Shoulder Dislocation

October 28, 2009

Filed under: UPPER LIMB — Tags: , , , , — Andy Bellamy @ 5:12 pm

What is a dislocation? Everyone knows, right? A true dislocation of a joint requires the complete separation of the two sides of a joint. What is often called a dislocation is actually a sub-luxation, or partial separation – they still hurt and do damage, but tend to recover faster.

This is an example of a shoulder dislocation. It is of a rare type, inferior, (or downwards into the armpit), and is caused by hyperabduction and makes up only 1% to 2% of all dislocations. This is a Luxatio erecta type.

1_16.12.08 A&E

So, if it is so rare, why does it matter? Well, it is rare overall, but is relatively common in sporting people who fall!  Mountain biking, moto-X, soccer goalkeeping, equestrian sports and skateboarding.

If YOU end up in the emergency room with your arm stuck above your head, the chances are that they will not have seen it. The key to relocating this joint is to dislocate it again first…..FORWARD, creating an ANTERIOR dislocation, then a more normal reduction to its proper position.

As well as the usual problems associated with dislocations, (AC joint, nerve and blood vessel damage), the inferior type causes damage to the floor of the armpit and can lead to  concurrent fractures of the upper arm, AC joint, as well as injury to the nerves, (brachial plexus), or specifically to the axillary artery.

Recovery can be slow, even with conventional physical therapies, medication and exercises. You will probably have to start with PASSIVE movements, such as pendulum swinging which you can see if you run the video. Remember that passive means just that – let someone else make the movements for you, (physio,osteopath), or use the weight of a tin of beans or can of coke and your body movements to generate the impetus.

Repeat these exercises several times a day and at every opportunity. If you don’t use the range of motion, you may well lose it! Repeat each direction on movement about 30 to 40 times. ie, 30-40 clockwise, anticlockwise, front-to-back, etc.

Good luck with your rehab and make use of all the tools available to you; information, professional advice, devices like the Rotater and, most of all, use your imagination.

NEW ShoulderCentric SITE & BLOG

September 6, 2009

As a result of my earlier fall and subsequent surgery, I have, (perhaps inevitably), taken a more active interest in shoulder problems than I did before. As a result of using an excellent product for shoulder injury rehabilitation called ‘The Rotater‘,  I had something of a ‘Victor Kiam’ moment and have become exclusive UK distributor for this product.

We don’t normally endorse products so positively, but this thing really does do what it says on the tin. Take a moment and have a look! If you would like to know more, drop in and see us at the clinic or check  these sites;

Main ShoulderCentric Site

The Blog for shoulder exercise and rehab articles.

Facebook Page for general shoulder information:

Scott Welch - Boxer using Rotater

Scott Welch - Champion Boxer using the Rotater

The Rotater is used to enhance the process of rehab after surgery and can also be used to improve shoulder mobility that may help your sporting ambitions. Flexibility and improved range of motion, (ROM), for golf, tennis, rugby, baseball, boxing and goalkeeping can all be helped with its regular use.


June 17, 2009


Some of you may have heard that ‘your author’ was foolish enough to fall off his mountain bike while trying to keep fit and keep the expanding waistline manageable.

This happened on the 16th December, just before Christmas and just after getting back from holiday – excellent timing!

I won’t go into the gory details, but I dislocated my right shoulder and fractured part of the upper arm bone. I can’t fault the Ambulance Service who promptly picked me up from the back of the Downs, but I’m not convinced that ‘gas-n-air’ does more than give you something to do! However, thanks boys for bringing me in, mud and all.

Worthing A&E did their sterling best to put things back in place, but sadly failed. My ‘inferior’ dislocation, (and I can tell you it didn’t feel at all inferior at the time), is apparently rare, but the sight of them checking up on the internet before ‘having a go’ was a bit unsettling, as you can imagine. By now I had had my arm above my head for 6 hours and I was prepared to let them try anything. They told me I wouldn’t remember anything! I’d like to have a word with that very enthusiastic chap sometime.

Next day,after a good, morphine-induced sleep, I was taken to theatre to have the shoulder back in place, discharged later that day with a promise to screw the detached bits back in a few days.

Three weeks later, it was expertly done, leaving me with three shiny screws, a lovely scar and a lot of physio to look forward to.

Physio was an experience, I can say. As an osteopath and with a now-long-ago background in the NHS, I did have some apprehensions, but they were completely unjustified. I won’t mention her name so as to avoid embarrassment, (after all, her colleagues might blackball her for treating ‘the enemy’), but I had expert, professional and effective treatment and I like to thinkthat weboth learned somewhat from each other.

Weekly treatments for 5 weeks, with lots of self-torture at home meant that I was back at work part-time 6 weeks after surgery. I was also aided by a device that I ordered from the US, called the ‘ Rotater ‘, which proved to be a huge benefit. It is a simple device that gives control to the user and lets you relax the shoulder while in use. It’s is so easy to fight the therapist and ‘cheat’, thinking you are getting more improvement than is real.

I was discharged after about 10 weeks post-op and now comes what I think is the really hard part. I and most of my friends and relatives have become bored with the whole thing. It is now, back on my mountain bike, SCUBA diving and working full time again, that it is so easy to stop doing the exercises and stretches – I’m coping OK, aren’t I? Well, yes, but it isn’t better yet and it is easy to avoid doing the things that still hurt or are difficult. Please take my word for  it, keep it up – shoulder injuries, including frozen shoulder, sub-acromial impingement problems, rotator cuff tears and dislocations take a long time to really heal – think in terms of at least a year!

Looking on the positive side, I have learned a great deal both about my specific injury type, as well as shoulder injuries in general. I hope that I will be both more sympathetic and empathetic toward my patients in future – but beware, I have also learned that a I have been too soft on them in the past………


Rotater Cuff Injury & Tear


A group of 4 muscles in each shoulder, named for its vague similarity to a short sleeve shirt cuff. Damage to the cuff may be referred to as rotator or rotater cuff tear, rotater cuff strain or rotator cuff injury.

  • These muscles are the supraspinatus, the infraspinatus, the subscapularis and the teres minor muscles. These muscles start on or under the shoulder blade and their tendons wrap around the shoulder joint and the tendons attach to the humerus, or upper arm bone. Their job is to stabilise the joint while it goes through its many movements.**
  • The most likely point of injury is to the tendons of the muscles and can range from microscopic tears to large holes in the cuff.
  • The supraspinatus tendon is the commonest site of tearing.
  • The size of the tear and the amount of pain suffered does not correlate well. Large tears can be seen on scanning that are symptom-free!
  • Rotater cuff tears can happen at any age and may from sporting activities, such as throwing sports, traumatic injuries like dislocations and fractures, but are most common in older age. Degeneration of the tendons, abrasion under the acromio-clavicular joint, (the bony knob on top of your shoulder) and postural problems, (being increasingly round shouldered), are all causes.


  • · Pain often starts around the upper, outer arm
  • · Pain gets worse when you lift the arm and try to use it above your head
  • · A painful arc of movement – i.e. lifting the arm, initially without pain, until you get a sharp pain, which you might be able to go through with effort, when it then eases again
  • · Pain when turning the arm out to the side when the elbow is bent, (external rotation)
  • · Waking at night with a dull, persistent ache or just when you are resting
  • · Pain over the front and side of the shoulder when you lean on the arm of a chair
  • · Pain when you push the arm sideways against a resistance (the ‘impingement sign’)
  • · Weakness, especially overhead or out to the side
  • · Poor range of motion – can’t do up bra, reach back pocket, brush hair and so on
  • · Crackling (crepitation) and creaking when you do move


  • · Shoulder dislocation from sports injuries
  • · Lifting or catching something heavy
  • · Falls on to an outstretched arm
  • · Overuse, especially new activities or sports – perhaps soon after retiring from a sedentary job
  • · Age-related degeneration of the shoulder tendons and impingement, (pinching)
  • · Poor posture, (round-shouldered), which reduces the amount of room under the acromion, especially the supraspinatus muscle (more…)


March 16, 2009

Filed under: THE NERVOUS SYSTEM — Andy Bellamy @ 9:40 pm


Please note that the comments in this blog come from many years of clinical experience and practice, combined with details and opinions taken from various sources, including open-source internet articles. Where relevant, links are provided.

Please also note that we cannot comment on individual cases without taking a proper history and conducting a full examination.


The nervous system, (NS) is a system that can become involved in any injury or over strain. The nerves can be damaged directly or be indirectly affected by other tissues. There may not even be any obvious injury but nerve tissue can be affected by poor posture and/or repeated awkward movements.

Even very minor injury to nerve tissue can lead to scarring and therefore tethering which in turn affects the mobility and glide of a nerve. It only takes a minor injury to make a nerve behave differently.

Even if the nerve tissue is not injured, we have to remember that the majority of tissues in our body have a nerve supply and that ‘error messages’ of any damage, are sent to the brain via the nervous system. These may contribute stimulate our protective mechanisms such as muscle spasm.

The NS is, (in simplified terms), like “one long piece of string” and injury in one area can lead to repercussions in other parts of the body.


One of the most common nerve injuries that you hear about is sciatica, which is a complaint which many people visit the Physiotherapist and Osteopaths here at the Adur Osteopathic Clinic to seek help. However, many people do label any pain referred from the spine as ‘sciatica’, which is technically incorrect.

True sciatica involves injury to the root of the nerve in the lower part of the spine and causes referred pain down the back of the leg and often includes sensory, (sensation), changes such as tingling or numbness, and possibly weakness.

The nerve roots a little higher in the spine can send, (refer), pain down the front of the thigh and leg. Pain and symptoms from the trunk level can radiate round the sides or even into the front of the chest. Nerve involvement in the neck region can cause symptoms to be referred down the arms.


The nervous system is so widely spread in the body that referral potential is such that no area of the body is exempt; however, there are patterns of symptoms and area distribution, which give us valuable clues to location and nature of injury.

It is when our Osteopaths and Physiotherapists see and hear of symptoms that don’t fit a familiar pattern that they may suspect nerve tissue involvement.

Symptoms can occur in patches or clumps down a limb or spine. For example, tennis elbow can coexist with carpel tunnel syndrome, low-neck pain and then mid-thoracic symptoms can present. (more…)


October 8, 2008


Please note that the comments in this blog come from many years of clinical experience and practice, combined with details and opinions taken from various sources, including open-source internet articles. Where relevant, links are provided.

Please also note that we cannot comment on individual cases without taking a proper history and conducting a full examination.

SO, HOW DANGEROUS IS IT to go windsurfing and kite surfing? Well, a quick search of the internet will throw up various reports of serious and even occasionally fatal events involving, in particular, kitesurfers.  However, these events are still rare and are no more frequent than other ‘dangerous or extreme sports’.

What sorts of injuries do we, as osteopaths and physiotherapists, see as a result of these now popular sports?

Here in Shoreham-by-Sea there is a particularly active group of surfers that range mainly from mid-teens to mid-fifty’s and who spend as much of their free time on the water as they can. Great fun with lots of adrenaline, wonderful exercise and what a way to get away from the mobile and other distractions!

However, where there is pleasure there is often pain and these sports are no exception. One of my best friends, who is almost messianic when it comes to windsurfing, tells me that he never has any injuries! Except, that is, for the bruised ribs caused by his harness as he came to a sudden stop recently, the neck strain and stiffness and foot and shin pain from doing too much for too long.

This is fairly typical from what I hear at the Adur Osteopathic Clinic and remember that those comments are from an experienced windsurfer!

Our Osteopathic and Physiotherapy Practitioners are frequently asked to help with treating injuries sustained while doing water sports such as windsurfing and kitesurfing.

NOVICES & LEARNERS typically suffer forearm muscle problems from gripping too hard until they learn to relax as well as shin and foot strains for much the same reasons.

Back strains from rigging and up-hauling tend to happen more in the early stages, but no one should be complacent about them as potential risks.

  • As is often the case, prevention is the better path to tread.
  • Take up Pilates to gain core strength and make you fitter before problems start.
  • To ease backache while sailing, try tilting you pelvis back and forth in the quieter moments.
  • Many of these problems can be overcome simply by practice and good coaching in the early days.

What are the common injuries in these sports?

Where I, as a Registered Osteopath and my colleagues come in is when it goes beyond a ‘bit of a strain’ and becomes a proper injury.

Listed below are some of the most common types of injury and where they occur on the body.



Filed under: AB'S PERSONAL VIEWS — Andy Bellamy @ 12:33 pm


Irony is quite difficult to define, but there is a form called situational irony and I think I have just become a victim of it.

I am now spending my third day recovering from acute low back pain. As an osteopath of 20-odd years, (and a back pain sufferer of over 30 years), I am aware that while my patient patients are expressing their sympathy to my face, what they are really thinking is ‘physician heal thyself’. If only life were like that, eh!

At work, on a daily basis, I hear the comment,

“But I just bend over to…….and my back went”.

So, I tilt my head, put on my best professional, but slightly patronising, voice and say,

“Well, it’s never actually that simple. What have you really been doing? How about a couple of days ago, for example? It always takes a day or so for things to swell up enough to cause problems.”


7:45 AM As it happens, that’s exactly what happened to me! I was ‘just’ walking to work and, out of the blue, my left lower back was suddenly sharply painful.

7:50 AM By the time I actually got to work, the pain was sufficient to make me bend forward at the waist, because if I didn’t, it made me catch my breath.

10:45 AM By coffee time, I was finding it difficult to feel my sympathy for my patients, let alone any empathy. Surely, my pain was much worse than theirs? I had started to tilt over to the right by then and maintaining a professional composure and osteopathically correct posture was starting to look comical.

All I wanted to do was get the weight off my feet. A vague but worrying ache had developed over the side of my left leg and into my groin. How am I going to work? What about my desperate patients? What about the credit crunch?

12:45 PM Time to cancel the afternoon list. Pass that task on to the staff and let them take the flack.

Now I can now hardly stand or put weight through my left leg.



June 29, 2008

Filed under: HEAD & NECK PAIN — Andy Bellamy @ 8:50 pm


Please note that the comments in this blog come from many years of clinical experience and practice, combined with details and opinions taken from various sources, including open-source internet articles. Where relevant, links are provided.

Here at the Adur Osteopathic Clinic, the Osteopathic and Physiotherapy Practitioners are frequently asked to help with treating the symptoms of Cluster Headaches.

This name might sound almost ‘cosy’; you know, collected together, cuddly and supportive!

However, this type of headache, (often wrongly called cluster migraine), is probably the most painful of them all. Sufferers describe absolute desperation and even suicidal feelings when enduring attacks. In my experience, the pain can even change the personality to the extent that normally patient, pleasant people can say the most awful things to their partners or anyone else nearby. If you are on the sharp end of the comments, cut them a little slack, please!



June 18, 2008

Filed under: HEAD & NECK PAIN — Andy Bellamy @ 10:17 pm


What type of person visits the Adur Osteopathic Clinic for advice on migraine?

It can be anyone, male or female, from children to the elderly.

Please note that migraine in children may not show as a headache and is often termed Abdominal Migraine, with symptoms including nausea, vomiting and loss of appetite and lasting anything from 1 to 72 hours.

Migraine headaches often begin in childhood or adolescence. According to some surveys, as many as half of all schoolchildren experience some type of headache. (more…)


April 29, 2008

Filed under: LOWER LIMB PAIN — admin @ 7:58 am

The Osteopaths & Physiotherapist at the Adur Osteopathic Clinic see patients with all sorts of aches and pains. One very common symptom that presents to us is heel pain.

This very painful condition is often caused by a condition called Plantar fasciitis, (also known as Policeman’s Heel or Heel Spur), and can really affect a persons work, sporting and social life.

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