A broken collarbone conservatively managed, using the routinely prescribed collar and cuff or shoulder arm sling or a figure of eight splint, is not a treatment and can only be described as benign neglect of the broken bone. They do nothing to elongate the bone out to its original length or rectify rotation or encourage union of the two ends.
Those scenarios are a frequent cause of a condition called Scapular Dyskinesis (or winging scapula or shoulder blade malfunction).
Shortening of more than three millimetres can throw additional strain on the shoulder blade and other elements in the kinetic chain such as spine and pelvis and predispose the patient to future discomfort and even injury.
The relationship between muscles and bone framework is altered with devastating effect. Muscles contrive to work abnormally, shoulder blades can 'wing' unnaturally outward and shoulders fall forward; all adversely affecting pelvic and spinal alignment. Posture is weakened and, if left unchecked, cause the stronger muscles to reverse roles and weaker sets are then deployed. Chronic or intense pain ensues with a life left compromised by an altogether avoidable condition.
Our understanding of shoulder problems has increased in the forty years of my involvement in the field. We have come to understand the importance of the shoulder blade, how commonly it is compromised, and how resistant to surgery it can be.
So how do we tackle such an important and potentially life-changing condition?
Scapula dyskinesia comes in varying degrees and can often go undiagnosed. It is a debilitating but not untreatable condition and we need to be able to treat all degrees of severity, not just the critical cases that come into my clinic.
One of the complications in treating the condition is the lack in the scapular (shoulder blade) of good mechanoreceptors - sensory receptors that rapidly transmit sensory information to the brain and the means by which the brain senses the position of shoulder joints/scapula.
Patients simply don't know if their scapula is winging, added to which the brain readily accepts the abnormal movement as normal.
For the vast majority of patients, physiotherapy is the first line of combat. In many cases, again for the majority, corrective exercise alone does not solve the problem. With surgery very much a last resort and no promise of success, patients are often left disappointed and in despair.
We need new ways to tackle this condition. Having had first-hand experience of Angel Med’s ClaviBrace Gilet, I am very excited with the results we are seeing.
For me it obeys the crucial principle of supporting the three pillars, or better stepping stones - namely the pelvis, spine and shoulder blades – upon which effective shoulder function ultimately depends and it delivers this in a way acceptable to the wearer.
This is still a medical brace, but components have been cleverly concealed in an everyday-looking gilet and since long-term wear may be necessary, it avoids any feeling of self-consciousness.
