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shoulder dislocation - tales of woe/joy wanted
Mr Milk
9:43:45 AM

I'm looking for some free and possibly dodgy advice...

I seem to be having a problem with my shoulder dislocating when I go rockclimbing. It's painful and unpleasant and it tends to ruin my day when it happens. It's happened three times now and I think I can see a pattern developing.

Naturally i have been speaking to Dr Julian about it, though I'm a bit perplexed. Julian seems to think that shoulder surgery is a bad idea. While I'm not one to argue with someone with such vast knowledge and fashionable attire, I would like to know:

Is there anyone out there who has had shoulder surgery and was it terrific and wonderful or a painful waste of time and money? I've heard a couple of good stories from people who have had it, and not many good stories from people who have tried the natural rehabilitation methods.

I quite like sport climbing so I tend to use my shoulders a fair bit. I'm not very interested in becoming a trad dad at 23. Considering that I go crazy when I don't climb, I can't really just find another pursuit either. Neurofen and whiskey are fun, though not a sustainable endeavour.

Anybody with some personal experience feel free to influence me!

11:20:33 AM
Sounds like a classic Bankart lesion to me.

Surgery is not the end of the world - A good friend of mine in the UK had the repair done about 4 years ago. His shoulder was loose and kept popping out at annoying moments. He was no slouch and was climbing 30/V11 prior to the op and returned to that level within a year or so of the op. I had a SLAP repair done on my shoulder in June by Jerome Goldberg at Orthosports who is highly regarded in this field. It cost in the region of $3,500 (surgeon and anaethsatist) and I got about $1,000 back from Medicare. Thankfully I had insurance for the hospital/theatre costs etc. So as you'll see, one of the down sides is the cost but hey, if climbing is a big a part of your life as it is mine, you find the money somehow. The other is you'll be looking at a straight 6 months off with (plus 4 weeks immobilised in a sling) with a full recovery taking around a year. I've just started to climb again now after the much rehab and strength building to get some muscle back on my withered arm. I struggled with the shoulder for over a year before finally getting an MRI which identified the problem. I tried physio for 4 months and in the end went to see John Orchard (sports physician) at Sydney Uni to get a final opinion before electing to get surgery. He was pretty blunt - "Its a big tear and it won't fix itself so surgery is the way to go if want to return to climbing at full strength"

I had my last surgical appointment a couple of weeks ago and he was happy that it was fully recovered. The full range of movement will take a while and a lot of stretching. The bottom line is that I now a 'new' shoulder which I can use to the full extent and unless I do something at least as traumatic as the original injury it won't tear again- So I'm pleased I went through the procedure. I'm already back out crankin' and couldn't be happier.

Good luck!
1:38:09 PM
Hi Jesse,
Dodgy shoulders are so much fun and i have my good news story for you!
I seem to suffer from lax joints as i have dislocated both shoulders a wrist and my hip over the years..
i am 45 now and started dislocated my shoulders around 23 after about 30 times i had it operated on i think the op was called a puty plat? which involved tightening the whole shoulder it has been fantastic since, my other shoulder had a number of dislocations thru snow skiing and has not felt so great, if it gets caught backwards while out from my body i worry its going to come out, if i was going to have it fixed try and do the research on YOUR surgeon i always try and go where the footy players go as their management looks around for the best, its one of those things where you are being told surgery may not fix it and you will be worse off, i had knee surgery to fix a meniscus tear and have had a great six years sure i cant play squash anymore but its better than walking downhill matching feet all the time, ask Julian what exercises can strengthen your shoulder and i used to ski with my shoulder taped, not that it would stop it popping but it gives you an idea when its getting close to the dislocating position...
just to give you an idea how loose my shoulder had become it used to dislocate when i sneezed or sometimes just fall out as i slept, getting it back in was the crap part
hope this helps
3:55:18 AM
I have a dodgy shoulder. First anterior dislocation was caused in a XC skiing accident in 1996. I have
since managed to injure the shoulder skiing, climbing, swimming, and surfing. After the first couple of
dislocations I decided to see a physio. The physio recommended using a theraband for strengthening
the joint and shortening the stretched ligaments. I found that therabands work well for rehab, and I
have had pretty good mileage doing functional fitness type exercises also, as this builds stabilising
muscles around the shoulder. When in the weight room, avoid machines - use only free weights or
body weight, and lift with good technique. Avoid further dislocations as this makes the joint weaker
(easier said than done, I know). I haven't had a disloc in about 6 years, but I'm still careful. I've done
a lot of very hard and varied exercise since then involving shoulders, with no ill effects. I was
examined by a physio about 4 years ago and she said that my dodgy shoulder appeared now to be
stronger than the good one!

Naturally, your mileage may vary, depending on the nature and seriousness of the injury. Obtain a
second opinion if you're not sure, but I'd say Dr Julian has probably seen quite a few bad shoulders by

Neurofen and whiskey is not such a bad treatment either. I'd go for Chemist's Own and maybe wash it
back with a nice peaty single malt like Talisker, though currently I'm enjoying Wasmund's ;-)
8:05:01 AM
If the damage to the capsule that holds your shoulder together is bad enough, then no amount of rehab
will stop your arm falling off. Mine came out skating (first), then skiing, surfing, hang-gliding, jumping
into a canyon, and finally leading a route at Piddington which was by far the scariest and most serious
incident by far... so trad isn't your answer either.

Get your shoulder assessed properly. The surgeon who fixed mine poked around and pushed and
pulled enough to show me how and when the bones were likely to dislocate. I seem to remember him
saying that the fundamental damage to the capsule will only get worse -- they don't heal themselves --
so the rehab option is just lipstick on a pig (my words, not his). It might work if there's enough capsule
left to hold your arm in, but you won't know that till you get it looked at.

If you choose the surgery option, be prepared to do the rehab. It's uncomfortable (to put it mildly). I
know a few people who never really did the work in the year after their operation, and only got about
85% of the range of movement back. Once you've got your basic physical movement, work with a
trainer who understands your injury to build strength and flexibility. I lived with a limited range of
movement for years, thinking it was a normal result of the procedure. Turns out it was scar tissue,
which I would never have discovered on my own, or been able to fix (that's uncomfortable too.)

The op was the best thing I ever did, though. There's nothing worse than sitting at home rotting
because you can't get out and do the stuff you love in case your arm drops off.

4:21:58 PM
most people saying similar things to my experience of surgery for an unstable shoulder. as a climber it was the crappest year ever long and yes painful rehap to get your range and then strength back. as a physio im on the opposite end of the painful rehab and could not recommend enough that surgery is the only thing that will fix a shoulder that is not sound from a structural point of view. im the first to accept that if certain ie labral or gross stability tests come in positive that all the physio in the world will do jack!!
Mr Milk
10:41:14 AM
thanks for all the tales guys... sorry to hear that some of you have the same problem! seems like surgery is the go though. I read a study about shoulder dislocation and surgery and over a group of about 100 sporters open rehabilitation surgery had a dislocation recurrance rate of 12% over a ten year period compared with over 60% recurrence for manual physio rehab. It seems quite good.

Hey Stu! Was your surgery Athroscopic or Open?

I've been trying to get a consultation with either Des Bokor or Jerome Goldberg, as both have been recommended, but it seems they earn plenty of cash from messed up joints and so are on holidays and things. I'm hoping I can maybe see a specialist sports injuries doctor who can recommend an alternative surgeon. Any ideas?

I'm getting all antsy about things and the closest appointment I can get is Feb 9th... :(

any help would be super.
11:18:56 AM
Hey Jesse,

It was arthroscopic so instead of having a nice scar to impress the chicks with, it just looks like someone attacked me with a stapler.

I think its the right decision but its always worth getting a second opinion before you take the plunge. Have you had an MRI?

Both surgeons you mention were also recommended to me and apparently make up 2 of the top 3 shoulder specialists in Australia (I can't think who the other guy is but I think he's based in Melbourne). In view of this (and the fact that he's close to where I live and patches up numerous footy players and cricketers) I went for Jerome. Esp after meeting him - he seem liked a good guy so I didn't mind him carving me up.

As is usual, the best guys are the most sought after so appointments can be hard to come by. I have to say that I know it sucks to wait, but I would in this situation. Get the best surgeon rather than taking some old hack just because he can do the job quicker.

Try John Orchard (sports physician) at the Sports Injuries clinic at Sydney Uni for a second opinion.

Again it can be tricky to get an appointment but you should be okay now as the footy season hasn't started yet. He may be able to recommend someone else but its likely that he'll tell you to wait for Des/Jerome.

If you're sure that you want surgery, and are getting antsy waiting, get Julian to give you some pre-hab excercises to do to strenghten the shoulder generally. Hit the iron and start putting some more muscle on to the shoulder/upper arm to compensate for what will waste away while you're in the sling. I did this and even then, I was amazed how small and withered my arm was when the sling was off. Be aware that it is a slow process and Jerome in particular is renowned for being very conservative with his rehab taking longer than others. Write off the best part of this year now!

Let me know if you want anymore info.

7:20:53 AM
Hey Jesse, I've been talking to your flatty Ben about this too. I've had the operation for essentially the same problem, and it's fixed it really good. I saw Julian and other physical therapists for years, but the reality was that they under structure was so broken that no amount of strength and conditioning would fix it. I had the Op in April and it feels fantastic now. It's taking me a while to get back to full strength, but I'm intentionally not hurrying.

It's worth getting fixed. My main benefit is not worrying half way through a multipitch "how will get out of here to hospital if my shoulder pops right now". I needed drugs and strong men to get mine back in. I wrote an article in Crux about my experiences too, if you want an uninformative account.

6:34:38 PM

i've had dislocations and sublux's over the last 7 years. the final straw was when it came out in my sleep (of course it's my luck that i'd sleep with my arm in abduction with external rotation!)
i got an open reconstruction from dr bokor in august last year.
i tend to agree with what hargs has said re rehabilitation and strengthening of the capsule and rotator cuff etc and the actual damage to the shoulder joint...
when i spoke to bokor he said that the success rate (ie the shoulder not coming out again) was better with the open reconstruction, though of course there's a bigger scar.
i ended up opting this way as i'd rather a better percentage of it not coming out, plus it was about 1k cheaper.
as someone without health insurance it's been a big out of pocket expense. surgery plus physio.
i've missed a trip to nz, gramps and thailand as a result and i (secretly) cry alone thinking about not climbng or going out watching mates.
but it's all long term perspective.
i could continue to climb with the tears in muscle, ligament and a loose shoulder and risk a sublux or dislocation all the time, then be off climbing and doing rehab, or i can take one steady hit of time out of the sport get it fixed and slowly get back into it.
i also agree with evanbb. there's one guy at physio who's had 5 reco's on one shoulder and 4 on the other. the guy gets physio, gets kinda strong and then pushes too early and it goes again. i think a disciplined slow approach to the recovery process and getting back in is the smarter option. after such a long time off the rock all i want to do is go nuts, but i'm mindful that when i get back on, i need to take it slow to avoid injury when my strength is not at its besst.
personally i'd rather be out of the sport for 6months-1year and have a stable shoulder rather than climb below my limits scared of pushing myself because my shoulder will pop, plus hopefully (touch wood) i won't have any more shoulder problems and can continue care free climbing for the rest of my days.

10:48:39 AM
Throw your shoes underarm
Mr Milk
10:26:17 AM
Thanks for all your help chaps. It's nice to hear a few positive stories.

I've got an appointment to see both des and jerome.

In the meantime...


10:42:17 AM
On 20/01/2009 Mr Milk wrote:

Don't knock it. I genuinely believe that when you're recovering from injury you've got to give your body plenty to work with. Eating (one handed) is a good way to pass the time too. Don't expect much conversation from Des, but he seems to know what he's doing. Have you lined up a physio? The guy I saw was brilliant, but not sure where he's practising now, he might just be pushing paper and pens around a desk.

My rehab was stretching/movement exercises first, with some massage to relieve the tension. It felt really weird at first, probably because it hadn't been working properly for years. Since then I've had a solid regime of pushups, with an aim to doing a one arm, which really strengthens the stabilising muscles. My shoulders have literally never felt better, and the op was done mid april last year.

Post Edit:
Just spoke to Sandeep. He's not practising, but recommends Rod Whitely, in Hornsby as "the guy he would see".
12:18:42 PM
Don't worry - You won't get that fat. You can hit an exercise bike while you're still in the sling. You should also be capable of running within 2-3 months. Eating one handed is a pain in the arse, as is dressing yourself, washing yourself and wiping your bum (if its your non-wiping hand). I hope you've got someone to help you out as the time in the sling is pretty damn hard on your own.
Also, get used to not sleeping properly. Whilst the apparently limitless supply of Tramadol, Prodeine, Temazepam and Endone help, its one of the things I found really ground me down. Normally, when you damage a muscle and immobilise it, it kinda stops hurting, but if you have bone work (anchors/shaving etc) done, no amount of immobilisation stops the throbbing, particulary at night.

I stuffed my face with loads supplements too - Glucosamine, CLA and various other vitamins and stuff. And before anyone starts on about placebo effect etc, I don't care, I was going to eat anything that might speed up the healing time, no matter how negligle the effect was.

And Jerome is lovely bloke and very personable. In fact, after seeing the quality of his stitching, I'd let him take up the trousers on my best suit.

Go out and by yourself and Xbox 360 now while they're cheap. Best way to waste away much of the couchtime.

Good luck,
10:30:33 PM
That's great. Finally I see someone posting success with physio. Everywhere I see on the net it's filled with tales of gloom and despair. Thanks your posting shows that this annoying injury can be beaten with patience and hard work.
11:23:57 PM
On 20/01/2009 StuE wrote:
>And Jerome is lovely bloke and very personable. In fact, after seeing
>the quality of his stitching, I'd let him take up the trousers on my best

- Laughed my arse off!! Well that's sold it for me, I'm going with Goldie.

Mr Milk - I'm looking getting the op done in a few months time, and have the MRI booked in and then the second appointment with Des lined up after that - he doesn't seem to be the most chatty guy but I haven't heard a bad word about his skills with a knife - we might have to trade war stories.
10:35:59 PM
Hrmm just to cheekily tag onto the end of this conversation.... i recently got a hold of my written MRI report and it turns out I have a anterosuperior to anterointerior labrum tear :(

It has been a year since the sublux that caused it and altho it has gotten stronger... my shoulder still feels gross.

Anyone know a decent ortho based in melbourne?
White Gold
11:35:16 PM
I dislocated mine 5 weeks ago for the first time. A week before Melbourne cup long weekend! Going to see John salmon this week. He does 700-800 ops a year with 75% of those on shoulders. A very good shoulder surgeon and conservative with his decision on whether to opp or not. Does a lot of the footy players. I have an extensive labral tear from 5.30 around to 12 o'clock. And moderate posterosuperior hill sach lesion.

Have seen a physio and had a few opinions. Most saying to try and avoid surgery as it is my first dislocation and just to do the rehab. That's probably sweet for the those other people who don't climb? Have been doing all the exercises and its feeling good but not going to rush back into climbing. Just have to wait and see what John says this week.

Out of interest how many other people have dislocated their shoulder, then done the rehab without surgery and not had it pop a 2nd or more times?
How old were you when you dislocated it the first time?
Were you still doing rehab when it dislocated the second time?

Eduardo Slabofvic
1:25:48 PM
I dislocated my right shoulder when I was 23. I recently re-injured it, and the quack reckons that the MRI indicates an old labrum tear, maybe from the dislocation incident. He has suggested trying a cortisone injection as a way of overcoming the pain and suffering, as if its an old tear, then I climbed with it for 25 years. If it works, great! If it doesn't, then another nip and tuck session.
6:46:16 PM
Richard Dallalana. I had a tear from 11 to 5 oclock. It took 6 anchors to sew it back down again - it was a big tear. He was really good at explaining the mri, what the options were, did a thorough physical examination of my shoulder as well. He's worked with climbers, circus performers, footballers - he really did seem to understand what I demand of my shoulder. He's sent other climbers home saying surgery isn't the best option for them. He was pretty clear surgery was the best, in fact, only option for me if I wanted to climb much again, or indeed, keep any muscle function as I had synovial fluid leaking from the joint and compressive the nerves. The surgery seems to have gone great, I was even given the go ahead to do easy climbing at 4.5 months - 6 weeks ahead of schedule. And today the physio told me she doesn't need to see me again and I'm at 170 degrees of upward range now - only 10 degrees to go! Woohoo!

John Salmon was recommended to me, but he won't see uninsured patients. I think that's all rather crap.

The surgery is outrageously excrutiating, and you really can't do anything with that arm for 6 weeks and really limited for another 6 weeks. It was awful and I was miserable, but the outcome looks really good now. And it was only getting worse beforehand - i probably increased the tear by continuing to climb on it for 3 months whilst noone managed to diagnose it. I'd also recommend Julian Saunders - he's worked with lots of climbing injuries and is really on the ball with it. He doesn't normally refer people to surgeons, I was the 2nd in 3 years, so if he suggests surgery, you can be pretty sure it's not going to heal from conservative management.

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