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  • SLAP lesions

    Hi there,

    I'm sure that you have all been in a situation where you have had many diagnoses about your injuries. For me I have had two shoulder injuries from dance and now I'm in need ot seeking a sports physician.

    Can anyone firstly suggest a good sports physician in the Canberra/sydney region who specialises in shoulder injuries? I know the shoulder is very complex so I would prefer to get someone who knows what they are talking about. And if you can understand after seeing sports chiro's in the US (where I hurt my shoulder), to physios and osteopaths, who have come up with so many diagnoses I'm just about fed up. I'm starting to think that the sport's chiro's diagnosis was more accurate than any other who said that I did a subhumoral dislocation.

    Also are any of you aware of any recent studies done on the benefits of strengthening the muscles around the shoulder (e.g. rotator cuff muscles) compared to surgery? I'd prefer not to go down the path to have surgery as it would take a long time to recover and being a competitive latin dancer this makes it very difficult.

    I'd greatly appreciate anyones advice.

  • #2
    Sydney has a better choice of shoulder surgeons. Amoung them include: Jerome Goldburg; Des Bokor and David Sunnabend. Bokor is at Parramatta and Goldberg at Randwick. Don't know about Sunnabend though. Hope that helps.

    Comment


    • #3
      Hi Angieliu,

      All of the guys mentioned below are reportedly excellent shoulder surgeons but, as you're after a sports physician, I can highly recommend Seamus Dalton at North Sydney Orthopaedic and Sports Medicine Clinic (02 9437 5999). Really helped me out - thorough, professional, made the correct diagnosis, suggested the correct treatment and conservative in his approach - won't suggest surgery unless it's really necessary. If you're after excellent shoulder sports physio's - Joel Werman in North Sydney (02 9955 8766) or Henry Wajswelner at the AIS in Canberra (also sees private patients).

      Good luck.

      Cheers,

      JB

      Comment


      • #4
        Thanks

        JB,

        Thanks for your advice. I have been reading up and have found that sports physio's and the like in Sydney to be more experienced and are also happy to offer more advice than most here in Canberra.

        Do you know how I can get in touch with the physio who works for the AIS? I'd be keen to get a second opinion.

        Thanks muchly

        Angie

        Comment


        • #5
          Hey Nicholas,

          Thanks for your advice. I will see how I go in canberra with the sports medicine physician here and see what they have to say. I don't think they can really make a proper diagnosis until I get an ultrasound or a MRI. People have been making random diagnoses and without it.

          Will keep the Sydney sports physician in mind and get in contact with them in the new year for a second opinion.

          Comment


          • #6
            Originally posted by angieliu
            JB,

            Thanks for your advice. I have been reading up and have found that sports physio's and the like in Sydney to be more experienced and are also happy to offer more advice than most here in Canberra.

            Do you know how I can get in touch with the physio who works for the AIS? I'd be keen to get a second opinion.

            Thanks muchly

            Angie

            Hi Angie,

            I have to emphasise that both Joel and Henry are sports physiotherapists not sports physicians - both are extremely good but they are physiotherapists not doctors. If you are after a diagnosis, ordering of tests and recommendation of treatment options for your situation you are best seeing a sports physician (sports doctor) first. I don't know that you'd find anyone better than Seamus when it comes to sports physicians who specialise in shoulders / upper back. (The doc who I saw in Canberra when I originally injured my shoulder was still doing his sports physician training and was young and inexperienced, I wouldn't recommend him - he has since moved back to Melbourne anyway). Seamus is located at North Sydney Orthopedic and Sports Medicine Clinic and they also have excellent imaging department (ultrasound, MRI etc) - a bit more expensive but worth it. From memory you'll need a referral from another doc to see Seamus.

            If you are still after physiotherapy in Canberra, you can make an appointment with Henry by ringing the AIS Dept of Physical Therapies on 6214 1728. (He also works a few sessions at a clinic in Belconnen but they are more expensive and are not as well equipped). H works with the upper body sports at the AIS and is excellent with shoulders. The AIS Dept of Physical Therapies (Physiotherapy) is located in the AIS Sports Medicine and Science Unit. If you don't know the AIS grounds see http://www.ais.org.au/campus_map/AIS-Canberra-a4.pdf for an up-to-date map (Building 18). If you're visiting the AIS, it's probably best if you park in one of the car parks on Leverrier Crescent (there's a bit of public parking next to Building D and more further up) walk through past the new pool to the Sports Med and Science Unit (there may also be parking out the back near the soccer fields but I'm not certain of that).

            Christmas time obviously might not be the best time to be trying to see someone but good luck. Let us know how you go.

            Cheers,

            JB

            P.S. I am based in Sydney but have worked alot in Canberra over the last six years or so and still spend a few months down there a year. (I work in sport).

            Comment


            • #7
              Hi JB,

              I understand that Joel and Henry are both physiotherapists and that the only way to diagnose a SLAP lesion is a MRI which is the pathway I'm going to head down so that it can be properly diagnosed and from there I can consider the options. I've managed to track down Henry at the AIS so I will look into it further.

              When I saw the Sports med doctor, they suspected a SLAP lesion and said that the only real treatment option is surgery. From my understanding on reading up on SLAP lesions, surgery is normally a last resort if it is a type 1 or 2 lesion. So I wonder if you can help with pointing me in the direction of finding some recent literature on treatment alternatives for SLAP lesions?

              I think that she took the approach that because my shoulder has been playing up on and off for 6 months that I was looking for a quick solution. Which in fact is totally opposite to what I'm looking for. I'd prefer to look at an exercise rehab program to strengthen the muscles around the shoulder to help stabilise the shoulder joint better and for the time being avoid certain things to put any further strain on it.

              I think that given the situation, it may just be a really good idea to go and see Seamus and get a second opinion.

              Thanks so much for all your help with this. It's so hard to squeeze information out of doctors. Maybe that's just the nature of the profession!

              Take care and have a great christmas

              Angie
              P.S. if you don't mind me asking do you work in physio or sports science?

              Comment


              • #8
                Hi Angie,

                I'm not a medico and haven't had a SLAP lesion so I can't comment on their diagnosis or treatment [my shoulder inury was a supraspinatus tear complicated by secondary capsulitis (a frozen shoulder)], however I can recommend all of the above guys as excellent medicos to see if you have a shoulder injury (often half the battle is knowing the right people to see. Not all medicos are created equal). Further to that, in my experience, sports physicians will give you plenty of information (and Seamus is certainly very thorough) - in complete contrast to OS's (orthopedic surgeons)!!

                If you're after information in the meantime, I'd just Google SLAP lesions and look for recent info from reputable journals/sites.

                In terms of exercise rehab programs - both H and Joel are excellent!

                Re my background - the short answer is sports science, although its a bit broader thanhtat.

                Anyway, 'hope it all goes well. Let us know how you go and have a great Christmas / New Year!

                Cheers,

                JB

                Comment


                • #9
                  SLAP lesion- inconclusive

                  Hey JB,

                  Hope you had a good Christmas and New Year. As for my shoulder, it has actually calmed down and does not hurt much. After 2 weeks of proper rest it feels so much better. No dull aching pain.

                  I did a MRI scan which showed that there was no evidence of a tear (which is good I think) and so I'm heading over to see Henry to see what sort of exercises he can give me. But a question, do you know much about the benefits of hydrotherapy with shoulder injuries? I started doing some aqua fit classes thinking that it would be good for overall body toning and thought about it that it is low impact on your muscles and also you use the gravity of the water to build strength. Who knows..

                  Take care with your injuries. Rest can do amazing things!!
                  Angie

                  Comment


                  • #10
                    Hi Ang,

                    Yes, they were good, 'hope yours were too!

                    'Glad to hear your shoulder has settled with a bit of rest - you're absolutely right, rest (or for me, some time off work) can do amazing things!

                    See Henry, he will give you a good ex rehab program (I can do rotator cuff exercises in my sleep!) or, if he thinks it warranted, will send you straight off to a sports physician. If you just have physio initially and continue to have problems he will suggest that you see a sports physician. Hopefully your MRI results are accurate and you have no tear (good news), keep in mind, however, that MRI results are not always accurate (the quality of the images depend on the strength of the magnet - vary from machine to machine - and the ability of the technician operating it and the accuracy of the report will be dependent on this and the diagnostic ability of the radiologist writing the report). I won't go anywhere other than the Imaging guys at North Sydney Orthopedic and Sports Med Clinic in Crows Nest now because I know they do a great job. I've had some poor quality films and reports from other places.

                    Re the aqua fit classes / pool work - I'd be guided by what Henry / sports doc says about your shoulder. From a personal point of view, pool work has been great for me in terms of my knee injury (I needed something low impact) but is no good in terms of my shoulder - the water increases the resistance my shoulder has to work against and stirs it up (I don't do any work for my shoulder in the pool, only kicking for my legs).

                    Let us know how you go!

                    Cheers,

                    JB
                    Last edited by jellybean; 10-01-2007, 07:07 AM.

                    Comment


                    • #11
                      Hey JB,

                      New YEars and Christmas were a blast. New YEars more a blurr and entailed very little sleep, lotsa dancing and much more.

                      I'm going to see Henry on Friday so I'll see what he thinks. The sports med physician (I can't figure out if there is a difference between sports med physician and sports physician, is there??) said the MRI showed that there was a sublabral recess of the bicep tendon. It didn't make much sense to me because it didn't show how or why I was having shoulder problems. But you know, at least it's not a tear and I'm really happy with knowing just that. I think that my shoulder was also playing up a lot after the physio treatment I had (infrarential and ultrasound) really stirred things up and I hear that ultrasound can induce tendonitis in the shoulder capsule too. So, I'm going to go and see Henry first, get a good exercise program which is what I have been wanting for like months, and if it's still not getting any better then I'm going to see Seamus.

                      As for pool work.. I'll see what henry says. I did a class the other day and it was very low impact for my shoulder. I was a bit worried about it so I took things at a slower pace. I was talking with my friend who used to do exercise rehab and she was thinking that it would be quite good because you can do rotator cuff exercises in the water.

                      Well better get going. Take care of your knee and shoulder.

                      Angie

                      Comment


                      • #12
                        Hi Ang,

                        'Sounds like a good plan! (P.S. Sports med physician / Sports physician - same thing, physician who specialises in sportsmed).

                        Rotator cuff exercises in the water would probably be ok if done correctly (the number one important thing with these is that you learn to do them correctly and then that you do them correctly and diligently - both Henry and Joel will drum that into you.) For me (small full thickness tear of the supraspinatus tendon at the insertion), other pool work (i.e. swimming using my arms doesn't work).

                        'Hope the session with H goes well.

                        Take care.

                        Cheers,

                        JB

                        Comment


                        • #13
                          Hey JB,

                          Saw H today and he was awesome. My gosh he was so thorough with everything I was a bit taken by it all. Have been given lots of exercises and am going back to see H next week so hopefully on a good road back to shoulder stability. And more importantly this has been exactly what I have been looking for ever since I hurt my shoulder the second time.

                          It's funny, Henry took a look at my shoulder and did some tests and told me straight out that there was some shoulder instability there in the joint but when I asked the sports doctor because I had bought this shoulder brace, she didn't think that there wasn't any shoulder instability and not much use for it.

                          He also asked how I was referred to him and that I couldn't say because I don't know your name.

                          Oh well, thanks for the referral for Henry, at least things are heading down the right path (I hope) so that I can't hurt my shoulder again.

                          Angie

                          Comment


                          • #14
                            Hi Ang,

                            ?Glad to hear the session went well, Henry is fantastic with shoulders. (As I think I?ve mentioned before, I tore the suprapspinatus tendon in my shoulder ? skiing fall ? and then developed secondary capsulitis (a frozen shoulder) about 3 months later. I sometimes wonder if the frozen shoulder would have developed at all if I?d been able to get treatment from him throughout my shoulder rehab. I was working down at the AIS for a few months when I did my shoulder, Henry treated me for the first 2 ? 3 months post-injury, I was then on the road for a month and wasn?t able to find a physio with the same mobilisation skills, my shoulder deteriorated and the frozen shoulder took hold (not a pleasant experience).

                            If your shoulder can be fixed with physio, H will fix it. (Your job is to be diligent with the ex rehab program!).

                            Interesting that H noticed instability when the sports doc didn?t? I don?t know anything about the sports doc you saw (some are definitely better than others), but I do trust Henry?s judgement.

                            With regards to the referral, just mention this site! It helps plenty of people. As for my name, something I like about this site is the anonymity it offers!? However, from the small amount you know about me I?m sure Henry could work it out if it was important to him.

                            ?Hope everything continues to go well. Let us know how you go.

                            Cheers,

                            JB

                            Comment


                            • #15
                              Ahh the joys of anonymity JB!!

                              With regards to your shoulder, I actually wonder the same thing when I did my first shoulder injury. At that time I trusted every word my osteo said and he said to just rest it because he thought that it was a rotator cuff tear. So I did and then about 2 months after that I started with the resistance band and managed to get some strength back. It wasn't until my shoulder really started playing up after dancing continously for 3 weeks that it still wasn't that good and then I hurt it again. If guess I was smart enough to see the chiro who popped my shoulder back in but I gave up on treatment when the chiro back home suggested going to the sports doctor. 6 months later I'm finally doing that when in reality all I was looking for was someone to give me some exercises to help strengthen the shoulder joint. I knew it was unstable because I hurt it and when you have an unstable joint, the logical thing to do is to strengthen the muscles around to support it. I guess I was fortunate that I didn't get a frozen shoulder from my first injury. I can't imagine how unpleasant a frozen shoulder would be though.

                              In terms of diligence, I know I have to be good and do my exercises everyday but they are not pleasant and anything that makes my shoulder uncomfortable, I'll avoid it like the plague.

                              I thought that it was also really interesting that Henry said that he noticed instability. I guess the sports doctor was more concerned about a tear than instability and that would be why she sent me to see Henry to see if I could stabilise the muscles around my shoulder more.

                              I guess it'll just be a matter of waiting and seeing how things go.

                              Cheers,

                              A

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