# How to know how bad you injured your shoulder



## Flying_Spaghetti_Monster (Jun 3, 2010)

So I took a really hard hit to my shoulder on Gorilla on the Green Narrows. I was able to roll up, and paddle out with pain though. I kinda was dazed from the hit which has not happened before, and I have taken some hard hits before. It mainly hit right at the bend of my shoulder the part that is mainly exposed. It also hit my shoulder blade. Long story short it seems to be getting worse, but I can fully rotate it (With moderate to severe pain) It feels like something is going on in the ball, and socket. My question is how bad could it be? Could it be a very bad internal bruise? 

Here is a video I put together. I believe when my boat rocks to the side is when I take the hit. This is to kinda show the force that it was at. 

A Day Spanking the Monkey on Vimeo

The hit is around 2:00 so you don't have to sit through the whole thing. Just looking for advice from some hard core creekers.


----------



## fullmer (Aug 23, 2006)

Not to give you a lecture. . . but instead of asking hard core creekers, most of whom have taken a few shots on the noggin themselves, you should ask a doctor, more specifically one who specializes in shoulder injuries. If you have insurance take a trip to the hospital and visit the doc. He or she will probably take some x-rays and maybe run a CAT scan. You will then have a better sense of the damage.

Good luck.


----------



## Flying_Spaghetti_Monster (Jun 3, 2010)

Yeah I know. I am all for going to the doctor, but sometimes people go to the doctor, and it not needed. If it continues for to much longer I will get some x rays. Just trying to see if I am over reacting to the injury.


----------



## NathanH. (Mar 17, 2010)

Could be the inflammation going through it's course for healing the damage. Kind of like you don't notice the bruise until it's swollen and hurts a lot the next day. Give it a couple days to do its thing. If there is permanent/severe damage it'll still show up on the MRI in a couple days after you see if the pain subsides anyways.


----------



## Flying_Spaghetti_Monster (Jun 3, 2010)

Cool man I am hoping it heals naturally. I hope it is just an internal bruise.


----------



## GAtoCSU (Apr 18, 2005)

Just chill out and don't paddle for a week or two. Re-evaluate the stability of the joint prior to getting back on the water. Xray isn't going to be sensitive or specific for the type of damage that you might have suffered from, and I don't think you want to get a $3,000 MRI right now, so I would advise you to take some naproxen or something and sit out a week or two. If it's still bothering you, consider going to PT for an evaluation (if you insurance or bankroll will support it) or an orthopedic surgeon for stability testing/MRI.


----------



## Flying_Spaghetti_Monster (Jun 3, 2010)

Yeah that is what I was thinking. I thought about hand paddling for a while in hopes of not putting to much pressure on it, and building up the muscles around the injury. I also will cool it on Gorilla until it feels better.


----------



## SummitSurfer (Jun 23, 2010)

As a medic, I would encourage you to get an X-ray. You may not have broken it totally but possible cracked it, stress'd the joint, chipped your acromium arch/process or your humoral head. Either way you don't wanna wait, sooner your healed, the sooner your back in the water. Plus, what happens if you have small fracture, and complete it to full compound on the river??? ......that would suck to be your friends and for you! Play it safe!
What you describe in rotator pain does seem like it will be fixed with duck tape and bailing wire!
Hope all is well!
****


----------



## SummitSurfer (Jun 23, 2010)

Sorry........."won't be fixed with......"


----------



## NathanH. (Mar 17, 2010)

I might add never treat an injury with heat. Give it some ice therapy.


----------



## Rich (Sep 14, 2006)

My leg and ankle took a beating on Clear creek @ 1,150.
Lots of ice and pain medication and I convinced myself it was nothing
and I actually did two more days on the Ark @ 3,900 (big fun!).

Five days later when the pain and swelling were not going away, I went for the doctor and xrays. Hairline fracture of the tibia, badly spained ankle and an hour lecture on how I had delayed healing of the soft tissue,
could have compromised future range of motion, etc etc etc.

Its the end of a great season, your not going to miss much boating by healing now. Get it looked at.


----------



## T.J. (Apr 24, 2007)

Something similar happened to me earlier this season. Looking on the Internet I went for the 2 weeks of icing and ibuprofen and no paddling. I wound up not feeling like it was completely healed(and I'm older) so I gave it another week. Seems to be ok now(2 months later). I also tried to compare the shoulders after the injury to see if they were symmetrical and they appeared to be. If one is lower than the other you need to get it looked at. I'm not a doctor. I wouldn't go kayaking until you are positive it is stable. Good luck!


----------



## Theophilus (Mar 11, 2008)

Took about a month to heal from this one. Ice and easier paddling for a while.


----------



## Fry (Jun 12, 2010)

Rest-Ice-Compression-Elevation. In your case, rest & ice. Shoulders are complex and slow to heal. An ibuprofin regimen, about 1600 mg/ day (2 200 mgs 4x/day) for inflamation. Rest 5 days minimum. When you get back into it, ice the joint after working it. Freeze some dixie cups full of water, peel the paper back and rub the ice on the joint, that is a very effective way to cool the joint. Ice for maybe 10 minutes max.

I'm not a doctor, but I have suffered shoulder injuries all my life and had a few surgeries... And I did stay at a Holiday Inn Express last night...


----------



## Hans (Aug 21, 2008)

X-ray won't show ligament or tendon damage. I took my orthopedic doc's advice that it "was just muscle bruising & it'd go away". it didn't just go away, so I went in & got an MRI that showed there was a lot of damage that wouldn't heal on it's own. i found another surgeon/practice & had it repaired less than a week later.

my injury was a blunt force impact... shoulder to concrete. "clicking" or locking up when you try full range of motion, generally points to damage other than muscle or bone, and you can build muscle to hold your shoulder in place, but it won't fix the problem often.

good luck!


----------



## Flying_Spaghetti_Monster (Jun 3, 2010)

Fry said:


> And I did stay at a Holiday Inn Express last night...


I love that quote. Here is a picture of the injury about an hour after it happened.







It does not show the best detail, but gives an idea of the damage.


----------



## SummitSurfer (Jun 23, 2010)

Looks like you "may" have some posterial acromium difformity. BUT its really hard to tell from pictures. Still would encourage you to see the doc.
But this may help..... find a friend, have him stand in front of you and put a hand on each shoulder, (doctors, nurses, medics use this tech) and ask him to feel both shoulders at the same time. Any diformity other than tender swelling could possibly indicate a skeletal issue. If you can muster it have them palpate (push) on areas that are painful to determine if they feel bone fragment, floating hard pieces or just soft tenderness in tissues.
Again, I'll tell you like I tell my patients, I'm no doctor and none of us on the buzz, while good intentioned, will be able to tell you better than an Xray and professional consultation.
Suck it up, go see a doctor, get it figured out so you can quickly have some PEACE of mind and get back on the water fast.

Hope that helps,
****


----------



## GAtoCSU (Apr 18, 2005)

GAtoCSU said:


> Just chill out and don't paddle for a week or two. Re-evaluate the stability of the joint prior to getting back on the water. Xray isn't going to be sensitive or specific for the type of damage that you might have suffered from, and I don't think you want to get a $3,000 MRI right now, so I would advise you to take some naproxen or something and sit out a week or two. If it's still bothering you, consider going to PT for an evaluation (if you insurance or bankroll will support it) or an orthopedic surgeon for stability testing/MRI.





Hans said:


> X-ray won't show ligament or tendon damage. I took my orthopedic doc's advice that it "was just muscle bruising & it'd go away". it didn't just go away, so I went in & got an MRI that showed there was a lot of damage that wouldn't heal on it's own. i found another surgeon/practice & had it repaired less than a week later.
> 
> my injury was a blunt force impact... shoulder to concrete. "clicking" or locking up when you try full range of motion, generally points to damage other than muscle or bone, and you can build muscle to hold your shoulder in place, but it won't fix the problem often.
> 
> good luck!


You make it sound like the original ortho guy did something wrong. Running a conservative practice and not ordering $3000 tests on every person who comes through the door is a good thing. I'm sure if you would have called him up 2 weeks later and asked for a more in-depth workup that he wouldn't have any issue sending you down the street for a MRI. 

If you want the works treatment, find an ortho clinic that has their own $3,000,000 MRI machine and I'm sure they will recommend that you get a MRI the same day you present.


----------



## GAtoCSU (Apr 18, 2005)

SummitSurfer said:


> Looks like you "may" have some posterial acromium difformity.


What would that be? The AC joint is on the anterior side, and the acromium is nothing more than the most lateral aspect of the scapula. It's a completely solid structure with no ligament or joint anywhere near the site you are talking about.

Are you trying to say that he broke the bone, and you are seeing soft tissue displacement from the fracture? Our eyes over here see nothing more than an abrasion, early stage of bruising, and some soft tissue swelling from the area of impact.

I don't think that Speg. has insurance, so taking a conservative approach initially is a good thing to do, especially if he has full range of motion in that joint. If he doesn't, then he should seek medical attention at his convenience. There are clinical indications for MRI's and surgery that can't be assessed over the internet, unless there's a gross deficit in his function.

I'll stop patrolling this thread. The only reason I decided to post is b/c I know the author if it.


----------



## SummitSurfer (Jun 23, 2010)

Yep thats what I'm saying.....bone difformity! Remembering, this is just from a picture and nothing can replace the in person evaluation, but it seems to me that his acromium "process"(bone) is missing, lower than normal or broken/chipped or floating. It could also be just his normal anatomical development with some inflamation of the sub tissues. 
Where the abrasion is most concentrated in the photo, I'm of the opinion it should normally stand up a little more posterial. But again......its a picture and difficult to compare to the other normal shoulder because its not pictured. Spagetti could load pictures all night, its not going to be as good as a hands on assessment of the shoulder.
Spaghetti: In some of the larger city's in Utah there are free hospital, clinics used for teaching med students, medics, nurses doing "clinicals" etc etc. (Teaching Hospitals) ie Denver General etc. See if you can get into one of those. The only difference is that you may wait a while to be seen and have students standing in on a patient assessment.
I don't wish any of this on you and truly hope its just bruised and that you can be back on the water soon with just a war story to tell.
Best of luck,
****


----------



## Duckins (Nov 7, 2008)

FSM-I bet you'll be good to go in a couple of weeks. If you have full range of shoulder motion it's unlikely you have a dislocated shoulder, which is probably the only thing that you shouldn't wait on if cash is an issue. Hunting for answers on the 'Buzz you'll probably get some funky recommendations. Here are mine...
-GAtoCSU gave some good advice. Try some ice, but lay off it for a while before getting seen.
-Don't listen to Hans. He doesn't know what he's talking about (sorry Hans).
-Don't let anyone send you for a MRI without getting x-rays first. You can see a lot from a good x-ray, and a MRI doesn't substitute for it.
-Don't get a MRI unless your shoulder still hurts enough that you would get surgery on it. MRIs can show a lot of irrelevant "damage" that can lead to unnecessary surgery.


----------



## Gremlin (Jun 24, 2010)

The last time my shoulder turned green, it healed just fine. I suspect I will feel pain there again just like in my left foot, lower back, bottom three right ribs, and right knee. Alcohol helps.


----------



## GAtoCSU (Apr 18, 2005)

SummitSurfer said:


> Yep thats what I'm saying.....bone difformity! Remembering, this is just from a picture and nothing can replace the in person evaluation, but it seems to me that his acromium "process"(bone) is missing, lower than normal or broken/chipped or floating. It could also be just his normal anatomical development with some inflamation of the sub tissues.
> Where the abrasion is most concentrated in the photo, I'm of the opinion it should normally stand up a little more posterial. But again......its a picture and difficult to compare to the other normal shoulder because its not pictured. Spagetti could load pictures all night, its not going to be as good as a hands on assessment of the shoulder.
> Spaghetti: In some of the larger city's in Utah there are free hospital, clinics used for teaching med students, medics, nurses doing "clinicals" etc etc. (Teaching Hospitals) ie Denver General etc. See if you can get into one of those. The only difference is that you may wait a while to be seen and have students standing in on a patient assessment.
> I don't wish any of this on you and truly hope its just bruised and that you can be back on the water soon with just a war story to tell.
> ...


He's living in Georgia now. Maybe I'll go paddle with him next weekend and give him an eval.


----------



## SummitSurfer (Jun 23, 2010)

You guys have fun and be safe. It's my hope that I'm very wrong and you guys have a good ride. 
Best of luck, 
****


----------



## Hans (Aug 21, 2008)

GAtoCSU said:


> You make it sound like the original ortho guy did something wrong. Running a conservative practice and not ordering $3000 tests on every person who comes through the door is a good thing. I'm sure if you would have called him up 2 weeks later and asked for a more in-depth workup that he wouldn't have any issue sending you down the street for a MRI.
> 
> If you want the works treatment, find an ortho clinic that has their own $3,000,000 MRI machine and I'm sure they will recommend that you get a MRI the same day you present.


well to be honest, the 1st ortho guy did not do his job. my injury could have been diagnosed with simple professional manipulation of my shoulder, which he never did, then verify with the MRI to determine the extent of the damage that was not revealed by an X-Ray. I knew there was significant damage, described my sensation of a "popping" into place immediately after impact, which any ortho should know is a complete dislocation of the joint & tendon/ligament damage is likely. I ended up with a 2 o'clock to 11 o'clock tear of my genoid labrium, and having had that years prior on my other shoulder & not diagnosing/repairing for 2 years, significantly increased the healing & recovery time. That injury was diagnosed with physical manipulation, then verified by MRI. Money was no object as it was from an auto injury. but regardless, that's not really my point....

unless he has a snapped clavical, obvious without X-Ray, not much will be revealed by getting an X-Ray. The shoulder is the most complex joint we have, and to get us the range of motion we have, it is also the most vulnerable. My point is, ligaments & tendons provide the static stability, muscles provide the dynamic. Muscles can also be developed that will compensate for loss of static stability within the joint, however it conceals internal damage at the same time, while allowing for repeat & more damaging injuries in the future b/c the static stability is already compromised. Heal times & actually recovery increase once the real injury is addressed after years of "muscle compensated healing" is prolonged. 

recovery of quickly addressed shoulder injury needing surgery... about 2 months & my shoulder is better than new & never is painful

recovery after 2 year delay of similar injury needing surgery... about a year, with 3-4 years of pain associated with it & not nearly the stability I have in the quickly repaired shoulder.

anyways just trying to be helpful, FSM was asking how to determine how bad a shoulder injury could be, and i was giving him some "free" advice based on having two shoulder injuries from blunt force impacts, as the costs of addressing his injury obviously are a concern.

i'll be in augusta Monday thru Wed, wanna grab a beer? beta on where to go would be cool also!


----------



## Hans (Aug 21, 2008)

Duckins said:


> -Don't listen to Hans. He doesn't know what he's talking about (sorry Hans).
> -Don't let anyone send you for a MRI without getting x-rays first. You can see a lot from a good x-ray, and a MRI doesn't substitute for it.
> -Don't get a MRI unless your shoulder still hurts enough that you would get surgery on it. MRIs can show a lot of irrelevant "damage" that can lead to unnecessary surgery.


ouch Tim, just read this. is it possible two locations had crappy XRay machines, as both the ER immediately after the accident & the 1st ortho's a week later revealed nothing?

my PT diagnosed it by physical manipulation 48hrs before the results of the MRI came in. my first ortho had two chances to physically manipulate it prior to the MRI on my demand, but didn't. 

the ortho/surgeon I went to when I lost confidence in the first b/c they were "constrained" by money issues, we talked about other stuff to fill up the presurgery consultation time as we both knew what needed to be done & it was a very obvious injury, and we scheduled the surgery for 3 days later.

i really wish the X-Ray machine (a third one) I went to last month under a managed care system (KP) was "quality", as it came back negative on damage in my ankle, yet every day I am in pain & have a hard time walking.

so I guess my point is, for many joint injuries a X-Ray is a complete waste of money as it will not reveal anything.

alright, time to get off the buzz i see the buzzards are about. tim, did you get on bailey today, saw you were talking about flying in?


----------



## Flying_Spaghetti_Monster (Jun 3, 2010)

GAtoCSU said:


> He's living in Georgia now. Maybe I'll go paddle with him next weekend and give him an eval.


Best post yet. Heck yeah Scott I hope I am feeling better by next weekend, and I can get that eval.


----------



## Duckins (Nov 7, 2008)

Yeah, Scott, get him checked out so we can put this one in the grave. 

Hans, I couldn't make Bailey this weekend, but it's tempting to fly back sometimes. The PP in Ogden is slightly better than nothing at all. Don't know the whole story on your shoulder, but I'm glad it's better. Had to do a little shit talking since I'm now a depressed, sorry sucker out here in the desert, with only mediocre/warm beer to drown my sorrows. Guess my point is that it's best to get a XR first in most cases. Even a normal XR (or MRI for that matter) can be useful information clinically.


----------



## GAtoCSU (Apr 18, 2005)

Hans said:


> i'll be in augusta Monday thru Wed, wanna grab a beer? beta on where to go would be cool also!


I'd love to but I 'm studying for my internal medicine clerkship exam that is Thursday and Friday, and seeing patients in the hospital as well. If you're in Augusta I would hit up Bee's Knees, Tako Sushi, and Rhineharts.


----------



## GAtoCSU (Apr 18, 2005)

XRay is like $75
MRI w/ contrast injection is about $3500
Bankhart repair and glenoid redcution is about $12,000

There's no telling what you have or what you don't have by looking at pictures or anything else. Unless it's bothering you to the point that you are seriously considering surgery, what's the point of investing that amount of money in a diagnostic testing?

Paddlers and athletes dislocate their shoulders all the time and don't suffer tear their labrum. If they do, and it impacts their life significantly enough to justify going under the knife, the five year success rates for not having another relocation isn't really that great, especially in people like us who go right back out to Gorilla and mess up another line on the drop.


----------



## asleep.at.the.oars (May 6, 2006)

That strikes me as some pretty solid advice. I'm not an orthopod, but the ones I work with will do a good exam and look at the plain film, say what will be on the MRI the PCP ordered, and only then pull out the MRI pictures - and be right.
If there's no fracture and no loss of function, I'd say no to an MRI as well.
Good luck with the recovery.


----------



## Duckins (Nov 7, 2008)

So... been 3 weeks. What's the verdict?


----------

