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This article is a transcribed edited summary of a video Bob and Brad recorded in February of 2022. For the original video go to https://youtu.be/wdymXr2b0H4
Bob: What are we going to talk about today, Brad?
Brad: We are going to talk about the shoulder, separation versus dislocation. There’s a clear difference between the two and you need to know what you actually have.
Bob: I think it’s often mixed up. I think people think separated is dislocated.
Brad: Right, but not so! What we’re going to talk about is first a separated shoulder. We are going to use Sam (the skeleton). Here you’ve got your clavicle or your collarbone. Same thing. It comes over and there’s ligaments connecting the end of your collarbone to your scapula or shoulder blade. The bone on the end is called the acromion. There’s a ligament here from the clavicle to the acromion. There’s also another ligament that goes underneath and connects to the coracoid process. You don’t need to know these names. And a third ligament, the Conoid ligament. They all stabilize the clavicle, which is a really important part of your shoulder movement.
Bob: Really, when we are talking about separation, we’re talking about the clavicle. It’s that
bone right here, you can feel it easily on yourself.
Brad: So, what happens if you have a separation, it’s the clavicle literally separating from the acromion and the coracoid process. These two bones. So, the line represents if you have a separation. There are three grades of separation: one, two and three. First grade is the acromioclavicular ligament is torn. If you have a second degree, it’s a little worse, the acromioclavicular ligament and the trapezoid ligament are torn. If you have a third degree, that’s the worst. All three of these ligaments are torn and this clavicle just pops right up. I had this happen to me and my wife has it right now after ten years but hers is not very noticeable. When it happens, the collarbone sticks up pretty high, it can, and it looks obvious.
Bob: And it’s called?
Brad: This is called the piano keys syndrome.
Bob: I didn’t understand that at first but if you push down on it, it pops back up. So, like a piano key.
Brad: Yup, you’ll see a bump there. I remember mine was dislocated and I moved around, and it really popped up. It hurt; it was no fun. I looked in the mirror and it was like; I didn’t think about piano key, but you can push down on it because there’s nothing holding it. You can push down, and it pops back up. After it’s happened for a while, for a few days, it typically settles down: it’s not so painful. Then you can push it up and down.
Bob: What’s amazing about it is, quite often the body will heal it.
Brad: Yes, it rarely has surgery. Unless it’s really severe or if you’re a high-level athlete and you need it, they may do something or if it’s an aesthetic, or an appearance thing, like if you’re a model and you have bare shoulders.
Bob: You don’t have to worry about that, Brad.
Brad: No, I have no problem with that! So, that’s a separated shoulder. Xray’s will show you don’t need an MRI. Same with a dislocated shoulder.
Bob: You probably could almost see it manually.
Brad: Right. You’ll get an X-ray to confirm things though. If you look at this side, here we have the shoulder joint.
Bob: We have the humerus and the ball, and it fits into the socket right here.
Brad: A dislocated shoulder has nothing to do with a separated shoulder. Everything is intact on the clavicle, but the head of the humerus pops out of the socket.
Bob: If I remember right, like 95% go forward. They don’t go back like this.
Brad: Yeah, probably the rest will go down or down and forward. It really doesn’t matter, it hurts!
Bob: The mechanism for doing so is it needs to be understood. By turning your arm out, like this, that causes the head to move forward.
Brad: Or if you have an outstretched arm and you fall and there’s a lot of leverage, it causes that same dislocation. Again, no MRIs are needed, just an x-ray. Usually, you can see it. Then, hopefully, it pops back in. Sometimes you have to go into the ER.
Bob: The surgeon has to do it.
Brad: It’s very painful. Hopefully they can get it done. My mother, she fell on the ice and hers dislocated. Actually, I saw the x-rays and it went down on the rib cage. She went to the ER, and they pushed it back in and then she was much happier. After that, typically no surgery. You need to do some strengthening. Let it settle down for a few days, and then get into some strengthening exercises.
Bob: Let’s make this point, Brad. If you are younger and you keep dislocating your shoulder, then they might do surgery. You’re more susceptible to this if you are younger. The ligaments have more stretch.
Brad: You might be considered hypermobile, maybe your joints are all a little lax.
Bob: But, if you’re older, this is one of the few advantages of being older is they probably won’t do surgery.
Brad: Sure, ha-ha. That does make me feel better. I’ve never dislocated a shoulder.
Bob: Me either.
Brad: There’s one thing I did want to mention here. Should we show them the sulcus sign?
Bob: Sure
Brad: So, if you have a dislocated shoulder, this bone, you pull down and you’ll see a bump right there. I’m going to see if I can relax, you can't see it very well. My ligaments aren’t loose. Some people are loose enough where you can see a gap here between the acromion and the humeral head. If you have a stroke and all these muscles are lax, that’s pretty common on a stroke patient.
Brad: There’s rehab for this. We aren’t going to get into the dislocated shoulder, but I’ll just get it back into place, that’s the next step. We’re going to talk a little bit about the separated shoulder. We’re not going to get too detailed in this.
Bob: Right, just give you some basics.
Brad: So, you’re going to give it a break. Ice it, ibuprofen, all that stuff, when it initially happens. You may find yourself being suggested to wear a brace. When I had mine, I had what they called a Figure 8 Brace. I don’t have one here and I’m not even sure if they use them anymore.
Bob: I don’t know if they do anymore. I don’t think so.
Brad: I actually liked mine. I had to wear it for a few weeks, and it pulled my shoulders back and it supported it.
Bob: You just liked it because it got you attention.
Brad: No, I actually wore it underneath.
Bob: You probably had it outside your suit.
Brad: I would have, a blaze orange one. So, that may happen, it depends on your doctor or your surgeon if they want you to brace it or not. Also, avoid sleeping on it. It’s really easy to avoid it because if you roll over on a separated shoulder, in my experience, it woke me up screaming because it hurt like crazy, especially the first week.
Bob: It’ll let you know.
Brad: You get really good at sleeping on your back or the other shoulder. Once it's feeling better you can start moving it more. I was a therapist at the time and my surgeon said once it’s feeling better, do your PNF exercises and I just did it on my own and it worked very well. Basically, you might start with Codman exercises just to get it moving, in the flex position.
Bob: When you’re doing that, you’re really relaxing.
Brad: Right. From there you can do assisted flexion, just raise it up as far as tolerated. You’ll get so far and then it’ll start to pull and hurt. Then you go back down.
Bob: The work is being done by the left arm.
Brad: Right. I like using the ball actually. If this is my sore shoulder, you can just roll it out. Watch my shoulder, I roll it out and back.
Brad: Then I can roll it out to the side. When that feels better, then you can go to the wall.
Bob: Which adds a little gravity to it.
Brad: Yup. Then you can assist it, roll it up and down. Ten repetitions. Turn sideways. It is going to be a little more challenging this way. Use a hand here and roll it that way. After about a week or two of that, it’s going to get stronger. Then you’re going to start strengthening it. But you’re not going to strengthen it until you can raise it up, pretty much all the way. You might need a little help with that. You have some favorite ones you want to talk about, Bob?
Bob: Probably just external rotation, that’s probably the big one.
Brad: Sure. We’ll take a band here. You want to start strengthening the rotator cuff to help stabilize things. You can do this one, scapular retraction. You’re going to want to do this one for sure, using both hands. Ten of that one.
Brad: I do want to talk about resisted flexion. I like bands, I’m a band person. You can use weights, dumbbells, if that’s what you have. You’re just going to go up as far as you can.
Bob: You can use a soup can if you want, to start.
Brad: How about chowder?
Bob: Whatever. Beans work too.
Brad: It actually works good because you’re not going to need much weight or resistance. Out to the side. Make sure you go across your body because that’s a real functional motion. It’s going to pinch a little bit more at first, so be careful with that.
Bob: Avoid pain.
Brad: For the people that are not athletic or don’t do over head work, you can rehab this pretty easily. As long as you can reach up into the cupboard. I’m thinking maybe for people that aren’t that active or if you’re older, you know.
Bob: That shows how the body is so amazing that it heals itself.
Brad: I remember the doctor told me it’s going to heal up fine. Just keep working it and sure enough, it did. They said you’re going to notice it when you get older and I’m noticing it, but it’s not bad. Very good, good luck with your separated shoulder and we do have some dislocated shoulder exercises.
Bob: Look for those on our YouTube channel. Thanks!
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