many things in this disease make us balance the opinion of one medical person against another. We are the ones who have to make a decision about treatments that could be ok in either direction that we decide.
I pray that your mother responds quickly to her treatments and that the pain of the fracture begins to diminish quickly.
Nancy in Phila
Within a couple of weeks of starting treatment the pain began to subside and the x-ray done of the humerus 6 weeks after the fracture showed that the bone was healing. Once the pain subsided I stopped wearing the sling and was able to use my arm without loss of motion. I had to be careful of not lifting things with that arm and not doing anything that caused a rotation of my upper arm.
My last visit with the orthopedic surgeon 5 months after the fracture showed that the bone was almost completely healed. It didn't heal completely straight, but close enough to be ok. 4 1/2 years later my arm is good most of the time. I occasionally have discomfort in the fracture site when I overuse the arm, lift something too heavy or am over tired.
I think that you probably will get a different view from each orthopedic surgeon that gives you an opinion. If your mother can tolerate surgery, it might be good to consider it since the arm will be quite stable afterwards and might heal more quickly. If your mother has mobility problems and is at risk of falling, the surgery might also be good so that she is at less risk of fracturing that arm if she should fall.
So many things in this disease make us balance the opinion of one medical person against another. We are the ones who have to make a decision about treatments that could be ok in either direction that we decide.
I pray that your mother responds quickly to her treatments and that the pain of the fracture begins to diminish quickly.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Shoulder fracture - best way to help heal right?
My experience relates from my sister who died of multiple myeloma, but broke a hip while battling the disease. It was 18 years ago and I realize things change, but they surgically repair hers because of the multiple myeloma. They felt the disease would not allow her hip to heal properly or swiftly enough.
My point is with all she has in front of her, immobility might not be something she would want to endure on the chance the shoulder will heal. If it doesn't she will still have to have surgery. I would do no less than either surgery or another opinion from someone qualified from the multiple myeloma perspective.
My point is with all she has in front of her, immobility might not be something she would want to endure on the chance the shoulder will heal. If it doesn't she will still have to have surgery. I would do no less than either surgery or another opinion from someone qualified from the multiple myeloma perspective.
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Wayne K - Name: Wayne
- Who do you know with myeloma?: Myself, my sister who passed in '95
- When were you/they diagnosed?: 03/09
- Age at diagnosis: 70
Re: Shoulder fracture - best way to help heal right?
Thank you so much for your replies.
The doctors have suddenly decided to do some radiotherapy on the shoulder for pain. I am a bit concerned, as they had originally told me that they didn't want to do that, because it might affect the bone marrow and we're still hoping for transplant later on. Now they are saying that it's a very small risk next to her quality of life.
Has anyone here had radiotherapy for a fractured bone and then went on to have autologous transplant?
The doctors have suddenly decided to do some radiotherapy on the shoulder for pain. I am a bit concerned, as they had originally told me that they didn't want to do that, because it might affect the bone marrow and we're still hoping for transplant later on. Now they are saying that it's a very small risk next to her quality of life.
Has anyone here had radiotherapy for a fractured bone and then went on to have autologous transplant?
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knoulp - Who do you know with myeloma?: My mother
- When were you/they diagnosed?: November 2013
- Age at diagnosis: 66
Re: Shoulder fracture - best way to help heal right?
My mother has had the misfortune of breaking both shoulders in the past few years. In both cases the ortho opted for just the sling and letting the bone heal itself. One of the tears also involved a torn rotator cuff that required surgery, which was not as successful as we had hoped due to osteoporosis.
Mom has recovered about 75% of usage in both arms. Key to her recovery was working with a physical therapist, and doing the exercises they prescribed daily. They can be painful, and certainly were boring, but she persisted and did very well.
Lyn
Mom has recovered about 75% of usage in both arms. Key to her recovery was working with a physical therapist, and doing the exercises they prescribed daily. They can be painful, and certainly were boring, but she persisted and did very well.
Lyn
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Christa's Mom - Name: Christa's Mom
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: September, 2010
- Age at diagnosis: 53
Re: Shoulder fracture - best way to help heal right?
Hi Christa's Mom,
Thanks a lot for your reply.
How long did it take before your mother could use her arms again?
Thanks a lot for your reply.
How long did it take before your mother could use her arms again?
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knoulp - Who do you know with myeloma?: My mother
- When were you/they diagnosed?: November 2013
- Age at diagnosis: 66
Re: Shoulder fracture - best way to help heal right?
Hi Knoulp,
Each of them was 3-4 months, but I think both the timing and the range of motion recovered depend on how diligent you are with the PT. Before she retired, my mother was a nurse practitioner, so she was very diligent! I should also say, my mother does not have myeloma (my husband does), so that will also impact recovery. Good luck!
Lyn
Each of them was 3-4 months, but I think both the timing and the range of motion recovered depend on how diligent you are with the PT. Before she retired, my mother was a nurse practitioner, so she was very diligent! I should also say, my mother does not have myeloma (my husband does), so that will also impact recovery. Good luck!
Lyn
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Christa's Mom - Name: Christa's Mom
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: September, 2010
- Age at diagnosis: 53
Re: Shoulder fracture - best way to help heal right?
I agree with Lyn that physical therapy and consistency in doing the exercises that the therapist recommends are key in regaining the use of the arms. I had shoulder replacement therapy, presurgical testing is how my multiple myeloma was found, and wouldn't had regained as much use of my arm if I hadn't had phyical therapay and hadn't been religious about doing my home exercises. I am a physical therapist and know the benefit of therapy to safely regain the use of the arm after a fracture such as your mother's.
Another modality that I receive is Myofascial Release (MFR) from a John Barnes trained practitioner. It is a gentle treatment working with the fascia in your system which is everywhere in your body. A good therapist is able to identify where there are soft tissue restrictions in your body which may be impacting the area of injury and help to resolve them. In a very gentle way MFR helped me to regain ROM in my shoulder at a time in my physical therapy and home exercise program when I wasn't making any measurable gains. After being treated with MFR my range had improved and my pain had lessened dramatically. Then my strengthening program began to be really successful.
My therapy was slower because I was severely anemic from the multiple myeloma. My surgeon wouldn't release me to return to work for 7 months after surgery because of the strenuousness of my job as a physical therapist. I would say that it was about 4 months after surgery that I could use my arm for most regular self care activities and reaching into cabinets and lifting things down that weighed about 2-3 pounds. A year later after my other arm fractured in the proximal humerus, it was about 3 months before I could do most things with my arm again. I still had pain at the fracture site when I lifted anything over 1 pound for quite a long time. At that time I had progressed to active myeloma and just started treatment with Rev and Dex along with Zometa infusions. I returned to full time work after 4 months.
How is your mother doing now?
Nancy in Phila
Another modality that I receive is Myofascial Release (MFR) from a John Barnes trained practitioner. It is a gentle treatment working with the fascia in your system which is everywhere in your body. A good therapist is able to identify where there are soft tissue restrictions in your body which may be impacting the area of injury and help to resolve them. In a very gentle way MFR helped me to regain ROM in my shoulder at a time in my physical therapy and home exercise program when I wasn't making any measurable gains. After being treated with MFR my range had improved and my pain had lessened dramatically. Then my strengthening program began to be really successful.
My therapy was slower because I was severely anemic from the multiple myeloma. My surgeon wouldn't release me to return to work for 7 months after surgery because of the strenuousness of my job as a physical therapist. I would say that it was about 4 months after surgery that I could use my arm for most regular self care activities and reaching into cabinets and lifting things down that weighed about 2-3 pounds. A year later after my other arm fractured in the proximal humerus, it was about 3 months before I could do most things with my arm again. I still had pain at the fracture site when I lifted anything over 1 pound for quite a long time. At that time I had progressed to active myeloma and just started treatment with Rev and Dex along with Zometa infusions. I returned to full time work after 4 months.
How is your mother doing now?
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Shoulder fracture - best way to help heal right?
Thank you Lyn and Nancy 
My mum is still in hospital, having just received her first two weeks of chemo (VCD). They did some light radio therapy on the arm to help reduce the pain. There has been very little improvement, but she did her last radio only a few days ago, so we're still hoping.
They did bring in a physical therapist and they've been doing very light stuff, mainly on the rest of the arm, not the fractured part. I guess it's too soon to start moving the arm (?) It has only been fractured for a month and it still causes a great deal of pain for my mum to move her shoulder at all. How soon after fracture did you start physical therapy?
I have never heard of MFR before. Thank you Nancy. I'll definitely check it out!
My mum is still in hospital, having just received her first two weeks of chemo (VCD). They did some light radio therapy on the arm to help reduce the pain. There has been very little improvement, but she did her last radio only a few days ago, so we're still hoping.
They did bring in a physical therapist and they've been doing very light stuff, mainly on the rest of the arm, not the fractured part. I guess it's too soon to start moving the arm (?) It has only been fractured for a month and it still causes a great deal of pain for my mum to move her shoulder at all. How soon after fracture did you start physical therapy?
I have never heard of MFR before. Thank you Nancy. I'll definitely check it out!
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knoulp - Who do you know with myeloma?: My mother
- When were you/they diagnosed?: November 2013
- Age at diagnosis: 66
Re: Shoulder fracture - best way to help heal right?
I had my first physical therapy session 2 weeks after surgery for my shoulder replacement to give me an updated home program for what I had received in the hospital. I didn't begin regular therapy sessions until 6 weeks post surgery and then went 3 times per week for 4 months. Other than doing some active motion exercises without moving my upper arm, I didn't start doing any full arm exercises for my fractured arm for 6 weeks. It was too painful to move my upper arm before then. I could feel the bone ends moving against one another. Once I started therapy I did active motion exercises for a couple of weeks and then gradually added light weights. I did most of the therapy myself with some input from one of my PT colleagues on when to progress and with which exercises.
Nancy in Phila
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
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