Shoulder Surgeons in San Francisco Area Discuss Separation vs Dislocation

Despite my many years of medical experience I would be the first to admit that it is easy to confuse a shoulder separation with a shoulder dislocation, and I am sure that many other shoulder surgeons in San Francisco (and further afield) would admit the same. In fact without a visual investigation, such as an X-rays, it can be difficult for the most experienced medical professionals to distinguish between the two.

The shoulder one of the most moveable joints in the body and is made up of three bones; the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). The shoulder blade has a shallow socket into which the ball of the upper arm fits. The joint then has a network of soft tissue, including muscle, ligaments and tendons which keeps all of the bones in place.

Many shoulder surgeons in San Francisco will agree that the danger with the shoulder joint being so mobile is that it is prone to instability and dislocations. When a shoulder dislocation occurs the arm bone becomes separated from the shoulder blade. This can be caused by repetitive strain especially where the motion is overhead, for example in sports like tennis or swimming. A blow to the shoulder can also cause a dislocation depending on how the joint is sitting at the time. My main concern with shoulder dislocation is that in severe cases the surrounding tissue may become badly damaged which results in chronic instability. This means that the strong tissue that usually keeps the bones in place are weakened to the point that they allow the arm bone to slip out of its socket easily. Chronic shoulder instability can be very unpleasant but in some cases can be treated non-surgically. The most common treatments suggested by shoulder surgeons in San Francisco are physical therapy, which includes specific strengthening exercises to help keep the shoulder in place and prescribing non-steroidal anti-inflammatory medications.

A shoulder separation occurs when the clavicle is allowed to come away from the shoulder blade due to the connective ligaments being torn or damaged. This is most common in athletes who take part in contact sports such as football, rugby or martial arts where they are likely to suffer falls or aggressive tackles. A shoulder separation can occur in degrees of severity, ranging from a sprain or partial tear to a complete tear of the supporting ligaments. The Rockwood classification, which is a numerical scale ranging from i to vi, is used to define the severity of the damage based on a physical examination (and sometimes X ray results). Most shoulder separations cause some level of deformity as the shoulder blade sags with the weight of the arm and creates a bulge over the shoulder.

As with shoulder dislocation, shoulder separation can also be treated without a surgical procedure. The arm will have to be reset and immobilised in a sling to allow the tissue to rest and recover. Ice packs and medication will probably be needed to alleviate pain and discomfort from swelling. Shoulder surgeons in San Francisco have progressed in treating shoulder separation however in some cases there may be significant deformity in the shoulder even if it returns to full mobility.

Many patients who have had a shoulder separation experience pain in their shoulder due to the bones rubbing on each other in a way that they shouldn’t because of the deformity. In cases where the bones are not rubbing abnormally, some doctors believe that the ‘pain’ that patients complain about is more psychological than anything else. It is believe that the seeing the deformed shoulder subconsciously causes patients to believe that they should be in pain. I am not sure if this is actually viable, however, I do believe that it is something that should be investigated.

For patients I would advise that they wait a reasonable amount of time for everything to ‘settle’ but if the problem persists after therapy, then it may be necessary to undergo surgery. My personal preference is to try all non-invasive treatments before suggesting surgery. Some shoulder surgeons in San Francisco feel that performing surgery sooner rather than later will fix the problem straight away, however the recovery time can be up to 6 months, whereas depending on the damage, physical treatments can have a patient up and about in as little as 4 weeks.

Don’t let shoulder pain limit your way of life! If you’d like an initial consultation with one of the top shoulder surgeons in San Francisco, call my office today.

Dedicated to getting you back in the game,
Dr. K

Michael B. Krinsky, M.D., M.C.
20990 Redwood Road
Castro Valley, CA 94546
(888) 478-5688