Adur Osteopathic Clinic Blog

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.

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.

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 - 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.

HOW TO GET SOME TIME OFF WORK

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………

Andrew