Dislocated Shoulder
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Elderly parent's shoulder dislocated by caregiver
Jan 2014
My father has Alzheimer's disease (very advanced) and is now living in a skilled nursing facility out of state in the town where he grew up. Recently the facility notified me that one of the caregivers, while attempting to dress him, dislocated his shoulder. Apparently my father was being ''resistive'' -- their word -- and his shoulder ''just popped out'' of the socket. They insist that this happens easily in elderly people and I'd like to know if that's true. I'm not planning to sue them, but I would really like to know whether this is common and not really preventable, i.e. that it can occur even if a caregiver is being extremely careful and gentle. To my knowledge, my dad has never dislocated his shoulder before, so this isn't something he would be especially prone to. upset daughter
It's pretty easy in general to dislocate a shoulder. Even more with someone who is yanking himself away. They are very painful, but also will pop back in, relieving the pain immediately. Probably caused the caregivers a lot of stress too.
This sounds very upsetting for you; your father is lucky that you are involved in his care. What I do know is that it is totally reasonable for an alz patient to be combative, especially with grooming/dressing etc. so a dislocated shoulder sounds reasonable. I like that the facility told you; long distance, they could have tried to not tell you if they are not trustworthy.
If it were my parent, I would want to know what other peoples' experiences are. Do you know other families of residents there? Are there reviews on yelp/similar? If it is in his hometown, do you have family friends who could help connect you? It is worth putting the event out to the ombudsman for review, especially if it is far from you and you can't go check yourself.
If this persists, you may want to look into moving your father and researching the best ways to move a person living with Alzheimer's. I also thought that you might want to read about some best practices in caring for people living with Alzheimer's disease in this excellent article that I read a few months ago: http://www.newyorker.com/reporting/2013/05/20/130520fa_fact_mead. anon
Well, I was a geriatric aide for about 5 years many, many, many years ago. This was before all the bullshit about using machinery to move people around -- we were using Posey belts and lifting techniques to move immobile patients from bed to bathroom, bathroom to bed, bed to wheelchair etcetera. Let me tell you that in the five years I did this NOT ONE PERSON was injured. There were times, in those prehistoric days, when we might have had to let someone down to the floor gently because of their weight, combativeness or other issue (and this was very, very rare). We also always had a male aide on staff to help with both the male patients as well as the heavier people. The point is: NOT ONCE did I or any of our staff member EVER dislocate a shoulder. To dislocate a shoulder, one must pull on the arm. This is NEVER a modality used to move or reposition a patient. Granted, it's been 30 years since I did this work, but we had far fewer gadgets to work with, and we were required to use appropriate techniques to move patients no matter what. Combative or not, not ONCE did the 13 patients I cared for on a nightly basis for five years EVER have anything more than a bruise (usually from bumping on a guard rail or something). I say, file a report because this is unusual and not something to be written off. heather
I thought you'd get a lot of answers so I didn't respond the first week, but if you have concerns that your father is getting substandard care, or being abused, you have some recourse. Here's a wide range of steps you can take, not necessarily in this order: Speak to the director of nursing or administrator at the nursing home and ask for an explanation. Speak to your father's physician, who may or may not be affiliated with the facility and ask if s/he has concerns, is aware of the dislocated shoulder, etc. Contact the ombudsman for your area. I don't know which state your father is in or I'd have looked it up for you, but I believe every state is required to provide ombudsmen who will look into concerns at skilled nursing facilities. I did a ride-along with one in San Francisco and their job is to meet with residents and address their complaints; they are independent and work on issues ranging from theft of personal property to bad food to medical orders not being followed. You can also call the local Area Agency on Aging for more information on ombudsmen and other programs, including Adult Protective Services.
There's a lot you can do despite not living near your father. Don't be put off by the nursing home if you have concerns. good luck and hope all is well with your father
Sorry to be late replying to this post. I would contact http://www.canhr.org, and see what they have to say. They are a great, no wonderful org and often if you call you talk directly with an elder law attorney. For free! Even if it's not their exact focus they can be incredibly helpful. California Advocates for Nursing Home reform. Check it out. And each case is different. And Elders are fragile. And combative Alz patients can be very strong. You may never know exactly what happened but you can do more research on possibilities. Good luck. A live in Family caregiver.
I am a physician specializing in geriatrics and was appalled when I read your letter, as was the physical therapist I read it to. A shoulder dislocation during the course of routine care is NOT common. Without some underlying pathology - such as an old shoulder subluxation related to a stroke - it takes a fair amount of force to dislocate a shoulder. Moreover there are several red flags here: the description of your father as being "resistive" not only indicates the nursing facility is trying to shift the blame, but also that they do not seem skilled at dealing with a demented patient who resists care (which IS very common). I am also concerned that they seem to have shrugged off possible mistreatment by one of their staff without investigating what happened.
You are correct to be concerned. First I would contact the nursing home ombudsman where your father lives, explain your concerns and ask them to investigate. Do you have family or friends who can visit the facility (preferably unannounced) and get a sense of how your father is being treated? Do staff seem to treat him with affection, or are they irritable? Overworked? Contact me if you would like to discuss further. laurie
My shoulder was dislocated after a fall. It dislocated again a couple of weeks later (after just moving it above my head). I was reluctant to go the surgical route and went through months of physical therapy to strengthen the muscles. In the end, it was determined that there was a fracture that could be fixed surgically. (Barkham's fracture, I believe.) The surgery solved the problem. My suggestion is to ask for detailed imaging of her shoulder to see if it is something that can be fixed surgically, or is related to some other cause.
While not her shoulder, my teen has a knee dislocation issue with her patela. She was a dancer with a lot of flexibility. Her first injury was dancing and she had PT to strengthen it. A year later she was on a long backpacking trip. She totally over stressed it leading to a big surgery, ligament replacement, trimming the bone, etc. and months of PT. It is a long recovery after surgery and it can be traumatic as well. This was supposed to prevent it from happening again. She danced on it and it was generally ok. But being a teen she decided to go skiing. She wasn’t doing much as she was a beginner but she fell lightly and her ski didn’t release. Her knee dislocated yet again. They thought she might need surgery again but did a lot of PT again. No further surgery but she can’t ski, backpack, etc. and likely not ever be able to. All this is to say that even if you get the surgery she may not be able to do all the things she wants. PT is really the best bet before looking at surgery and then always stretching, taking breaks, resting when needed will really help (of course it’s not easy to get teens to do this).
This was / is me! Happy to chat about my experiences in more detail so feel free to reach out but in short I would highly recommend getting surgery. Her dislocations will likely only get worse over the years and they are super painful and stressful. The surgery is hard but 100% worth it.
Hi - my super athlete son didn't have repeated dislocations, but he did have endless shoulder problems due to damage from several sports injuries. First, I'd like to recommend Dr Nirav Pandya at Childrens Hosp Oakland, as well as Dr Ishaan Swarup, the surgeon who repaired my son's broken elbow at one point. Dr Pandya may be the right guy for you. They are both AMAZING and also very nice. I suspect, given how young she is - with her whole athletic life ahead of her - that she'll need surgery plus PT. Her doctor will also probably flag you on "overuse" which is the backstory to injuries for many young athletes. My son's shoulder/arm problems are now about 3 years in the past and they were solved by: surgery, tons (and tons) of PT, months (and months) of rest and minimal use, then starting a very shoulder intensive sport and weightlifting routine that seems to have resulted in extremely strong arms and shoulders. Fingers crossed.
👋 Hi! Sorry to hear your teen is going through this.
Not sure if you like your ortho dr. But you may want to get a second opinion- if you feel like you need to solicit advice online it’s a sign your specialists are not up to par.
Dr Benjamin Ma at UCSF is great with shoulders. He can recommend PT that is specializing in shoulders too.
Hi my son had a similar experience at the same age (mostly from pitching in baseball) and ended up having surgery before college but sadly it did not prevent future dislocations which became frequent and always painful. So after college he had a second surgery “Laterjet Procedure” which had also been done on his physical therapist who raved about it. Now a couple years later he is very happy with the result, back into sports, no more dislocations. However, he was warned that having these 2 surgeries increases his risk for arthritis at an earlier age, but he was willing to trade that for the significant benefit. Good luck and best wishes!
Sorry to hear that your daughter is going through this. I had a similar experience with an initial traumatic injury causing shoulder dislocation and then subsequent repeated dislocations. It got to the point that I couldn't do anything raising up that arm or it would dislocate. It did not matter how much strengthening or PT I did - the ligmament was torn and it would never be normal again. The worst was when it would dislocate while I was sleeping. Not fun! I avoided surgery for 10 years, sufferering each time it dislocated (trying on a dress, at a friend's wedding wrapping my arm around the person next to me for a photo, taking clothes out of the dryer... over 100 times, ugh!). So, I finally decided enough was enough and scheduled surgery. The surgery was fine, though recovery tricky due to immobilized arm for several weeks and raising young children simultaneously. However, I should not have waited so long. I can finally use my arm like I should. I can open curtains, try on clothes, and sleep without it coming out of the socket. Well worth a few weeks of recovery. I did all the PT afterwards and that was very helpful in my full recovery. I finally feel like I have normal use of my shoulder. I would recommend surgery early on if I were to do it all again. Hope this helps.
I'm sorry this is happening to your daughter and I think it's really important that she see a good shoulder specialist and hopefully she can have surgery to fix it. I am now a grandmother and have had multiple shoulder dislocations, the first one at age 16 in my gym class, while I was doing a somersault. The teacher was able to put it back in place and I had no treatment for it at all (we lived in a small rural community and this wasn't even reported to my parents). About 12 years later I dislocated the same shoulder while turning over in my sleep and over the next 30 years I dislocated it another 12 times--very painful and frightening. Then I slipped on a wet step and dislocated my "good" shoulder and it too has become unstable. By this point surgery was not an option and I've worked with a great trainer who really knows shoulders and he has helped me stabilize my shoulders somewhat. I haven't had a dislocation in years but I'm always cautious with my shoulders and avoid certain positions. My dad had a couple of shoulder dislocations and I suspect there's a genetic component in my case. Good luck to your daughter!
My father solved his dislocations with PT and was able to continue his active lifestyle. Now, in his 80s, he does crossfit! PT requires discipline to get results. My cousin, who got the same stretchy shoulder ligaments, chose to have a cadaver ligament placed to provide shoulder stability.
I can't speak to shoulder dislocations but my kid (nonbinary, AFAB) had recurring kneecap dislocations. The first one was from a hard fall at age 12, and then they had about 1 per year throughout their teens, and each time it seemed to take less to trigger it. Some were subluxations (where the kneecap pops out of place and spontaneously pops back in) and some were full dislocations with an ER trip to reset. And as you know, the "out of the blue" nature of dislocations -- where one moment you're fine and the next moment you're in excruciating pain looking at months of recovery -- is traumatic.
We were in conversation with a surgeon fairly early on, but the apparently some kids grow out of it. Finally my kid had surgery at age 19. The surgeon estimated a 50% chance of success. In the 4 years since they have had only one subluxation, but the joint feels loose and they have chronic pain that limits daily activities. In hindsight I wonder whether we could have avoided damage to the knee by operating sooner.
I dislocated my shoulder first when I was 20 and then again when I was 28; however, in between it nearly dislocated several additional times by doing things similar to your daughter (waving arms overhead in an aerobics class). I did modify what I would do such as never laying with my arm straight back over my head like in a yoga class, etc. and was told that as we age our tendons tighten up which is what seemed to happen, albeit very slowly. I could do things like swim and rock climbing so it may make sense for her to have surgery.
Best of luck!
What a tough experience to have at such a young age. I experienced a similar progression of dislocations in my early 20s and I finally went to see an orthopedic surgeon after my third dislocation. Much like your child, I simply put my arm above my head to do a silly dance. Imaging showed that my initial dislocation caused a compression fracture to the head of the humerus (the "ball" of the arm bone) which flattened the surface of the bone. This why it slipped out of place when I simply lifted my arm above my head. I delayed surgery for a year, but I was also careful not to raise my arm above my head during that time, which is obviously problematic.
My surgeon (Dr. Kirk Jensen) performed a surgery (Bankart repair and capsuloraphy). He did an excellent job. Rehabilitation was long: my right arm was immobilized for 6 weeks and then I slowly built up my strength and range of motion under the supervision of a gentle and skilled PT (Christine Allen). It was certainly a process, but I can't imagine living my life with the constant threat of dislocation. What if it dislocated again and I couldn't seek medical help? Was each dislocation causing more damage? Feeling like your arm is not properly connected to the body is a terrible feeling.
Since the rehabilitation is long and it is difficult to cook, clean, work, study, etc. without the use for an arm for an extended period of time, I would also consider the benefit of doing surgery before your 16 year old leaves home for college/next steps in their life. Having the home support will optimize recovery. Then, your child can leave home without worrying about repeating dislocations and live life to their fullest.
As for me, there has been much dancing, swimming, and all the good things life has to offer. Good luck with this tough situation!