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Anyone else dislocate their shoulder skiing? - Page 3

post #61 of 87
Heh. I remember those little victories, too. Keep 'em coming!

Question for you dislocators... I'm about 10 months into this... had a setback three months after the original accident that put me back in the immobilizer for several weeks and so set the dislocation rehab back to ground zero.

I have much of my range of motion back and, while still relatively weak, am making gains in that area. However, it's still SO STIFF. Almost every time I move that arm I can feel the stiffness in that joint. It's not arthritic pain or anything like that, just a subtle stiffness that won't go away which increases significantly after any kind of exercise. And, there's still some numbness - the doc warned me that because the dislocation was so serious and stayed out for as long as it did that I would likely have some nerve damage, perhaps permanent. That's annoying but the stiffness is a real drag.

Does the stiffness ever go away or is this just something I'm going to need to learn to live with?
post #62 of 87

Mountaingirl

Get the surgery! I own my own PT practice just outside of Boston. I can tell you that it will never be the same. Once maybe, twice dislocated after 10 months no. They do some amazing things now and you won't have to worry about it after.
post #63 of 87
Thread Starter 
Sorry to hear of your setback, mountaingirl. My experiences may be unique, so take them for what they are worth. Stiffness: still present after three months, especially after waking in the morning and after setting in the office all day. I do rehab exercises both in the mornings and evenings to alleviate the stiffness. Numbness: went away after about two months. I had an area around the top of my humerous that was numb, but now feels normal.

I still recall the humeral tuberosity fracture I had in 1992 that seemed to take years before it felt 100%. Therefore, I'm expecting this dislocation recovery to take some time before everything is healed.

Mark, that was a great progress report. I know what all those milestones feel like. As Samurai stated, I have been fortunate enough not to fall again this season, so things continue to improve daily.

I wish everyone here a speedy recovery with no setbacks.

Duane
post #64 of 87

6 Weeks out and doing good

This Saturday (March 28th) will be 6 weeks for me, and I agree with Mark- it's the small victories like driving 2 handed or reaching up for things. The constant dull ache and pain in the shoulder from working out is getting old that's for sure. I am still in PT three times a week and per my visit today am about 80%. I have been able to ski for a couple weeks now, although my orthopedic said I was only to ski with the kids (3.5 and 6.5) in order to keep me in check. I quickly disobeyed this and had a good couple adult ski days last week even got in some slalom training by cross blocking with my right hand only. All in all it's not that bad now, but I have worked hard at home and in PT to get it back. In the words of a good friend this past weekend "you ski pretty good for someone who is hurt" which was good to hear- apparently he didn't notice my lack of solid left pole plants!! :
post #65 of 87
I hear you, samurai. But I'm not quite willing to accept the no-fall rule as a given. I've read your story and it sounds pretty awful with the tendency to re-dislocate if you just move it the wrong way or roll over wrong in bed.

In my case, my doctor says he doesn't think I'm at any increased risk of future dislocation (compared to never having dislocated before). The bone broke, so the ligaments didn't get stretched. He's supposedly the best shoulder guy in the Vail/Summit region, so I tend to trust his judgement. He told me that if I fall, just try to cover/center my arms rather than reach out. He didn't tell me to avoid falling at all costs. He did say that if I fell wrong, it would probably hurt bad. :

Not that I like the idea of falling. But I think that skiing with a mindset of "If I fall at all, I'll be badly injured" would cause me to ski fearfully, in an unhealthy tension. That could set up its own bad outcome. I don't want to look at a steep or a bump run and fear trying it because I might fall. Even on the groomed, skiing with a "don't fall" mindset could put a constant background fear/stiffness into background consciousness, rather than a flow state with positive visualizations. I do need to accept the limitations of my current ability, and be mindful of how far I go outside of my comfort zone. But if I'm going to carry fear of falling with me from now on, I might as well stop skiing. I'm not willing to do that.

Having received an award at last year's ESA for "some incredible diggers" I think I have to be willing to push my limits, too. I'm just speaking for myself. Everyone's perspective, limits, medical advice, and adjustments based on injury history is going to be different.

In some ways, I think I need the first time I fall and do not get hurt, as a milestone in recovery. Not that I'm going to go looking for that...

I will attempt to avoid "stupid snow" in the future - the spots that make me do something stupid.
post #66 of 87
Quote:
Originally Posted by mountaingirl1961 View Post
Almost every time I move that arm I can feel the stiffness in that joint. It's not arthritic pain or anything like that, just a subtle stiffness that won't go away which increases significantly after any kind of exercise. And, there's still some numbness - the doc warned me that because the dislocation was so serious and stayed out for as long as it did that I would likely have some nerve damage, perhaps permanent. That's annoying but the stiffness is a real drag.

Does the stiffness ever go away or is this just something I'm going to need to learn to live with?
hey mg,

I'm not far enough in rehab yet to know if it goes away totally. Recently my PT started some deep tissue massage, and that seemed to make a significant difference, everything felt loosened up. "Broke up a lot of junk in there." There might be scar tissue and various junk from the injury - you might want to check with your doc and/or PT about what might help.

I was lucky with the numbness; pretty much all gone as of a few weeks ago. Definitely had it for a while though, along with some loss of strength. Has the numbness gotten any better, even if slowly? Or is it pretty much where it was all along?
post #67 of 87
Hey MG. The stiffness does go away, but range of motion may be limited forever. That fluctuates per person, imo. But nowadays, if I'm sore it's because I have NOT been working out. My muscles get weak, soft and the ligaments then need to work extra hard to support my shoulder... this causes fatigue and pain. Now... I consider that pain as a warning sign to get the daily rehab back up to 20 minutes a day. sometimes I take a week or so off just to relax and lay on the couch, by the end of that week-long break from rehab, my shoulders will start aching. But in all honesty, we need breaks from working out. Even pro athletes take time off from exercising. Exercising everyday really isn't all that feasible. Hopefully you will start to discover how you can control that ache and pain via (light) exercise.

And Mark... I completely hear you about not wanting to give up the falling in fear of actually becoming a panzy. Perhaps I'm not articulating myself very well on this. Let me try again.

Not falling is a state of mind. A confidence so strong that falling is not an issue. Sure, I tip-over some times, but those highspeed tumbles from 'experimenting' with something new have ceased. I still do new tricks, etc... I just don't 'try' them. I have developed the ability to know before the motion whether or not it will work. I no longer say; "Hmmm... this 'might' work." I have grown to understand my limits. And in all humble honesty, I actually rip much harder now than I used to before my series of injuries. (Which really rekindles the Pipe-dream of IFSA Big Mountain events.) If only I would have had this attitude before my injuries, when I was competing, I would have been taking the crown. (I don't compete now or rechase my dream because frankly, I don't need to.)

So don't misunderstand my No Fall rule as backing away from being aggressive. Just learn to accept how over-aggression will get you hurt and then result in even more time re-gaining confidence and re-learning how to rip. That 120 foot air may be too aggressive for the landing and snow conditions... accept it. Stomp the 80 footer and ski on confident in your decisions to have the bravery to back away when it just might be too big. I completely understand one's need to test himself. Just don't sit down and try to take a test in a subject that you have never studied in hopes that you may prove to yourself that you actually have the knowledge from some miraculous force. Just because you know the answer doesn't mean you have the intelligence to prove the theorum. Trial and error is not a way to progress in the long-term. Trial and error is something teenagers do until they learn that injuries actually last more than a week.

anyway, I get all hyped up over this new attitude that I have developed, forgive me. But I will compare it to solo climbers' confidence in not falling off the rock. They haven't stopped being aggressive, they just stopped falling.
(okay, no arguments about Dan Osman or any other unfortunate climbers please... you get the point, I'm sure.)
Anyway, rock on y'all. And to each his own... learn your body... chau...
post #68 of 87
Thread Starter 
Samurai,

I get what you are saying. I've had a great season so far despite my injury. I feel like I'm still ripping also. As mentioned before, I was fortunate in that I only spent 8 days away from the slopes after the dislocation. I probably didn't develop as many mental demons because of this short time off.

The day of my accident (powder covered moguls) I was skiing faster than my comfort zone, but because the bumps were soft I decided not to slow down. The fall happened before I even realized I was off balance. I have continued to ski bumps this season along with all other types of terrain...only now 100% of my ability is where I stop and I still have a great time and get the adrenaline rush we all chase.

Duane
post #69 of 87
A couple of years ago I had a freak fall at Wolf Creek, and landed, full force, right on the tip of my right shoulder. I stood in the trail moving it, and could move the arm fine while holding it below the waist, but to raise it above shoulder height hurt like craaazzzy!. I finished skiing out the day and also the next and came back home to NC. While sore for a couple of months, it reached a point where I eventually had to go to the orthopedist.

The Doc and I discussed how the injury happened, how it felt at the time of injury, what I did next, etc. I told him I'd continued to ski after the fall, and he got this crazy look ... I didn't come all that way for nothing! Finally the doc diagnosed that I'd actually had a broken arm: . I asked what I needed to do, and he said nothing ... it's pretty much all healed up by now, and said put your shirt on and I'll write a scrip for the pain and inflamation.

Right outside the door was the nurses station, and as the door closed behind him on the way out, I overheard him say to the nurses there," Y'all ain't gonna believe this ... this guy in here falls and breaks his arm skiing and continues skiing the rest of the day. What does he do then ... hell he goes skiing the next day too"!

To this day I still have problems with the shoulder. It clicks, and clacks like a rachet and my right arm\side is much weaker than the left, especially when lifting things over my head.

Bottom line is shoulder injuries are bad business, and take a looong time to heal up.
post #70 of 87
Quote:
Originally Posted by samurai View Post
That 120 foot air may be too aggressive for the landing and snow conditions... accept it. Stomp the 80 footer and ski on confident in your decisions to have the bravery to back away when it just might be too big.
Trust me, I'm not looking for 120 foot air, or 80 foot air either. Way too old for that. "Doctor, can I play the violin after the accident?"

Thanks for the insight - good thoughts.
post #71 of 87
Quote:
Originally Posted by MarkXS View Post
I was lucky with the numbness; pretty much all gone as of a few weeks ago. Definitely had it for a while though, along with some loss of strength. Has the numbness gotten any better, even if slowly? Or is it pretty much where it was all along?
It got better, and then stalled. As I said, the numbness is subtle... it's always there, but nothing too overt. Just annoying... more a reminder that things aren't healed up than anything. Every once in a while, like right now, it goes numb all the way down my arm into my hand, but that only happens about once a week. Wierd - like my arm has fallen asleep.

FWIW, ski=free and all, the setback wasn't another dislocation. I went over the bars of the bike (again)... landed on the same (and this time quite atrophied) shoulder, broke a rib and clavicle and helmet. No dislocation, though, which was to me an extremely encouraging sign. They put me back in the immobilizer for a few weeks which set back the improvement in strength and ROM from the dislocation to square 1.

So, at this point only the one dislocation, and I'm feeling pretty good that it's in the socket to stay given the good hard bang I gave it a couple of months ago. It's just so stiff, though.

My prescription for PT ran out and so I've been working on my own doing weights and aerobics and pilates as well as my normal panoply of recreation (backcountry skiing mostly, although back to easy biking and very easy climbing as of last week). Sounds from what you guys are saying like I should probably go see the doc again, though, and see what she says about getting more structured again.
post #72 of 87
numbness...

my hands go numb all the time in bed. Sleeping has been completely repositioned and is still something that requires "effort" 10years down teh road. sweet.

On a side note, I've got a buddy who blew his shoulder once. 4 years down the road and he has yet to move that arm.

thank your numbness.
post #73 of 87
Speaking of numbness and other nerve stuff: did anyone else have weird, almost tetanic, contractions of their biceps? Until about a week ago, I often got totally involuntary contractions buzzing away in my bicep. Not too strong, but very fast. Felt weird as all get out. Didn't hurt, just really strange and annoying.

Glad that's gone.
post #74 of 87
yes. in the bicep. they still occur and I have no idea how to treat them. I haven't even tried actually. They just last a few minutes, kind of irritating at the most.
post #75 of 87

Numbness, Twitching, Cycling, Confidence, etc..

I am enjoying reading everyones comments, progress and issues- it's reassuring to know that you/we all are experiencing similar issues- it keeps me sane to know others are having similar experiences and questioning the kinks and such.

Six weeks out and my bicep still is not 100% back to normal feel/touch. At times it feels toned like muscle should and at other times it's like jello. My PT says this is par for the course.

I also still have loss of sensation at various points such as tricep area and upper forearm, other times its A-OK. Tingling in the hand comes and goes but for the most part is improving and happens less frequently. I get muscle spasms/twitching upon occasion but nothing too significant. It's more a novelty than anything and does not last long to date. Hopefully that wont change!!

I have been cycling (road bike) on the wind trainer for a couple weeks in an upright position off the bars. I got out Wednesday for a group ride- just an easy 30 mile spin and could not believe the discomfort. Both on the bars, in the drop, or with my arm in the "immobilized" position and one hand on the bars it was unpleasant. Part of it I attribute to it being cold (42 and brisk wind) but the joint seemed to stiffen and then ache the entire ride. lots of numbness in my left hand (left dislocation) and forearm. Afterward on Thursday was very tender and sore but I am feeling OK today.

Confidence skiing has improved but is still not 100%. I was extremely tentative at first skiing only with my young children (3.5 and 6.5 yrs) No "adult" skiing and absolutely no ski racing. I slowly ramped up, but was tentative the first few times out and first few runs each time. Although we wrapped up the season this past weekend I was able to get out with some of the junior racers and really let em rip. Left handed pole plants were weak at best, but I had the ski up on edge pretty good (Booting out in a GS course caused my dislocation) and I was pretty comfortable with my form and getting that left hand out there. Slalom gates were OK, but strictly RH cross blocking cause I was too chicken to try with the LH.
I'm sure the first couple GS events next year will be a mental battle, but I look forward to getting back after it.

My PT has been doing ultrasound to break up any scar tissue which may have formed. This was fine at first but has become painful as of late. He explained this was due to the intensity of the ultrasound, and lessened it. It feels like a really deep dull and painful ache akin to a bone bruise.

All in all I'm doing good and have no complaints as it seems there will be no long term negative effects. I can't wait to just get back more of the day to day stuff without pain (shutting the car door, carrying a light grocery bag, etc).
post #76 of 87

Unstable shoulder

Part 1
I tore my rotator cuff and popped my supra spinatus in my l shoulder about 15 years ago. Trying to snowboard on the bunny run. I had an instructor with me. No one told me to not to sit down whith my arm down (to ease my butt to the ground. I shoulda known!) Any way I jammed my shoulder. I had a doc who did not do a good diagnosis. He missed the popped supra spinatus. Only gave me therapy... I didn't think that he was right... I shoulda gotten a 2nd opinion. I didn't discover it until part 2 with a new doc.

Part 2
Fast forward a 7 years or so. Trying a friends skis the bindings were not set to my boots.
Forward fall and landed in the 'Statue of Liberty' position. Dislocated shoulder this time. Ski chopped up my face a little. I popped the shoulder back in on the trail and skiied to the patrol shack. Showing the emt how I landed it popped out again. I wrestled it back in while the emt watched.
New doc found out that the supra s. was popped and had retracted. No way to do a repair by now. "Learn to live w/ it"

Shoulders are tough for operations. I didn't have one.
They have knees figured out pretty well but not shoulders.

Lots of therapy and it came back to a reasonable state. But only about 85% range of motion and strength. I have to humor it and be careful.

Part 3
So, of course, about 2 or 3 years after the first dislocation. New skis, first run of the season caught a shovel edge. Down I went headfirst in the Statue position again.
Shoulder out! Of course I did this in front of a group of people that I knew. Popped it back in (took a few minutes) and skiied off. Impressed a couple of folks in the group.

Currently
So that was about 2 or 3 seasons ago. I have been lucky to not land on it again. It is pretty good now still at 85% or so. I do everything I want to with that arm.
I'm 59 in May. I ski about 30 days a year teaching part-time in the East. Maybe I fall a 2 or 3 times a year.

Now my other joints... that is a much longer story.
I've been rode hard and put away wet. But I still keep up with a bunch of people a lot younger.

Heck, it's all fun!
post #77 of 87
Thread Starter 
Month 4 progress report:

It has now been four months since the injury. I was determined to continue skiing this season despite the accident and in doing so not fall again. As many of you have read, this strategy has been successful...until this past weekend at Whistler. While standing in the terrain park watching my buddy ride a rail, I lost my balance and fell on my shoulder. Since it happened so slowly, I made sure to keep the arm tucked by my side as I fell. I felt some pain, but nothing traumatic. Within a few minutes everything felt as before the fall. Not that I plan to fall again in the final weeks of this ski season, but it is nice to know that I'll probably be okay if I do.

The shoulder continues to get stronger and more mobile. I have stopped taking Ibuprofrin before bed as the shoulder is less painful at night now. About once every two weeks or so, I will make some reflex motion that causes me pain, but other than that I rarely notice the shoulder during the day. I am still cautious when lifting heavy objects, like a suitcase on my recent trip, but at least I am back to comfortably carrying my skis over the shoulder again. I slacked on my rehab routine while in BC but as of today am back to my permanent regemin. I hope everyone else is doing better also. Happy Healing.
post #78 of 87
Thread Starter 
Wanted to post an end of summer follow up on the shoulder. After the ski season ended in early May, I dusted off the road bike for my weelky summer training rides. Gripping the bars on the drops felt a little uncomfortable the first day, but after that bike riding was back to normal. No spills on the bike this summer. In June, looking for another activity to add to my summer rehab/fitness routine, I dug out my tennis racquet for the first time in over 10 yrs. As I had imagined, serving and hitting forehands with pace were felt in the shoulder for the first few days of practice. Since then I have been playing matches a couple of times a week and no longer experience any discomfort with any shots.

From a range of motion and strength standpoint, I'd say the shoulder is about 95% now some 9 months after the injury. This is actually somewhat better than I had expected based on other injuries I have survived and recovered from. I'm looking forward to the upcoming ski season and hope to have an injury free one (as I'm sure everyone else is). Snow is in the forcast for our mtns tonight!

I hope all who posted on this thread last season are healing as well.
post #79 of 87
no dislocations for me for the last couple of years. Now... just 7(?) more dislocation-free years to go and I believe I'll have replaced every cell in my body.

(I think it takes ten years for our cells to replace themselves in our body's entirety. Which explains why old people shrink.)

btw, keep up the therapy guys. I still do and it's key.
post #80 of 87
Update- 7 months post dislocation and doing great. Got back into the gym this week at the advice of my orthopedic to build overall core strength pre-season. (He says it can't hurt) Doing lots of stretching and light weights for now and will start with Yoga soon. Things have improved over the summer to the point where I don't even second guess it. Did some wheelbarrow work in the yard a couple weeks back and it hurt the next morning, but nothing I could not live with. Been doing the PT workout daily at home and stretching each morning too. Been on the bike alot, started to ride some cyclocross this past week and didn't hesitate at all. Longer road rides require sitting up and stretching but that is fine. Looking forward to getting back on snow and testing my mental ability to hang them out there in a race course to see how it goes.
post #81 of 87
One week after surgery now.

Surgery started as a normal arthroscope. Once inside, damage was waaaaay too bad and the doc (Metcalf in PC) opted for open joint surgery. Got a bone graft and 3" scar to show for it. Still on pain meds, and the whole joint feels as bad as when it is popped out, but some slooooow progress is being made. Ski season is likely gone, but it had to be done. Turn away if you are squeamish:

post #82 of 87
Quote:
Originally Posted by SJB View Post
Update- 7 months post dislocation and doing great. Got back into the gym this week at the advice of my orthopedic to build overall core strength pre-season. (He says it can't hurt) Doing lots of stretching and light weights for now and will start with Yoga soon. Things have improved over the summer to the point where I don't even second guess it. Did some wheelbarrow work in the yard a couple weeks back and it hurt the next morning, but nothing I could not live with. Been doing the PT workout daily at home and stretching each morning too. Been on the bike alot, started to ride some cyclocross this past week and didn't hesitate at all. Longer road rides require sitting up and stretching but that is fine. Looking forward to getting back on snow and testing my mental ability to hang them out there in a race course to see how it goes.

Be careful with your stretching. I know it's important your first year after surgery to prevent scar-tissue buildup and gain a full range of motion. However... a couple of years of stretching fairly mildly and one day I just blew my shoulder while stretching in my living room and found myself taking a 2 year step back. Now I really limit how much stretching I do and in which ways I stretch.

BTW... no matter how much you stretch, you may never have 100% pre-injury range of motion. For example, I'm nearly ten years down the road, have very fit shoulders and still don't have the ROM to paddle a surfboard or swim the butterfly. I don't expect I will either. As long as I can do normal exercise, ski, and not pop-out, I'm quite happy.

Shoulder surgeries change life styles.
post #83 of 87
I'm very late to this thread, but dislocated mine twice the season before last. Both were about a month apart at most. Took about 8 months before my right shoulder felt "good". To this day, I still only have maybe 90% motion. Probably more like 85%. Both times I was lucky and it popped back in immediately after dislocating, so I made it down under my own power, although very gingerly and had to ice and stay of skis for a few days.

Nearly two years later, I still wake up in the night from shoulder pains/numbness if I lay on it weird for too long. I guess that will never go away and it's not bad enough to even contemplate surgery.
post #84 of 87
Quote:
Originally Posted by Taylormatt View Post
Nearly two years later, I still wake up in the night from shoulder pains/numbness if I lay on it weird for too long. I guess that will never go away and it's not bad enough to even contemplate surgery.
the numbness still exists for me too.

as far as contemplating surgery is concerned, I'll repeat my previous advice;

Only take on a surgery if your injuries are significantly affecting your life. I recommend change in life styles before surgery. Surgery is VERY traumatic.

I think it may be time to consider surgery when you can no longer control it. If you wake up and it's out, consider surgery. If you reach up to the cupboard for a glass to pour your milk in, and you dislocate, you may want to consider surgery. But just because your shoulder fell out after you cartwheeled down a steep mountain after crashing at 30mph, that doesn't necessarily constitute a surgery. That constitutes stopping the life style of falling at 30mph.
post #85 of 87
9 months post-disloc & fracture, pretty happy with where I am. About 95% ROM back in most planes of motion, lots of times I don't even think about it. Some stiffness but not too bad.

The only real limit is when upper arm raised to shoulder level with elbow at 90 degrees, and then attempt to rotate back. I'm not describing this right but I'm the computer geek in the family, not the alignment/fitness guru. Imagine lying on your back on the bed, raising your partly-bent arms up over your head with the forearm settling back onto the mattress. I used to sleep that way all the time, but the left arm feels a tweak a bit before it can sink all the way back down.

But reaching up to the top cabinet shelf I don't even notice the shoulder most of the time. I can sleep on that side without any significant discomfort. I could do a good reaching pole plant (and ride the crazy slingshot lift) at Portillo a couple of weeks ago without problems. I haven't sensed any "about-to-pop" events. I did take one small fall at Portillo and didn't feel any fear about it. Granted it wasn't a crash-n-tumble like the original event. But when I started to go down it wasn't a "oh-my-gad-I'm-gonna-pop" feeling.

I was fairly good about PT, and then post-PT stretching. I also pushed myself to use that arm a lot just in everyday life, as soon as I could bear the pain: reaching to the upper shelf, using it to turn the steering wheel (hitting the extend and rotation together), carrying items with it. At a certain point I think the everyday usage helped more than the formal stretching exercise. Could be doing more with strengthening but that's a larger issue than just my shoulder.:
post #86 of 87
Quote:
Originally Posted by samurai View Post

as far as contemplating surgery is concerned, I'll repeat my previous advice;

Only take on a surgery if your injuries are significantly affecting your life. I recommend change in life styles before surgery. Surgery is VERY traumatic. .
Amen to that. Problem is, that by definition, a dislocation tears ligaments. Every time you re-dislocate, you do more damage to the bone (chipping and breaking of the ball and socket). Don't go too long or you end up like me (see pic above). Doc thinks there is still a 15% chance I will have to do a total joint replacement. Do not keep re-injuring it. I know.
post #87 of 87
Also a little late joining, but here goes:
Here's a list of my shoulder injuries to date:
1966: R shoulder dislocation while skiing. Kept arm in sling 6 week, no further dislocatons.
1977:R rotator cuff tear while skiing. Chronic pain, getting worse until surgically repaired (open) 1992. Successful recovery from surgery.
1999:grade 1 AC (acromio-clavicular) separation going over bike handlebars on pavement. Arm in sling several weeks, shoulder back to normal in about a year.
2006: Chronic rotator cuff tear L shoulder, repaired surgically (just getting old, I guess). L shoulder is now normal.
By open, I mean non arthroscopic. I work as a surgical assistant, specializing in shoulder surgery, and my bias is to avoid the arthroscopic route. This is not to say that that is not a good way to go, just that it is not my preference.
If I have any advice, it is: 1. If you hurt your shoulder, it probably won't get better by itself. Get professional attention. 2. If you need surgery, get it from someone who speciallizes in shoulders.
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