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Stage 2 ligament tear in shoulder... advice welcome!

 Poster: A snowHead
Poster: A snowHead
So, at the end of a fantastic week of skiing in 3Vs, my OH has managed to tear at least one and possibly two ligaments in her shoulder in a ski accident...

We have already been in touch with health insurance and are in the process of researching appointments to get a second opinion from an osteopathic surgeon, but I would very, very much welcome advice from fellow snowheads on next steps for dealing with this injury. In particular any London area specialists that people have experience with or would recommend (for either a consultation now, possible surgery, or for physio in the near future).

She is doing well and we are hopeful for a full and speedy recovery, but from reading this forum over the last few years I know that there will be a wealth of experience out there to be drawn upon...

Many thanks in advance.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
@Pynch, What ligaments? Does this help https://www.shoulderdoc.co.uk/article/1448

I had a fall last season and suffered a grade IV AC joint dislocation. The bill for the doctor (I skied down to his surgery) plus medication came to less than the insurance excess so i never bothered claiming on the insurance. The shoulder made quite a lot of progress on its own but there was still pain in some actions so I had a shoulder lockdown 4 weeks ago and it is now making very good progress. I expect to be skiing again before the end of this season and expect an almost total recovery.

For the record I simply went to my GP on arival back in the UK got a quick appointment at the local hospital where all the asessment and treatment was carried out well.

I have no idea what a "osteopathic surgeon" is but the local orthopaedic surgeon did an excellent job.

So my advice is to call into your GP taking any French X-rays with you and ask for an appoinment at the local trauma clinic and take from there. You GP should know better than us.
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@Pynch, I'm sorry to hear about your OH's shoulder problem. I have personal experience of the knee side of Wimbledon Clinics, and cannot recommend them highly enough (Jonathan Bell specifically)

http://www.wimbledonclinics.co.uk/

They cover the complete range of specialities, and I think this would be a very good place for you to start. Good luck with her recovery
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@johnE, Thanks for this - from the link I think she is somewhere around their grade three (the French doctor used a system that only went up to a severity grade of 4 rather than up to 6).

Also, I did indeed mean an orthopaedic surgeon (Various people have been talking about how an osteopath would fit in eventually causing my brain fart). We are definitely going for a further consultation at a hospital etc..., I'm just checking collective wisdom too. Glad you have made a full recovery.

@genepi, cheers the Wimbledon Clinic is something I've seen on here with reference to knees, but I will look at if it is possible for shoulders as well.
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I have had 3 shoulder ops over the past 2 years and my surgeon has been fantastic. He is based out of spire watford and harpenden and is called Tony Corner (he is with BUPA, Vitality etc) www.tonycorner.com

Depending on the degree of shoulder drop will determine if they operate, usually a grade 3 would receive treatment. I had a surgilig stabilisation and lots of physio. I then had another 2 crashes which ended up creating a 3rd distil break and a hook plate also inserted and then removed 9 months later. To be honest there were times I thought I would never get back but I'm now fully back and skiing next week Smile (it never stopped me skiing by the way, but this year I'll be throwing caution to the wind once again!)

Good luck,

Steve
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@Pynch, My French doctor said "Grade II", the orthopaedic registar did a holding weights test and said "Grade III" the consultant said the hanging weights test was useless and the registrar should not have done it. He looked at the original X-rays and since one was with my arm raised above my head could see the displacement of the clavicle and went on from there (Grade IV). I meant to ask him which it actually was after the operation but forgot. All he said was that it was a boring operation with no excitement.

Your OH may make a full recovery without any intervention, but a consultation would be a good idea.
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The grading schemes are not very precise or consistent. That's a good link though from @johnE

The most common is a partial rupture of the AC ligament. It's a common rugby injury, for instance, often heals well with just strapping and physio, sometimes leaves a bump.

More serious is complete rupture especially if the CC ligament is also completely ruptured - likely to need surgery. But you'd probably need a really big impact to do that - I would have thought unlikely at recreational ski speeds. I did mine crashing a motorbike on track.

Surgery seems to have evolved since I did mine, happily. If I did it again if probably go and see Tony Kochhar at the London bridge hospital. He didn't operate on me but seemed pretty up to date when I saw him about related nerve damage.

But we're pretty lucky in this country - any consultant orthopaedic surgeon with an interest in shoulders is likely to be very good.

Best of luck. Shoulder injuries are painful.
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Quote:

More serious is complete rupture especially if the CC ligament is also completely ruptured - likely to need surgery. But you'd probably need a really big impact to do that - I would have thought unlikely at recreational ski speeds. I did mine crashing a motorbike on track.

Of course I was recreational skiing at recreational speeds, bounced off an icy mogul and crashed into another on my left shoulder. The result was all 3 ligaments completely ruptured and a fair sized bump. Like @gravityslide, I had a shoulder lockdown as it is now known. The liturature appears to be positive about the procedure.
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Thanks all - this was what seemed a (relatively) mild fall but directly on to the handle of a ski poll, seemingly at exactly the wrong point of the shoulder.

Words like 'boring' and 'routine' are what we were hoping for, but hard to know just how to balance optimism when in the midst of X-rays, painkillers and insurance claims!

For those who have been through this, any insight on how soon you began physio and the kinds of exercises and equipment you used would be a great counterpoint to the more official advice we are seeking.

Thanks again.
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@Pynch, with a shoulder injury i would only take advice from a physio. Check your travel insurance. Mine had £500 worth of physio cover
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I can recommend an excellent shoulder surgeon in Newcastle if anyone comes across this thread and needs one. Jaime Candal-Couto works at both Wansbeck and Hexham hospitals. Sorted out my 77 year old Mum's shoulder last October and she is back to almost full movement, having being severely restricted following a fall. She had lots of physio, all on the NHS.
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And love to help out and answer questions and of course, read each other's snow reports.
I would ask to be referred to a shoulder specialist by your GP.

I crashed a microlight onto the beach at Wells Next the Sea some years ago. I knew I had broken my hand in the crash but the shoulder pain wasn't. Most of the time and sometimes for days, it felt fine. Then I could exert it by something simple like changing gear in the car and I would be close to tears. My GP referred me to a specialist (on Bupa). I had an Arthogram (sp) to inject magnetic dye into my shoulder was then rushed round and shoved into the MRI scanner. It showed that I had detached all but 5mm of my rotator cuff tendon from my arm.

The surgeon screwed 4 fixings into my arm bone, cut a slot below them, pushed the tendon ends into the slot and then wired the tendons in place to the screws. I had my arm strapped to my body for 3 months and then in a sling with no raising for another 3 months. The physio that followed was painful but eventually got me back full movement and strength.

At the start I had terrible muscle wastage on my left upper body. My surgeon said a full recovery would take up to 3 years but I got back to full fitness in 18 months. I was doing over 1400 raises a week with a 1kg dumbell, then 2kg and eventually built up to 8kg. The blood vessels through these tendons are tiny, it's a long haul back to fitness.
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holidayloverxx wrote:
@Pynch, with a shoulder injury i would only take advice from a physio. Check your travel insurance. Mine had £500 worth of physio cover


I think we were all taking it as read that the OP intended to get a referral to an orthopaedic surgeon given the obvious severity of the injury. A physio is no substitute for this - they would immediately tell you to get a surgical opinion, given the history.
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johnE wrote:
Quote:

More serious is complete rupture especially if the CC ligament is also completely ruptured - likely to need surgery. But you'd probably need a really big impact to do that - I would have thought unlikely at recreational ski speeds. I did mine crashing a motorbike on track.

Of course I was recreational skiing at recreational speeds, bounced off an icy mogul and crashed into another on my left shoulder. The result was all 3 ligaments completely ruptured and a fair sized bump. Like @gravityslide, I had a shoulder lockdown as it is now known. The liturature appears to be positive about the procedure.



Very unlucky. That lockdown device seems to be much better than the hook plate I had (but it wasn't available then), which had to be removed after a couple of years . Hopefully the OPs OH doesn't need the procedure at all.
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turbosmurf wrote:
holidayloverxx wrote:
@Pynch, with a shoulder injury i would only take advice from a physio. Check your travel insurance. Mine had £500 worth of physio cover


I think we were all taking it as read that the OP intended to get a referral to an orthopaedic surgeon given the obvious severity of the injury. A physio is no substitute for this - they would immediately tell you to get a surgical opinion, given the history.


He was asking what exercises others do. My response was to that . Of course an OS is the right course of action as is consulting a physio in due course for rehab.
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 Poster: A snowHead
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Hi all, thanks for input. Good news from our consultation with the orthopaedic surgeon: no surgery!

She is on the edge of stage 2/3 of the 6 stage classification, which means a noticeable bump (that will probably say forever), but no increase in clavicle separation in the weight bearing x-ray, so full strength and range of motion should be recovered.

The pain has also significantly reduced over the last two days and she will start doing light movement with her arm next week. She has a physio appointment set up for two weeks once the swelling has gone down to get a proper exercise regimen under way so she can make a full recovery as quickly as possible.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Pynch, I sympathise with you, and all snowheads with a musculoskeletal injury trying to find a suitable specialist.
Unless you are "in the know", how on earth do you sift out the average from the don't-go-near from the expert?
A simple Google search of "Shoulder Surgeon London" starts off featuring one guy - but is he any good?
There have been attempts to make surgeons (and all doctors) publish their outcomes, but on the whole this has been resisted (much better for cardiac surgeons, but that took a series of disasters to initiate).
So how do you choose?
First: only consider an expert in your area of injury. So not any old orthopaedic surgeon, but a Shoulder Specialist.
Second: go with a team. Teams work together and support one another, and are usually better than individuals working alone.
Third: are they are used by professional teams or Olympic teams? Usually a good recommendation.
I would also ask your surgeon: "do you ski?"
Best of luck.


Last edited by Obviously A snowHead isn't a real person on Thu 9-02-17 14:48; edited 1 time in total
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@Pynch, it'll be right as rain within 6 weeks.
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@Pynch, I am currently recovering from type 4 AC separation caused by a snowboarding accident at New Year.

I am seeing a consultant in London. I am happy to send you his details.
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@Bennyboy1, Thanks for the offer. We are getting good care (so far as I know) at present, but do send them through just in case!
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So.. progress seems good. She is still wearing the isolation sling for portions of the day and using an ice pack occasionally, but she seems to be able to move it much more all of a sudden and she's not needed many painkillers, though has tended to take them so that it doesn't ache at work during the week.

A question for those who've been through this before - is there a view of if painkillers should be avoided before a physio session, does it make a difference one way or another?
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I would recommend getting off them as quickly as you can and only take them when absolutely necessary.

Apart from anything else, they play havoc with the metabolism.
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A quick update: She's just had her first physio session and it is feeling much better. Some targeted massaging of the shoulder has done wonders for how tight it feels and she is now stretching it out several times a day to bring back the range of movement before starting to do re-strengthening exercises. She rarely uses the sling anymore.

One word of caution for those experiencing this in future; the physio noted that whilst the sling / treatment she received straight off was textbook to treat the injury and the pain, it did not set her up in the best way possible for recovery.

If she had been taped / strapped up by a sports physio specialist from the very beginning the bump (bone!) now visible on her shoulder would be much smaller Sad

He also said that whilst very good at reducing pain, anti-inflammatory tablets slow the healing process in joints as they slow the body's natural response so he would not have had her taking this at the beginning, providing the pain was manageable.

But, all that said, the prognosis is good and she should get back full movement and muscular strength if she does her exercises.
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@Pynch, Good news. Keep doing the exercises.
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Having shared some of the more 'adventurous' injuries in this section with my injured partner, she has some perspective on her own injury, and stories of people getting back on the slopes after much, much more serious falls have really motivated her, so thanks to everyone for sharing.

So far she has made great progress - hasn't been wearing the sling for more than three weeks and the bump has got visibly smaller. No strength in the arm at all yet really and and she has been advised against any strength based work until swelling has completely gone down, so physio has focused on stretching to maintain range of movement (which has been surprisingly painful on occasion).

She has started going back to the gym to keep up general fitness (mainly cardio / leg based exercises), but we have been a little concerned at some mixed messages from the Physio vs. the initial consultation with the surgeon about long term recovery and future sports.

The physio now seems to be saying that there may well be some limitations and continued weakness and much higher risks for any kind of contact sport / impact (such as a skiing fall). Whilst there is obviously a physical change in the shoulder, the surgeon had said that after 12 weeks all sports (including rugby if she felt like it) would be absolutely fine.

The idea of an enduring weakness and limitations in activities has obviously got her a bit down...

Have others had similar ambiguities during recovery for this injury?
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Prof Jonathan Rees in Oxford is outstanding and one of the top shoulder guys in this country.
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@Pynch, Hello Im sorry to hear about your partners injury; having a grade 5 myself I fully sympathise and hope she is recovering well!? I completely missed your post (my life imploded in February and I've been an 'absent' snowheads since), I hope she is making a good recovery and this will all be surplus to requirements but I'll pitch in anyhow...
To cut a long (details in another post somewhere on here) story short: skiing crash, grade 5 ACJ separation, misdiagnosed, long wait to see consultant, missed window for optimal type of surgery, after several surgical opinions and much research I decided not to have surgery and instead rehab it, inexperienced NHS physio, eventually paid for private sports physio (Space in Edinburgh - I highly recommend), worked bloody hard, intermitantly got thoroughly chuffed off with it all, perked up, been skiing twice since now... Confidence severely knocked the first time but I refused to give in to it and very much enjoyed my last skiing holiday! 2.5 years later 97% function, feeling and strength regained, pain free 99% of the time and finally back at work, I'm a nurse so have a physical job and it only really bothers me at the end of a really busy day...
I completely understand the frustration - and fear that can be caused by conflicting opinions and advice, especially with regards any long term complications or limitations and being told not to ski (have completely ignored that last one!) These injuries are rare and the advice for the best way to treat and manage them is conflicting. I was an A&E nurse and my ex partner was a surgeon and even we found accessing the right information and expertise tricky. I honestly think that being kind to yourself and pacing your recovery (resting it) can be as beneficial as all the strength work and that long term, daily stretching and occasional massages to loosen spasmed muscles are very important. We can all feel the pressure to regain our previous level of fitness/function as soon as possible and don't think about the time it can take to physically lay down and strengthen new tissue and/or psychologically accept an injury like this - especially as a woman - any injury/scar that may be disfiguring will be tricky to accept. Our bodies are not machines and it sounds ludicrously corny but time is a bloody good healer! I may have a bit of a lump and a clunky, wonky shoulder (no Quassimodo jokes please!) but I'm pain free most of the time and that is more important to me than having matching shoulders! Though I can imagine a younger woman may feel differently... There is a lot of bravado made evident on snowheads at times and some may think I'm talking tosh, but I'm speaking as a nurse as well as someone who has lived with this injury for over two years now.
Every injury is different and I was in some ways lucky, mine being a 5; all my tendons are severed and my clavicle is so elevated that once my initial inflammation had settled and scar tissue formed; I only really get pain now from a spasmed trapezius - where my bone is now lodged... I feel for your partner, if hers is a 2/3 she will be in more pain as her ligaments are only partially ruptured and bone ends in proximity with one another and so may rub - this is partly why I think she may benefit from taking things slowly... If something hurts despite pain relief - just stop doing it!
It has been a long and (at times) dark and confusing treck back to normality for me but there is light at the end of all this. Persistence and determination will get her through it! Madeye-Smiley
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@Pynch, it's anecdotal and only generally on topic but my OH fractured something in her shoulder - skiing but remarkably slowly with kids. Definitely unfortunate accident.

The UK NHS were fine, but she was ultimately "discharged" with about 80-85% range of movement and strength as that was as good as she'd get.

Not ideal (at all, esp. for a fit 30 year old) but well, you live with it, right?

Fast forward a few years and apropos of socialising, she started private pilates classes with a chum. The teacher was an ex olympic athlete who had a rather extensive personal experience of many musculoskeletal injuries.

Anyway, and I'm not suggesting anything special about pilates, but after 18 months or so of fairly intensive work she was back to 100% r.o.m. and near equivalent strength.

Curious about your comment about NSAIDs impairing healing as a brief search doesn't bring back obvious studies confirming that?
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Hows the shoulder now? Im still suffering from a shoulder injury I got years ago.
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