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Shoulder Injury 101 - Page 3

post #61 of 78

@ jzamp.  Thanks for the links.  My physiotherapist taped it up for me, very similar to what your link shows (not exact).  The tape makes a lot of difference.

 

I went skiing, but only did lazy gs turns (most of them were lazy), nothing too strenuous.  Was very careful not to fall, not my usual style, but I was able to pull it off, once I got used to the GS radius (requires not getting too far inside- getting too far inside requires recovery that causes pain in separated shoulder) after being on the SLs for the last while.

post #62 of 78
Quote:
Originally Posted by tball View Post
 
Quote:
Originally Posted by Ghost View Post
 

Why would you want less pain meds post surgery  :confused?  I always enjoyed my pain meds :D.

 

Well, potential addiction, for one.   Being cognizant enough to actually enjoy a weeks worth of Netflix, for two.  And three, avoiding post surgery, um, constipation from the drugs... which I know of one case that was as painful as the surgery recovery. :eek

 

Shoulder surgery is a very painful recovery.  After a day on the hard stuff, my wife did fine alternating Tylenol and Ibuprofen because of the ice machine.   When she had to stop icing because of frostbite it was straight back to narcotics.


In my experience, Tylenol does nothing, even with lots of codeine.  Maybe it's because I have used cough medicine with codeine since I was a kid.   Aspirin does not do much either.  Morphine makes my daydreams seem more real and takes my mind of the pain.  Oxycodone, Oxycontin and the like (eg. percocets) actually diminish pain felt.  My MD friend has warned me about mixing Codeine and Jack Daniels (something I've done in the past), so though that might work, it's off my list.   Current injury, I'm sticking to Scotch.  Too bad it's not covered by my drug plan ;)

post #63 of 78
Partial tear of supraspinatus last jan. Steroid injection 9 mo later under fluroscopy. Pain free until this Feb. Follow up appointment tomorrow. Most likely need more PT and another injection. Been living life on NSAIDS but still skiing and do not care. This was all related to going head over tips in powder but hit something solid underneath. Thank god for helmets!
post #64 of 78
Quote:
Originally Posted by voghan View Post

I got a 3rd degree ac separation over a year ago. I skied on it the next day. It actually felt better holding poles. No surgery, nice bump on my shoulder that feels like its getting smaller. You can't make it worse by falling on it again.


Wrong, you can make it bad enough to require surgery. 

That "nice bump" on your shoulder is the only bone to bone connection between your entire arm and your skeleton... I don't need to explain why it would be bad to not have it anymore do I?

post #65 of 78
Quote:
Originally Posted by Ghost View Post
 

@ jzamp.  Thanks for the links.  My physiotherapist taped it up for me, very similar to what your link shows (not exact).  The tape makes a lot of difference.

 

I went skiing, but only did lazy gs turns (most of them were lazy), nothing too strenuous.  Was very careful not to fall, not my usual style, but I was able to pull it off, once I got used to the GS radius (requires not getting too far inside- getting too far inside requires recovery that causes pain in separated shoulder) after being on the SLs for the last while.


Lot's a different techniques, depends on what the therapist is most comfortable with and the actual condition of the joint.  :) 

post #66 of 78

I broke the bottom third of scapula in two and also snapped two ribs a couple days before Thanksgiving. Just finished my fourth week of PT. Trying to get my shoulder to function correctly is bear. I have about 80 percent of my flexibility and 10 percent of strength back. I'm still hoping to get on the slopes this season.

post #67 of 78
Quote:
Originally Posted by jzamp View Post


Wrong, you can make it bad enough to require surgery. 
That "nice bump" on your shoulder is the only bone to bone connection between your entire arm and your skeleton... I don't need to explain why it would be bad to not have it anymore do I?
The bump was from the fall. I saw a doctor, had xrays and he said I don't need surgery. I asked if falling again would make it worse. He said no. Its been a year now and it doesn't bother me at all. It hurt for a few weeks and I enjoyed a daily Aleve but I healed and it's all good.
post #68 of 78

I guess I do have to explain it

the bump is always there, it's where the collarbone meets your shoulder blade. It get's bigger when you have a separation because you tear some of the ligaments keeping them together.

Gravity pulls your arm down but not the collarbone, hence the bigger "bump".

If you fall on your shoulder again you risk tearing more ligaments/fibers. Same mechanism same result, only that now it's worse.

If you tear everything you risk the collarbone moving way to much. it may end up on top of the shoulder blade, in front of it, piercing the skin, and so on.
Given the amount of sensitive structures that are around that area, nerves, blood vessels, muscles, etc. you do NOT want that to happen.

At that point surgery might become the only option if good alignment cannot be maintained anymore.

 

Now this might have not been the case for you, I don't know... but for someone with a grade 3 separation it definitely is a possibility. Therefore, one should be advised accordingly.

post #69 of 78
Quote:
Originally Posted by jzamp View Post
 

I guess I do have to explain it

the bump is always there, it's where the collarbone meets your shoulder blade. It get's bigger when you have a separation because you tear some of the ligaments keeping them together.

Gravity pulls your arm down but not the collarbone, hence the bigger "bump".

If you fall on your shoulder again you risk tearing more ligaments/fibers. Same mechanism same result, only that now it's worse.

If you tear everything you risk the collarbone moving way to much. it may end up on top of the shoulder blade, in front of it, piercing the skin, and so on.
Given the amount of sensitive structures that are around that area, nerves, blood vessels, muscles, etc. you do NOT want that to happen.

At that point surgery might become the only option if good alignment cannot be maintained anymore.

 

Now this might have not been the case for you, I don't know... but for someone with a grade 3 separation it definitely is a possibility. Therefore, one should be advised accordingly.

You don't need to explain anything.  I've seen the xrays, there aren't any ligaments holding onto the shoulder anymore.  The shoulder blade was fine.  Since this fall I've taken a few good ones on my mtb bike and it hasn't been re-injured.  Maybe you're a nurse or something but I trust my doctor, I went to a specialist.  He said my only limitations would be in lifting weights.  No more bench presses for me.  Maybe my build helped me with this injury but I can say 14 months later i'm fine.  No PT, no surgery but I avoided standing for long periods of time and rested my arm whenever sitting.  I fell on my first day on my trip to Big Sky and I wasn't going to sit out the trip.  I took advil and aleve and skied the next two days.  Once home I took a week off but still skied almost every weekend after that.  Here is a picture of my xray.  So yeah, I know exactly what I did.

 

post #70 of 78
You saw ligaments on the x-ray uh? Interesting...
Maybe you missed the part where I said "this might have not been the case for you" but I'm talking in general, not your specific injury, which I never evaluated, seen, or dealt with...

Anyway, here's a visual help that shows the different levels of separation
sd_rockwood_classification.jpg

"Grades 4 to 6 are treated surgically"
http://thesteadmanclinic.com/shoulder_acseperation/overview.asp
post #71 of 78
Quote:
Originally Posted by jzamp View Post

You saw ligaments on the x-ray uh? Interesting...
 

Maybe you missed the part where I said "this might have not been the case for you" but I'm talking in general, not your specific injury, which I never evaluated, seen, or dealt with...

Anyway, here's a visual help that shows the different levels of separation


"Grades 4 to 6 are treated surgically"
http://thesteadmanclinic.com/shoulder_acseperation/overview.asp

 

yeah...  thought the same.  Question: why hasn't there been an MRI ordered  (sorry if I missed that) ?  

post #72 of 78
Quote:
Originally Posted by Finndog View Post

Quote:
Maybe you missed the part where I said "this might have not been the case for you" but I'm talking in general, not your specific injury, which I never evaluated, seen, or dealt with...


Anyway, here's a visual help that shows the different levels of separation



"Grades 4 to 6 are treated surgically"
http://thesteadmanclinic.com/shoulder_acseperation/overview.asp

yeah...  thought the same.  Question: why hasn't there been an MRI ordered  (sorry if I missed that) ?  
Most AC joint separations do not warrant an MRI because the treatment is basically the same. Only for severe ones where surgery is needed an MRI might be requested.
post #73 of 78
Quote:
Originally Posted by jzamp View Post


Most AC joint separations do not warrant an MRI because the treatment is basically the same. Only for severe ones where surgery is needed an MRI might be requested.

THANKS!  good to know.  Would you want to R/O tears (like ligaments) or other damage that cannot be seen on film? 

post #74 of 78
Quote:
Originally Posted by Finndog View Post

Quote:
Originally Posted by jzamp View Post

Most AC joint separations do not warrant an MRI because the treatment is basically the same. Only for severe ones where surgery is needed an MRI might be requested.
THANKS!  good to know.  Would you want to R/O tears (like ligaments) or other damage that cannot be seen on film? 
A few special tests and a good history will be more than enough to diagnose it, the ligaments tear in progression so no real "need" to see them.
post #75 of 78
Quote:
Originally Posted by jzamp View Post


A few special tests and a good history will be more than enough to diagnose it, the ligaments tear in progression so no real "need" to see them.


If it were me, I may want MRI documentation especially if the tear becomes worse requiring surgery, then requiring rehab prompting use of short term disability.

post #76 of 78
Quote:
Originally Posted by thekidd326 View Post
 
Quote:
Originally Posted by jzamp View Post


A few special tests and a good history will be more than enough to diagnose it, the ligaments tear in progression so no real "need" to see them.


If it were me, I may want MRI documentation especially if the tear becomes worse requiring surgery, then requiring rehab prompting use of short term disability.

 

 

Quote:
Originally Posted by jzamp View Post

Most AC joint separations do not warrant an MRI because the treatment is basically the same. Only for severe ones where surgery is needed an MRI might be requested.
post #77 of 78
Don't forget the OP is in Finland. His insurance may have different standards about when expensive imaging is allowed.
post #78 of 78
If anything it would be a lot cheaper for him compared to the avg US cost
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