Anterior Shoulder Dislocation

Having played a lot of Rugby since a young age, it has become a central part of my life outside of, as well as within school. Having played a couple of times for the 1^st XV while in year 11 I was excited about the next season when I would be a part of the sixth form. However, towards the latter half of my U16 season I badly dislocated my right shoulder while making a tackle. The injury was one of the most frustrating things I have had to deal with, keeping me off of the pitch for the rest of the season! After much physiotherapy and recuperation I was very much looking forward to what the forthcoming season held. However, after a promising start to the season for the team unfortunately the injury reoccurred in a similar fashion but to an even worse extent. Although on the first incident the shoulder had to be put in place by the A&E team, it had only been displaced for an hour or so. This time perhaps due to the reoccurring stress on the shoulder, the A&E team were not quite so successful taking along the lines of 8 hours before I finally felt the pop I had been dreading.  Because of my personal involvement with this injury, it has become something that I have endeavoured to find out more about and so in this article I will try to briefly explain the injury as well as the rehabilitation process I am currently undergoing.

A shoulder dislocation occurs when the shoulder is wrenched upward and backward for example, while under great pressure from an external force. The force can be such as a fall or collision (as I experienced) with enough strength to displace the shoulder. The anatomy of the shoulder means that approximately 95% of shoulder dislocations occur at the lower front of the joint. There are two main parts to the shoulder; the socket of the scapula (the shoulder blade) and the humerus (the ball attached to the arm). Because of the shallowness of the socket, it makes the shoulder particularly vulnerable. For this reason the scapula is “extended” by an area of cartilage and is supported by ligaments called the joint capsule. Furthermore a group of four tendons collectively called the rotator cuff, reinforcing the shoulder joint from above in front and behind.  When the arm is moved away from the body and rotated in a certain position, the joint gives way and the humeral head is ripped away from the scapula socket. The stress on other features of the shoulder, such as ligaments in the rotator cuff, the ring of supportive cartilage and the joint capsule are torn.

Upon getting to A&E I was given medication to reduce the pain such as codeine. I was also greatly thankful for the Nitrus Oxide which was the only thing that seemed to moderately reduce the pain before morphine was administered! The dislocation is then confirmed on X-Ray in order to make sure the diagnosis is correct, while also checking for any other breaks in the neighbouring bones. The shoulder is then moved into a number of different positions, while being put under different pressures in order to relocate it. This is not a pleasant experience!

The shoulder is then usually placed in a sling which immobilizes the joint and greatly reduces the amount of movement experienced by the entire shoulder. This helps to reduce the risk of recurrent dislocations. After a number of weeks, the range of motion is then gradually increased, with strength exercises added in order to return the joint to normal function. Recurrent dislocations are common due to the damage done to the tendons and ligaments after the initial dislocation. Having suffered from two dislocations in recent past I am now awaiting shoulder surgery which will help to repair damage to the scapula joint and restore normal function.

It’s not all bad however. The injury has left me with a desire to perhaps pursue a career in orthopaedics somewhere in the future!

Sam

Work Experience; Day two- Respiratory

On day two, I met Dr. Jarad who is a consultant respiratory physician. We spent the morning in the respiratory department and I had a chance to see how Dr. Jarad supervised some of the younger doctors who were also on the ward. It was nice to see how he was able to support them with their decision making and act as a tutor to those less experienced than himself.

 After this, we went across the road where we spent the afternoon in his hot clinic. In this service it was very interesting to see how Dr. Jarad tailored his skills amongst his patients depending on for example their age. He was able to discharge his patients with a management plan that he had drawn up for them after examination.

It was interesting to gain another day of experience in a completely different field of medicine, and I was very much looking forward to my final day at the BRI where I would be shadowing an F1 doctor which I shall write about soon!

Cheers!

Sam

Work experience; Day One - Vascular surgery

Several months ago I secured my first exciting piece of work experience. After emailing Jane Stiddard, head of work experience at the BRI, I sat an interview with her and a colleague the following week. Soon after I found that I had been accepted for a 3 day placement during half term which I realised was a great opportunity. My placement was split into three departments and so I have chosen to break each day down into a separate post!

On the first day I shadowed Dr. Marcus Brooks a vascular consultant in theatre where I was able to observe several operations. Both patients treated had been diagnosed with having an AAA, or aortic abdominal aneurysm. This is where the large blood vessel that supplies blood to the abdomen, pelvis, and legs balloons outwards and becomes abnormally large. If it is left untreated it may rupture and this could lead to death in the worst case scenario! However, despite both patients having the same diagnosis, Dr. Brooks decided to use different forms of treatment on the patients. This was due to their medical histories being rather different. The first operation performed was what he called a traditional repair. A large cut was made across the abdomen and after the aneurysm had been located, it was replaced by a man made graft that would perform the function of a healthy aorta. Conversely, the second operation performed was called an “endovascular stent treatment”. This form of surgery offered a quicker recovery time and was probably chosen by Dr. Brooks because of the other medical complications this man had. In this surgery, a stent was fed through the arteries in the man’s groin, up through his aorta, until it acted as a replacement for the damaged area. The team of surgeons did all of this while watching via X-Ray imaging to guide the stent.

I found the day particularly engaging and it made me even more aware of just how amazing the technology used today is. I found the way in which the surgeons took the prognosis and history of each patient into account before surgery, in order to determine which of the several procedures they would use very interesting, although I hadn’t really thought about it before! So this was day one... I shall write another post about my second and third day of work experience soon!

Thanks,

Sam