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| Q&A: Dr David Hartman on Head Injuries (824 Posts)
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Justins shoulder
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On 10/23/2003 Chris B
wrote in from
(204.78.nnn.nnn)
Hey Justin, i'm going thru the same thing now. Over the course of the summer, i dislocated BOTH my shoulders. It hurt ALLOT at first, but then subsided enough where advil would take care of the pain. Problem was whenever i worked out, i reaggravated it and started from square one. Then, out of the blue, just from laying down on the floor, my right one popped out again, with very little effort. I had an arthogram and mri and they found i tore my laibrum (spelling?) cartilage. This is a thin layer that covers your shoulder socket like a plate and has a thin lip on the edges. It's not uncommon with shoulder dislocations. Problem being, it really never heals. It is both the result of shoulder instability, AND makes it worse. To compound this, once you dislocate your shoulder, youre prone to do it again more easily. So what to do?...Surgery is an option. To me, personally, cutting thru muscle and tendons is a FINAL option, not the first. You could go with a support strap. Ive got friends with these. They work like those spongey straps for your knees. The wetsuit idea is good too. However, this is putting a bandaid on a broken leg. It will keep it tighter when you want to, but it's not solving the problem. I went with physical therapy, covered by my medical insurance....3 times a week for 4 weeks. What they are doing is working the small muscles around the rotator cuff to stabilze my shoulder. This is NOT something you can do on your own. They must first locate exactly where the discomfort is, then give you very very specific excercises to tighten it up, such as muscles in your armpit...i mean,...i wasnt even aware i COULD strengthen those muscles!....As you get older, if youre athletic, your joint stability will naturally loosen. Even if you work out, youre likley only working the major muscle groups that give good definition. This is an entirely different muscle group. They'll also teach you different techniques to maintaining strength in the area, as well as supporting areas in your back and shoulders. If you dont take it seriously, and get some real treatment, youre going to just do it again, and again.....hope that helps.
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Justins Shoulder
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On 10/5/2003
baugh
wrote in from
(63.231.nnn.nnn)
I had similar problems with my shoulder about 15 years ago... luckily I had health insurance that covered this kind of surgery... If possible see a sports medicine orthopedic surgeon for advice on surgery... At the time of mine there were two options. 1. The "tightening up" option which is mentioned in one post. 2. The other a reconstrutive operation with a bone block. (a very small piece of your bone is cut off, moved and re-fastened with a screw) The end result offering limited movement when your arm is lifted above your head. sorry for the limited details here... but it was some time ago that I had the surgery... I went for the second option "bone block" procedure and am really happy with the results. No dislocations since! Shoulder dislocations are so painful... I remember my shoulder popping out at a vert ramp contest in milwaukee, and the same winter snowboarding in Utah and after that rolling over in bed!... It was horrible... The only thing I enjoyed was the Morphine Drip... I wish you luck... Is there anyway for you to get health insurance that will cover this?
Try this band-aid solution in the interim:
Go find a snug fitting wet suit top (shortsleeve or long sleeve cut-off just above the elbow ) and sew or fuse the armpit area down just above the elbow and to the side of the body... It is restrictive and hot but, helpful to
have limited mobility in this area... It worked well for me and i even wore it the first year of my recovery from surgery.
good luck!
-jon baugh minneapolis
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Justin's Case
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On 9/29/2003
Dr. Dave
wrote in from
(68.74.nnn.nnn)
Justin,
If your shoulder is popping out just from throwing a tennis ball, I'm not sure that physical therapy is going to do it for you. Is there a public hospital where you are? See if there is a social service agency that might know of a way for you to see a doc to evaluate you. Even if you just have an HMO, it sounds like you have a good case to be kicked upstairs to a specialist.
Readers? Any ideas for Justin?
drdh
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Shoulder
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On 9/29/2003 Justin
wrote in from
(196.25.nnn.nnn)
Thanx for getting back to me. As much as I would like to go to surgry to fix my shoulder up I do not have that kind of funding. I was stupid not to go to pyshotherapy when it first happened, its gotten to a piont now I cant even throw a tennis ball that hard with out my arm popping out. Do u know of any sites that could have exercises so I can work my shoulder?
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Shouldering Justin's question. . .
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On 9/28/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Justin.
There are several possibilities. Basically if physical therapy doesn't work, you might be a candidate for open or arthroscopic surgery to tighten everything back up again. Arthroscopic surgery, if it's indicated, has the advantage letting the surgeon go into your shoulder with a viewing tube and a scalpel, rather than opening everything up. It's a smaller incision. Anyway, the bottom line is that your shoulder joint may have become "loose" and prone to repeated dislocations unless you tighten it up.
For first time dislocations, a sling and activity restriction is used for several weeks. A supervised physical therapy program is also crucial to prevent repeated dislocations. The therapy is directed at strengthening the muscles around the shoulder and upper back that help stabilize the shoulder in its socket.
For young patients, there is a high risk of recurrent dislocation. For these patients with repeated dislocations, surgery may be indicated. The surgery involves repairing and tightening the structures within the shoulder that were damaged during the dislocation. The most common procedure is an open reconstruction.
Arthroscopic (minimally invasive) reconstruction techniques, however, are evolving regarding the treatment of shoulder dislocations. Application of these techniques such as thermal stabilization and arthroscopic repair are becoming more popular and effective.
(above descriptions are from website www.emedx.com/emedx/diagnosis_information/shoulder_disorders/shoulder_dislocation_outline.htm )
Let us know how it works out. drdh
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Dislocated Shoulder
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On 9/27/2003
Justin
wrote in from
(196.25.nnn.nnn)
Ive dislocated my shoulder sk8ing. Unfortunatly it has become a comman thing while skatin even while doing a trick and just trying to balance out my shoulder while pop out. Knowing this happens often it stops me from wanting to go futher in my sk8in. Do u have any advise on getting it in better shape.
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Mike's mental misfiring
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On 9/18/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Mike,
Sorry about missing you yesterday. Sounds like a concussion, which usually a temporary change in your mental status as a result of a head injury. You do not have to be unconscious to receive a concussion. The good news, is, as you are discovering, that the effects usually fade fairly quickly. If you are continuing to have difficulties, if they interfere with your school stuff, if for any reason they start getting worse, e.g., loss of balance, headache, change in vision, nausea, etc., it's a definite ticket to the ER or your regular doc. So if it continues to get better and doesn't interfere with anything, just rest and ice and stay off your board for a few days. (Repeated concussions can be far worse than single concussions).
Let us know how it goes. Sk8 safe and wear the helmet.
drdh
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head injury
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On 9/18/2003
mike
wrote in from
(63.226.nnn.nnn)
the doctor not in? so i feel better now (no thanks to doc for consoling me). head is still bruised as hell, but mentally feeling better.
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head injury (again)
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On 9/16/2003
mike
wrote in from
(63.226.nnn.nnn)
so, most of the time i wear a helmet. i don't when i skate the small local park because i just don't fall that much and when i do, it is not that bad. i know i know...boo on no helmet, i will wear from now on. here is the deal. i went up on the extension in the bowl (if you want to call it that, like 5 feet tall), hung up, rolled down, while picking myself up off the bottom, my board rolled in and hit me square in the back of the head, right on the pointy part. hurt like hell, but felt better quickly. girlfriend's dad is a doctor and he stiched me up that night in the kitchen (4 stiches). to be honest, i haven't been the same since. my short term memory is slow, but not bad. just feels like i am in a dream kind of. could be because i am busy and perhaps sleep deprived (i work full time and am taking 15 hours of college). could i have sustained a brain injury from what happened? what symptoms should i look for? what can i do to remedy/ help the healing process. i don't really want to spend time up at the hospital. my experience is they don't really know what is going on anyway, and cost a fortune. i have insurance, but hate to use it. i have had enough big claims over the years and don't want to add the small ones. let me know what you think...
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ICE's Big Toe
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On 9/12/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Ice, ever try neosporin and a big ol' bandaid for that big toe? If it stays infected, go to your doc in the box. drdh
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One last word
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On 9/12/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
The other thing to keep in mind after one of these injuries is that it's almost always More Expensive and Less Effective to treat a badly healed injury than it is to fix it straight up.
You guys have to keep yourselves going long enough to teach your kids to sk8. . . . Let us know how it goes
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Swolen Ankle
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On 9/12/2003
David F
wrote in from
(64.219.nnn.nnn)
Thanks Doc,
After it happened I did a web search on sprained ankles at www.mayoclinic.com and other websites. They all said in some cases "to hear a loud snap or poping noise was normal" But this thing has been going on way to long. The only thing holding be back (besides money) was the fact that I could walk just fine, and I can't count how many times I have been in the E.R. to get checked out for some injury and the only answer I get from the Doc was "Yep....You hurt yourself, take some aspirin and take it easy for a few days"....
The one time I don't go to the hospital, and it really is something to be checked out.
I will reply when I find out whats really wrong.
Thanks again
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Hugs & Kisses
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On 9/12/2003
ICE
wrote in from
(165.121.nnn.nnn)
Your the Best!!!!!!!!!!!!
Thanks
Oh yea,
I also got this infected big toe and ................................................. ................................................. ..............................
Thank's again,
your a true benifit to the comunity and we appriciate it. I don't care what anybody else says about you.
Your alright in my book!!!!!!!!!!!!
I think this is the third or forth time you've taken time to help me out and I do appriciate it.
Live long and sk8 hard
ICE
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David's F'd leg and Ices knee
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On 9/11/2003
Dr Dave
wrote in from
(12.207.nnn.nnn)
David,
Get thee to a doc. Readers, can you suggest some low cost medical ideas for David? In Chicago, there's a County Hospital, which takes you, but makes you wait. David, I think you've got to check this out.
Ice, lay off the squats until you have someone telling you that you're healed. That's a recipe for re-injury. If your doc is telling you to take the anti-inflammatories, maybe it's a good idea.
The problem with extreme sports is that you've got to take care of yourself to avoid being a one hit wonder. Pad up, helmet up, and put some bucks into one of those non-taxable medical accounts just for this purpose. Almost passing out, hearing loud snaps, going numb and long-term swelling are basically tickets to the ER, the HMO, the PPO or whatever. I know that insurance sucks, but what's your body worth to you? To your girl (or boy) friend? OK, end of rant. Get checked out guys. drdh
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My Knee
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On 9/11/2003
ICE
wrote in from
(165.121.nnn.nnn)
So yea..............
I was sk8en a bowl 2 weeks ago, and the board shot out from under me. I jumped off and did a knee slide (wearing pads). I guess I put more weight on my left knee than the other and OH DAMM!! When I got up it felt like I almost dislocated my knee. So I got in my car and drove 5 hours home. The next day I could barely move my leg from the knee down so I whent to the doctor. She looked at it and told me that I may have dislocated the knee cap and twisted the leg at the knee. She gave some ibuprofren (sp?) and told me to do what I want, and take it easy. Great!! Now it's two weeks past and the knee is'nt bad I can walk and do most functions fine, but when I bend my knee past 90* with weight on it standing (squats) it hurts like hell and dose'nt feel very strong. Also it's still pretty stiff. Maybe im posting too soon but wanted a second opinion. Whatdoya think?? I keep streching it and doing what I can to loosen it up, but just wondering. I never really took the pills but for a few days. Any Ideas or coments??
Thanks.
ICE
[It sucks getting old(er)]
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Swolen Ankle
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On 9/11/2003
David F
wrote in from
(64.219.nnn.nnn)
Being 26 years old and working behind a desk for 50 hours a week, I'm not in the same shape I used to be in when I was 16 and skated street and vert every waking moment of the day. Looking for a fun way to excercise, I went and pulled out my old flipidy trick deck last month and desided to get back into ramp skating. Went to the new local indor skate park and descided to take it easy and start on the 3ft spine. I wasnt there for fifteen minutes and lost my balance coming off the tranny, I tried to plant my front foot to catch my balance, but my ankle gave out and folded inward HARD. I heard a loud SNAP! and then my entire foot went numb, then I felt like I was going to pass out for a minute. I regained my composer and left triing not to look like the old guy who got hurt in front of all the 13 year old froot booters. It hurt like hell and by the time I got home it had swelled to the size of a baseball sticking out from the outside of my ankle. I have been hard core street luging for the past 4 years, so I'm no stranger to sprained ankles, just thought I would take it easy for a few weeks and all would be fine.
Well its been 5, going on 6 weeks now, its still stighlty swelled. It doesnt hurt to just walk on, but it will hurt like hell if I run, jump, point my toes, or leave it it a wierd position for any length of time.(indian stile sitting)
My insurance SUCKS, so I have been triing to avoid a costly hospital and x-ray bill.
Should I give it more time, or did I really break it this time?
Thanks in advance.
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Hurt's Elbow
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On 9/1/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
"Tennis Elbow" is one of those conditions which is literally a pain, but not usually serious (assuming you are not playing at Wimbleton tomorrow). Some of the suggestions below for home treatment may help, but if not, see your doc. Also, try to figure out what you're doing that's causing or worsening the pain in the first place. Bad form in a racquet sport or repeated injury could keep the symptom going. Good luck, drdh
Here's some info from UK MedInfo:
Tennis Elbow or Lateral Epicondylitis is a condition when the outer part of the elbow becomes painful and tender, usually as a result of a specific strain, overuse, or a direct bang. Sometimes no specific cause is found.
Tennis Elbow is similar to Golfer's Elbow which affects the other side of the elbow.
Symptoms
The outer part of the elbow is painful and tender to touch. Movements of the elbow, and also movements which involve lifting, with the hand on top, hurt.
Causes
Although called tennis elbow, lateral epicondylitis is much more commonly seen in people who are over using their arm doing something else. It could equally well be called "plasterer's elbow" or "mechanic's elbow" or "painter's elbow".
The most common cause is over use of the muscles which are attached to the bone at this part of the elbow. That is to say, the muscles which pull the hand backwards (the wrist extensors). All the extensor muscles of the hand attach to the elbow at the outer part (the lateral epicondyle). If they are strained or over used they become inflamed, which means they are swollen, painful and tender to touch.
Sometimes the inflammation is caused by a direct injury or bang. Sometimes, especially when the cause is direct injury or strain, the muscles are actually partially torn.
Rarely the inflammation comes on without any definite cause, and this may be due to an arthritis, rheumatism or gout. Sometimes the problem is partly or completely due to a neck problem, which is causing pain in the elbow via the nerves from the neck.
Diagnosis
The doctor or physiotherapist will test for tenderness over or near to the bony bump on the outside of the elbow. He or she will also test to see whether the pain gets worse when you bend the wrist back (extend it) against resistance. In the event of both these signs being present, it is likely that you have tennis elbow.
Your doctor may also examine your neck, as this may be the cause, or part of the problem. After all many of the things that might strain your elbow might also put a strain on your neck.
Treatment
Rest helps, with avoidance of the activities which over use the elbow.
Physiotherapy treatments, which may include heat or ultrasound therapy
Use of anti inflammatory drugs and ordinary pain killers (analgesics).
The doctor may suggest an injection of a small dose of steroid to the affected area. This is not the sort of steroid banned for athletes. If used it can last for up to three months, and although it may need to be repeated you seldom need more than two or possibly three injections.
You can buy a brace from a sports shop or pharmaceutical supplier, which can be helpful. This is probably largely because it reduces the amount you can use your elbow.
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elbow
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On 8/31/2003 hurt
wrote in from
(206.40.nnn.nnn)
Doc
My elbow had been hurting for some time, what do you know about tennis elbow?
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my busted hand
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On 8/8/2003 herbn
wrote in from
(152.163.nnn.nnn)
i knew you had to say that, Dr Herbn looked at the x ray and break looks like it was a clean straight break with just a slight shift, length wise,my hand actually feels pretty good, the dislocated knuckle is more annoying, it seems to tighten up at night ,hurt in the morning and loosen up during the day, by the night time i'm ready to hit the gym or go skating. I've decided to break this cycle and splint it for a few days, and see what happens, hopefully nwhen i take the splint off , i'll be stretching things out ,with less set back.
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Herbn's finger dinger
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On 8/6/2003
Dr. Dave
wrote in from
(68.74.nnn.nnn)
Might be worth it to ask your orthopedist about the quality of the healing on the x-ray and whether the bone needs to be reset, splinted, pinned, etc. Let us know.
drdh
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broken hand
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On 8/5/2003 herbn
wrote in from
(205.188.nnn.nnn)
don't come to ths site often,but,i got back from a long wait last night at a hospitol to have x rays done on a sore hand that i was beginning to have concerns about. I'll be five weeks on sunday that i crashed and dislocated the second knuckle on the middle finger of my right hand,not a drastic looking sideways angle but a straight in jamb,ouch! not pretty anyway so i put it back where it's supposed to be and took it easy the rest of the way down,riding over time to ice. Well my hand did seem sore and it swelled along with the finger, but this isn't the first finger i've dislocated(pinky and ring fingers) so i expected some local sympathetic swelling and soreness. After a couple of weeks i figured ;ok seems i sprained my hand too. WEll ,it's been just about 5 weeks and talk of shifted bones,and arthritis,and stuff got me curious enough for an ER visit, and sure enough it WAS broken, but it's an angular break in the middle of the bone with a slight displacement less than an 1/8 inch on the x ray(which looks like it's around doublesize), if the break was near the ends effecting joint function i would be more concerned,but i don't think any good doctor is gonna try to rebreak it ,its a long seam and the bone would probabely break somewhere else first. I've been lifting weights and skating with limited biking since the injury,some of that seems kind of dumb in retrospect,but i've rigged up some immobilization (is there really a proper angle, and why?)and am planing on taking it real easy for a while,but even with my somewhat unothodox active healing methods i don't think i'm to far off from the minimal 6 weeks in a cast , that is the most usual sentence for having too much fun.Actually a proper set would probabely have me healed ahead of schedule and knawing off the cast after a few weeks, so i did lose sometime.I've started taking calcium and glucosamin,anything else? Any of you non professionals have similar experiences?
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Raising cane...
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On 7/25/2003
Tom M.
wrote in from
(164.227.nnn.nnn)
Hey psYch0Lloyd,
I've got this keen idea for some padded devices which can be wrapped around a person's knees. Maybe you can help me market them? <g>
Seriously, the photo (in the other forum) looks pretty raw.
Hope you heal quickly!
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PsychOLloyd's New Concept
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On 7/24/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Congrats man, you've invented. . .THE CANE BOARD! The new extreme sports gift that helps the aged avoid hospice care entirely! Give one to Grandpa Fred whose only purpose in life seems to be sucking up your inheritance on useless things like blood pressure pills and cruise vacations that he doesn't remember anyway. . . .
And maybe you should get those knees looked at. . . ..
drdh
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Raising cane...
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On 7/21/2003 psYch0Lloyd
wrote in from
(198.160.nnn.nnn)
Skinned both my knees pretty badly last Wednesday when I was showboating for some betties and managed to hit a patch of sand. The plastic on my hands saved the palms but my knees pretty much lost a lot of skin from during the ensuing slide.
I continued to ride after washing up a bit but knew that as soon as it scabbed over I would be in for a real treat. A couple applications of honey provided the necessary antibiotics (boy that burns) but as the week wore on I started having some mobility issues. It hurt most whenever I switched from standing to sitting or vice versa (ya know the cramp yer toes and shrivel yer sphincter kinda pain). I've since resorted to some heavy duty medication to get through the workday. The only other time that it really doesn't bother me is when I skate.
Anyway I've been hobbling around with a cane lately just because it helps me get around a little easier. So when I step on a deck I've been taking it along for the ride. I've found that the cane can work to my advantage and even acts like another appendage to assist with propulsion. When pumping around it easily stows right over the front trucks acting almost like the handle for a scooter (only it swivels and isn't permanently attached). When kicking along the cane usually hits the ground on the other side of the board at the same time my foot hits the ground providing power from both sides of the deck. When pumping the cane can be switched from hand to hand and even used as an outrigger especially for the toe side turns.
I can even see that if someone has an occasional back problem and they find that they have to skate because it's sometimes easier than walking, then using a cane in this manner can really make life a little bit more enjoyable.
The cane I use is a quality balanced walking stick weighted at the handle like a door knob. I plan to experiment with other devices to see how they can enhance the ride but I think that as we age we will find that this will allow us to do so gracefully and still maintain the ride.
Knucklehead Geriatric Racing Team
PS
My story might change as soon as the medication wears off but sure it is fun dreaming this stuff up...
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Dan, who didn't lose face
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On 7/11/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Dan,
Can't add much to a story where a helmet saves your brain, teeth, face etc. Glad you cheated your plastic surgeon out of a publishable facial reconstruction case.. . .
Small addition. . .I'd say that even if the helmet didn't crack, it should be replaced.
Great story!
drdh
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