Shoulder Separation ?'s

[rbibbs]

I'm asking for my brother... not for medical advice, but to build my own understanding of this condition I'll be helping him with once the doctor has released him to exercise.

He's 48yo, a little on the heavy side and a little on the inactive side. He's separated the same shoulder 5 times in 2 years. He says it 'comes out to the front then moves to the side' under moderate loads, although I think initially he fell on it. In between separations, he's able to move it with no discomfort. The treatment has been the same every time, morphine, reset the joint, put it in a sling for a month. I don't think he's been directed to do rehab on it, he's just going by what the doctor says. (Got an MRI this morning, so we'll know more structurally soon, but I'm guessing it won't show much.)

The questions that arise are:
The major muscles that keep the humerus from moving ventrally away from the joint?
Ways to strengthen those without risking dislocating it again?
Speculation as to why he doesn't 'feel' the impending joint overload and respond to it with appropriate tensions?
All dissertation on this condition is welcome and appreciated.

[bob_stra]

Hey Rick

This is more Jarlo's thang, but here are a few quick links. I always start with these myself when I'm looking for sumthin'

http://tinyurl.com/556tf
http://www.wheelessonline.com/

Eg: http://www.wheelessonline.com/o6/66.htm

Something to read till he gets here.

[JasonE]

Bob -

I love those sources you keep bringing to the table! :shock:

[rbibbs]

Thanks very much Bob. That's the perfect amount of background material to be able to analyze the MRI results and recommendations from an informed position.

If he's got a torn AC (or the other one), he's gonna have to get that fixed or this will keep happening. I'd hate to think his muscle tone is so bad that the ball just 'pops' out of the socket with moderate exertion. Perhaps he was diagnosed 'too optimistically' with the original event. If the advice was 'wait and see', well we've seen haven't we?

I should be on the phone with him tonight, see where we stand. If he's headed for surgery (looks more like that) he'll need licensed professional rehab. Hey, he's got bucks, fly us both to Honolulu for the winter, make the best of a bad situation. :wink:

[rbibbs]

Update, MRI results: The original injury was an undiagnosed broken collarbone. It went undiagnosed the other 3 times too. Treatment now is pretty straightforward. We'll work on Occ Rehab once he's cleared to exercise on his own.

[Matt_OZ]

Glad to hear things are working Rick, he's lucky to have a brother with your knowledge and compassion. Shoulders are tricky little suckers aren't they?

Stay well buddy,
Matt

[Jarlo Ilano]

Rick,

It is currently broken? Or not healed correctly? Called a malunion.

Sorry came in so late, long workday! :roll:

You and your brother are welcome in my clinic anytime!

Talk to you later, by the way, you want anything from over here? Did they have Zippy's when you lived here? Good chili! :lol:

[rbibbs]

Thanks Matt. He's in medical hands, hopefully more thorough than they were the first 4 times. I'll make a knuckledragger out of him yet.

Thanks Jarlo. In a perfect world, we'd stop by once a week. He didn't specify whether it's still broken or healed incorrectly. Also updated the timeline, the original injury was 10 months ago. I don't get all the details at once, since he doesn't know the significance of them, and like most people when their doctors talk technical, his eyes glaze over.

Zippy's sounds familiar. Yeh brah, fry-mahi plate, macaroni salad, 2 scoops rice (haole style) (with gravy) and chopsticks. Bag o' poi might be fun :D .

[rbibbs]

Fascinating stuff! The full written diagnosis goes like this:
Large Hill-Sachs impaction fracture along the posterosuperior humeral head measuring 2 X1.5 cm. Anterior inferior labral tear with complete avulsion of the anterior inferior labrum and associated periosteal stripping along the anterior glenoid consistant with an ALPSA lesion. No bony component to the anterior labral injury. High grade partial anticular surface tear of the distal anterior supraspinatus tendon with a thin portion of the bursal surface remaining intact. This is at least 70%-80% thickness partial tear of the supraspinatus. No full thickness tear. The infraspinatus tendon is intact. The acromioclavicular joint is within normal limits and the coracoacromial ligaments are intact.

Drawing conclusions for my own 'processing' of this 'case':
Deadass wrong that MRI "wouldn't show anything". Brother was misquoting doctors at times... 'broken collarbone'/'humeral head fracture'... dislocation/separation... or the doctors were changing their interpretations... both within the realm of expectability... conclusion, don't draw longterm conclusions from shortterm data.

While his shoulder was 'working' he asked me for a "strengthening program" and he proposed doing his nightly 40-min walk carrying weights. Not knowing his condition with certainty, I told him "walk in a loop and drop them off at 20-min, not more than 2 pounds, wait and see what that does before you attempt more." Bless him, if I'd said "bench press your bodyweight" he probably would have tried. Bless me, I didn't.

This ain't no fly-by-night doctor he's going to, it's one of the orthopaedists for the Dallas Cowboys. He probably sees a half-dozen shoulder dislocations a week. BUT, he sees them in conditioned 20yo athletes, not overweight inactive 48yos. I appreciate his initial 'minimal-intervention' approach, it's statistically consistent with resolution of dislocation because dislocation statistically occurs in males under 35. Were I an orthopaedist, I would make a note to myself to MRI any dislocation patient over 35. Some of the damage was quite likely incurred in the subsequent dislocations and could have been prevented.

As it stands he's going into surgery, presumbably to get the labrum reattached. Then he'll be in prescription rehab for a while. I'll follow the case.