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Old Jul 26th 2011, 11:26 pm   #1
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Default "Dropped" shoulder (medical question)

My right shoulder has dropped (the end of it is now about an inch lower than the left shoulder) over the last 3 months. Constant pain 7/10 for the last four weeks.

I met with an orthopaedic surgeon today. Lots of xrays, he said he couldn't see any issues with the bones. It was a brief consultation, he examined me, told me that there's nothing he can do to fix it other than surgery.

Similar to the physiotherapist, neurologist and ER doctors, no one is really sure what has happened (but obviously it's related to the MVA I had last year).

Neurologist has booked me in for an MRI in October to look at the brachial plexus (the whole cord of nerves that serve the right arm).

Orthopaedic surgeon has booked me in for a functional MRI to examine the muscles, tendons etc. They're so busy at the hospital I suspect that MRI will probably be done closer to the end of the year. "You just have to wait your turn", he said. I asked him to speculate on the tears and he mentioned the rotator cuff and labrum as possibilities.

Maybe the drop in the shoulder position is causing something to pinch the brachial plexus and I have that nerve damage in the arm anyway.

I'm not really coming up with anything on internet searches so was wondering if the wonderful docs, nurses and those who have experienced shoulder injuries could give me an idea of what to expect over the next few months and surgery-wise? Looking for a survival plan here

Shitty day really. Up until May I thought it was all getting better. When the pain in my shoulder took over as the "dominant" pain I assumed, after advice from the physio, it was probably just a small rotator cuff tear (as I can raise the arm above my head without too much difficulty) and that the surgeon would just give me a cortisone injection today and that would be that.

The brief examination and quick determination that I'd need surgery was not what I was expecting and they way he told me, that it's a serious issue, was unexpected and just not what I wanted to hear.

I haven't had a family doctor since mine moved to Halifax last November. Did you know that 5 million Canadians/PRs are also without a family doctor?

Any advice, experiences, jokes etc appreciated.
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Old Jul 27th 2011, 12:20 pm   #2
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Default Re: "Dropped" shoulder (medical question)

I'm no medical professional, but I've had something that sounds what you've got. It's happened to me twice.

Parsonage Turner Syndrome.

Clickity here and here. (these are random links I googled for, I haven't studied the pages).

I didn't have pain for as long as 4 weeks, I think it was more like 2, but I'm sure each person is different. Essentially your whole shoulder is held together, up and in the correct position by muscle (aside from it's socket of course).

This condition results in muscle wastage, and the shoulder drops because of the lack of muscle holding it up. It's caused by the nerve signal to those muscles being cut off (possibly due to damage). Even if it's temporary nerve damage, that muscle wastage can happen 'very' quickly, sometimes days. Carrying a very heavy bag with a shoulder strap can damage these nerves (my doctor at the time said that's how it happened to him).

Only treatment is steroids IF (and only if), you catch it very, very, very early, essentially day one or two of the painful period, and this only minimises the muscle loss, it doesn't stop it.

The neurologist booking an MRI would suggest he's looking for the same thing, or ruling out other things to diagnose this. I had an MRI scan the first time, but not the second as they assumed it was the same thing. What they did do was a nerve conductivity test to make sure the nerve had recovered from whatever went on and was now sending the required signals to the muscles in my shoulder.

If the nerve signals are there, you will recover, but I was told that once the muscle has wasted like that it would take a long time to come back. It started to come right with me after about 9 months, but it is probably more like 18 months to 2 years to be back to what it was before.

Then again, your shoulder dropping may be nothing to do with this

A long post (apologies), but I hop you get sorted out, or at least get an answer.

Cheers

Chris
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Old Jul 27th 2011, 1:46 pm   #3
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Default Re: "Dropped" shoulder (medical question)

Thanks Chris, that's really helpful (and sorry you had to go through that).

When I had that last EMG back in June, the neurologist, after talking non-stop for a few minutes, paused seemingly concerned then mumbled "nerve seems fine" then went on to write up the brachial plexus MRI req. I thought this was weird at the time but even more so now. Anyway, I called his office this morning to let him know the orthopaedic surgeon thinks I need surgery (and has booked me in for the other MRI), I'm obviously curious to see how he reacts.

That muscle "wastage" you talked about sounds like a diagnosis that matches up with what I've been through. Over the last year, although I've used the arm as much as possible (to avoid a frozen shoulder) I've still found myself supporting it in whatever ways available to try and find some comfort. I've avoided a lot of activities with it too, which has been difficult as it's the dominant arm. So I wouldn't be surprised if there was a bit of atrophy in there somewhere as well as the previously diagnosed nerve damage.

Again, really appreciate the content in your reply. What was your do/don't do activity list? Physiotherapist told me no heavy weights or reaching out for things with the arm (he's on vacation this week so I'm unable to relay the surgery info to him until next Tuesday). Also, did you have sympathetic reflex syndrome as well?

Quote:
Originally Posted by chrisparr View Post
I'm no medical professional, but I've had something that sounds what you've got. It's happened to me twice.

Parsonage Turner Syndrome.

Clickity here and here. (these are random links I googled for, I haven't studied the pages).

I didn't have pain for as long as 4 weeks, I think it was more like 2, but I'm sure each person is different. Essentially your whole shoulder is held together, up and in the correct position by muscle (aside from it's socket of course).

This condition results in muscle wastage, and the shoulder drops because of the lack of muscle holding it up. It's caused by the nerve signal to those muscles being cut off (possibly due to damage). Even if it's temporary nerve damage, that muscle wastage can happen 'very' quickly, sometimes days. Carrying a very heavy bag with a shoulder strap can damage these nerves (my doctor at the time said that's how it happened to him).

Only treatment is steroids IF (and only if), you catch it very, very, very early, essentially day one or two of the painful period, and this only minimises the muscle loss, it doesn't stop it.

The neurologist booking an MRI would suggest he's looking for the same thing, or ruling out other things to diagnose this. I had an MRI scan the first time, but not the second as they assumed it was the same thing. What they did do was a nerve conductivity test to make sure the nerve had recovered from whatever went on and was now sending the required signals to the muscles in my shoulder.

If the nerve signals are there, you will recover, but I was told that once the muscle has wasted like that it would take a long time to come back. It started to come right with me after about 9 months, but it is probably more like 18 months to 2 years to be back to what it was before.

Then again, your shoulder dropping may be nothing to do with this

A long post (apologies), but I hop you get sorted out, or at least get an answer.

Cheers

Chris
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Old Jul 27th 2011, 3:37 pm   #4
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Default Re: "Dropped" shoulder (medical question)

I didn't have the reflex syndrome you mention, or at least I wasn't told about it and therefore didn't know I had it if I did.

The doctor and consultant asked if I was reaching for things and missing, but that didn't happen for me. I guess the other muscles were compensating well enough. No idea what the muscles are called but the muscle on top of the shoulder between the shoulder and neck wasted away as well as one or two at the back over my shoulder blade.

Your post prompted me to stand in front of the mirror and compare shoulders as I totally forgotten about it before I saw your post. Originally my right shoulder had dropped about an inch to an inch and a half. There's only about a centimeter difference now.

As for do/don't things....... Well I can't remember ever been told to stop doing things I always did, but I did ask if I should do extra exercises on my weak shoulder (I was a member of a gym at the time), and whilst it wasn't a definite 'no', they didn't seem keen on me doing that.

If anything else pops back into mind I'll let you know.

Cheers

Chris
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Old Jul 27th 2011, 3:40 pm   #5
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Default Re: "Dropped" shoulder (medical question)

PS

Regarding the extra exercises..... Even thought their advice seemed to be don't do it, I seem to remember doing extra reps of certain exercises on my weak side anyway, and no harm seemed to come of it.

Chris
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Old Jul 28th 2011, 12:57 pm   #6
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Default Re: "Dropped" shoulder (medical question)

Quote:
Originally Posted by chrisparr View Post
I didn't have the reflex syndrome you mention, or at least I wasn't told about it and therefore didn't know I had it if I did.
It was probably a few weeks, if not months, before I realised I had it and mentioned it to the neurologist. Basically if anyone touched my right arm it would cramp up like crazy. It then developed into a mental issue in that if I thought someone was going to touch my arm, it would cramp up. Not much fun when you're scared that the people closest to you might accidentally cause this to happen on a regular basis

Quote:
Originally Posted by chrisparr View Post
The doctor and consultant asked if I was reaching for things and missing, but that didn't happen for me.
If I'm not careful, I'll knock over whatever it is I'm reaching for. Sometimes I get a hold of it then my arm unintentionally throws it. I've not broken anything yet, or hit anyone with the object (so I'm still seeing the funny side of it )

Quote:
Originally Posted by chrisparr View Post
As for do/don't things.......whilst it wasn't a definite 'no', they didn't seem keen on me doing that.
I found that pretty frustrating too, when I was in physio last year, they (after I was recovered enough to go into the gym) made me do exercises that I could do and avoid anything that caused pain. For the last couple of months that's all I did. So I quickly grew tired of it and quit going for a while so I had more energy for the regular things in life and my family.

I've been reading through those links you suggested and I think I'll make a list of every possible shoulder injury and take that to the physiotherapist next week. If I can get him to go through the list, one by one and try to rule out what I don't have then we should end up with a good idea about what's going on in there. With some of those injuries I'm seeing outcomes like 'years to resolve', 'muscle transplants', 'possible paralysis', I guess it's ultimately up to me to look after myself properly!

Thanks again Chris (and if anyone is reading this please send him some karma!)
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