July 20, 2014

How to Fix a Broken Shoulder Part 2: Diagnosis & Treatment

By Slacker | Guest Writer

Previously on How to Fix a Broken Shoulder .....

"To my surprise, the big pain never came & I was still able to use my right hand for light tasks. Off to TTSH (Tan Tock Seng Hospital) I went but not before a bath & lunch as the wait will be way too long I'm sure. It didn't feel too bad but changing of clothes was a real wake up call if you know what I meanGiven the symptoms & my prior experience, I remember thinking that I should be back in no time but unbeknownst to me then, this split second has changed my way of life forever.."

The A&E nurses & doc were somewhat surprised at how calm & matter of fact I was (thanks to my prior experience which calls for another article). I guessed that's why she only offered pain killers (which I declined), 1 day MC & told me to reuse my old arm sling (if I can find it, it was a good 9 years back after all)!

I took it as a sign that all will be back to normal in no time. The swelling went down pretty fast & the pain & soreness were pretty much gone by the 3rd day. I found my old slings & used it primarily when commuting, just in case I get bumped by Singaporeans who are walking blindly, engrossed with their mobile devices.

On the 2nd day, I was back to work & my boss tapped on my injured shoulder hard a few times, thinking that it would be a harmless joke. I was really HIGH and I could probably hit some Celine Dion high notes. He was probably unaware how bad my injury was as I removed my sling once I reached office. 

Morale of the story: Wear your sling, made sure every Tom, Dick & Harry knows about your injury.

I later did some googling, compared the illustrations to my x-rays and concluded that the injury looks like a Type-III AC joint disruption. Generally, surgery is not performed as studies have shown that the recovery is about the same whether surgery is prescribed or not. Some people have also commented in the forums that a complete tear is less painful than a partial tear down the road as there is less contact between the bones. Wonder if I should feel happy or not, hmm...



The Treatment

Time always seems to slow down when your master hand is hurt as even doing basic stuff takes much longer with your less dominant hand (give it a try & you'll know what I mean). Guess that's how old folks feel as they lose the dexterity & strength in their fingers. Though I could use my right hand, it felt weak & even simple things like washing my face, I had to use my left hand to support my right or it just doesn't feel right.

By the end of the week, it was mostly back to normal except my arm feels somewhat loose when walking & I had to hold onto my shirt or my bag's shoulder strap for support. A fear that this will be the case for the rest of my days came up & it was SCARY..

Around the 10th day, my colleague recommended a Sinseh (Traditional Chinese Medicine physician, from Shaolin linkage no less!) that specializes in joint/muscle injuries & told me to see him soon for best results. So there I went, the Sinseh (who coincidentally suffered the same injuries as me on both his shoulders, had equally interesting stories to tell) gave me some very drastic diagnostics - the worse being some of my muscles will degenerate & fail eventually.. He was adamant that I go for an operation as soon as possible, otherwise the unthinkable will happen.

I was in shock and everything came crashing down.

 It was unthinkable given my lifestyle. 

I had to get a 2nd opinion fast & wasted no time in consulting an experienced Specialist who works with the SSC (Singapore Sports Council). After a detailed diagnostic, Dr Lim  showed me how some muscles on my right have stopped working compared to my left (e.g. when I squeezed my shoulders back, my left shoulder blade was moving down while my right was moving up).

Though less drastic, Dr Lim did say a lot needs to be done & I was determined to follow all his instructions to make it happen. It was tough as the rehab exercises focus on strengthening the small supporting muscles around my shoulder blade to hold the entire arm in place. The ligaments in my AC joint are gone & the muscles are all I have left to support my arm. Posture is key & it has to be precise as these small muscles are weak & hard to target. Posture was never my strength & I really struggled.

During the 1st few weeks my upper Trapezius muscle (the 1 between the neck & shoulder) would get very sore & stiff. I had suffered from this before & really went to great lengths to relieve the soreness - massager, infra red heating, stretching, lying on massage ball etc.

Then the soreness went away & I took it as a good sign, my body is finally better . Boy was I wrong! During my next consultation with Dr Lim, he sighed & said, "It's not good, it's a sign that your muscles have overworked & started to fail & give up."

I was like, WHAT!?! Really shocked. The something that I took as a good sign is actually something so negative.

He adjusted my rehab routine and I had to retrain my upper Trapezius to work again. Just great, an up became a down again and the roller coaster ride continues. I was getting pretty deflated but was resigned to doing the exercises.

Back to Tan Tock Seng

The 1st Specialist I saw in TTSH (Tan Tock Seng Hospital) was a complete waste of time and I really felt like smacking him in the head if I haven't known better. No concern shown, no advice given and kept wanting to end the session. He didn't even offer Physio Therapy until I asked! Among his 1st sentences was: "I think you should come back in a month's time for a 2nd opinion". Well, I hope you get the same injury & I'll be glad to give you my opinion, you idiot.

As such I didn't have high hopes for my first session with the TTSH Physiotherapy department. However, the therapist showed genuine concern & was very helpful, even going off to consult his senior when he wasn't sure. For that I'm very grateful but the reality is that I could tell he was out of his league. 

He did helpfully mentioned a couple times that I was "high level".....

After my 2nd session, the TTSH therapist cleared me to go back to my normal activities. I was over the moon and the words were music to my ears. 

Finally ya finally, Woo Hoo

However, when the euphoria faded, I realized I probably should not rush through with normal activities even though I was itching to go. Next week I will be seeing Dr Lim again, and until then, I would just continue working hard on my rehab, heal some more, get his confirmation and hopefully, get be back into my normal routine!

My Normal Routine....
So high were my hopes that I can feel the bounce in my feet as I walked towards the clinic but it soon dropped to the canvas as my hopes were dashed, completely.. He was shaking his head & mumbling, "How could he clear you when your shoulder is still tilting forward?" 

The rest of the words were just a blur. I was so eager to go training that evening but that thought evaporated into thin air.

Throughout my visits to TTSH and Dr Lim, I was visiting the Sinseh regularly every fortnight. He would use medicine, acupuncture with heat, cupping & even letting of blood to aid my recovery & sore muscles. There were times where he would put some secret Shaolin formula on my shoulder, wrap it up & told me to leave it there for 3 days. Given the bucket loads that I sweat, I could feel the itch already :-D

During one of my subsequent visits, he examined & told me I must be a "genius" as my collarbone was remarkably close to its original position even though he did not use the tying method (as too many days had passed when I 1st went to him). I did not tell him about the rehabilitation efforts that I have put in.

To be Continued....

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