Common shoulder injuries
Some common injuries to the shoulder include:
Shoulder dislocations
A dislocation occurs when something forces the bones on either side of a joint out of alignment. Shoulder dislocations are usually caused by an accident, such as a sporting injury or fall. In the shoulder, dislocations can involve three joints:
The glenohumeral joint
The ball at the top of the upper arm can be forced out of its socket, either towards the front or the back.
The acromioclavicular joint
An injury can cause this connection between the collar bone and shoulder blade to become separated.
The sternoclavicular joint
This connection between the collar bone and breastbone can also be interrupted.
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Shoulder fractures
Fractures are broken bones. In the shoulder, fractures are usually caused by trauma, such as a fall, sporting injury, or car accident. Shoulder fractures can involve the collar bone, shoulder blade, or top part of the upper arm bone.
Shoulder fractures need urgent medical attention to reduce the risk of complications and maximise the chances of the break healing well.
Shoulder instability
Your shoulder joint is very flexible and relies on soft tissues to keep it in place. Some people are born with loose soft tissues, which can make the shoulder joint less stable. Trauma – including a sudden injury such as a dislocation and repeated small stresses from playing overhead sports – can also lead to shoulder instability. Shoulder instability can cause pain and increase the risk of dislocation.
Rotator cuff tears
The rotator cuff is a group of muscles and tendons surrounding the shoulder joint. They help keep the shoulder ball in its socket and work with bigger muscles to control shoulder movement. The rotator cuff can be sprained or torn by an injury such as a fall or sudden pull on the arm. It can also be affected by wear and tear over time.
Risk factors for rotator cuff problems include older age, genetics, shoulder instability, repetitive joint overload, and a hook-shaped collar bone.
Shoulder impingement and tendonitis
Impingement occurs when tendons inside the shoulder catch against the upper part of the shoulder blade, called the acromion. This can cause sharp pain. Over time, repeated rubbing can lead to irritation and inflammation of the tendons. Impingement and tendonitis are often associated with activities that involve a lot of overhead movements.
Shoulder injury diagnosis
To find the cause of your shoulder problem, your health professional will do different things depending on the type and severity of your injury. If you’ve had a fracture or dislocation, for example, an emergency doctor will order imaging tests such as an Xray, CT scan or MRI to see what’s happening in your shoulder.
They will also look for signs of damage to other tissues, such as nerves or blood vessels, which could be serious if not discovered and treated. An orthopaedic specialist will often be consulted to help make the diagnosis and decide on the best course of action.
If your injury is less severe or you’ve had symptoms for a while, your doctor will probably do an assessment in their rooms. They will ask questions like how the injury happened and how it affects your daily life. They will look at your shoulder, checking for things like tenderness, swelling, and pain or limited movement.
Your doctor might also refer you for imaging tests to see what’s happening in your shoulder, along with blood tests. These can help provide a more complete picture of your shoulder injury. Your doctor might also refer you to an orthopaedic specialist for a review and opinion.
How are shoulder injuries treated?
Shoulder injuries come in a wide range of types and severities, which will affect how they’re managed. A serious injury such as a fracture or dislocation needs urgent and specialised medical care. Treatment for a rotator cuff injury or impingement could involve medications, rest from aggravating activities and physiotherapy.
Non-surgical treatment for shoulder injuries
Non-surgical treatments used to manage shoulder injuries include:
Medications – such as pain killers and anti-inflammatories
Physiotherapy – to ease symptoms and treat underlying issues such as stiffness, muscle weakness or poor movement patterns
Exercises – to improve flexibility, strength and movement control
Heat or cold therapy – to reduce inflammation and ease pain
Corticosteroid injections – to reduce pain and inflammation
Platelet-rich plasma injections – which can aid healing.
Surgery for shoulder injuries
Some shoulder injuries need surgery to repair or replace damaged tissues
and help ensure you have the best chance of making a good recovery. Your
specialist might also recommend surgery if other treatment options haven’t
managed your symptoms effectively.
Surgery can often be performed arthroscopically (through keyholes using a special camera and instruments), but some procedures need to be done in the traditional manner. Your orthopaedic surgeon can discuss your options with you and provide guidance about the best course of action in your situation.
Examples of surgeries used to manage shoulder injuries include:
Repairs
Shoulder fractures may be managed by repairing the damaged bones with pins, plates or screws. Surgery might also be performed to repair tears in the rotator cuff or other tendons.Decompression
This involves removing spurs or small sections of bone or soft tissue to relieve pressure and prevent tissues catching or rubbing.Shoulder stabilisation
This surgical technique is used to make the shoulder more stable and reduce the risk of re-dislocation.Other procedures
If you have a rotator cuff tear that isn’t repairable, other options include tendon transfers and trimming away damaged tissues.Joint replacement
This involves replacing the shoulder joint with an artificial one. It is most commonly used to manage shoulder arthritis. In cases where the rotator cuff is badly damaged, a technique called a reverse shoulder replacement might be recommended. This involves placing the socket in the upper end of the arm bone and fixing the ball to the socket in the shoulder blade. This allows different muscles to move the arm.How long does it take to recover from a shoulder injury?
Recovery time can vary significantly depending on injury type and severity, as well as factors like your age and lifestyle. For example, a small rotator cuff tear might get better in about six weeks, whereas it could take a year or more to recover from a serious shoulder fracture.
Many people will need physiotherapy and rehabilitation after a shoulder injury or surgery to restore movement, function and the ability to do things like drive, work and participate in sports or hobbies.
Your orthopaedic surgeon can provide personalised advice about how long it
might take you to recover from your shoulder injury.
References
https://orthoinfo.aaos.org/en/diseases--conditions/shoulder-trauma-fractures-and-dislocations
https://orthoinfo.aaos.org/en/diseases--conditions/common-shoulder-injuries/
https://orthoinfo.aaos.org/en/treatment/reverse-total-shoulder-replacement/
Content reviewed by
Mr Owen Mattern, Orthopaedic Surgeon at Holmesglen Private Hospital.
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