10 months after falling on an outstretched hand (FOOSH) his shoulder pain had become so severe and chronic, it required surgery to repair a piece of cartilage. He later found another, relatively rare problem with the other shoulder.
This patient was a skateboarder who had fallen many times, by his own account. He developed pain in the left shoulder after a particularly bad fall, and despite medications, rest, and gradual return to activity, he did not recover. His pain was severe and stopped him from doing most things with his left arm.
He underwent MRI and was found to have a tear of the top of the labrum – a piece of cartilage shaped like a suction cup ring – that went from front to back. In medical terms it was a Superior Labral Anterior to Posterior tear or SLAP. 10 months after the injury, the SLAP was repaired, and he was placed on severe restrictions after surgery to make sure that it had a chance to heal.
Juveniles after this kind of surgery are more likely to be immobilized than adults, because they can recover their flexibility faster than adults, present a lower risk of “frozen shoulder” from immobilization, and because they tend to surpass their restrictions. This patient was no exception, reporting to his first therapy appointment performing movements that had been restricted. I was able to explain to him what was not correct, and the importance of waiting and following the postoperative protocol strictly. Despite his early movement, his elbow was significantly stiff at his first visit, and his insurance company set up several obstacles that made it difficult to get a timely start to his therapy. Anticipating all of these factors, I had already drawn up a simple plan to follow, with illustrated instructions, that would keep things where they needed to be for up to a two week delay. Thankfully, we were able to get him in before that.
His therapy was spent mostly on slowly restoring his motion, while avoiding any movements that might jeopardize the repairs that were made. Specifically, biceps contraction (like an arm curl) could be detrimental. I were able to coordinate with his mother who spoke and understood limited English, to make sure that he stayed on track.
Only late in his treatment was he allowed to participate in strength training, and during the very late phase of his rehabilitation, he was found to have a thumping sound from the opposite (right) side, near his sternum. He had noticed a problem there for some time, and it appears, from examination, that he has suffered a significant tearing of the ligaments stabilizing the sternoclavicular (SC) joint. These injuries are relatively rare, however, this is the 4th I have observed in my career. His surgeon was not aware of it. Most of the time, as long as there is no pain or significant limitation, these injuries are left alone. They will not recover, but they typically don’t cause much of a problem either.
He was able to return to full activities with full strength and full movement of the shoulder, although he still requires significant “warm up” to get his shoulder completely loose. This will continue for some time, and he has a plan to address that at home.
