Shoulder injuries

Shoulder injuries are common among athletes such as baseball players, golfers, cricketers who overuse their arm in their sporting activities. Players of contact sports like football and rugby are also susceptible to shoulder injuries. This article highlights some of the most common shoulder injuries.

Acromioclavicular joint injury or AC joint injury

The AC joint is where the clavicle (collarbone) meets the scapula (shoulder blade). This joint can be injured by falling on the shoulder or elbow or onto an outstretched arm. Symptoms are swelling, pain on moving the shoulder especially when trying to lift the arm overhead or across the body, and in a more serious sprain a lump or step deformity may form at the joint. AC joint sprains range from a mild sprain with joint capsule damage (Grade 1), moderate sprain with some ligament rupture (Grade 2) and complete rupture of all AC ligaments (Grade 3).

Physiotherapy treatment may involve rest, ice and ultrasound to help relieve pain. A sling may be worn to immobilise the joint and prevent further injury. Once the acute phase is over we can commence gentle mobilising and stretching exercises and a gradual return to muscle strengthening exercises. Taping the AC joint for extra support is often helpful when the athlete has regained full pain-free range of movement and can return to sport.

In only the most severe of sprains, surgical repair may be needed and this is followed by physiotherapy to help regain range of movement, strength and function.

Recovery for a grade 1 injury may take around three weeks, for a grade 2 injury you can expect a 6 week recovery period and with a grade 3 injury, it may take up to 12 weeks.

Shoulder dislocation

A dislocated shoulder is a very common injury that can occur during contact sports such as football, rugby or judo. Pain accompanies the event and the person has a feeling of the shoulder ‘popping out’. The shoulder joint has a distinctive appearance after dislocation, with the humeral head (top of the bone of the arm) protruding forwards with a hollow space above it. The shoulder will have to be relocated to prevent further complications. The sooner after the injury that the shoulder dislocation is reduced, the easier it will be to do. An x-ray should always be performed once the dislocation has been reduced to rule out any associated fractures.

Resting the shoulder in a brace is recommended and according to the extent of the injury, surgery may be indicated.

Physiotherapy focuses on shoulder strengthening exercises and resuming full function once the pain is under control. A return to sport can be expected between 6-12 weeks depending on the severity of the injury.

Rotator cuff injury

The rotator cuff is a group of muscles that work together to provide stability to the shoulder joint. The acronym SITT usually applies to these muscles: The supraspinatus, infraspinatus, teres major and teres minor muscles.

Athletes such as cricketers and swimmers, whose sports require excessive overhead arm action, are prone to rotator cuff injury. The injury usually involves tears of the rotator cuff tendons (most commonly the supraspinatus tendon). Other common ways to injure the rotator cuff are through falls, motor vehicle accidents and when the person hangs on to something to prevent a fall, all of which can result in tears. Rotator cuff tendinopathy, usually a longstanding wear and tear injury to the rotator cuff tendons which is left untreated can result in torn tendons.

Symptoms of rotator cuff injury include pain when raising the arm forward or out to the side or moving the hand up behind the back, weakness of the arm and shoulder, pain along the front of the shoulder and perhaps down the length of the arm, tenderness when the front of the shoulder is prodded and a decreased range of movement of the shoulder joint. In severe cases, surgery may be required but more often than not, conservative physiotherapy management is very effective in treating rotator cuff injuries.

We will perform a thorough assessment to determine the type and extent of your injury and to design a treatment plan. Ice, heat and ultrasound may be used to control pain. Passive mobilisation of the shoulder joint and soft tissue massage and trigger point therapy of surrounding muscles are very helpful in reducing pain and improving function. Taping the shoulder can ease pain and provide stability. Most importantly, you will be taught exercises to improve range-of-motion and we will give you specific exercises to strengthen and stabilise the shoulder.

Frozen shoulder (Adhesive capsulitis)

Frozen shoulder (also known as adhesive capsulitis) is a condition characterised by stiffness and pain in your shoulder joint. As the condition worsens, your shoulder’s range of motion becomes markedly reduced.

Some patients develop the condition after a traumatic injury to the shoulder such as a motor vehicle accident or following shoulder surgery, but this is not necessarily the cause. Most often, frozen shoulder occurs with no associated injury and is quite baffling for those who have a frozen shoulder develop unexpectedly. Some risk factors for developing a frozen shoulder include age and gender (middle-aged women are the most susceptible), endocrine abnormalities (such as diabetes and thyroid problems), previous longstanding shoulder injury and some genetic conditions such Parkinson’s disease.

Most often, a frozen shoulder can be diagnosed with a physical examination. Physiotherapy treatment for frozen shoulder primarily consists of symptomatic pain relief which includes heat, ultrasound, massage and passive stretching. We will give you exercises you can do at home to help with your range of movement and maintain your strength.

It takes on average between eighteen months and two and a half years for a frozen shoulder to resolve on its own but during that time we can provide you with much-needed pain relief.

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