I’m nil by mouth at the moment because latter today I’ll be checking into the hospital for a several procedures that are going to be carried out under a general anaesthetic.
- An injection of hyaluronic acid into the glenohumeral joint (to lubricate the joint
- Another cortisone injection
- Some x rays that will be taken after some die has been injected into the joint to further investigate the cause of the problem.
Last week both my surgeon and my physiotherapist thought that the problem with my left shoulder was due to some post operative adhesive capsulitis (frozen shoulder). Due to the small range motion I have at posterior abduction. However, I think the problem may in fact be due to some glenohumeral joint subluxation (partial dislocation). I think the confusion has occurred because of something that happens to the muscles at the point of subluxation called – “Apprehension”. This prevents the muscles moving any further and dislocating the shoulder, and at this pint it becomes impossible for me to move the shoulder any further.
What I have realised this week, is that if I support the shoulder (so that the shoulder muscles are not involved in the movement) by leaning my elbow against a wall, I can then move my body so that the shoulder is moved through the point of rotation where I am unable to move it normally. When I did this the first time I expected it to be very painful – as you would expect with a frozen shoulder that was being forced to move further than normally possible, but in fact there was no pain at all.
What did happen was a very strange sensation where I thought for a second the arm was going to come completely out of the shoulder joint, but then at the last second it popped back into the right place.
Here is a good explanation of subluxation of the glenohumeral joint I found at the website of Orthopedic Surgery and Sports Medicine at the University of Washington
Dislocation of the glenohumeral joint is the complete separation of the articular surfaces; immediate, spontaneous relocation may not occur. Glenohumeral subluxation is defined as symptomatic translation of the humeral head on the glenoid without complete separation of the articular surfaces. Subluxation of the glenohumeral joint is usually transient: the humeral head returning spontaneously to its normal position in the glenoid fossa. In a series of patients with anterior shoulder subluxation reported by Rowe and Zarins, (Rowe and Zarins, 1981) 87 per cent were traumatic and over 50 per cent were not aware that their shoulders were unstable. Like dislocations, subluxations may be traumatic or atraumatic, anterior, posterior, or inferior, acute or recurrent, or they may occur after previous surgical repairs that did not achieve complete shoulder stability. Recurrent subluxations may coexist with or be initiated by glenohumeral dislocation. Rowe and Zarins (Rowe, 1956; Rowe and Zarins, 1982) reported seeing a Hill-Sachs compression fracture in 40 per cent of the patients in their series on subluxation of the shoulder, an observation indicating that at some time these shoulders had been completely dislocated. Apprehension refers to the fear that the shoulder will subluxate or dislocate. This fear may prevent the individual from participating fully in work or sports.
From what I can gather the problem has been caused because either the tendons are too lose, or the muscles are not working (coordinating) properly following on from the surgery in January. Treatment is usually physiotherapy (exercises to strengthen the scapular muscles) and if that fails surgery.