Shoulder injuries are common not just in athletics but also in the general population.
There are many ways that someone can injure their shoulder. When looking at any injury, the injury is either acute or chronic.
Acute means that the injury occurs immediately while playing a sport or exercising. It is something that happens quickly. Some examples of acute injuries are strains, sprains, fractures and dislocations.
Chronic, the other type of injury, is something that occurs over a period of time.
Today we will be focusing on the most common acute injuries in the shoulder.
Before diving into the different types of injuries, we should understand the anatomy of the shoulder. The graphic shows the bony structures in the shoulder. This article will touch on the clavicle, acromion, head of humerus, glenoid and shaft of humerus.
One of the most common injuries occurring in children is a clavicle (also known as the collarbone) fracture. This is typically caused by falling on an outstretched hand or taking a direct blow to the bone.
Approximately 80% of all clavicle fractures occur in the middle of the bone. This injury will often present with deformity, allowing us to see and feel the bone protruding where it is not supposed to.
When athletic trainers think an athlete has a clavicle fracture, our initial treatment is to put them in a sling and refer them to get an X-ray. When wearing a sling, it is important to adjust the strap so that their elbow is bent to approximately 90 degrees. The severity of the fracture will determine on how much time it takes to heal. A fracture that does not require surgery will usually take about 4-6 weeks to heal.
The acromioclavicular joint, or AC joint, is the most commonly sprained joint in the shoulder. This is the point of the shoulder and is where the clavicle meets the acromion process.
When someone has an AC joint sprain, it might also be referred to as a separated shoulder. The mechanism of injury for an AC joint sprain is a direct blow to the shoulder, whether that is something hitting the joint or falling on the joint.
Individuals with an AC sprain are typically point tender on the bone and have decreased shoulder mobility. The most painful motion is bringing their arm across their body.
Depending on the severity, individuals might also have a step-off deformity. Individuals with an AC joint sprain are usually put into a sling. Once their pain has decreased, they will work on range of motion and strengthen the surrounding musculature, specifically the deltoids. For athletes, athletic trainers will usually pad or tape the shoulder when returning to play.
Shoulder dislocations are the most commonly dislocated joints in the human body. This takes place at the glenohumeral joint and makes up about 50% of all dislocations.
The glenohumeral joint is a ball and socket joint. With a dislocation at the glenohumeral joint, the head of the humerus comes out of the glenoid fossa.
Someone who has a shoulder dislocation should seek medical attention in order to reduce the dislocation. Once someone has a shoulder dislocation they are 80-90% more likely to experience repeat shoulder dislocations. This is due to stretching and tearing of ligaments surrounding the joint and capsule.
People who have dislocated a shoulder will typically present in a position that mimics being in a sling. They also may have numbness and tingling in their shoulder or arm and spasm in their deltoid muscles.
When someone dislocates their shoulder, it is important to determine if any other structures are damaged. If there are no other injuries associated with the dislocation, our treatment as athletic trainers is to strengthen the muscles surrounding the joint, especially the rotator cuff muscles.
Lastly is the humerus fracture. The typical mechanism of injury is a direct blow to the shoulder. There are multiple spots on the bone that can be fractured, but the most common site is at the surgical neck. Depending on the site and type of fracture, an individual might need to get surgery. If they do not require surgery, they will often be placed in a cast for 4 to 6 weeks, and we will do rehabilitation with them once their cast is removed.