Dislocated shoulder from bike fall Dislocated shoulder from bike fall

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Thread: Dislocated shoulder from bike fall

  1. #1
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    May 2011
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    Default Dislocated shoulder from bike fall

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    A few days ago I had a bad fall while biking which resulted in a dislocated shoulder (not to mention chipped teeth & road abrasions). I was brought to the emergency room in ambulance, and they reset the shoulder. As of now, my pain is manageable, but my shoulder has very little mobility and no strength. Today I am going to meet with my regular doctor. I have a few questions for the people here:

    1) What should I ask my doctor in terms of diagnostic, imaging or others? Is "classical" PT useful for this? In the ER I got no assessment of other potential damage to ligaments, etc.

    2) What is the rehab protocol that have been successful for this kind of injury?

  2. #2
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    So, MRI analysis is that there are a number of partial & full tears on tendons and ligaments, see below for details. The person i reviewed the MRI with strongly suggests surgery, but then he's a surgeon. I'm going to review the MRI with another surgeon for a 2nd opinion.

    MRI results:

    Impression

    1. Evidence of recent anterior dislocation with Hill-Sachs and Bankart lesions.
    2. At least partial avulsion at the humeral attachment of the inferior glenohumeral ligament associated with the above.
    3. High-grade partial-thickness articular sided tearing at the distal supraspinatus tendon.
    4. Tendinosis and low to moderate grade partial-thickness articular surface tearing at the distal infraspinatus tendon with overlying subacromial/subdeltoid bursitis.
    5. Full-thickness longitudinal tear at the distal superior subscapularis tendon with high-grade partial-thickness tearing inferiorly.
    6. Longitudinal tear at the superior labrum which could be posttraumatic or degenerative.
    7. Moderately severe AC joint DJD.

    Final Report Signed by: [redacted]
    Inland Imaging, PS
    Sign Date/Time: 01/07/2022 8:08 AM PST

    Narrative
    MRI UPPER EXTREMITY, JOINT; WITHOUT CONTRAST (CPT)

    MRI RIGHT SHOULDER
    CLINICAL INFORMATION:
    Shoulder pain, rotator cuff disorder suspected, xray done

    COMPARISON:
    XR SHOULDER RIGHT (1/4/2022);

    PROCEDURE:
    Coronal oblique T1 and T2. Sagittal oblique T1 and T2. Axial T2 and PD.
    Sedation: None

    FINDINGS:
    Bone Marrow: There is a mildly depressed impaction fracture (Hill-Sachs
    lesion) at the posterolateral aspect of the superior humeral head.
    There is contusion without definite fracture at the anterior/inferior
    glenoid.
    Joint Space/Capsule: There is a moderate-sized effusion. There is at
    least partial avulsion at the humeral attachment of the inferior
    glenohumeral ligament. There is thickening and increased signal of the
    partially retracted fibers. There is no dislocation.

    Acromion/Supraspinatus Outlet: Acromion process is Bigliani type 2.
    Acromioclavicular Joint: Intact with moderately severe DJD.

    Rotator Cuff:
    *Supra/Infraspinatus: There is high-grade partial-thickness articular
    sided tearing at the distal supraspinatus tendon. There is tendinosis
    and low to moderate grade partial-thickness articular surface tearing
    at the distal infraspinatus tendon. There is mild fluid signal in the
    subacromial/subdeltoid space.
    *Teres Minor: Intact
    *Subscapularis: There is a full-thickness longitudinal tear at the
    distal superior subscapularis tendon associated with partial medial
    subluxation of the biceps. Tendinosis and high-grade partial-thickness
    tearing are seen at the mid and inferior aspect of the subscapularis
    tendon.

    Biceps/Rotator Interval: Intact though demonstrating mild medial
    subluxation at the level of the lesser tuberosity.
    Glenoid Labrum: There is tearing and partial detachment at the
    anterior/inferior labrum. Longitudinal tear is also seen at the
    superior labrum.
    Articular Cartilage: No focal defect or significant thinning is
    identified.

    Miscellaneous: Extensive edema is seen along the anterior aspect of the
    subscapularis tendon.

  3. #3
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    Quote Originally Posted by JDelage View Post
    So, MRI analysis is that there are a number of partial & full tears on tendons and ligaments, see below for details. The person i reviewed the MRI with strongly suggests surgery, but then he's a surgeon. I'm going to review the MRI with another surgeon for a 2nd opinion.

    MRI results:

    Impression

    1. Evidence of recent anterior dislocation with Hill-Sachs and Bankart lesions.
    2. At least partial avulsion at the humeral attachment of the inferior glenohumeral ligament associated with the above.
    3. High-grade partial-thickness articular sided tearing at the distal supraspinatus tendon.
    4. Tendinosis and low to moderate grade partial-thickness articular surface tearing at the distal infraspinatus tendon with overlying subacromial/subdeltoid bursitis.
    5. Full-thickness longitudinal tear at the distal superior subscapularis tendon with high-grade partial-thickness tearing inferiorly.
    6. Longitudinal tear at the superior labrum which could be posttraumatic or degenerative.
    7. Moderately severe AC joint DJD.

    Final Report Signed by: [redacted]
    Inland Imaging, PS
    Sign Date/Time: 01/07/2022 8:08 AM PST

    Narrative
    MRI UPPER EXTREMITY, JOINT; WITHOUT CONTRAST (CPT)

    MRI RIGHT SHOULDER
    CLINICAL INFORMATION:
    Shoulder pain, rotator cuff disorder suspected, xray done

    COMPARISON:
    XR SHOULDER RIGHT (1/4/2022);

    PROCEDURE:
    Coronal oblique T1 and T2. Sagittal oblique T1 and T2. Axial T2 and PD.
    Sedation: None

    FINDINGS:
    Bone Marrow: There is a mildly depressed impaction fracture (Hill-Sachs
    lesion) at the posterolateral aspect of the superior humeral head.
    There is contusion without definite fracture at the anterior/inferior
    glenoid.
    Joint Space/Capsule: There is a moderate-sized effusion. There is at
    least partial avulsion at the humeral attachment of the inferior
    glenohumeral ligament. There is thickening and increased signal of the
    partially retracted fibers. There is no dislocation.

    Acromion/Supraspinatus Outlet: Acromion process is Bigliani type 2.
    Acromioclavicular Joint: Intact with moderately severe DJD.

    Rotator Cuff:
    *Supra/Infraspinatus: There is high-grade partial-thickness articular
    sided tearing at the distal supraspinatus tendon. There is tendinosis
    and low to moderate grade partial-thickness articular surface tearing
    at the distal infraspinatus tendon. There is mild fluid signal in the
    subacromial/subdeltoid space.
    *Teres Minor: Intact
    *Subscapularis: There is a full-thickness longitudinal tear at the
    distal superior subscapularis tendon associated with partial medial
    subluxation of the biceps. Tendinosis and high-grade partial-thickness
    tearing are seen at the mid and inferior aspect of the subscapularis
    tendon.

    Biceps/Rotator Interval: Intact though demonstrating mild medial
    subluxation at the level of the lesser tuberosity.
    Glenoid Labrum: There is tearing and partial detachment at the
    anterior/inferior labrum. Longitudinal tear is also seen at the
    superior labrum.
    Articular Cartilage: No focal defect or significant thinning is
    identified.

    Miscellaneous: Extensive edema is seen along the anterior aspect of the
    subscapularis tendon.
    Findings 1 and 2 are the ones the most strongly indicate surgery. With both a Hill-Sachs and a Bankhart lesion, your shoulder is going to be structurally unstable and your risk of repeat dislocation is extremely high. I would be quite shocked if they did not see an actual fracture at the anterior inferior glenoid during surgery.

    If I were a betting man, I would bet on a Hill-Sachs and Bankhart repair, RTC repair, labral repair with anchor, biceps tenodesis, and Distal Clavicle Excision

  4. #4
    Join Date
    May 2011
    Location
    Seattle
    Posts
    181

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    Thank you Will. I am meeting with another shoulder specialist in a couple weeks (earliest I could get him) to get a second opinion. One thing I have heard is that different specialist might disagree on the analysis of the MRI. I wish I could just upload it somewhere and get some solid analysis done that way (in addition, not instead of, one-on-one consultations).

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