clavicle malunion

[HJer]

I suffered a comminuted fracture of my mid-clavicle 6 years ago when I got bucked off my horse. I wore a figure-8 brace for six weeks, took some physical rehab. exercises and everything was fine. About 8 months ago I started experiencing some pain behind my shoulder which has increased to the point where I am experiencing a burning sensation all the time. I just saw an orthopedic surgeon who says I need surgery to rebreak the clavicle and set it correctly with a plate and pins. According to the Dr. the malunion has resulted in my clavicle being shortened which is straining all the ligaments, etc... in my shoulder. In the meantime I just got an MRI done which shows some fluid in my shoulder consistent with mild bursitis - would a simple procedure to drain the fluid fix my problem or is the bursa sac leak a result of the malunion?

What is the recovery like for a surgical procedure to repair a break that is so old? Has anyone been through this?

Thanks much.

[Heidi]

Hi

I personally would get a second opinion before resorting to surgery.
From reading what you have said I would assess your shoulder biomechanics and posture etc as it is likely that you have altered movement patterns and muscle imbalances as a result of the injury and the now shortened position. This will have caused a change in the movement at the shoulder and may be putting more stress on some muscles and others may even be inhibited.

The burning sensation in your shoulder could be muscular or nerve related. Do you ever feel any sensations such as pain, tingling, numbness or burning passing down the arm?

I would visit a physio/physical therapist etc who can assess your shoulder/neck/upper back and see if there is anything which can be done first in terms of therapeutic treatments and exercise rehabilitation.

[HJer]

Heidi -

Thank you for the suggestion. I did see the ortho.surgeon today and he is now recommending 6-8 weeks of physical therapy. Surgery is now considered a less than ideal option because he saw how small my bones are ( I am a very petite person, but physically balanced for my size/weight). The Dr. said surgery would be likely if therapy does not alleviate the problem.

I am scheduled to call a physical therapist this week. What would the therapy involve - I got no hints from the Dr. other than saying it would try to strengthen my muscles to compensate for the dropped shoulder I have currently and to restore range of motion.

As to my current symptoms - I do have a burning sensation and periodic bouts of tingling/numbness down my right arm and into my fingers. That's what bothers me the most as I still ride and also have to work 8 hours a day. By about 5 hours into my work day I cannot concentrate. The Dr. said that he could prescribe Vicodin for the pain but I hate taking medications.

Thanks for any info.

Jane

[Heidi]

Hi

Its great that you are going to the physical therapist. They will be able to assess your shoulder from a muscular/neural point of view that usually Doctors dismiss.

What your physical therapy entails will depends on what the therapist finds and also what kind of treatment methods they personally prefer and are trained in.

I would more than likely be giving you are rehabilitation program including strengthening and stretching exercises as well as massage and soft tissue tehcniques. If necessary, also postural re-education techniques.

Either way, expect to be given exercises to do at home. These tend to only take up to 15 minutes a day though and make the world of difference rather than just doing them weekly in the clinic.

[HJer]

Thanks Heidi -

The physical therapist has started me on a series of stretching exercises. His initial findings are as follows: I have some winging of the scapula, but what he is most concerned about is the fact that I have almost a 50% loss of strength between my left and right hand. I am left handed and he said it is not unusual to see a 10-20% difference between dominant and non-dominant hand, but 50% is worrisome. He also found sutle manipulation of my neck produces similar burning sensation so he is concerned that I have a nerve impingement in my neck that is complicating the problems associated with my clavicle malunion. Phys. therapy will be in the office 2 x's a week with daily home exercises.

It will be interesting to see if the exercises fix my problem.

[Heidi]

Thats encouraging that you are on the right route. Just bear in mind that it can take weeks for exercises to have an effect on your pain levels. If you imagine how long your shoulder has been in this condition, its not going to improve over night! Many people make this mistake. I guess all I'm saying is stick with it and don't give up if you don't see any immediate improvement.

Good luck!