shoulder-dislocation

How to look after a shoulder dislocation

I have spent decades studying shoulder dislocations. By having them myself and as a musculoskeletal physio on the Northern Beaches. It’s a good thing too, because shoulder dislocations account for about half of all major joint dislocations in Australia.

Maybe you fell off your bike on your way from Manly to Dee Why on the weekend, or copped a shoulder charge in a friendly game of footy and heard your shoulder POP and give way.

There is something about all our sun, surf and sand mixing with plenty of beach volleyball and other stressful-on-the-shoulder sports that make shoulder injuries a daily occurrence.

Thankfully, with effective early management and a solid dose of expert physiotherapy, most shoulder injuries such as dislocations and fractures can be treated without surgery.

The shoulder is an amazing joint that gives us a huge range of movement. The trade off unfortunately, is that the shoulder joint is a little bit more unstable than your hip joint and more prone to dislocation.

How do I know if I have dislocated my shoulder?

Trust me. You’ll know.

Shoulder dislocations are extremely painful and if it doesn’t pop straight back in, you won’t be able to move your arm at all without turning the pain up to 11/10.

If you have dislocated your shoulder, the humeral head in your shoulder pops totally out of your glenoid socket causing:

  • Pain when you move your shoulder
  • Deformity of your shoulder joint – your shoulder won’t be sitting where it should be (ouch)
  • Loss of normal shoulder motion
  • Shoulder tenderness and weakness
  • Bruising and discolouration around your shoulder
  • Swelling
  • Numbness in the shoulder area, arm or hand

What should I do if I dislocate my shoulder?

Shoulder injuries are serious. Do not try to relocate a dislocated shoulder yourself.

The longer it takes to seek attention the more the muscles spasm and the more difficult it is to put the shoulder back into the joint.

If your shoulder does not reduce (pop back in) by itself very quickly you will need to get to your nearest emergency department immediately. If a reduction is not done properly, damage to the humerus, rotator cuff or other structures within the shoulder joint is possible.

This is going to make your already painful injury worse and prolong your rehab.

Ice your shoulder for the first 48–72 hours after dislocation

Ice is going to be helpful for your pain and swelling and you should continue to place ice packs on your shoulder for 30 minutes max every 3 to 4 hours until the pain and swelling are less noticeable.

If your pain is not controlled or you notice numbness of your arm or part of your hand return to the emergency department ASAP.

Wear a sling

But only for as long as your physio or doctor prescribes. The length of time you are in the sling will differ depending on the extent of your injury and there is more harm than good to be done by sitting in a sling for 6 weeks after a dislocation.

During the first phase of recovery only remove your sling to perform your prescribed exercises or to clean under your armpits. Do not lift your arm up; lean forward and let your arm hang.

How long will the effects of a shoulder dislocation last?

Everyone recovers from injury at a different rate.

Your healing process could be anywhere from 4 to 12 weeks, depending on the extent of your injury. With proper healing and rehabilitation you should regain full movement and strength in your shoulder in well under 6 months.

If you do the rehabilitation exercises that are given to you by your physio.

How rehab is performed depends on the extent of your injury, your age and your likelihood of re-injury based on a number of factors. Return to your activity will be determined by how soon your shoulder recovers, not by how long it has been since your injury occurred.

The goal of rehab is to get you back to your pre dislocation activities as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage.

Luckily for you if you are over 40, the likelihood of re-dislocation is quite low whereas if you are under 20, your likelihood of re-dislocation is very high.

You can usually return safely to your sport or activity when:

  • Your injured shoulder has full range of motion without pain
  • Your injured shoulder has regained normal strength compared to your uninjured shoulder.

If you’ve got questions, or a sore shoulder yourself, musculoskeletal physios are experts in shoulder injuries and rehabilitation, so give us a call on give us a call on (02) 8964 4086 or book an appointment.

ice-injury

Do I use heat or ice for my injury?

Should I use heat or ice for…?

It’s one of the most common questions I’m asked in the office at Physio Dee Why or out and about at sports events on the Northern Beaches.

Ever since the invention of the frozen bag of peas, most people have wondered whether heat or cold would help ease their pain for a number of injuries and ailments. You might have even tried both in an effort to scientifically prove which one is the best.

Knowing the benefits of heat and cold for injuries, along with understanding the proper duration for each can help you manage your injury from the outset and speed up your recovery in the process.

How do ice and heat therapy work?

Using ice on an injury works by lowering the local temperature of the surrounding tissue, resulting in decreased blood flow, nerve activity and swelling.  Ice can also make your pain worse if your body is already cold, causing muscles to tighten and contract more, rather than relaxing and easing the tightness that’s causing the pain.

Whereas heat raises the local temperature of the surrounding tissue; increasing blood flow to the area, metabolic rate and muscle elasticity. Because muscle tension can spiral into many other problems, including headaches, which cause more pain; so many people swear by a relaxing hot bath or a stint in a sauna to improve their overall health and well-being.

So, heat therapy works to relax injured muscles, heal damaged tissues and improve flexibility and ice temporarily reduces nerve activity, reduces swelling, bruising and slows circulation to the affected area.

Because they work so differently, it’s important to see why both treatments need to be used properly. For instance, heat does not go well with swelling. Using heat therapy when you are hot and have a new swollen injury is a recipe for more pain. Crack out the ice pack instead.

When should I use ice on an injury?

  • Musculoskeletal trauma
  • Tendonitis
  • Acute or chronic pain
  • Acute inflammation
  • Bursitis
  • Muscle spasms

When should I use heat?

  • Decreased range of motion
  • Muscle guarding
  • Muscle spasms
  • Myofascial trigger points
  • Subacute or chronic pain
  • Chronic inflammatory conditions

After looking at the benefits of using ice and heat for injuries and how each works, as a general rule:

  • If the injury is new or has occurred within the last few days – Ice it
  • If there is noticeable swelling with your pain – Ice it
  • If you have decreased range of motion with no swelling – Use heat
  • If you have muscle tightness, spasms, or trouble relaxing – Useheat
  • If you have had chronic pain with no range of motion loss and significant swelling – Ice it first, then use heat

Heat and cold therapies are excellent ways to ease pain and relax muscles. However, neither is a substitute for an expert physio.

If you find yourself relying on ice or heat over a long period without decreases in your pain levels, consult with your Fixio physio for more in depth and permanent treatment options.

sore-wrist

How hand and wrist pain can be treated with physiotherapy

Everything we do revolves around the use of our hands. Whether we’re cooking, playing sport, eating, driving or texting our mates; we would be very limited without the amount of functions our hands can perform.

Your hand and wrist contain a total of 27 bones, 34 muscles and over 100 ligaments and tendons.

All that hardware means there’s a whole laundry list of things that can cause pain.

Conditions like De Quervain’s tenosynovitis restrict thumb movements, cause pain along the thumb side of the wrist, decrease grip strength and can hang around and recur without the right treatment.

This means that hand and wrist injuries require special guidance and knowledge from a Northern Beaches physio to treat and leave them in the past.

Why do I have hand and wrist pain?

Using a computer all day is the most common cause, believe it or not.

At first glance, boring old computer use might seem low stress on the body but it easily contributes to a large portion of the neck pain, back pain, headache, wrist fatigue, shoulder fatigue and carpal tunnel syndrome we see here at Fixio.

All those hours spent leaning over your desk is very taxing on your hands and wrists due to typing, writing and poor body posture. Some people keep typing until they get pins and needles or numbness in their fingers, or pain and swelling in their wrist or fingers. You need to be taking a break long before that point.

Other common causes of hand and wrist pain include:

  • Overuse
  • Carpal tunnel syndrome
  • Wrist tendinitis 
  • Menopause
  • Getting older
  • Wrist & Hand Osteoarthritis
  • Inflammatory arthritis
  • Trigger finger
  • Dupuytren’s contracture

How do physiotherapists treat hand and wrist injuries?

With there being so many possibilities when it comes to hand and wrist injuries, there are a range of treatments used by physios.

The bespoke treatment plan for your hand and wrist injury depends on the type and extent of your injury and is guided by a thorough assessment by your Fixio physio. Injuries like fractures and ligament injuries may require immobilisation, while overuse injuries may require specific stretching exercises or modification to your work equipment or technique.

When you meet with your physio, we will be looking for clues to help with our evidence based diagnosis.

  • Inspectingthe palm and dorsal surfaces of the hands for any obvious joint swelling, deformity, skin discoloration and the presence of cysts or nodules is one of the first steps we will take to diagnose your pain.
  • We’ll measure your Range of motion by opening and closing your hand to help determine the number of affected joints, and assess the severity of your condition. An inability to flex or extend may suggest an underlying tendon disruption, displacement, or dislocation.
  • You’ll have Strength testingthat can include resisted motion in both flexion and extension across each joint in your hand.
  • This might include Grip strength testing for a measurement of the integrity and strength of the muscles of your hand and forearm. Reduced grip strength is a symptom of nearly every hand and wrist complaint though, so it’s only a small piece of the puzzle.

For specific advice regarding your wrist pain, get in touch with your expert local Northern Beaches physio ASAP.

hip-pain

Trochanteric Pain Syndrome

Do you have pain on the outside of your hip?

Does it get worse when you:

  • Sit down for a while and then stand up
  • Walk up or down stairs
  • Stand for a long time
  • Get in and out of your car
  • Lay on the side that is painful

You may have Greater Trochanteric Pain Syndrome (GTPS),[1] also commonly referred to as hip bursitis or gluteal tendinopathy. GTPS occurs when the tendons, muscles or bursae that lie over the greater trochanter at the top of your thigh bone become irritated.

The good news is that this common condition can be managed well by an expert musculoskeletal physio and here on the Northern Beaches, we see a lot of it.

What causes Greater Trochanteric Pain Syndrome?

The exact causes of GTPS are many and not always well understood. Because GTPS can affect many parts of your life, it is important for your physio to identify what factors are exacerbating your cycle of pain. Once your physio has done this, they can get stuck into providing short term pain relief, education around activity modifications and exercises you can do so that you can get back to doing activities you enjoy.

Lateral hip pain causes include:

  • A recent increase or change in your exercise routine and loading
  • Gluteal muscle weakness
  • Iliotibial band tightness
  • Tightness of adductor muscles
  • An imbalance of muscles in the greater trochanteric region

Who is most at risk of suffering from lateral hip pain?

If you are a female between 40 and 60, you are more at risk of developing GTPS. You may also be more likely to develop GTPS if you:

  • Have a previous/current history of back pain
  • Are overweight
  • Run more than 30km per week
  • Have knee arthritis

How can physiotherapy treat GTPS?

GTPS is often a vicious cycle of pain which causes patients to avoid many activities, leading to further muscle weakness around the hips and in turn, more pain.

Our Fixio physiotherapists are up to date with the latest evidence and base our management of GTPS on evidence based principles so we can make sure we are always giving parents the best care and advice.

At Fixio we may use different types of treatments to control and reduce your pain and swelling, including ice, heat, taping, exercises, massage and manual therapy.

Your Fixio physio will work with you to:

  • Reduce Pain and Swelling
  • Improve Motion
  • Improve Flexibility
  • Improve Balance
  • Learn a Home-Exercise Program

To help prevent a recurrence of GTPS, your physio may advise you to:

  • Follow a bespoke flexibility and strengthening exercise program
  • Always warm up before going for a run or playing sport
  • Gradually increase any physical activity, rather than suddenly increasing the amount or intensity
  • Learn and focus on maintaining correct posture

Is dry needling recommended for lateral hip pain?

Studies have actually shown that dry needling is at least as effective as a cortisone shot for the treatment of a number of injuries, Greater trochanteric pain syndrome (GTPS) included.

“Cortisone injections for GTPS did not provide greater pain relief or reduction in functional limitations than DN (dry needling). Our data suggest that DN is a non-inferior treatment alternative to cortisone injections in this patient population”.[2]

Is there anything I can I do now to reduce my hip pain?

  • Avoid sitting with your legs crossed
  • Avoid sleeping on the irritated side
  • Avoid bearing more weight on one leg than the other

If you are experiencing lateral hip pain, contact our team today. Call us or book online.

 

 

[1] Lin CY, Fredericson M. Greater Trochanteric Pain Syndrome: An Update on Diagnosis and Management. Curr Phys Med Rehabil Rep. 2015;3(1);60-66.

[2] Brennan KL, Allen BC, Maldonado YM. Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial. J Orthop Sports Phys Ther. 2017;47(4):232-239. doi:10.2519/jospt.2017.6994

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