ASMI Sports Medicine Forum
« shoulder »

Welcome Guest. Please Login or Register.
Dec 20, 2009, 4:56am

[Home] [Help] [Search] [Login] [Register]


In order to post and/or recieve information on medical related issues you must be 18 years or older. Please include the city/area where you live so that someone can recommend a specialist in your area.

ASMI Sports Medicine Forum :: My Injury :: My Arm Injury :: shoulder
   [Search This Thread][Send Topic To Friend] [Print]
AuthorTopic: shoulder (Read 312 times)
nictyl
New Member
*
member is offline





Joined: Nov 2007
Gender: Male
Posts: 25
shoulder
« Thread Started on Oct 27, 2009, 5:10pm »
My son just got back from football practice and injured his right shoulder trying to make a tackle, he was hit on the side[not front nor back] of his shoulder 4-5 inches down from top of shoulder by a knee. He said he felt like his shoulder popped out then went back in. He cannot lift it laterally past 90 degrees without pain and when he tries to move it straight back he has pain, He can move it forward to 90 degrees before it's painful. I think that we're past x-ray time here and need an MRI. What is the difference between a dislocation and a separation and what do we think this is? Thanks,
nictyl
Link to Post - Back to Top  IP: Logged
rockinfire
Junior Member
**
member is offline





Joined: Apr 2009
Posts: 74
Re: shoulder
« Reply #1 on Oct 27, 2009, 9:03pm »
It sounds to me like he subluxed his shoulder joint. A true dislocation rarely will reduce on its own and needs to be relocated in the ER. A subluxation refers to the shoulder partially slipping out of joint and then spontaneously returning to its resting position. The initial treatment would be a sling if needed to support the shoulder and ice 20-30 mins at a time multiple times a day. Followed by a gradual rehab program to return to activity.
Make sure he doesn't try to throw anything or carry heavy objects (bookbag, and make sure they keep him out of weight training until released to do so by MD, etc). He definetly should not be reaching into external rotation, overhead, or into extension/behind him beyond his comfort level. He should be able to do things close to his body relatively pain-free and with fairly normal strength.
You need to see an orthopedist soon to determine (with x-ray initially----an MRI is not needed at this point) position of the shoulder and to initiate the rehab approach based on his specific symptoms presenting in the clinic at that time. If not treated correctly these types of injuries can lead to lifelong problems.
A "separation" is usually experienced from a fall on the tip of the shoulder with the arm tucked at the side so it doesn't sound like that is his problem. Sounds like he subluxed his shoulder to me.
Best of luck to you and your son.
« Last Edit: Oct 28, 2009, 9:33am by Glenn Fleisig, Ph.D. »Link to Post - Back to Top  IP: Logged
Glenn Fleisig, Ph.D.
ASMI Team
*****
member is offline

[avatar]


[homepage]

Joined: May 2005
Gender: Male
Posts: 856
Location: Birmingham, AL
Re: shoulder
« Reply #2 on Oct 28, 2009, 9:33am »
I agree with every word rockinfire just said.
Link to Post - Back to Top  IP: Logged
nictyl
New Member
*
member is offline





Joined: Nov 2007
Gender: Male
Posts: 25
Re: shoulder
« Reply #3 on Oct 28, 2009, 1:44pm »
Had ortho appointment today and x-ray was clean, we are scheduling an MRI, initially non contrast, to check for possible tears as I hear that they almost always accompany dislocations and sometime subluxations. He pitches for his high school so we need an imediate, as definitive evaluation as possible to address healing timeframe. Thanks for you r feedback. nictyl
Link to Post - Back to Top  IP: Logged
soxcrates999
Senior Member
****
member is offline





Joined: Jul 2008
Gender: Male
Posts: 259
Re: shoulder
« Reply #4 on Oct 28, 2009, 8:17pm »

Oct 27, 2009, 9:03pm, rockinfire wrote:
It sounds to me like he subluxed his shoulder joint. A true dislocation rarely will reduce on its own and needs to be relocated in the ER. A subluxation refers to the shoulder partially slipping out of joint and then spontaneously returning to its resting position. The initial treatment would be a sling if needed to support the shoulder and ice 20-30 mins at a time multiple times a day. Followed by a gradual rehab program to return to activity.
Make sure he doesn't try to throw anything or carry heavy objects (bookbag, and make sure they keep him out of weight training until released to do so by MD, etc). He definetly should not be reaching into external rotation, overhead, or into extension/behind him beyond his comfort level. He should be able to do things close to his body relatively pain-free and with fairly normal strength.
You need to see an orthopedist soon to determine (with x-ray initially----an MRI is not needed at this point) position of the shoulder and to initiate the rehab approach based on his specific symptoms presenting in the clinic at that time. If not treated correctly these types of injuries can lead to lifelong problems.
A "separation" is usually experienced from a fall on the tip of the shoulder with the arm tucked at the side so it doesn't sound like that is his problem. Sounds like he subluxed his shoulder to me.
Best of luck to you and your son.



Rockinfire,

Are there varying degrees of subluxations, dislocations and separations and if so are treatment modalities significantly different among those varying degrees?

Thanks
Link to Post - Back to Top  IP: Logged
rockinfire
Junior Member
**
member is offline





Joined: Apr 2009
Posts: 74
Re: shoulder
« Reply #5 on Oct 28, 2009, 9:26pm »
I am not aware of any varying degrees of subluxations that are noted in the literature. But a subluxation that occurs more frequently can eventually lead to dislocation

Dislocations are noted as primarily being anterior or anterior/inferior. On a rarer occasion the humeral head dislocates posteriorly such as when someone reaches their arm out for the dash of their car before impact during an accident. Most dislocations require a trip to the ER for correction. When we are on a sideline of an athletic contest, the orthopedist can sometimes reduce the dislocation right then and there. The sooner it is put back in place, the easier it is on the athlete.

Dislocations are usually termed as traumatic (caused by an event) or atraumatic (voluntary). Most atraumatic dislocators have what is called muti-directional instability meaning their joint can sublux/dislocate in multiple directions. As you can imagine, this is NOT a good thing. Surgery is not usually the best option for these folks. If you know a kid that can do "circus tricks" with his/her shoulder tell them to stop because they are only making things worse. This type of excess shoulder mobility is more common in girls than boys. All types of subluxations/dislocations require rehab to learn positions to avoid and specific strengthening techniques to give the most optimal chance for recovery and to help prevent further episodes.

AC joint seperations are classified from a mild sprain that just has the joint capsule partially disrupted to a significant seperation/dislocation that requires surgical stabilzation. The treatment choice in these cases range the spectrum from sling and ice for a few days and gradual return to activity, to surgery with several months of rehab.

If any of these conditions are not treated correctly, chronic shoulder pain can develop with progressive arthritis being a possibility.

Link to Post - Back to Top  IP: Logged
soxcrates999
Senior Member
****
member is offline





Joined: Jul 2008
Gender: Male
Posts: 259
Re: shoulder
« Reply #6 on Oct 29, 2009, 10:18am »
Thank you for your time with that it was very helpful!
Link to Post - Back to Top  IP: Logged
nictyl
New Member
*
member is offline





Joined: Nov 2007
Gender: Male
Posts: 25
Re: shoulder
« Reply #7 on Nov 5, 2009, 12:53pm »
Just got MRI report. Acute to subacute Hill-Sachs fracture with associated circumferential labral tearing as well as stripping of the anterior inferior scapular periosteum. Dr apppointment nexr week. Any thoughts on ability to return to pre injury pitching levels, probably labrum surgury??
Link to Post - Back to Top  IP: Logged
Glenn Fleisig, Ph.D.
ASMI Team
*****
member is offline

[avatar]


[homepage]

Joined: May 2005
Gender: Male
Posts: 856
Location: Birmingham, AL
Re: shoulder
« Reply #8 on Nov 6, 2009, 4:33pm »
nictyl,

Is your son seeing an orthopaedist with sports medicine training, especially with shoulders? Send me a private message or post here with the name and location of your doc. I will tell you whether I think he/she is the right doc.
Link to Post - Back to Top  IP: Logged
nictyl
New Member
*
member is offline





Joined: Nov 2007
Gender: Male
Posts: 25
Re: shoulder
« Reply #9 on Nov 12, 2009, 12:13pm »
Taking the conservative healing approach, 6 weeks in a sling, then rehab. I see that a Perthes lesion (Bankart variant) seems to be less damaging than a true Bankart or Bankart osseous lesion due to the integrity of the periosteum which could allow partial healing (non surgical) and may become re-synovialized. Any thoughts on conservative healing of a circumferential labral tear, shoulder went right back in relocation not necessary, don't have effected circumference arc yet. Also Hill-sachs less than 1/3 of humeral head not too bad. He has no pain with a very normal range of motion. If he can stay away from his girlfriend...!!
Link to Post - Back to Top  IP: Logged
nictyl
New Member
*
member is offline





Joined: Nov 2007
Gender: Male
Posts: 25
Re: shoulder
« Reply #10 on Nov 13, 2009, 12:37pm »
While looking on the internet I came across some articles relating to a Japanese study that says external immobilization seems to be a better treatment than internal immobilization as it keeps the shoulder (labrum) in a position much more condusive to healing although it is an akward position to maintain. Any thoughts?
Link to Post - Back to Top  IP: Logged
   [Search This Thread][Send Topic To Friend] [Print]

Google
Webasmiforum.proboards.com
Click Here To Make This Board Ad-Free


This Board Hosted For FREE By ProBoards
Get Your Own Free Message Boards & Free Forums!