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Anterior shoulder dislocation recovery process

Wilson On The Drums · · Woodbury, MN · Joined Dec 2010 · Points: 940

I had arthroscopic surgery in spring of 2011 after a hyperextension injury set off 3 dislocations, each with about 3-4 months of pt in-between. By jan of 2012 i was in full swing and i consider that the real start of my climbing ( i had done some previous TR stuff and easy scrambling but had never really considered myself a climber and had never really pushed myself). the recovery was long but i also resisted the urge to jump into anything too strenuous (spring 2011-jan 2012). My shoulder feels great now and i've never had any problems with it climbing. i have a little bit of scar tissue that can click every now and then and for some weird reason when i fly i feel pressure build up in my shoulder?? stronger than ever though. good luck with your recovery and take it easy.

Wilson On The Drums · · Woodbury, MN · Joined Dec 2010 · Points: 940

i should also note that i had about 75% of my labrum torn.

Lisa Rosenthal · · Sacramento · Joined Oct 2014 · Points: 1

I just got my MRI back too and it's typical:
bankart lesion
moderate hills-sachs lesion

Mine isn't as clearly bad, which is positive and negative. It would be really nice to have an obvious answer. But maybe I could get by without surgery, which has inherent risks that we often gloss over.

The surgeon said that if you keep your arm in a sling for 6 wks, instead of the more commonly recommended 3weeks, your odds for no redislocation greatly increase. I'm going on the surgery list for now, but will need to think more until that date comes.

In terms of open vs arthroscopic, he said open is slightly more stable and he reserves thst procedure for athletes in contact sports like football, and probably climbers. That's his opinion and depending on the doc, that consensus might change.

good luck! I'm still on the fence and I love reading what ppl have to say.

Paul Jakob · · Unknown Hometown · Joined Dec 2014 · Points: 0

My MRI results + doctor's opinions came too. I have a second bankart lesion and a very small tear on the supraspinatus tendon. Because I'm in the 5th month, no climbing and still having pain, I will see a surgeon on january 5th.

@Nate
Sounds like surgery is the best conduct for you. Good luck and keep us updated how your return to climbing goes. I really hope you can pull it off and go back to the rocks/ice.

@Lisa
I think we have similar lesions. I don't have the hill-sachs, but I've got a nice bankart and a supraspinatus tendons (small) tear. I will see the surgeon soon, but I do feel less and less pain in the shoulder. Do you know what you are going to do? Do you feel any improvement with time and exercises? I think your case and mine are borderline where the doctors prefer giving the conservative treatment another chance. What I don't like about this idea is that, to my knowledge, we're exposed to subluxations and luxations that will again throw us down for 4-6months. The surgery would have us "fixed" and ready to climb at about 9 months and the probability of re-injury is lower? This is my biggest question now, because the sports doctor said "it is my decision".

And open-versus-arthro, I guess we'd need a surgeon to explain. But to my knowledge, open allows the surgeon to perform more corrections and visualize better, but for straightforward cases, arthro is fine, done in athletes often and wins you several months in return-to-activity. Then again, it'd be best to get this information from a top-of-the-pyramid shoulder surgeon.

Let me know, I'm really curious how the return to activity is for people who underwent these procedures.

Kent Pease · · Littleton, CO · Joined Feb 2006 · Points: 1,066

I'll add one more experience to the database.

I had several dislocations from different activities, and eventually had surgery. Recovery was about 6 months for normal activities and feeling generally good, 9 months for moderate climbing although with some weakness and apprehension, and 12 months for full recovery and strength. That was 20+ years ago and the results have been good with some expected (and probably beneficial) loss of motion. I still do PT exercises and shoulder-specific weight training about 2/week. If I slack off on the shoulder work I begin to get pains.

The OP's motion which caused the dislocation of an overhead Gaston also caused one of my dislocations and the final one before my surgery. Based on a combination of my experience and discussions with doctors and PT's, PT is very helpful not only for dislocations but other shoulder ailments as well. However, if your shoulder is in certain positions your shoulder will dislocate regardless of your muscle strength. Some people are more susceptible than others, and recurring dislocations make your shoulder less stable.

Today I climb relatively strong, but there are a few moves and shoulder positions (with either side) that I avoid. It is simply not worth the risk.

Lisa Rosenthal · · Sacramento · Joined Oct 2014 · Points: 1

@Paul Jakob--This all happened less than 2 weeks ago, so I'm still in a sling for the next 4 weeks. Haven't done any exercises-the doc wants everything to stiffen as much as possible. As of now, I am only on the waitlist for surgery because the next schedule is not out yet. Unless I get to swoop in when someone cancels, which I'd prefer, I won't have a surgery until probably late March or April, which I'm not too happy about. By April, I would be able to start climbing again through the PT route. Since this is just my first dislocation, PT only may work (I know a slim chance, but nonetheless a chance) and I will do that if I can't get a surgery date in the next 6 weeks. If I dislocate it again in the next few yrs, I'm going to opt for surgery in a heart beat.

Since you've already done it again and waited several months, I don't know what I'd do in your place. You went for 11 yrs without another shoulder tweak, so I'd call that a pretty big success. It seems like you know what motions to avoid and how to keep it strong. I'm kind of surprised you had issues when you were putting in a piece, which is definitely an inopportune and potentially dangerous point on a route. Not having surgery and waiting to see if I dislocate my shoulder again scares me because I've found myself on more multipitches without cell service. I also don't want to dislocate it again at decking height.

I was really surprised when my shoulder popped out. I still don't know how to avoid that. People say gastons and one hand dynos are hard on the shoulders. Luckily I don't like to dyno. Mine was a slippery pocket in a dihedral, high and sort of laterally out, and nothing with my other hand. Pulling in my body closer to the wall popped it. What specifically are the movements to avoid?

Paul Jakob · · Unknown Hometown · Joined Dec 2014 · Points: 0

Hi Lisa,

Sorry if I am being repetitive, but did you get an MRI done?

In my first shoulder injury I had a bankart tear between 3 and 5 o'clock on the glenoid: I was young (19), and had really nice US-style gyms and a 50m college swimming pool available. I only did sport climbing then. The surgeon explained to me "if you were a pitcher or a quarter-back, I'd operate, but try the conservative treatment first". I even joined the swim after a year, it worked really well: in 5 months I was climbing, did my hardest climbs the second year after the injury. But I did have random muscle pains for a year.

I found out that I could do everything except raise my arm "from behind" and throw objects. This august I was on an easy multi-pitch route at the Aiguilles Rouges near Chamonix: it was cold, I was balancing and needed to lift my arm with to place a camalot (external rotation, abduction) and I felt the pop as my elbow reached ear-level. It seems to me that as long as the muscles were engaged, I was problem-free, but if I needed to rely on the joint itself (as in throwing), it was a problematic shoulder. The fall was ok, I had good protection under me: my brain was instantly worried about the hassle of a shoulder injury. Also, it comes right back in, but I was at the 12th pitch....

I think we have very similar issues. I'll see the surgeon on the 5th, hopefully if it's the knife it can be scheduled quickly. The sports physician I saw here showed my 10-yr-old labrum's attempt to "heal" in the MRI and made it clear that "the second injury is more painful". Because I do a lot of trip-climbing (south america, places where silly injuries can cost a lot), he thinks I should have a solid shoulder: otherwise, if I were a grade-cranker he'd again advise for the conservative route: he argues the surgery is not as simple as the surgeons claim, and to forget climbing for the next year. It's interesting to see people returning at month 5-6.

What I really wanted to know from someone who got the operation, whether they could perform classical mountaineering 5 months later: walking, scrambling, rope managing, the usual. This way I'd have hope for the summer.

I hope you get over your injury and find many years of happy climbing ahead :)

Lisa Rosenthal · · Sacramento · Joined Oct 2014 · Points: 1

Yeah, MRI has been done. bankart and moderate hills-sachs. Hopefully the labrum is reattaching in the correct position at this moment. Considering ppl go back to climbing at 6 months, you probably have a good chance at mountaineering at 5.

Paul Jakob · · Unknown Hometown · Joined Dec 2014 · Points: 0

Thanks,

I re-read your posts. A Hill-Sachs lesion indicates a more extensive humeral-glenoid separation.

My doctor showed me the 10 year old bankart in the MRI and the fresh new one. I don't think the body does a great job of healing that type of tissue on its own.

NateGfunk · · Unknown Hometown · Joined Apr 2013 · Points: 50

Hey Paul and Lisa,

I have a lot of the same worries as you guys. Im looking to get surgery in early jan and would LOVE to be able to get back on the road bike and do some big easy mountains over the summer. Only time will tell.

@lisa, your doctor suggested you stay in the sling for 4 weeks? my surgeon suggested i stop using a sling after 10 days. Literature seems to agree that theres nothing to be gained for young first time dislocators by immobilization. Perhaps the route is different for preop and noop shoulder recovery. I have already done a couple sessions of preop PT, which has been all ROM and VERY LIGHT isometric work. Perhaps you could inquire about a more aggressive treatment plan. It seems that 4 weeks of immobilization is excessive, but im not a doctor.

Edit - Here are some studies regarding sling immobilization. Theres also some interesting research in immobilization in ER to promote bankart repair, but its all very inconclusive:

ncbi.nlm.nih.gov/pmc/articl…

REALLY interesting article on an aggressive nonop rehab regimen:
ncbi.nlm.nih.gov/pmc/articl…

ER immobilization:
ajs.sagepub.com/content/36/…
ncbi.nlm.nih.gov/pubmed/243…
ncbi.nlm.nih.gov/pubmed/179…

Berweger · · Unknown Hometown · Joined Jan 2012 · Points: 0

I am 7 months post-bankart repair / capsular tightening (open repair). I've had life-long problems with both shoulders dislocating, but this one finally got progressively worse so I decided to pull the trigger. While I'm no surgeon, my understanding is that the open repair also allows for the capsular tightening (and better visualization of the actual bankart repair), which helps increase the success odds by another few percentage points for chronic cases. There seems to be no major difference in the recovery timeline (though they do have to sever the subscapularis to gain access for an open procedure), although the open one is reputed to be a bit more painful in the first few days.

A couple of worthwhile recovery benchmarks (I assume there will be some difference between doctors, but this seems to be the rough consensus):
4 weeks: begin PT
12 weeks: start biking and running (basic rule is this: nothing that could result in a serious fall until 24 weeks).
16 weeks: start lifting weights >10lbs
24 weeks: cleared to do all activities (including climbing). I was told to be careful, though: it's not completely healed until a year after the surgery...

As far as climbing goes, I deliberately didn't train my forearm strength during the recovery so I'd have something limiting me. After a month I'm leading one number grade below where I left off (in the gym). It still creaks and pops a bit, but it does feel solid!

As far as mountaineering goes: bear in mind that at 5 months it's still super weak (you're basically going to let it atrophy for 8 weeks straight)... So while you may be ok with mountaineering itself, your ability to respond to an emergency situation may be massively compromised.

But there is one key thing where I'd hope someone could learn from my mistake: Mine got to the point where it started popping out spontaneously while climbing (grabbing a jug, weird sidepull, etc.). I was always lucky enough that I had a good enough stance where I could work it back in, and I learned what movements not to do. But seriously: that was stupid - I should have had the surgery after the first non-trauma-induced dislocation! I can imagine many scenarios where a spontaneously dislocated shoulder while climbing could lead to much, much, worse consequences than a 6 month recovery from surgery. But it's amazing how easy it was to go into denial about the odds of it happening again...

Berweger · · Unknown Hometown · Joined Jan 2012 · Points: 0

@lisa: the moves to avoid will differ a bit depending on the location of your bankart lesion (i.e., how it popped out before). But in general, gastons (and internal rotation in general) will put it in a vulnerable position, as will anything (particularly external and internal rotation) near the edge of the range of motion.

NateGfunk · · Unknown Hometown · Joined Apr 2013 · Points: 50

@Berweger, thanks for your input - this is exactly the sort of info im looking for. What sort of overhead sports specific PT did you do early on (if any)?

Berweger · · Unknown Hometown · Joined Jan 2012 · Points: 0

@nate: Honestly, I did very little sport-specific rehab. My first three to four months were mostly to regain range of motion and involved at most some weak thera-bands (It actually took 5 months to raise my arm vertically above my head again). After that, the recommendation I received was to do shoulder/back exercises (pull ups, rows, side/front raises) to help the shoulder stabilize (no emphasis on chest). The fact that these were very climber-friendly exercises was a happy coincidence...

Lisa Rosenthal · · Sacramento · Joined Oct 2014 · Points: 1

@Nate--I think the preop regime is different than just rehab. My doctor said that if I'm sure I want surgery (which I'm not if the date is in 4 months from now), I can get rid of the sling and start PT. I do think his instruction to keep it in the sling for such a long time is atypical, but I'll do it.

I also saw lots of studies on IR vs ER. Unfortunately I've been in a traditional sling since the beginning, so that's not worth worrying about. I'm really hoping ppl start having the flu so I can swoop on some cancellations!

Good luck with your operation!

Paul Jakob · · Unknown Hometown · Joined Dec 2014 · Points: 0

@Nate
I have a climbing buddy who wrecked his shoulder in a ski accident: but it was ugly. He had a couple of fractures, the biceps tendon was completely ruptured, it was a real mess. He was back to cycling at month 8, it's all he could do, but he still needs a lot of time to go back to climbing. His case doesn't really serve as reference to me because it was a violent trauma, required 3 operations, etc. Also, he's nuts to be exposing himself to a bike-fall on that shoulder, but he seems happy.

@Berweger
Thank you so much for the input. You are right that going mountaineering with a weak shoulder can be risky, but I would avoid summits that can have a turn to the worse. As long as I can do alpine hikes this summer, I'd be really happy: I am already thinking long term.

I've been bugging former colleagues who became MD's about the surgery options. What I could gather is the typical "it's case by case" - josr-online.com/content/6/1/28 - I'll just trust the surgeon, there's little more I can do about it. But your case sounds more serious if your shoulder was popping out spontaneously so frequently. I've had two subluxations, 11 years apart, and both were so painful. To get back to climbing, I did extensive rehab. How did you manage to have those injuries and still climb?

@Lisa
After my first injury, I was free "to do anything that didn't hurt", and this time was told the same: I even did a gully last week, it was ok, but the mechanics of ice-pick handling can be easily "brought down" to a bad shoulder. I think your doctors have very good reasons to recommend the sling for a while, given what you described :/
I hope your body heals quicker than mine...

NateGfunk · · Unknown Hometown · Joined Apr 2013 · Points: 50

@Paul, yeah i road ride mostly for cardio training and predominantly mountain bike for kicks. Im pretty hesitant getting back to either because of the fall potential. Eventually Ill get back on the road first - then maybe some xc fireroad stuff. I think Ill invest in a really nice trainer...

Paul Jakob · · Unknown Hometown · Joined Dec 2014 · Points: 0

@nate

the question goes back to all our questions here: when is it safe to bike? A bad bike fall can wreck a perfectly healthy shoulder and many other body parts. I think because it's not an overhead activity that will strain the shoulder, it might be worth the gamble. We can't become bed-ridden for a whole year because of this (?).

Berweger · · Unknown Hometown · Joined Jan 2012 · Points: 0

Hey Paul. Apart from the first trauma-induced dislocation, which was out for about an hour before being set in an ER (the cramping after it's been out for a few minutes is the bad part), all the dislocations after were more or less painless. Don't get me wrong: the sensation of the joint no longer functioning is completely terrifying, but there was no immediate physical pain since it always went back in within 30 seconds. The only thing I did have was some low level soreness that lasted a few weeks. I was actually really surprised when I found out that most people found the whole thing excruciating...

hanshan · · Canada Mofuga · Joined Feb 2008 · Points: 230

You guys that want to get out biking but are worried about your shoulders should get a recumbent, you could even get a trike that you can't fall off. I destroyed my shoulder a few years ago, avulsed the supraspinatus, a few fractures, dislocated for over 6 hrs with extensive axilllary nerve damage with no innervation in the shoulder for 6 months, plus adhesive capsulitis. I did a year of full time rehab and the trike was a daily part of it (also healing a multiple compound tib fib fractures). My other suggestion would be the use of heat in assisting with rom exercises. Stretching in the sauna just can't be beat.

Guideline #1: Don't be a jerk.

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