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kirbz
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  Quote kirbz Replybullet Topic: Shoulder Dislocation
    Posted: 20 Jan 2013 at 5:46pm
I know this is a popular topic on paddling forums 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 (Dr. Gee at UW in Seattle) so I would have thought he'd know something about this... If any of you have worked with a specific doctor I'm also open to more specific recommendations. :-)

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?
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otterend
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  Quote otterend Replybullet Posted: 20 Jan 2013 at 6:13pm
Mike McAdam, MD is a good choice for a second opinion. He is in Seattle near Swedish. Your first doc may have nailed it accurately with his DX. But since it's nagging you, get another perspective. McAdam has a special interest in shoulders. He's one of the Seahawks' surgeons. Full disclosure - my daughter is his PA. My ski buddies have been seeking Mike's assessments for years with good reviews. McAdam has a following in the rugby community too.

Chris
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  Quote Ellingferd Replybullet Posted: 20 Jan 2013 at 7:01pm
Send a pm to "hardboof". He may have some advice for you.
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firewater
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  Quote firewater Replybullet Posted: 20 Jan 2013 at 7:16pm
I too had a small labral tear. I had a small frayed labrum that would "catch" and cause a weakness and painful sensation in my shoulder. I had many contributing factors (pitcher in a hardball league, outfielder in beer league/softball and of course kayaking). Dr. Richard Kirby is who I saw based out of Seattle. Looking back I wish I would have tried PT first. I haven't had any problems since the surgy, but I also participated in a lot of PT post surgery. Its just one of those "what if" type situations.
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chipmaney
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  Quote chipmaney Replybullet Posted: 21 Jan 2013 at 5:21am
Disclosure: I had a full dislocation but not a labral tear. I have a lot of thoughts on this:


1) I understand you lack of trust, but asking a bunch of knuckleheads on PP instead of listening to your doctor seems, to put it diplomatically, a poor choice. Your injury is unique. If you do not trust your doctor, then get a second opinion from a sports doctor. The second doctor will also tell you to go through a course of PT, and then maybe you will feel better. my doctor also told me it would I would not re-injure my shoulder, and I was climbing within 4 weeks.

2) Surgery is never the first option, particularly if this is your first shoulder injury. Why would you want to go through the pain of surgery AND then still have to do PT if it's not necessary? If PT is not effective, you can always opt to have surgery later--the converse is not true. It is important to be disciplined with you PT, though, otherwise you will lose RANGE OF MOTION, which sets you up for easier re-injury.

3) Also, I considered the fact that I might need surgery down the road if I re-injure my shoulder or, as is often the case scar tissue begins to impinge movement as one gets older. I did not want to start a precedent of surgery that may need to be repeated in the future.

Let me tell you, I had the same concern you did. I did not trust my doctor. But I focused on the PT. I was boating in 10 weeks, and it took about 6 months to get to 90% and 1 year to fully recover.

sitting all alone on a mountain by a river that has no end
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James
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  Quote James Replybullet Posted: 21 Jan 2013 at 7:24am
I think you are smart to ask paddlers, not because they are going to have any clue on how to help you with your injury, but because it is a very common injury for paddlers and so you can gain alot of insight into what doctors have done what and how people feel about it.

Here is my take, I had a Labral Tear too. Doctor did not recommend surgery, recommended PT. I did PT for about 6 months but really half assed, and I basically thought the doctor was full of crap and that I was going to need surgery because range of motion and a few of the hitches where I felt pain / restraint in moving through. I decided to give it another 6 months, and I basically stopped doing PT in any serious fashion. The pain never went away and niether did the range of motion issues. I figured I would schedule a surgery in the next year, of that time we got new health care, things changed on my work front and basically a full year went until I saw the doctor again. This time it was a different doctor that was recommend by a few other paddlers as being a good shoulder specialist, I can dig his name up but he is a Group Health Guy. So he does another MRI with contrast and tells me the same thing, the size and location of this tear does not along need surgery if you PT it really hard you should be happier with the results that surgery. I wrote him off and told him all I wanted was for him to write up the surgery recommendation so I could get it done. He told me he would not do it unless I did another 6 months of PT. I was a little pissed. I joined a Gym to get access to some good equipment and then really and I mean really put effort and time into doing PT for my shoulder.

6 months later I noticed a ton of things in life that I had changed due to the pain in my shoulder, like picking things up or rolling my shoulder in certain movements when I reached over my head, grabbing heavy things off shelves, I just started doing them again and I was not feeling the pain. At first I remember thinking, I should try this, and then it just became second nature again. WOW I was so happy.

It has been 1 year and I still do PT just much much less and I am still very happy with the Doctor that convinced me to go this course. At this point I can't tell a difference between my shoulders.

All I am going to say is if you choose to try PT first, get a good PT that knows the injury, then be serious, do exactly what they say and don't flake out.
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not-very-clever
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  Quote not-very-clever Replybullet Posted: 21 Jan 2013 at 8:20am
my advice: dont just listen to one person
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  Quote Tobin Replybullet Posted: 21 Jan 2013 at 9:34am
I did a number on my shoulder in 2009 - 2 surgeries, multiple anchors and donor ligaments later combined with A LOT of PT and it is good to go.
That said, I had an amazing ortho and a shoulder that would not be healed by PT alone. 90% of injuries including tears can be resolved with PT but the only way to know is to try it. Other than time you have nothing to loose by committing to a strong regiment of PT and seeing if you get the results that allow you to do the activities you want to do.
An MRI or an MRI with contrast will not complete the diagnosis for the ortho, history and an understanding of what you need out of your shoulder will help him to advise you what to do.
What does that mean? Your ortho (unless he is a kayaker) does not know the stresses associated with kayaking. So tell him, print an article and give it to him to read he is just a doctor, and expecting him to know everything is a bit silly.
My advice, try PT (but you have to go all in) keep a close eye on the health of your shoulder, if you get the results you want - SWEET! If you don't, talk to your ortho and surgery may be necessary.
Good Luck - my ortho is incredible but in Tacoma and it looks like you are in Seattle.
Cheers
Sure?
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James
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  Quote James Replybullet Posted: 21 Jan 2013 at 11:12am
I can't stress the PT enough. Before, or after surgery... Critical stuff. I have had mutliple knee surgeries and I guess because of the amount of damage I had done to my knees all the doctors basically said, you have to have surgery. PT was never an option. So when my shoulder got hurt I just figured PT was over rated and that I needed surgery. Don't do it half assed waiting to see what happens, man attack that thing without relent in accordance with the directions given obviously... But yea ...oh and after don't forget that strength in these areas goes away too, keep the PT going. I still work out my shoulder multiple times each week in fear that my next injury could be due to neglecting the joint..
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kirbz
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  Quote kirbz Replybullet Posted: 21 Jan 2013 at 12:36pm
Thanks for all the advice so far! Just to clear a few things up... 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. I'm also going to seek out a second opinion because you guys are pretty much confirming what I suspected. There's no right or wrong treatment for this kind of thing and the advice of your doctor is largely based on their understanding of the activities you do.

So... now I'm just trying to gather more information to share with my doctor and for finding another doctor I can seek out as a second opinion. So please keep it coming. I very much appreciate it and particularly like hearing from folks with posterior tears. Still not quite sure whether that is something that might be better or worse...

Cheers,
Kira
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  Quote doggievacation Replybullet Posted: 21 Jan 2013 at 12:56pm
Kirbz,

Good luck to you, man, whatever you decide to do!  Shoulder injuries suck, and labral tears are the very worst.  Here's what happened to me:

I injured my shoulder in 2005 while trying to get an old lawnmower started.  I mean, I really went ballistic on the pull cord, rather than driving down to the auto parts store to get some starter fluid.  Really stupid, yeah.  Anyhow, it hurt a lot and I had to bail on a Grand Canyon trip.  Tried PT, but it just made it hurt even more.  Eventually (like six months later) I went to see an orthopedic surgeon, had an MRI (with contrast, though I heard they don't use contrast for this anymore as it damages tissue).  MRI showed a labral tear.  Large enough that it wasn't going to heal on its own.

Had surgery in Feb. 2006.  Turns out the tear was 160 degrees long... basically half of my shoulder capsule was torn off the bone.  (posterior to inferior)  Since I had waited so long to get surgery, the ball of my humerus had been banging around inside the capsule shredding cartilage for six months.  (it looked like cotton candy in ortho pics.)  Surgery took almost 4 hours, just to clean up the loose strands of cartilage and insert three anchors in the bone to hold down labrum so it could heal. 

Rehab was a son of a bitch.  I was out of my mind with pain for the first three days.  Opiates couldn't touch it.  (I heard they now use a 3-day shoulder block to get you through that period.  Shoulder blocks mean NO pain.)  I had to sleep in a chair for three months.  Just too painful to lay down.  Healing of cartilage is VERY SLOW since there is very little vascular tissue (not much blood flow.)  PT was very important.  I totally dove into it, even though the pain in the beginning was off the charts.

Seven years later, I can tell you my shoulder is not nearly as strong as it used to be.  Labral tears often end careers for professional ball players (QB's & pitchers in particular) since they never really heal as well as they were pre-injury.)  Mine works good enough for paddling, though I definitely baby it.  In fact, it's time for me to get out the stretch bands to strengthen it for spring paddling.

Bottom line:  surgery is good stuff if you need it, but if your ortho doc thinks you can heal this w/o surgery then that is DAMNED good news.  Give it a serious try.  Do everything your PT says.  If that doesn't work and you still opt for surgery, trust me when I say that the PT you do post-surgery will be WAY more intense. 

Good luck to you man.  Keep us posted.
John

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