Dislocated Collarbone

[trevorg]

Apologies, typing one handed so lack of capitals.

I'm not doubting the doctors at the local hospital, but i've hear of dislocated shoulders and fractured collar bones, but this is what i appear to have and am going to see the orthopeadist in sa kaew tomorrow.

I attach my X ray and any advice on treatment and 'mending' would be most appreciated!

thank you in advance1

[FBN]

That seem like a grade III Acromio-clavicular dislocation.

There are two ligaments that keep that end of the clavicle in place and, in grade III, both have been torn.

This condition is not as painfull as a grade II where there is only a partial rupture.

This will require surgery to repair which may involve a srew to keep that end in place or other.

This does impact the strength and stability of the shoulder joint and of course there is the cosmetic deformity. If you are a golfer or tennis player, you would have to have it fixed.

Older guys would just let it be and live with the deformity.

Best!!

[trevorg]

FBN - thanks for your swift response, i didn't play any sports for probably 20 years until today. I'm a keen motorcyclist and have been known to throw shapes on the dance floor, as well as a bit of breakdancing (swan dives) have not been an issue.

The only fix is a nut and bolt job to re-attach (sorry to be crude).

I'm keen to know more, why did the collarbone (i assume that's clavicle) not break but just rip away. It happened as I did an accidental shoulder roly poly on a hard thai football field!

Thanks again for your explanation

[FBN]

This injury is usually caused by a fall on the upper arm with the arm close to the body on the side . The impact is from slightly below and axial on the arm or directly on the shoulder (upper arm) from the side. The clavicle will fracture if it is more of a direct blow from the front.

The surgical repair (srew job) will probably only be considered if you are below 50 or so depending on your physical activity.

[trevorg]

I'm 43 on thursday, and now for the biq question - should i get surgery in thailand as i have 'minimal' insurance - 80,000 for surgical and no OPD, or should i fly 'home' to the U?K where i get NHS as i am still a full NI and tax paying citizen? i only emmigrated 10 months ago and still weork for a uk com,pany who pay the same as the last 5 years.

once again apologise for the typing as one handed

thanks for any advice

[krading]

When in pain

get on a plane.

[Blues Factory]

I fell over playing football on the beach about 7 years ago and did the same, I had 2 pins inserted (now removed) and wire wrapped around the bone to hold it together (still have).

[Thongkorn]

Ouch . I feel for you . i fell on a boat a few years ago and did a job on my collar bone , I had months of pain, you do not know what nerve is attached to what until you cough fart or sneeze, i never went to bed for two months because i could not move in my sleep without waking up, Hope you get it sorted out,

[trevorg]

Update - after spending a few hours at the provine hospital and moe x rays, they've strapped me up tight in a shoulder harness that goe over both shouders and under both armpits and fastens at the centre of the back. I'm not in much pain but thats probably the painkillers and have reasonable mobiity in the arm, though i'm trying to minimize movement. i've got to go back in 1 week for more x-rays as they believe it may start to mend itself,(is this likely), if not surgery. I'll decide then whether to go home for it or not!

Thanks for your comments/ advice so far!

[trevorg]

Dislocated collar bone – update 1 week on!

Just got back from the government provincial hospital – supposedly having seen an orthopedist specialist. The doctors English wasn’t great (but I’m not blaming him for that – after all this is Thailand). What has upset me is that all he did was look at the same x-ray that they took last week, he didn’t ask me to take my shirt of or my clavicle support to look at bruising or how ‘displaced’ the clavicle is although I’m assuming he could tell this from the x-ray. All he asked is ‘am I in pain?’, which I’m not unless I over extend the arm in certain directions and I’m on painkillers so not sure!

Luckily I’d taken some pictures and diagrams of the various Grades of Acromio-clavicular dislocation from the internet and asked him to point at which one he thought it was, initially he just pointed at the Acromio-clavicular ligaments (grade 2) on an ‘anatomical’ sketch, but when I showed him the grade diagrams he pointed at 3 and 4. So who knows what’s wrong with it, certainly not that doctor!

I’ve got to go to Pattaya in the next couple of weeks and Pattaya Memorial and Bangkok Pattaya (Private hospitals) are on the list of ‘networked’ hospitals on my Health insurance so will try my luck there. Any experiences of these?

In the meantime can anyone recommend what I can be doing? At the moment apart from taking the painkillers and anti-inflammatories I am wearing a ‘figure of eight’ Clavicle Support bandage 24/7 except for a brief 5 minutes when I shower. I am not keeping the arm completely immobile but am not putting any stress or strains on it or ‘over’ extending it –i.e. if a certain movement starts to feel awkward or painful I stop!

So any ideas on exercises for strengthening other muscles to compensate or whether I should make it completely immobile for a period of time may help.

I’m not a sportsman anymore and do not need to lift heavy loads, so not convinced about surgery yet but do not want to end up lob-sided as a result of overcompensation.

I'd really appreciate your feedback and advice as my other option is to fly back to the UK and join an ever growing (4 month plus) waiting list, which I'm 'fortunate' enough to be entitled to but UK living costs far exceed those in Thailand! Sorry, I forgot my third option, my wife knows some old guy with some herbs and prayers that fixes things quick smart - Uncle Chans broken rib was fixed within two days apparently!

Fortunately the initial pain is much subsided, but I need to think of the next 40 years of my life!

Thanks again!

Trev

[FBN]

Thanks for the update..

The figure of eight is designed for a clavicle fracture and will have virtually no effect on this injury. The arm suspended in a sling would do more to prevent further distraction of the AC joint and I would suggest that.

there are no muscle strenghtening exercises recommended at this point but the arm can not be in a sling for that long, you will lose significant function. Ideally a definitive procedure should be done within 10 days to 2 weeks.

Not sure about options in Pattaya; places like Bumrungrad is usually better for sports injuries.

[WarpSpeed]

Hate to contradict a competent Dr. ?(and maybe I'm not) but by the look of that Xray, the opinions already expressed here and the Dr.'s cavalier attitude which is much like one I received a few years ago for something similar, unlikely it will mend without surgery. They just put you in a common Collar bone fracture sling and you really need to have something inserted to hold it in place properly. The fact that you are still taking pain pills is bad in and of itself as you should be getting off them after just a few days if it is mending, (unless you're a complete pus about pain) getting addicted to those is a serious concern as well..

It's like a leaf spring on your truck and has plenty of pre-loading on it and needs to be anchored and delaying is making it worse as it is going to heal improperly and require more repair and therapy for proper healing..

*Edit* FBN beat me too it, I concur completely..

Edited March 3, 2010 by WarpSpeed

[trevorg]

That's weird, I've just had my morning shower and took off the figure of 8 for it, and thought i'd like an half an hour out of it, but put on the original 'sling' that I was given instead, switched on the computer and checked this thread.

I've got an appointment tomorrow at the Bangkok Pattaya International hospital, once again, thank you for your help and advice! I'm now more certain that I should get some sort of surgery to re-anchor it! I'll let you know what happens!

[Bedrockguesthouse]

Alternatively go to Bangkok Rayong hospital in rayong if its on your list. Brilliant hospital was there yesterday for surgery. Get a quote first from any hospital. They quoted me nearly 17,000 baht and i got a bill of baht 12500.

cheers and all the best

[trevorg]

Further update Bangkok Pattaya Hospital

Very nice hospital, saw a doctor and had more Xrays straight away - definitely a Grade 3 Dislocation. Now for the quotation for surgery - aagh!

Surgery 2 hours at 30k/h = 60k

Supply (I assume this is materials for the surgery) 5k

Doctors fees 45-50k

First night on ward 25k

2nd night (if required) 20k

So that's 140-160k, the surgery seems reasonable at 60k (my insurance cover for surgery is 80k) but the Doctors fee and Ward price per night seem excessive. (I think I only have about 5k per night for room and doctors visits) Any thoughts would be appreciated.

I've spoken to and sent an e-mail to the insurers to try and get clarification on how much I'm covered. Provisionally booked in for surgery on Weds morning (10th) dependant on outcome from insurers.

[Sheryl]

Prices at this hospital run quite high, often even execeeding the very top facilities in bangkok.

Suggest you get a quote from the following for comparison (should be able to do this by email if you specify the surgical procedure in question):

Bangkok Rayong

Samitivej Sri Rachs

Phyathai Sri Racha

The Queen Sirikit Hospital at Sattahip would be a fraction of the cost and good quality but comforts and conveniences less and little English speaking except from the docs.

Wherever you go, do your homework first to be sure the surgeon is appropriately qualified, do not rely solely on recommendation of the hospital as to that.

[trevorg]

Thanks Sheryl, I'll be asking for quotes from the hospitals suggested tomorrow! To be honest, I was surprised that you hadn't 'chipped' in earlier as I see you give good and sensible advice on these kind of subjects! Much respect to you!

[trevorg]

Update post surgery!

Hi all - x ray attached

Discharged yesterday, back today to get a 'special' sling, Sunday for dressing change and Thursday to see the surgeon again. Will probably be in the sling for a few weeks and then have the pins removed in 12 weeks. The screws and wire stay in permanently, I believe. Staying in Pattaya for at least another week and then home to Sa kaew. On anti-inflammatories, anti-biotics and painkillers.

Total cost to date (i will give a breakdown when I feel more up to typing) 140k of which my insurers have paid 132k which I'm happy about. However after the insurers agreed the level of cover I received quotes from 2 other hospitals recommended above, 1 of 300k and 1 of 63k so it pays to shop around - I will not publish which on the net but PM me if you would like to know.

Overall I found everything about the hospital excellent including the doctor/ surgeon anaesthetist, nurses, food, room cleanliness etc I was kept completely informed every step of the way which is always re-assuring!

I will let you know more as my recovery progresses, and thanks again for your help and advice.

[Sheryl]

Glad to hear that all went well.

[trevorg]

Update - 1 year on!

Apologies for not giving any more information sooner, but i was 'called back' to the UK soon after this for a few months and forgot to re-post. The reason i returned to the thread is that I have a friend with a broken foot who's sent me an x-ray to post for your expert opinion, but i'll start a separate thread on that.

As I stated, I was called back to the UK about 8 weeks after the pins and wiring were put in and for some reason after 8 weeks I started to get a bit of infection where the pins were inserted, as I was going back to the UK the surgeon decided to remove the pins, there and then under a local anaesthetic. First pin slid out no problem, second pin would not budge and although he kept dosing me with further local it took about 40 minutes of gouging and pulling (not quite using his foot to provide leverage but not far off) this ended up causing a little bit of extra scarring but nothing significant.

Since the pins were removed, I did have an issue with the shoulder 'clicking' (not painful - just felt weird) if I over-extended but this went away after a couple of months.

Looks wise - the end of the collar bone does push the skin slightly higher than the other one, but its a couple of mm as opposed to 25mm before surgery.

I'm still aware that I had a problem and try and avoid any heavy lifting or pulling but as I'm naturally right handed (and it was my left shoulder) this is not an issue.

Regarding the hospital, as I said my THaiVisa Health insurance paid most of the surgery costs, but i didn't have Outpatients Cover so had to spend a couple of grand every time I had a check-up/ dressing change etc but all in all it was only about 20,000 (+ travelling and hotel expenses getting to and from Pattaya).

Anyway, thanks again for your advice and help last year.

[rak sa_ngop]

I'm 43 on thursday, and now for the biq question - should i get surgery in thailand as i have 'minimal' insurance - 80,000 for surgical and no OPD, or should i fly 'home' to the U?K where i get NHS as i am still a full NI and tax paying citizen? i only emmigrated 10 months ago and still weork for a uk com,pany who pay the same as the last 5 years.

once again apologise for the typing as one handed

thanks for any advice

I think you should be careful about assuming that you are entitled automatically to NHS treatment, especially in this age of NHS cost-cutting. I may be wrong on this but because you have been out of the UK for 10 months and have even decribed yourself as having emigrated you may find that you will have to wait 3 months (or is it 6 months?) before your free health care entitlement is re-established. Last time I visited a UK doctor I had to pay, and I fill in a tax form every year and was paying NI contributions.

[trevorg]

I'm 43 on thursday, and now for the biq question - should i get surgery in thailand as i have 'minimal' insurance - 80,000 for surgical and no OPD, or should i fly 'home' to the U?K where i get NHS as i am still a full NI and tax paying citizen? i only emmigrated 10 months ago and still weork for a uk com,pany who pay the same as the last 5 years.

once again apologise for the typing as one handed

thanks for any advice

I think you should be careful about assuming that you are entitled automatically to NHS treatment, especially in this age of NHS cost-cutting. I may be wrong on this but because you have been out of the UK for 10 months and have even decribed yourself as having emigrated you may find that you will have to wait 3 months (or is it 6 months?) before your free health care entitlement is re-established. Last time I visited a UK doctor I had to pay, and I fill in a tax form every year and was paying NI contributions.

Thanks for your reply, I just updated the topic from a year ago, (if you want to read the rest of the topic) and ended up staying in Thailand for the operation. I ended up being back in the UK for 5 months last year but am now back in Thailand and debating whether it's even worth me continuing to pay voluntary NI contributions, as you say, I may not be entitled to NHS and by the time I reach retirement age, it will probably be 75 and I'll be entitled to diddly squat as a pension. Shame that I paid in for 20 years, but may aswell cut my losses!