dislocated shoulder

[nativewolf]

Well just when things are going well my son is stepping down from harvester and slips and falls and hits hard, dislocates his shoulder.  Careful on ladders.  I guess he didn't have both hands on rails.

[Don P]

That's gonna leave a mark  smiley_deadheader alligator

[thecfarm]

Hope all goes well. 
He could be down for a while. 

[nativewolf]

He was not a happy camper in the ride to the hospital but the experience in the ER was superb, it was basically empty.  Doctor came by and gently pushed it back into the socket, pain free going back in according to my son.  We were in and out (and learned a bit about getting dislocated joints back into sockets) in less than an hour, a new record.  He's got a sling for a day or two then no felling work for many weeks, he's going to be stuck in the harvester and I'll be felling.  Heaven help me that is going to be a tiring month or two.  

[barbender]

 Ouch. We've had a few very bad falls of of machines over the years. 

 In the construction world, we were taught to always maintain "3 points of contact" and that has always stuck with me. I mention that to guys in the woods and guys think I'm nuts🤷

[beenthere]

Happened to me when I was on a vacation/work trip with my young family, returning from state of Washington and in Spokane. Fell and dislocated the left shoulder. Could hear/feel it dislodge out of the socket. 
Reached across with other hand and pulled it back into place. The three-day ride driving home was painful but could get by not moving that left arm using the arm-rest on the car. 
Healed up over time, but was an unforgettable experience, and hasn't bothered since (just calculated that it will be 60 years come this September). 

[doctorb]

As in all things, it's not always that simple.  While the histories like those above ("went back in place and has been fine ever since....") happen, there are also other patients with stories of chronic shoulder subluxation (trying to slide out of joint) and redislocation.  The younger you are (adult age, not kids) the more likely you could redislocate your shoulder in the future.

This is because the shoulder is held in the socket by soft tissue structures (labrum, joint capsule, rotator cuff), not boney contours (like the hip).  When you dislocate, you can injure these soft-tissue stabilizers which can lead to instability of the shoulder with certain activities in the future. 

There is no way to know if your dislocation is "routine" or may lead to future problems.  I would see a shoulder expert or a sports medicine doc.  An MRI may be needed to diagnose any associated soft-tissue injury.  An x-ray needs to be scrutinized for a humeral head fracture, called a Hill-Sachs lesion, that is often missed on initial evaluation and treatment.

[doc henderson]

I agree.  the ones that go back in easy, often go back out easy.  or they are not fully back in, but usually they do not function well if that is the case.  a patella goes back easy but is not a joint as much as a bushing to go round a corner. had a patient that lost his wife.  he would get drunk and relaxed and dislocate in his sleep.  the after putting the shoulder back in, he would get depressed and suicidal and need to stay for that.  I assume he is dead or better as I have not seen him in a few years.  might be 3 times a day if he was sad.

[Texas Ranger]

I dislocated left shoulder 60 years ago in college.  I did a lot of pushups in the army to strengthen that shoulder to pass the PT in basic.  Not a problem.  Couple of years ago it began to get sensitive, today, constant ache handled with aspirin.  Results of the dislocation?  Don't know, I also have not re injured it that I can remember.   

I think it is part of what you do as a kid comes back in old age to remind you of a miss spent youth.

[doc henderson]

do what you will, but aspirin tends to not be a good anti-inflammatory or pain reliever.  the dose required is well above the toxic range for many people at 24 pills a day, with hyperventilation and ear ringing.  ibuprofen is geared more to pain and inflammation.  it is still at 4 pills (over the counter) every 6 hours for healthy adults.  not to use with kidney insufficiency, or stomach bleeding issues.  If you are old and on an ace inhibitor for blood pressure it is not a good choice.

[Texas Ranger]

aleve or Advil, I can never remember them, I take one a day that usually does the trick. And my doc gave me the same advice, thanks for backing him up.  getting old is a pain in the posterior.

[doc henderson]

Advil or Motrin is ibuprofen.  800 mg 4 times a day is max.  you can get 800 mg pills for a buck each or take 4 of the 200 mg ones for a penny each.  Aleve is long acting, and only 1 pill twice a day.  easier to remember to take it.  meloxicam is easier on the tummy.  these are non-steroidal anti-inflammatory agents.  NSAIDS.  they can reduce fever and reduce pain and are anti-inflammatory at high dose.  steroids are anti-inflammatory and are steroids with all the side effects.  Tylenol is the brand name for acetaminophen.  It can reduce pain and fever but is not anti-inflammatory.  Kids can be given acetaminophen and ibuprofen at the same time as they are two different drugs, to reduce fever.  narcotics are pain relievers that work via narcotic receptors.  they may not help nerve pain, like sciatica, as these nerves transmit the pain signals from other areas, and do not have narcotic receptors.  They work on sever pain such as broken bones and or organ pain.  they are addictive and you can become dependent when on them for a while.  you may crave them and may withdrawal from them if you stop abruptly.  things like sedatives, alcohol and narcotics are cross tolerant.  so, if withdrawing from alcohol, we may treat with benzodiazepines (valium).  For muscle pain do not forget cold (first few days), heat, compression, massage, elevation etc.  Pain is pain, but also there is a mental component.  Old people tolerate it better than young.  they have had worse before and are not as anxious or afraid of it.  less medication is more when it comes to symptomatic relief.  remember, any good medication has potentially dangerous side effects.  Ibuprofen and all the NSAIDS should prob. be prescription.  As we age, we do not tolerate side effects as much as all our organs have less reserve to help out another organ.  carry on! 

[beenthere]

After all this great information, I'm happy that I have not experienced any residual discomfort in the shoulder that dislocated back in '64. Glad of that. Don't know of any activity that it has been limited from it either. 

Appreciate the input from the good doctors here. 

[Magicman]

doc, does "Gabapentin" fit into the mix and if so/or not, how?

[OlJarhead]

Ouch!  Hope he does EVERYTHING they tell him too!  in 1989 I dislocated my SV joint on my right shoulder.  I didn't do what I was told (dumb jarhead) and today it's still a problem and no fun.

[doctorb]

Magic-

For me, gabapentin (Neurontin) is not in the mix.  While the indications for this drug may have changed, I prescribed it to reduce peripheral nerve irritability.  Nerves can be injured with trauma, or nerves can get chronically overactive, like in neuropathy.  Gabapentin is not a pain reliever, unless the pain is due to nerve irritation, and it is not an anti-inflammatory drug.  I view this medication as having a fairly narrow application.  I'm interested if doc h has a different view.  I also have heard of this medication being prescribed in patients with seizure disorders.

[doc henderson]

I agree, it is to "stabilize" irritated nerves.  used for seizure and neuropathy.  nothing works well so this may be the best we have for nerve pain.  You have to ramp up the dose to a total of like 3200 mg a day over time before you can consider it a full trial.  It has helped a few, but not all.  there are better agents for seizures these days.  there are also nerve stimulators that can be implanted.  hard to know what will help on an individual basis.  

[Magicman]

The reason that I asked, I sometime have a shooting pain, especially in my right foot.  I can not wear a sock that has any compression or it is much worse. 

This is nothing really new, just getting worse with age.  I once described it to the Dr. as the sole of my foot was numb, but hurt.  It is a nuisance to have my feet hurt and I got no time for such crap.

My GP prescribed 100mg of Gabapentin to take as needed and said that if I needed more than one capsule, to take it because it was not addictive nor could I OD on it.  I have taken two at times but honestly I have no idea whether it helps or not.  If my feet don't hurt I think nothing about it, and if they do hurt I just want them to quit hurting so they won't hurt anymore.    

[Wlmedley]

I've been taking diclofenac for shoulder pain for at least ten years. It started with not being able to raise my right arm above my head. After X-rays and mri doctors determined that my right shoulder needed a complete replacement but recommended that I wait as long as possible. Tried steroid shots a couple of times but they didn't help. Wouldn't think shoulder pain would be to big of a deal but it wears on a person. Now I find myself using left arm a lot more and almost afraid I'm going to mess it up. I can mostly deal with it during the day but at night it makes it hard to sleep. Doctor said I could take two pills a day but I try not to. I have never dislocated my shoulder but pulling wrenches for 45 years hasn't helped it any.

[doc henderson]

pretty remarkable that we can last 100 years with some components working 24/7/365 x 100.  got to have a little wear and tear.  The neighbors' father was a mechanic and always complaining about his hands and shoulders.  I told them it will be a sad day for their family when he is finally not in pain.  We are friends, Virgil is no longer in pain.

[trapper]

I was prescribed  gabapentin for restless legs at night.  Allows my wife to tolerate me in bed at night,

[Don P]

If you get to the age most of us are, your shoulders are probably damaged. I can remember getting big timbers up and saying, that's just good shoulder pain. There is no "good" shoulder pain. One thing I think I've figured out over time is that once you've taken the shine off a joint the tendons are stretched out or MIA it takes good muscle strength and training to compensate. Putting the arm into the football passing position is a good way to pop it out. I hung up the kayaks.

[Old Greenhorn]

I will weigh in here too. About 20 years ago I pulled my shoulder straight out of the socket trying to dislodge a rock jammed anchor as a storm blew up. The dislocation resolved itself when the rock finally let. The details are irrelevant (although maybe an interesting story), but it took 3 years for the reduced range and pain to go away. Every time it would get close to healing I would do something stupid, not dumb, just plain stupid, and reinjure the healing that had happened. Of course, I also did not seek any professional help as is my practice. SO I just suffered. Finally a PT friend taught me some low impact range of motion exercises, which I did daily. My job duties also changed which allowed me to stop doing stupid things. 3 years after the original injury, I finally had no pain and range of motion came back for 90% of what I used to have. Since then I have never had a single issue or even the slightest pain.
 My lesson is, take your time, let it heal, it's not FAST, younger folks heal faster, but regardless of age DO NOT BE STUPID because this will cost you in the long run.

[thecfarm]

doc, does "Gabapentin" fit into the mix and if so/or not, how?

Wife and I call that a wonder drug. 
Wife had a bad wreck many years ago, did some damage to the nerves in the neck that let the blood flow to the brain??
Dr put here on gabapentin. She was on quite a high dose for a while. Most of the time she has side effects from any med she takes. If it says it might happen, it will with her. But anyways, no side affects from it!! She did have a lot of knee pain. That got much better. 
So Magicman, yes, it might help you. But I am no Dr either.
So it does help her. She is still taking it for blood flow and knee pain. 

[doc henderson]

the key to diagnosis, just like in other complex systems is treating the problem the patient/machine actually has.  If we use a fix for a problem you do not have, then poor Succes.  We use a risk benefit model, and if we use a treatment, that does not help, there is zero benefit, so no amount of risk is acceptable.  nerves are like an electrical problem with a logic board creating problems in one place, but it is really coming from somewhere else.  If you have pain in your shoulder and it hurts to move it and push on it, it is likely muscle or bone in the area.  If it is not tender and feels weak with tangling in your finger on that hand, it is likely a nerve impingement in your neck.  narcotics will not help this other than to sedate you so you can sleep.  It is not perfect.  MRIs can take a whole to get done.  sometimes we try stuff and if it does not work look again.  that is the problem with the ED in that we do not have the same doc each time to build on what was done.

[doctorb]

Magic-  most patients that get relief from gabapentin don't take it episodically as you described.  But...whatever works!  Your symptoms may be arising from an irritated S1 nerve root in your lower lumbar spine.  Most patients with neuropathy don't have the symptoms come and go with complete resolution between attacks.  

Old Greenhorn- I'll wager you had an acute rotator cuff tear, not a dislocation.   Just a guess.

[doc henderson]

yes, it takes weeks to taper up on gabapentin.   Tom, often a subluxation pulls close to out and then goes back in when the tension is relieved.  If it is all the way out it takes full sedation, often 20 minutes and a doc who is sweating so bad, it requires a scrub change and a shower when you get home.  cannot know for sure.  but if all the way out in an anterior dislocation, it is tough to go back in.   the exception is the unstable joint that pops out with sleep or alcohol consumption.  they go in easily and sling it up quick before it goes back out.  those should prob. have surgery.  some have had several surgeries and are screwed.... not the threaded kind.

[Old Greenhorn]

Well

 it was a bunch of years ago so at this point there is no way to be sure. I was laying forward along the gunnel of the boat and we were getting hit with 3' waves from a major squall coming down the river in a hurry. The wind was about 30 and the sky was charcoal black. With the anchor hung up hard and 2 small kids and my wife in a little boat it was a very serious situation. SO I laid on that gunnel and when the boat went down into a trough, I pulled the rope up as far as I could and wrapped my left arm in it, letting the next wave lift the boat, along with me and hopefully the anchor up. Well I felt the joint separate as the boat came up, but then the anchor popped free and the shoulder went back in. I was so busy trying to get that 40' of line back in the boat and get the boat headed into the wind that I didn't feel anything else. We were still in a bit of a fix. It took 20 minutes to make that 1/2 mile back to the dock by running up into the wind, then tacking and doing it again. That was a very long 20 minutes.
 Afterwards, I took two Advil and called it a day. The immediate issue was loss of range and pain associated with movement vertically. The position I was in when it popped was the same posture I have seen used for reduction of a dislocation, prone with the arm hung straight down, so I just figured I got lucky and did the injury and repair at the same time. Eventually it did heal up. I did have a little permanent loss of range, but not enough to whine over.

[doc henderson]

I am glad you were able to get your family safely out there.  and you may be right, and it went back in.

[Magicman]

Your symptoms may be arising from an irritated S1 nerve root in your lower lumbar spine.

You are right.  I went to the hip Dr. thinking that I would need hip surgery and after taking an X Ray, he said that I did not have a hip problem, but that I had a lower back issue.  My hip pain was my "butt muscle". 

[doctorb]

In general, posterior hip (butt) pain is not caused by hip joint issues.  Spinal stenosis, lumbar nerve irritation from herniated discs, spinal facet arthritis, and sacroiliac disease are all on the list, but hip arthritis is not.  For a vast majority of patients, hip arthritis leads to anterior hip pain in the groin.  

[Magicman]

No anterior pain here and seemingly not sciatic down the leg.  Just a pain in the right butt and my right foot.  I need all of the cushion in the bottom of my shoes that I can get.

I do OK with Reebok boots with an extra insole and Reebok DMX MAX shoes.  Actually those are all that I wear 7 days a week.  No socks with any compression.

[doc henderson]

there is a small muscle that runs across the butt cheek and the sciatic nerve.  I strained mine trying to pull a combative patient in bed and had 5 years of intermittent pain.  piriformis muscle.

Piriformis syndrome - Wikipedia

[Magicman]

Yup, that is the diagonal butt muscle that my Dr. described.    

[doc henderson]

I will now also occasionally affectionately refer to it as MMDBM.  Magic man's diagonal butt muscle.

[Magicman]

And I may need to refer to you as a bad man....but good, but good. 

[doc henderson]

Well of course that is a badge of honor and compliment coming from you!

[doctorb]

Piriformis syndrome is pretty unusual.  In my experience, it attracts a lot of blame when we really can't figure out what's going on.  

[doc henderson]

I had it and know the moment it happened.  slide the patient up in the bed on three, and everyone else pulled up on 3 and 1/2.

[Magicman]

My main problem is when I wake up after turning onto my right side.  We have a memory foam mattress, but it still gives me the butt hurt on that right side.