Shoulder Dislocation - Mountain Buzz
 



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Old 01-20-2013   #1
 
Placerville, California
Paddling Since: 2010
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Shoulder Dislocation

I know it's been discussed but I was hoping for some advice... I dislocated my shoulder a couple of weekends ago and just got my official diagnosis: posterior labral tear (a.k.a. posterior bankart tear). The doctor doesn't recommend surgery, saying that physical therapy should be sufficient. He also says it's very unlikely to happen again. However, I'm not sure how much to trust his advice.

My reservation is this. He doesn't know a thing about kayaking. When I told him kayakers were prone to shoulder injuries, he was genuinely surprised. It sounds to me like they largely base their recommendations on your age and the type of activities you do. So should I seek a second opinion? What am I supposed to look for in a doctor? This guy is a sports medicine orthopedist specializing in shoulders in WA so I would have thought he'd know something about this...

Also, are kayakers more prone to dislocating their shoulders forward or out the back? Because mine came out the back, which is apparently pretty rare for the normal population. Is that rare for paddlers too?

PS: I'm posting this on Boof and Professor Paddle too for specific recommendations on doctors on the West Coast.

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Old 01-20-2013   #2
 
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Eagle, Colorado
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Anterior dislocations >>>>>> Posterior dislocations. With that said, it's fairly common in kayakers. If you have a significantly torn labrum I would recommend you fix it. Even with rotator cuff strengthening exercises, you are still lacking the architecture that gives the joint it's innate stability.

I had a 6-12 o'clock posterior labral tear from 1998-2003, at which time it got so bad that I couldn't paddle class 5 anymore b/c I was a liability to myself and my buddies. I never had any full dislocations, just 10-15 subluxations, but it was so unstable that I could feel it slipping if I grabbed the milk out of the fridge the wrong way.

Surgery was a piece of cake. Underwent an arthoscopic bankhart repair with glenoid capsule reduction (controversial). It's been stable since 2003. No dislocations. No instability. No decreased ROM.

I was in PT within a week and had the sling off at 3 weeks. I was able to get in the pool/hot tub at 1 month and I was back on the water at 3 months. I did PT 3x/week from 7 days post-op to 3 months.

Good luck man. Try and talk your anesthesiologist into giving you a brachial plexus block on the day of your surgery to help with pain. The pain pumps that ortho's were using back in the day are no longer used (they were being put into the joint off label and have been connected to intra-articular cartilage damage).

There are a few ortho residents on here that could shed more light. Ortho's not my field of expertise by any stretch of the imagination.
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Old 01-21-2013   #3
 
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Originally Posted by GAtoCSU View Post
I had a 6-12 o'clock posterior labral tear from 1998-2003, at which time it got so bad that I couldn't paddle class 5 anymore b/c I was a liability to myself and my buddies. I never had any full dislocations, just 10-15 subluxations, but it was so unstable that I could feel it slipping if I grabbed the milk out of the fridge the wrong way.

Surgery was a piece of cake. Underwent an arthoscopic bankhart repair with glenoid capsule reduction (controversial). It's been stable since 2003. No dislocations. No instability. No decreased ROM.

I was in PT within a week and had the sling off at 3 weeks. I was able to get in the pool/hot tub at 1 month and I was back on the water at 3 months. I did PT 3x/week from 7 days post-op to 3 months.

Sorry, I don't mean to thread jack, but this is the exact situation I am currently dealing with. I have had a posterior labral tear since 1999 before I started kayaking and it has continued to get worse over time. It slips quite often when I roll, and actually dislocated while upside down in #6 a couple seasons ago.

I guess what I am curious about is where you had this surgery done, and if it was covered by your insurance. If not, what did it cost you? I do not have health insurance, but this procedure sounds like just what I need.

Thanks
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Old 01-21-2013   #4
 
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It was covered by my medical insurance. The big deal there is having an acute injury on top of a chronic condition, which make the injury more significant now and it needs to be treated. I had the surgery done in Georgia by a younger ortho doc that did a fellowship in shoulders and was about 5 years out of training.

Without insurance you're prob looking at $10,000 or something to get it done. Mine was out patient at a surgical center. No idea what the "negotiated" price would be once you get hit with those bills. PT is about $90/visit without insurance.
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Old 01-21-2013   #5
 
Join Date: Apr 2006
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If you have employer insurance and they have open enrollment (I.e ability to switch plans each year) closely investigate surgical and pt costs/limits of each plan. I had access to one plan with cheap surgical copays but only about a months worth of pt. I scheduled surgery for end of the year and then switched to a second plan with awful surgical benefits but unlimited pt on jan 1.

If none of that applies, fall is a good time for minimal paddle/ski disruption. You can usually ski by feb. and start easy paddling by summer.
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Old 01-21-2013   #6
 
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Rare indeed... what was the mechanism? Were you kayaking or doing something else?

Refer to my post from previous discussion on the buzz... https://www.mountainbuzz.com/forums/f...tml#post284102

To save a ton of flack: I would amend my prior-post in regards to labrums and stability...... while labrums are a factor in shoulder stability, is a lesser slice of the stability pie than the rotator cuff. Any how it really depends on how bad of a tear and how the rest of your shoulder is able to compensate. Most evidence based algorithms recommend 6 months of PT before surgery regardless... and if still not improved... then surgery. Many on the forum have had labral repairs and have had improved stability...however I am willing to guess (I could be wrong) few on the buzz have had a posterior labral tear or a posterior dislocation.


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Old 01-21-2013   #7
 
Placerville, California
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Thanks for the responses so far! I was indeed kayaking, although I'm not quite sure how it happened. I was upside down at the time. I think it could have been any number of things but I suspect it might have been an impact dislocation when I got a wee bit intimate with a rock (the doctor agreed it seemed like an impact thing). But my paddle could have also just gotten caught up on some rocks and pulled it out. I don't know. Needless to say, my shoulder just plain didn't work when I tried to roll so I got out. It went back in after I got to shore and was trying to figure out why my arm didn't work.

I'm definitely going to start the physical therapy regimen and give it all I've got. I love kayaking too much to not do so. But I also just want to explore the surgery option a bit further because I don't want this to follow me around for my whole life.

Burnor, I'm also wondering just how common posterior tears are for kayakers. Because, if posterior tears are equally rare for paddlers, then I don't feel as susceptible to re-injuring myself because my shoulder is weak in a way that isn't normally prone to injury for kayakers... Does that logic seem right? Or does it even make sense?
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Old 01-21-2013   #8
 
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Originally Posted by burnor View Post
Rare indeed... what was the mechanism? Were you kayaking or doing something else?

Refer to my post from previous discussion on the buzz... https://www.mountainbuzz.com/forums/f...tml#post284102

To save a ton of flack: I would amend my prior-post in regards to labrums and stability...... while labrums are a factor in shoulder stability, is a lesser slice of the stability pie than the rotator cuff. Any how it really depends on how bad of a tear and how the rest of your shoulder is able to compensate. Most evidence based algorithms recommend 6 months of PT before surgery regardless... and if still not improved... then surgery. Many on the forum have had labral repairs and have had improved stability...however I am willing to guess (I could be wrong) few on the buzz have had a posterior labral tear or a posterior dislocation.


~B
Full abduction with external rotation was my first insult. Final draw was a adducted and internally rotated arm with a force from A-->P. Felt my "good" one slip a bit Saturday with a mechanism similar to #1.

What's funny is that my wife (the PT) has measured me out and I'm more lax on my "good" arm that my "bad" arm.

I also don't think the algorithms are made for paddlers, climbers, or anyone else that is super dependent on the integrity of their arm. All the ortho guys that I've trained with feel that it's an integral component for long-term stability and that once there's proof of a tear (imaging) + a positive instability test it's time to go to the OR or quit the activity that's causing you trouble. However, for the 60 y/o dude who slipped while walking outside and landed on his arm PT might be the cat's meow.
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Old 01-21-2013   #9
 
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Originally Posted by kirbz View Post
Thanks for the responses so far! I was indeed kayaking, although I'm not quite sure how it happened. I was upside down at the time. I think it could have been any number of things but I suspect it might have been an impact dislocation when I got a wee bit intimate with a rock (the doctor agreed it seemed like an impact thing). But my paddle could have also just gotten caught up on some rocks and pulled it out. I don't know. Needless to say, my shoulder just plain didn't work when I tried to roll so I got out. It went back in after I got to shore and was trying to figure out why my arm didn't work.

I'm definitely going to start the physical therapy regimen and give it all I've got. I love kayaking too much to not do so. But I also just want to explore the surgery option a bit further because I don't want this to follow me around for my whole life.

Burnor, I'm also wondering just how common posterior tears are for kayakers. Because, if posterior tears are equally rare for paddlers, then I don't feel as susceptible to re-injuring myself because my shoulder is weak in a way that isn't normally prone to injury for kayakers... Does that logic seem right? Or does it even make sense?
I don't think there are any published studies that look specifically at the incidence of isolated posterior tears in the boater population. Did you get an MRI with an arthrogram? Where is your tear? I know I've seen multiple boaters with incomplete posterior tears (not the entire labrum) and complete labrum tears (full circumference). You would prefer the prior to the latter.

Here's a good look at a labrum tear. I think you can imagine how that defect would cause the entire joint to be more unstable than it was originally meant to be.

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Old 01-21-2013   #10
 
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Unstable Shoulder - Labrum Tear Surgery - YouTube
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