Shoulder Dislocated during Physiotherapy

[KieranJ]

Hi, I would really appreciate your opinions on this matter.

I dislocated my shoulder 3 years ago after a fall, after that it gave me no problems until 8 weeks ago when it dislocated again playing soccer.
After a trip to A&E I kept it in a sling for 3 weeks and naturally took care the weeks following this, especially not exerting it while having my arm in an outstretched position. Though i was was doing some light exercises and lifting some heavy enough objects during my daily business

So after 6 weeks of recovery ie. 10 days ago I was sent for physiotheraphy treatment by the Health Board here in Ireland and after 5min of doing 'tests' on my shoulder it came out of its socket again and I ended up back in A&E and put under anesthetic to have it put back in place. So I ended up back to square one again.

Just to let you know of the position I was in when my shoulder came out - I was lying on my back with my arm outstretched and elbow bent, my hand was behind my head at this point and I was pushing her hand.

I have since had a meeting with the girl and a 'spokeswomen' for the health board, and they are not admitting any wrong on their part, saying the test the girl was doing was a procedure and that the shoulder was very weak and the same thing would have happened with any other physio. Needless to say I feel I am being brushed aside.

Is this something that does occasionally happen because I've never heard of it, and what tests was the girl doing?

Thanks for your time and your opinions would be really appreciated, I
just want to get to the bottom of the situation.

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[Dr Damien]

KieranJ

Sorry to hear about your condition. It must be frustrating to have that happen to you. Recurrent shoulder dislocations indicate significant instability in the joint...because your arm was in external rotation during this "test" it was predisposed to a dislocation however sometimes it is necessary to carry out assessments during a consultation. These assessments can have adverse effects but that should have been explained to you. Also not knowing your history of recurrent dislocations might mean choosing a test position that was unhealthy for you, but the chances of this happening in any situation is possible, it could have been while assessing for the available range of motion as well.

I think the health should show some empathy at the least and perhaps a more experienced manipulator might have known better nonetheless it could happen to even the most skilled of manipulators.

Might I suggest you consider some surgical intervention to reduce to the likelihood of this happening again..

Cheers

[physioONE]

Hi

A little late in replying but I have an interest in shoulder conditions especially instability. I wouldn't lose faith in Physio's and a good Physio specialising in shoulders can help regain full function even from traumatic dislocations. Surgery is an option and yes get a referral to see an orthopaedic consultant but there will be Physio rehab afterwards. Therefore I would see a Physio now as well to get your confidence back that we can help and secondly as you will be familiar with the exercises should you go ahead with an operation your recovery will be smoother and faster.

Laura

[physiobob]

I would have thought that the treating physiotherapist would have know that they are placing the shoulder in an unstable position. Normally we would do this albeit carefully and holding close the head of the humerus to get a feel of the subluxation. It is a little hard to tell from what you have describe if the treating physio was performing an instability test or if they were challenging the joint perhaps a little to early. Is isn't something I would do so early post dislocation myself. All that said it is likely that it would have popped out again doing something as simple as scratching the back of your head etc. The indication that is did happen is one for an orthopaedic consult and possible surgical tightening.

Do let us know how you get on.

[KieranJ]

Thank you all for the reply, I guess it was just unfortunate because the girl was only in her late 20's and wouldn't have much experience, I have been to a highly regarded orthopaedic consultant since and he advised to keep the sling on for 4 more weeks and to stay away from physios, he suggested that physiotherapy is no help to this injury andthat it need just the required rest and a few simple but consistent exercises to strenghten the muscles.

Don't worry physioONE, I have not lost faith in ye .
I'm going on holiday in 2 weeks time to thailand so I'm a bit worried about my arm. I was wondering about going swimming and the different strokes, are there some that would make me vulnerable and some that would help if performed gently.
Also I am wondering about the rowing machines you find in the gym if this would be a good exercise for my arm.

[physioONE]

Hello
From the way you dislocated in the Physiotherapy assessment it sounds as if you dislocated anteriorly and therefore have an anterior instability. This is classically the 'stop position', imagine you are trying to halt traffic! So your vulnerable position at present is arm taken to the side 90 degrees with your fingers pointed up to the ceiling. If you have multi-directional instability other positions may be vulnerable also. So basically I would avoid or take care with any of these 'stop positions'. This includes butterfly, freestyle, back crawl and to a degree breaststroke! Gentle breaststroke with a small range may be ok but the resistance from the water will put more strain on your joint. I may go more for the snorkelling type of swimming where your arms are by your side or hold a float across your chest and use your legs. You may be fine swimming but the risk of it dislocating is there and being abroad when that happens wouldn't be fun.
It sounds as if the consultant is suggesting general rotator cuff strength exercises where you resist taking your hand towards your stomach and away from you with your upper arm and elbow at your side. Also the rowing machine should be fine.
Laura