♪ Bob and Brad ♪
♪ The two most famous physical therapists on the internet ♪
- Slow clap.
(clapping)
Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together we're the most famous
physical therapists on the internet.
- In our opinion, of course, Bob.
- What are you going to talk about today, Brad?
- What do you say? Well, Sam's here,
we've got to introduce Sam.
- Right.
He's going be a major part of this episode.
Absolutely. Be nice to him.
- Okay.
You want to talk about shoulder?
- Sure.
- Separation versus dislocation.
And there's a clear difference between the two.
- Right.
And you need to know what you actually have.
- I think it's often mixed up.
- It is.
- I think people think separated is dislocated.
- Right, right. Same thing-
- Right.
- but not so.
So, what we're going to talk about
is first a separated shoulder.
- Right
- So, we're going to use Sam.
This is really important that we use
Sam for this.
This shoulder is obviously non-functional.
(laughing)
We took his arm off,
but that's where the dislocated shoulder.
[Bob] Look over here.
[Brad] Over here, you got your clavicle
or your collarbone. Same thing.
And it comes over and there's ligaments
connecting the end of your collarbone
to your scapula or shoulder blade.
This is called the acromion, that bone is.
So, there's this ligament here.
There's also another ligament here
that goes underneath and connects
to the coracoid process.
You don't need to know these names.
But this bone to this bone,
and a third ligament,
this bone to this bone, okay?
And they all stabilize the clavicle, which is a
really important part of your shoulder; Movement.
So, what do you say-
[Bob] Really when we're talking about separation,
we're talking about the clavicle.
[Brad] Exactly.
[Bob] I mean that's that bone right here.
You can feel it easily on yourself.
- Yup. Here it is. I got these glasses on.
So, what happens if you have a separation,
it's the clavicle literally separating
from the acromion and the coracoid process.
These two bones.
[Bob] Sure.
[Brad] So, if there's a... can you get in on this?
This line right here represents if you have...
There's three grades of separation;
One, two and three.
First grade is this ligament is torn.
If you have a second degree, it's a little worse.
This one and this one 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 on to me,
and my wife has it right now after ten years,
but hers is not very noticeable.
But when it happens, this sticks up pretty high
it can, and it looks obvious.
- And it's called?
- This is called the piano keys syndrome.
- Piano key. And I didn't understand that at first,
but I understood that if you push down on it,
it pops back up.
- Yup.
- Like a piano key.
- Yup, you'll see a bump there.
And I remember mine was dislocated
and I moved around and it really popped up.
And it hurt, it was no fun.
And I looked in the mirror, and it's like,
I didn't think of a piano key there.
But you can push down on it
because there's nothing holding it.
So, you can push down and it pops back up.
And after it's happened for awhile,
for a few days, it typically settles down
and it's not so painful.
And then you can push it up and down.
- What's amazing about it, it quite often
the body will heal it.
- Yes, it rarely has surgery.
- Right.
- 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 if parents think,
like if you're a model.
- Model, right.
- And you have bare shoulders.
- You don't have to worry about that, Brad.
- No, there's no problem with that.
So anyways, that's a dislocated-
- No, a separated shoulder.
- ...separated shoulder. All up here.
- Separated.
- Absolutely.
- All right?
- X-rays will show you don't need an MRI.
- Right.
- Same with a dislocated shoulder.
- You probably could almost see it manually.
- Right.
- I mean, visually.
- But you'll get an x-ray to confirm things.
- Right.
- Now, if you look at this side,
here we have the shoulder joint.
And a dislocated-
[Bob] We have the humerus.
[Brad] Yup
[Bob] And the ball.
And it fits into the socket here.
[Brad] Right there. And a dislocated shoulder
has nothing to do with separated shoulder.
This, everything is intact
on the clavicle, but the head of the humerus
pops out of the socket.
[Bob] And like ninety-five percent,
if I remember right, Brad-
[Brad] I think you're right.
[Bob] Go forward.
[Brad] Yup.
[Bob] They don't go back like this,
they go forward, ninety-five percent.
[Brad] Right. And probably the rest
will go down. Or down and forward.
It really doesn't matter, it hurts.
(laughing)
[Bob] But the mechanism for doing so is,
and it needs to be understood, you actually...
by turning your arm out like this.
[Brad] Yup, that's-
[Bob] That causes the head to go forward.
[Brad] Yup. Or if you have an outstretched arm
and you fall, and there's a lot of leverage
and it causes that same dislocation.
So again, no MRI's needed, just an x-ray,
and usually you can see it.
And then hopefully it pops back in.
- Right.
- Sometimes you have to go in to the ER.
- A surgeon has to do it.
- It's very painful.
- Right.
- And then hopefully they can get it done.
My mother, she fell on ice, hers dislocated.
Actually, you saw the x-rays.
- It did go down.
- Down in the rib cage.
- Wow!
- And she went to the ER
and they pushed it back in,
and then she was much happier.
- Sure.
- And then 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.
- Let me make this point, Brad.
If you are younger and you keep dislocating
your shoulder, then they might do surgery.
- Sure.
- And you're more susceptible to this
if you are younger.
- Mm-hmm.
- Because the ligaments have more stretch.
- Yeah, you may be considered a hypermobile,
maybe your joints are all a little lax.
- Right. But if you're older,
this is one of the few advantages
to being older...
(laughing)
They probably won't do surgery.
- Sure.
(laughing)
That does make me feel better.
- Yeah, there we go.
- I've never dislocated a shoulder.
- Me neither.
- There's one thing I did want to mention here,
should we show them the sulcus sign?
- Sure.
- So, if you have a dislocated shoulder,
this bone, go ahead.
- You pull down-
- And you'll see a bump right there.
I'm going to see if I can... I'm going to relax.
You want to see if I can get a sulcus sign.
[Bob] Sure.
- Because right here in my acromion,
I'm going to relax, and-
- No, not really.
- My ligaments aren't loose.
Some people are loose enough-
- Yup, where you can see a gap here-
- Yup.
- ...if you really pull down.
- If you have a stroke-
- And all these muscles are lax.
- Right.
- That's pretty common to see a sulcus sign
on a stroke patient.
- Yeah it is.
- Mm-hmm. So, there we go.
Now we're going to, there's rehab for this.
We're not going to get into
the dislocated shoulder,
but I'll just get it back into place,
and that's the next step.
We're going to talk a little bit,
because that's the title of this-
- Right.
- Is the separated shoulder.
And I'm not going to, we're not going to
get too detailed-
- Right.
- In this.
- Just give you some basics.
- Right. So you're going to give it a break,
ice it, ibuprofen, all that stuff
when it initially happens.
- Right.
- You may find yourself putting, you know,
they may suggest a brace.
- Right.
- When I had mine, I had what they called
a Figure 8 Brace. I don't have one,
and I'm not even sure if they use them anymore.
- I don't know if they do anymore.
I don't think so.
- Yeah. I actually liked mine. I had to wear-
- Did you?
- Yeah, they said wear it for a few weeks,
and it pulled my shoulders back,
and it supported it. And it kept-
- You liked it because it gave you attention.
- Yeah. No, I actually wore it underneath.
- Oh, yeah.
(chuckling)
- I would've liked that, I would've.
- You probably had it outside your suit.
- Blaze orange runner.
- Yeah.
(laughing)
- Yeah so, you know that may happen,
it depends on your doctor, your surgeon-
- Sure.
- If they want you to brace it or not.
The next thing is, is you're going to start,
avoid sleeping on it.
- Right
- And it's really easy to avoid it,
because if you roll over on a separated shoulder,
in my experience-
- It'll let you know.
- It woke me up screaming, because it hurt
like crazy.
- Right.
- Especially that first week.
So you get really good at sleeping on your back,
or the other shoulder.
So the next thing, once it starts feeling better,
and I was a therapist at the time-
- Sure.
- And that my surgeon, she said-
- What you're doing-
- Yeah she said once it's feeling better,
you know, do your PNF exercises,
blah blah blah blah, and I just did it
on my own and it worked very good.
- Sure.
- But basically, you might start with
Codman exercises just to get it moving,
in a flex position. If that feels okay-
- When you're doing that, you're really relaxing.
- Yeah. And then right from there
you can go to this, and just raise it up
as far as tolerated. You'll get so far
and it's going to start to pull and hurt,
then you go back down. You do that-
- The work is being done by the left arm.
- Right, exactly. I like using a ball actually.
- Right.
- Let me get a chair here, Bob.
If this is my sore shoulder, you can just roll,
watch my shoulder. I roll it out and back.
Roll it out and back, then I can roll it
out to the side. And when that feels better,
then you can go to the wall.
[Bob] Which adds a little gravity to it.
- Yup. Then you can assist here
[Bob] It's a little bit harder.
- Roll it up and down here, ten repetitions.
Turn sideways. It's going to be
a little bit more challenging this way.
Use a hand here and roll it that way.
And after about a week or two of that,
it's going to get stronger.
Then you're going to start to strengthen 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.
- Sure.
- You got some favorite ones, Bob,
you want to talk about?
- Well, probably just external rotation-
- Sure.
- Is probably a big one.
- Yeah. We'll take a band here.
You want to start strengthening the rotator cuff
to help stabilize things. You can do this one.
You're going to want to do this one for sure.
Using both hands, okay? Ten of that one.
I do want to talk about resisted flexion.
[Bob] Sure.
- You know, I really think, I like bands,
I'm a band person. You can use weights.
- Yeah.
- Dumbbells, if you have.
And you're just going to go up as far as you can,
and remember-
- You can use a soup can if you want, to start.
- Yup. How about chowder?
- Whatever.
(chuckling)
- Beans. Yeah, it actually works good because
you're not going to need much weight
or resistance.
- Right.
- But make sure you go across your body too
because that's a real functional motion.
And it's going to pinch a little bit more-
- Yeah.
- At first so be careful with that, okay?
- Avoid pain.
- Yup. Out to the side-
- Avoid the pain.
- And for the people that are not athletic
or don't do over head work, you know,
you can rehab this pretty easily.
- Right.
- As long as you can reach up into the cupboard.
And I'm thinking maybe for just people that
aren't that active or if you're older, you know.
- Again, that shows how the body is so amazing
that it heals itself.
- Yup. I remember the doctor told me,
she... he said, well I had a female and a..
Oh whatever. They said
it's going to heal up fine.
- Sure.
- And just keep working it, and sure enough,
it did. I don't know. It still, you know,
they said you're going to notice it
when you get older.
- Yeah.
- And I'm noticing it.
(chuckling)
But it's not bad, so.
(laughing)
So, very good, good luck
with your separated shoulder
and we'll have- we do have
dislocated shoulder exercises.
- Sure. That'll be a different video.
- Different video.
- All right.
- Be careful.
- Thanks!