shoulder dislocation

[martycunn]

21 year old female chef who dislocated/subluxed her shoulder 3 weeks ago falling off chair with arm on door handle - sounds like it was relocated in A&E and had check xray which was ok
She been in moderate amount of pain- still ongoing 6/10- I thought she had positive apprehension signs/ labral tests with clunking so ordered MRI arthrogram for mon just gone. Her A/PROM is below 80-90 flex/abd due to pain

MRI- all ok except for evidence of bone marrow oedema in region of greater tuberosity in keeping with contusion and trabecular microfracture

Im thinking of just managing this conservatively with physio over the next 6+ weeks to see how she gets rather than get an ortho opionion & further tests - CT etc

so wondering whether it should be ok to see how get on over next 3-4 weeks with ROM/strength respecting pain etc rather than doing an immediate onward ortho referral based on MRI

Is it normal to still be some uncomfortable and have so much pain inhibition 3/52 post injury due to trauma- I can really progress her from AA gym ball rolls, scap setting- main relief is coming from taping

any thoughts please?

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[shane_gun]

Interesting, Was it her first dislocation? Anteriorly? Sulcus sign?
CT would be more value in diagnosing and grading if suspected fracture, I'd want to clear that with a specialist. also, if cleared to mobilise, she can do so with more confidence, especially if pain/inhibition the main issue. Prom should be more I would think by 3 weeks.

[otley258]

Hi, just a thought but has a rotator cuff injury of some kind been ruled out?

[martycunn]

Hi, yeah it's her first dislocation , MRI arthrogram showed cuff intact, have referred to ortho for ct scan prior to review, thanks

[physiobob]

6/10 is a little high after 3/52 but is this with exercise/rehab or is that it at rest. Note that the first time the injury happens the more the connective tissue trauma, including several bruised areas of bone which will take at least 6 weeks to settle. I suspect you are getting her to do to much to soon and this may be more the issue? Certainly pushing ROM in the first month following a dislocation is not something I would do nor even measure.

[martycunn]

6/10 is a little high after 3/52 but is this with exercise/rehab or is that it at rest. Note that the first time the injury happens the more the connective tissue trauma, including several bruised areas of bone which will take at least 6 weeks to settle. I suspect you are getting her to do to much to soon and this may be more the issue? Certainly pushing ROM in the first month following a dislocation is not something I would do nor even measure.

6/10 is with a sling and with no exs, i.e. at rest. I think she is now developing neural pain, her sensation around axilla nerve is intact, but cuff is obviously weak and pain is being referred into deltoid region, she sees ortho this week

[physiobob]

Have you worked on her cervical spine as C4 refers to that region. Might be involved. Deep pain might still be the bone bruise. Do let us know the results of the further investigations.