Overcoming the Shadows of Shoulder Dislocation: A Month into Recovery

It's been a month since my shoulder dislocation, but the road to recovery looks bleak?

Hello, doctor.
A month ago, due to a moment of emotional distress, I over-rotated my arm and accidentally dislocated my left shoulder.
I spent nearly four hours in the emergency room before it was successfully reduced.
This is my fourth dislocation, with the last one occurring five years ago.
The emergency physician mentioned that my dislocation was easily reduced, but I am worried that my situation is dire.
Since the reduction, I have been unable to lift my arm; even extending it forward to a 90-degree angle feels frightening.
Each day, I find it increasingly difficult to raise my arm, feeling weaker and weaker.
Even simple tasks like eating with a spoon feel strange, and I can't support myself on the injured arm.
I wonder if this is psychological, as I constantly fear it might dislocate again.
My muscles feel extremely tense, sometimes painful and sore.
The muscles in my upper body, including the trapezius and those around the scapula, feel like they are all stuck together.
I often need to massage the acupoints around my scapula to feel some relief, and after massaging, I experience a tingling sensation as blood flows, but the tightness returns quickly.
This issue of my arms and shoulders feeling stiff has been ongoing since five years ago, seemingly triggered by excessive neck manipulation.
As a result, I feel stiffness in both arms regardless of the position, accompanied by a rolling sensation and sound in my joints.
My upper and lower back muscles have also developed knots; while massage provides some relief, the stiffness returns shortly after.
I have tried using a massage ball, but it hasn’t helped.
I have consulted nearly ten orthopedic doctors, and despite undergoing an MRI at my own expense, they found no issues with my bones.
I am concerned that I might have a rare condition, but I don’t know what to do.
This has persisted for five years, and now with this recent dislocation, it feels even worse.
Initially, I planned to remove the sling two weeks after the reduction, but now I am afraid of dislocating again, so I have to keep wearing it to feel more secure.
When I returned for a follow-up, the doctor barely examined me and just sent me on my way, not realizing the significant aftereffects I would face.
I am now seeing a specialist in sports injuries at Chang Gung Memorial Hospital in Kaohsiung, but I live in constant fear and uncertainty about how to continue my life, terrified of another dislocation.
Until my next appointment next month, should I continue to wear the sling cautiously, or do you have any suggestions? I am even hesitant to start rehabilitation.
Thank you very much, doctor.
I truly don’t know what to do, and I hope to receive some advice or be referred to an expert in this area.

Chen Jianhong, 30~39 year old female. Ask Date: 2024/07/15

Dr. Wang Zhaomin reply Rehabilitation

Hello, after the shoulder joint dislocation has been reduced and entered the stabilization phase, it is important to strengthen the surrounding muscle training to prevent recurrence.
Prolonged use of a sling may lead to joint adhesions or muscle atrophy.
It is advisable to follow medical advice and use the sling appropriately.
Please visit a rehabilitation department where professional physicians and therapists can arrange an appropriate rehabilitation plan to achieve the best treatment outcomes.
Thank you.

Reply Date: 2024/07/15

More Info

It sounds like you are going through a very challenging recovery process after your shoulder dislocation. Given that this is your fourth dislocation, it’s understandable that you are feeling anxious and uncertain about your recovery. Let’s break down your situation and discuss some potential steps you can take to improve your condition.

First, it's important to acknowledge that shoulder dislocations can lead to both physical and psychological challenges. The fear of re-dislocating your shoulder is common among individuals who have experienced multiple dislocations. This fear can contribute to muscle tension and a feeling of instability, which may further inhibit your ability to move your arm freely.
From your description, it seems that you are experiencing significant muscle tightness and discomfort, particularly in the shoulder and upper back areas. This could be due to a combination of factors, including muscle guarding (a protective response to pain), postural changes, and possibly some underlying muscular imbalances that have developed over time.

Recommendations for Recovery:
1. Physical Therapy: Engaging in a structured physical therapy program is crucial. A physical therapist can help you with specific exercises designed to strengthen the muscles around your shoulder, improve your range of motion, and address any muscle imbalances. They can also provide you with strategies to manage your fear of re-dislocation.

2. Gradual Mobilization: While it’s understandable to be cautious, it’s important to gradually reintroduce movement to your shoulder. Immobilization for too long can lead to stiffness and further weakness. Your therapist can guide you on how to safely begin moving your shoulder without risking re-injury.

3. Strengthening Exercises: Focus on strengthening the rotator cuff muscles and the muscles around the shoulder blade. These muscles are essential for shoulder stability. Exercises such as external rotations, scapular squeezes, and wall slides can be beneficial. However, these should be introduced gradually and under the guidance of a professional.

4. Pain Management: If you are experiencing significant pain, consider discussing pain management options with your healthcare provider. This may include over-the-counter pain relievers, ice therapy, or other modalities that can help reduce inflammation and discomfort.

5. Psychological Support: Given the psychological impact of your injuries, it may be helpful to speak with a mental health professional. They can help you address the anxiety and fear associated with your shoulder dislocation and provide coping strategies.

6. Regular Follow-ups: Continue to follow up with your orthopedic specialist, especially since you are seeing a doctor who specializes in sports injuries. They can monitor your recovery and make necessary adjustments to your treatment plan.

7. Avoiding High-Risk Activities: Until you feel more confident in your shoulder's stability, it’s wise to avoid activities that could put you at risk for another dislocation. This includes high-impact sports or any movements that require overhead lifting.

8. Education: Educate yourself about shoulder anatomy and the mechanics of dislocations. Understanding how your shoulder works can empower you and reduce anxiety about movements that feel risky.

Conclusion:
Recovery from a shoulder dislocation, especially after multiple incidents, can be a lengthy and complex process. It’s essential to approach your rehabilitation with patience and a willingness to work closely with healthcare professionals. By addressing both the physical and psychological aspects of your recovery, you can improve your chances of regaining strength and confidence in your shoulder. Remember, it’s okay to seek help and take your time as you navigate this journey.

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