Arm Dislocated?

A snowHead

(this is the second of two posts re my health - I'm falling to bits)

6 weeks ago I slipped on a dodgy pavement, turned on mid air, and landed sideways on my shoulder (arm not outstretched). I had it x-rayed and there's a chip come away from the top outside of the humerus.

I couldn't move it very much until a couple if days ago, then yesterday I happened to be standing in front of the bathroom mirror when I stretched out both of my arms. I noticed that whilst the good shoulder the arm moves up whilst the shoulder stays relatively un moved, but with the bad shoulder the whole shoulder moves up, as if the arm is pushing the shoulder up.

Do you think it's dislocated or acting normally under the circumstances?

A snowHead

Not sure that you could lift your arm up if the shoulder was dislocated . How do they compare when stood in front of the mirror, arms by your side?

Well, the person's real but it's just a made up name, see?

@Frosty the Snowman, they look normal.

When they're outstretched the bad one looks like it's got a hamburger on it. It's not rotating in the joint, but the joint is moving with the arm.

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Probably needs a doctor, physio or appropriately-trained nurse to answer this one. Who diagnosed the chip? Who's treating it? Go back and take their advice.
I would suspect that if it was dislocated then it would hurt like buggry. Possibly tissue swelling, spasm in back or shoulder girdle muscles (if you couldn't even move it until a few days ago, it's unlikely to be moving right now) - but that's a pure guess, and only a trained healthcare professional can give you a proper opinon with said offending body parts visible in front of them.

Anyway, snowHeads is much more fun if you do.

I saw a minor injuries nurse yesterday and she wouldn't touch it, said that I should wait until my second appointment at the fracture clinic, but that's not until 10/2/20.

I'm HOPING to go skiing with my son on 29th march, but I'm worried that if I wait untill next appointment to relocate it (if that's the case) there won't be enough time for the joint to settle down enough for me to ski.

I just want it sorted out asap as I've been promising my 10yo son for years that I'd take him away, so I booked a trip for 5th Jan, but broke my arm on 15th Dec. He's gutted at the trip having been cancelled and I don't want to let him down again.

It's an emotional thing now, I just want it to be sorted out.

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If it was hurting me, or giving other odd symptoms, or seriously concerning / worrying me, then I'd trot off to another A&E, Urgent Care Unit or phone up the fracture clinic and ask for an urgent reassessment.
I'd assume that an MIU Nurse Practitioner should, however, be able to assess if there's dislocation or any other issue (but I don't know whom you saw, of course, nor of their expertise).
Your other obvious options are your GP (urgent appointment or otherwise, as you feel is warranted), Practice Nurse or an NHS or private physio. The latter might well be worth the £45-60 for a quick opinion.

Then you can post your own questions or snow reports...

@Grizzler, I think I'll go for the NHS private physio, it's worth a few quid to find out the state of play.

Thanks

After all it is free · Last edited by After all it is free on Thu 23-01-20 0:57; edited 1 time in total

@marodo2712, ....just come over from BPPV thread. I'm not a medic but we have had experience of dislocation on the hill, cycling and climbing. I would say dislocation unlikely. You may have scar tissue or haematoma in the joint from the injury - sounds very much like that. A dislocation would be EXTREMELY painful and the arm would be immobile through spasm etc. Because of pain immediately after the accident you will most likely have held the arm very static. This seizes everything up and scar tissue can form which immobilises the joint. Left for too long this can be an impediment to movement. If you had bleeding in the joint that would form lump(s) and seize the joint. They need to be dispersed by movement. Likewise tears in the rotator cuff, which can cause scar tissue to form - needs movement to be re-established. I would try heat/ice alternation and movement to the point of pain. That is, getting the motion back in. My partner fell on her hand and did the tendoms in on one finger. Medics said immobilise it but omitted to tell her when to start mobilising it. I nagged, she ignored me. Now she has a totally seized finger (bend into a curl) since scar tissue has adhered the tendon to the tendon sheath. She should have mobilised it the moment she could. Now she will require surgery to get it moving again. Our motto in cycling and climbing is - rest up, ease off, then wind it all up as soon as you can, and don't push it too hard - just enough stress to get the body building things up again (turns out it's quite a long motto).

@valais2, thanks. I'm moving it, and I'll continue to push it (gently!).

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Doesn't sound dislocated to me.

Shoulders are a PITA and often need long recovery. Don't push through pain.

snowHeads are a friendly bunch.

But agree with above. Stay mobile. Keep weights light!

snow reports

@marodo2712, it's not good news. You've got a Hill-Sachs lesion (the chip) and need an MRI to determine whether you've also got a Bankart lesion (torn/detached glenoid labrum) but it sounds likely that you have. One or more of your rotator cuff muscles are torn. You haven't had a full dislocation but an impact subluxation.

The reason your whole shoulder moves up is because the rotator cuff is damaged and you're subconsciously using your deltoid and bicep to raise your arm instead of your supraspinatus and/or subscapularis rotators. Can you raise your arm laterally to the side with your palms down? If you can't, your supraspinatus has gone. If you can't lift your arm in front, it's your subscapularis. The subscapularis is probably damaged anyway if the shoulder has been subluxated enough to cause a Hill-Sachs lesion.

Depending on the size of the Hill-Sachs lesion and your age/activity levels you will or won't be recommended for reconstruction. If one of your rotators is completely torn and/or your glenoid labrum is detached you'll need reconstruction anyway but it may be an easier arthroscopic repair. From memory, if he chip at the top of the humerus is greater than 20% of the surface area, your chances of future dislocation are high. The NHS will probably tell you "to see how it goes" but even if you build up your rotators you'll always be at risk without stabilisation reconstruction.

If you do surgery now, you can't go skiing in March. They'll tell you 6-9 months recovery time. A French Latarjet reconstruction would be quicker but still 3-4 months. If your rotators are not completely torn and the glenoid labrum is ok then you don't need surgery and can get a massive improvement in strength and mobility through hard work. But you will have to work the joint to total fatigue multiple times a day, every day, with weights and therabands. Nothing else will work, rest will make it weak. You've already had 6 weeks rest so any swelling has gone, what you're left with is a weakened/unstable joint that needs strengthening or repair.

Get an MRI as quickly as you can. Personally, I'd go to A&E and tell them you fell on it again yesterday so you jump the queue. There's nothing to stop you going skiing in March and doing any surgery over the summer. Obviously the risk of a full dislocation is greater in the case of a fall but that's about it. If it comes out, a doctor will put it back in and you're back to where you were. It's unlikely to significantly change any surgery requirement - shoulder surgeons repair all damaged bits at the same time once they get into the joint.

PM me if you'd like more info. I've had 3 reconstructions, dislocated my shoulders 34 times and seen some of the best shoulder surgeons in the world (and some of the worst).

You know it makes sense.

Here are a couple of image links. The first is of the x-ray, the second of me with outstretched arms 6 weeks later.

https://photos.app.goo.gl/jbyS1ZzYVkgqnZMW9

https://photos.app.goo.gl/3dtG4r4nny8naQsy9

Otherwise you'll just go on seeing the one name:

@marodo2712, that's an absolute classic image of a Hill-Sachs lesion - just google it.

Although it's under a shirt, your other image also looks exactly like what I said - you're using your deltoid to raise your arm instead of the supraspinatus. The humerus may also be displacing upwards which would be indicative of a torn labrum.

You need an MRI to see what the full damage is and an appointment with a good orthopaedic surgeon as soon as possible.

A snowHead

Thanks @Raceplate, I'll get on to the fracture clinic.

A snowHead

stop dicking about & get a professional medical opinion. a year after mine & I am still wakening up during the night because I cant get comfortable

Well, the person's real but it's just a made up name, see?

@Jonny996, from whom?

The fracture clinic won't see me until 10th Feb, and I don't have the money to pay for a private medical appointment. (I'm guessing they're super expensive.)

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I've got a physio appointment tomorrow, and depending on what they say, I'll call the fracture clinic and ask them for a walk in on Monday.

Anyway, snowHeads is much more fun if you do.

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@Frosty the Snowman, it smarted a little.

Embarassed

Then you can post your own questions or snow reports...

@Raceplate, you were pretty much spot on.

The physio said that, as well as the Hill-Sachs lesion, and damage to the rear of the supraspinatus and other general soft tissue damage, weeks of the arm and shoulder being out of action had led to something called the 'axillary recess capsule' had shortened and stiffened (my words not his, but I'm sure that's what he meant), such that when I try to raise my arm there is resistance, so the damaged muscle bows out and the remaining muscles do all the work, leading to the whole shoulder rising.

He dug his finger RIGHT in there, for ages! He gave me some exercises (get a cloth and a shiny table then, putting your weight onto your arm, polish the table, this can also be done on a shiny wall/door polishing up and down with your full weight on the arm).

One he'd finished torturing me I could move the arm much much more, so it's hot showers and lots of cleaning for the next few weeks

He gave me a 95% probability of skiing at the end of march.

He's a skier of many years and says that his favourite resort was Sol.

I left confused.

After all it is free

As an aside, theres a spectacular example of a dislocated shoulder being put back into place in I think the 3rd episode of "ski A&E" which was on tv recently, it's a somewhat worrying programme, but shows how differently people react to pain.
There was a 60+ lady whose leg bone had "exploded" - not a whimper, and a young chap who was " howling and screaming for pain relief " due to what amounted essentially to a bruise and cramp.

Ring the orthopaedic secretaries at the hospital you're being seen at, say your having major difficulties and is there any chance of them bringing your slot forward. If there's any space most of the time they'll accommodate.

Then when you arrive tell the receptionist you'd like to see the consultant (they put a little star/mark on the top of your sheet so the Reg or SHO don't pick it up).

Help!!

Arm Dislocated?

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