T Nation

Help For Mom: Injured Shoulder


#1


Hi,

Sorry - not sure where to post this!

I was hoping for a little advice. A few weeks ago my mom fell over and hurt her shoulder (she passed out, and her full weight was taken by her left shoulder). she's not remotely athletic, and doesnt take any regular exercise, but is otherwise healthy and has had no shoulder problems.

She had some x-rays, and the results came back a few days later, saying her collar bone had dislocated, but it should go back to normal. her doc said its nothing to worry about.

she said it hurts first thing in the morning, then its ok. she has full ROM and nothing hurts.

however, she is worried because it 'looks wrong'! take a look at the photo i've attached

her doctor seems to think its nothing to worry about, but does this look odd to any of you folks?

many thanks,
jim


#2

Definitely looks odd to me.


#3

Grade III AC joint separation...not much that can be done here as the joint is held together by ligaments and once they are torn they are torn. Sometimes the joint is screwed back together but not always that successful.

Best thing to do is concentrate on scapular retraction/rowing exercises in order to maintain proper biomechanics. Seems like your Mom may be "neandrathal no more" (no offense). Concentrate on posture, scap retract/rows, and general upper body strengthening with emphasis on posterior/back exercises


#4

First off, have your mom get a second opinion. Always.

I cringe because my shoulder used to look like that for a while. I fell the wrong - very wrong - way during a karate match in my late teens.

From what I can gather, it looks like it MAY be a AC (acromioclavicular) joint separation.

If you fall on your shoulder, the force pushes hard on the scapula. The collarbone is attached to your ribcage and can't shift with the scapula and the ligaments in the joint get ruptured, or torn.

The treatment depends on the degree of the separation. Usually, from what I remember reading, no matter what degree, that bump is very common. I had it, sat in a sling for a while, and it got better. I knew a guy who tore up his AC joint, had surgery, and he still had the bump - though not as bad.

Of course, I am not a Dr., and am doing my best with your photo.

Best of luck.


#5

From Shane Colbert
"From what I can gather, it looks like it MAY be a AC (acromioclavicular) joint separation."

[/quote]

A SERIOUS review of anatomy is in order if you think that "MAY be the AC joint."

The bump is called a "step deformity" and is the result of an AC separation.


#6

I severely separated my right shoulder in 1988. I was told my options were either surgery or wearing a special sling. I chose the sling - it kept my arm immobilized and had a strap that went over the top of the injured shoulder to pull it down.

It healed well and does not bother me (although I can tell that shoulder slopes more in pics). I'd say a second opinion is definitely in order. Good luck!


#7

The sling I am almost positive you speak of is a figure 8 shoulder strap that is also commonly used for clavicular fractures. The sole purpose of the strap is to keep the shoulders in a retracted position. Good for static positioning and reminding you to keep the shoulders back throughout the day but you should still concentrate on scapular retraction exercises.

Everyone is talking second opinion...get one if you want to waste your time, the second doctor's time, your money, and the insurance company's money. If you've got full ROM and no neurological symptoms (numbness/tingling in hand) the only thing a second doctor would tell you is what the first one told you.


#8

She definitely separated the AC joint. The mechanism of her injury is one of the most frequent causes of AC separation.

The figure of 8 sling which helps with scapular retraction may help, but it is more common to use it for an actual clavicle fracture. The sling pulls the shoulders back which allows the ends of the fractured bone to line up better and heal with less callus formation.

For the AC separation an arm sling may be more useful. It basically supports the arm, which decreases the amount of distraction that occurs at the AC joint. This allows the two surfaces to remain closer, which hopefully would allow it to heal without having as much of a gap between the clavicle and acromion. That should result in less prominent deformity.

Since she has no pain and full ROM I doubt surgery would be considered. The prominent bump in the pictures is probably related not only to the joint disruption, but also from inflammation of the tissues and even the bone due to the impact she sustained.

Since she has been evaluated by a Doc, if she is concerned with the cosemetic nature of the injury, have her ask him his opinion on the prognosis. If he feels that it will probably heal w/ a deformity, and she is uncomfortable with that, then she may want to get an orthopedic opinion on whether or not surgery would correct that problem.

Let me know if you have any other questions.

Take care,

Ryan