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View Full Version : OT- what specialist for shoulder injury


zennmotion
08-13-2014, 04:10 PM
OK so I'm stupid, my shoulder popped out of joint while surfing (:eek:) last Summer getting rolled up the beach that I had no business venturing from. I shook it off (or rather, back in) and thought it was OK. Wrong. I've dislocated it on a monthly basis since, often from nothing more than reaching in the wrong direction (like pointing to my PowerPoint screen during a major business presentation- that was interesting having to explain a sudden expletive and writhing in pain in front of clients for no apparent reason) Anyway, I gotta deal with it. So my insurance options for a first visit are for an orthopedist or chiropractor. Which discipline should I choose? Does an ortho understand anything beyond surgery? Can a Chiro provide a good diagnosis and know the limitations of therapy? I've never had a joint injury so I'm totally ignorant as to where to start. Thanks in advance.

gasman
08-13-2014, 04:24 PM
I'd see an orthopedic surgeon that specializes in upper extremity surgery, preferably one who has done an upper extremity fellowship. Yes, I did say surgery.You almost certainly have a torn rotator cuff. There are just four small tendons and some connective tissue holding the head of your humerus in the glenoid socket, there isn't much there when you see it repaired during surgery. With your shoulder dislocating so easily aggressive physical therapy may help strengthen your shoulder but you could easily need surgery to really repair the damage. I'm not sure that a chiropractor would be able to help as manipulation alone is probably not going to do much.
A good surgeon will help you get PT first if you want to avoid the knife but will be there if you need them.
Good luck.

Ken Robb
08-13-2014, 04:41 PM
Dr. gasman knows this stuff.

12snap
08-13-2014, 05:09 PM
Having dislocated my shoulder a few years ago, I 2nd gasman's recommendation to see an orthopod. With as frequently it's happening, I would expect the recommendation will be for surgery. Extensive PT will help but I think you would still be pretty susceptible to it popping out again.

firerescuefin
08-13-2014, 05:28 PM
Opinions are like.....But,

I'd also consider a DO Orthopod that is open to stuff like Platelet Rich Plasma....not that it's a panacea, but I...as well as others have had great success treating shoulder and knee issues (that are not full tears) with PRP.

malcolm
08-13-2014, 05:29 PM
I'd see an orthopedic surgeon that specializes in upper extremity surgery, preferably one who has done an upper extremity fellowship. Yes, I did say surgery.You almost certainly have a torn rotator cuff. There are just four small tendons and some connective tissue holding the head of your humerus in the glenoid socket, there isn't much there when you see it repaired during surgery. With your shoulder dislocating so easily aggressive physical therapy may help strengthen your shoulder but you could easily need surgery to really repair the damage. I'm not sure that a chiropractor would be able to help as manipulation alone is probably not going to do much.
A good surgeon will help you get PT first if you want to avoid the knife but will be there if you need them.
Good luck.

This

I will say its unusual for a first dislocation that was bad enough to destroy the joint to be self reduced, but if you are truly dislocating at will this will certainly need to be surgically repaired. As gasman says an orthopedist that is fellowship trained and a significant percentage of his practice should be shoulder.

malcolm
08-13-2014, 05:32 PM
Opinions are like.....But,

I'd also consider a DO Orthopod that is open to stuff like Platelet Rich Plasma....not that it's a panacea, but I...as well as others have had great success treating shoulder and knee issues (that are not full tears) with PRP.

If they are practicing board certified orthopedists it doesn't matter if they are DO or MD, the only difference is the medical school training and that is more alike than different today.

Plasma injections will not help a destroyed joint. If it's dislocating just by reaching up or out and he can move it around and relocate it the joint is completely shot as gasman said.

firerescuefin
08-13-2014, 05:39 PM
DOs seemed to be more open to PRP as a solution. Many MDs won't even talk about it. I've had partial tears in my knee and shoulder that I had great success with PRP. If you are looking at getting a second opinion (or a first) and are hoping to avoid surgery, I'd recommend looking into it. You're not burning any bridges.

Pretty hard to diagnose a joint over the interwebs .....just sayin

I will add, I've worked with some wonderful Orthopedic surgeons....just saying that there may be other options out there.


If they are practicing board certified orthopedists it doesn't matter if they are DO or MD, the only difference is the medical school training and that is more alike than different today.

Plasma injections will not help a destroyed joint. If it's dislocating just by reaching up or out and he can move it around and relocate it the joint is completely shot as gasman said.

malcolm
08-13-2014, 05:53 PM
DOs seemed to be more open to PRP as a solution. Many MDs won't even talk about it. I've had partial tears in my knee and shoulder that I had great success with PRP. If you are looking at getting a second opinion (or a first) and are hoping to avoid surgery, I'd recommend looking into it. You're not burning any bridges.

Pretty hard to diagnose a joint over the interwebs .....just sayin

I will add, I've worked with some wonderful Orthopedic surgeons....just saying that there may be other options out there.

If it dislocates at will and that is a big if that joint is destroyed. It requires a great amount of force to dislocate an intact uninjured shoulder and is often difficult to reduce one that is only minimally injured. I'm assuming what he is stating is correct and it is truly dislocating. I've seen many folks that thought their shoulder dislocated when it didn't. If what he is saying is correct as someone that has reduced probably a 1000 dislocations the joint is toast...just saying

I will agree this is all just talk with out actually examining him and a visit to an orthopedist DO or MD is certainly warranted.

gasman
08-13-2014, 06:02 PM
DOs seemed to be more open to PRP as a solution. Many MDs won't even talk about it. I've had partial tears in my knee and shoulder that I had great success with PRP. If you are looking at getting a second opinion (or a first) and are hoping to avoid surgery, I'd recommend looking into it. You're not burning any bridges.

Pretty hard to diagnose a joint over the interwebs .....just sayin

I will add, I've worked with some wonderful Orthopedic surgeons....just saying that there may be other options out there.

Osteopaths or DO's have the same training as MD's but receive additional training in manipulation like chiropractors. There are a couple DO's in our group of 48 anesthesiologists.
A number of orthopods I work with have been using PRP but they are using it less frequently. The more recent larger studies have not been able to show a big benefit with PRP and this is also what they have found clinically. It's expensive and many insurance companies don't cover it but there is little risk to the procedure itself.
Do go see a doc in person.

firerescuefin
08-13-2014, 06:03 PM
If it dislocates at will and that is a big if that joint is destroyed. It requires a great amount of force to dislocate an intact uninjured shoulder and is often difficult to reduce one that is only minimally injured. I'm assuming what he is stating is correct and it is truly dislocating. I've seen many folks that thought their shoulder dislocated when it didn't. If what he is saying is correct as someone that has reduced probably a 1000 dislocations the joint is toast...just saying

So, what bridge is he burning going down a more conservative route and seeking a second opinion before choosing to have surgery. I have known of quite a few cases where surgery was the "only viable option" where it wasn't the only one and people came out the other side very happy and very functional.

I haven't reduced 1000 dislocations, but I am a paramedic with a reasonable understanding of physiology and kinesiology. I have had 2 back surgeries included a multi level disc replacement. I have 2 hip scopes and a knee scope. I've also interviewed Orthopods and docs during my own treatment saga that viewed life and medicine through a straw. It took me a minute to figure out to find someone else. The guy that did my back was one of the 2 best surgeons in the world for the procedure. The guy that did my hips allowed me to sit in and watch 2 of them being done, and we exhausted other means before I made the choice for surgery.

I don't take away from you whatever expertise you bring to this conversation, but I would prefer you weren't so quick to discount the opinions of others if there may be some merit.

Good luck to the OP. I hope you get your wing fixed!

FlashUNC
08-13-2014, 06:14 PM
Ortho is your best bet. The ones I've seen don't choose surgery as a default, and tend to err conservatively, knowing what kind of impact surgery can have.

For my elbow, surgery was a must. For my knees, far less drastic measures were needed.

malcolm
08-13-2014, 06:16 PM
So, what bridge is he burning going down a more conservative route and seeking a second opinion before choosing to have surgery. I have known of quite a few cases where surgery was the "only viable option" where it wasn't the only one and people came out the other side very happy and very functional.

I haven't reduced 1000 dislocations, but I am a paramedic with a reasonable understanding of physiology and kinesiology. I have had 2 back surgeries included a multi level disc replacement. I have 2 hip scopes and a knee scope. I've also interviewed Orthopods and docs during my own treatment saga that viewed life and medicine through a straw. It took me a minute to figure out to find someone else. The guy that did my back was one of the 2 best surgeons in the world for the procedure. The guy that did my hips allowed me to sit in and watch 2 of them being done, and we exhausted other means before I made the choice for surgery.

I don't take away from you whatever expertise you bring to this conversation, but I would prefer you weren't so quick to discount the opinions of others if there may be some merit.

I'm not saying second opinions or more conservative routes shouldn't be explored. We haven't even established if he is truly dislocating, but if he is dislocating and relocating as easily as he suggests some things just are what they are and this is one of them. To fix a shoulder in the shape he describes will require surgery.
Not trying to be argumentative and I appreciate your position, but I don't think you understand how damaged a shoulder has to be to just fall in and out of place. I apologize if it seemed as if I was discounting you or your opinion. Differing opinions is what makes this place great.

zennmotion
08-13-2014, 06:21 PM
Thanks Drs. Gaz and Fire (get it? I crack myself up sometimes:p) I'll look for an Ortho shoulder specialist and check in with another or a DO if the conversation goes straight to surgery. I don't know if "it's completely shot"- that doesn't sound good, but the original surfing injury didn't seem that bad, the arm was overextended in front of me as I broke my momentum in the surf and shoulder popped for about 10 seconds or so, not much pain after it popped back in, but of course the multiple recurrences from reaching back or out are painful until it's relocated, then just a bit sore for a day. Unfortunately it's the left arm, so no more hooking the back of taxicabs :no:, my morning bike commute takes more time now (kidding) Got what I need now for first steps, thanks again everyone.

firerescuefin
08-13-2014, 06:22 PM
I'm not saying second opinions or more conservative routes shouldn't be explored. We haven't even established if he is truly dislocating, but if he is dislocating and relocating as easily as he suggests some things just are what they are and this is one of them. To fix a shoulder in the shape he describes will require surgery.
Not trying to be argumentative and I appreciate your position, but I don't think you understand how damaged a shoulder has to be to just fall in and out of place. I apologize if it seemed as if I was discounting you or your opinion. Differing opinions is what makes this place great.

Thanks for that :)

paredown
08-13-2014, 06:49 PM
FWIW, I had a second hard fall on my shoulder a couple of years ago. It had already been dislocated, and more or less healed up leaving my right shoulder quite a bit lower than the left when I was still racing.

So like the idjit I am, I ignored it a second time, until I was having trouble doing anything that required power from my shoulder, like driving screws etc, and I had lost a lot of range of motion. And it clunked and was causing me a lot of pain.

Finally went to the local orthopod who specializes in sports injuries.

After making bad jokes about how farked up it looked, he said clearly that "surgery was a last resort" (music to my ears) and referred me to the Physio that shares his office space.

Although it started off seeming a little lame, she had me doing the usual range of motion stuff, and ice/heat after. I can't remember the number of visits (6? 8?) but I did the daily exercises religiously on my own as well. Not only did the new injury damage clear up, by the time we were done, my shoulders are almost level (after 40 years of not being so) and barely clunk.

So put this down as a long-winded plug for second opinions and surgery as a last resort.

shovelhd
08-13-2014, 07:14 PM
Two orthopedic specialists that I saw when I separated my shoulder (grade 3, one tendon left) were cyclists. One races in my age group, and the other races women's pro. Both said shoulder surgery is not only the last resort, its the least effective and most risky surgery they do. 50% success rate, and if you fall on it again, it's all over. Not worth it.

I did the full PT thing, with a PT who was also a cyclist. That got me my full range of motion back. Once that calmed down I hit the weights over the winter, gradually adding weight every two weeks so that now I can lift the same amount of weight as before the injury.

Today the only residual is a small knob on my shoulder and the scar tissue from the bicep tear. This was the second time I tore it. The first time I tore it...you guessed it, getting rolled while surfing in Maine.

mgm777
08-13-2014, 07:41 PM
Zenmotion - I had my shoulder joint partially replaced three years ago. Went into surgery thinking it was just going to be an arthroscopic procedure only. Once in, the Doc realized the damage was much worse than the pre-surgical imaging revealed, so I ended up having the scope and a partial joint replacement. My doc is an Ortho who specializes in shoulders, primarily. He was not overly eager to jump to a surgical solution when I had my first office visit. He informed me that conventional wisdom is changing on routine shoulder surgery. He said the current research indicates that nearly 50% of all shoulder surgery patients report either "no improvement" or worse, after surgery. For me, he advocated PT, Chiro, and Massage therapy first, with surgery as a last resort. I did all that and still ended up in the OR. I can attest, first hand, that shoulder surgery sucks. Knowing what I know now, I would do as my doc advised, and try whatever non-surgical therapies you're comfortable with first to gain some relief. If unsuccessful, go see your Orthopedic surgeon who specializes in shoulders. Fortunately, in my case, the outcome was positive. I now have nearly 100% strength and mobility restored to my shoulder. Most important, I am now able to sleep soundly through the night again, without pain. My two cents.

chismog
08-13-2014, 08:13 PM
Ortho.

Don't mess around. If it has already happened a bunch of times it will happen again. You can dream it's gonna get better but it won't. :(

The good news is that the surgery works. :)

moose8
08-13-2014, 08:18 PM
Where are you located? People might have good suggestions for specific people to see.