Trauma injuries to the shoulder are common and can range from fractures, dislocations, to soft tissue tears. The scenarios for such traumatic injuries can vary from a midfield collision in the football field which may dislocate the collar bone, to a high speed car accident that can fracture the ball or the socket of the shoulder joint. While most shoulder injuries can be treated conservatively with a good, long-term result, some high impact trauma fractures are unlikely to heal by themselves. They are better treated with surgery because they carry a high risk of arthritis if left unattended.
Anatomy of the Shoulder
The shoulder is a highly mobile and powerful joint made up of scapula (shoulder blade), clavicle (collar bone), and the humerus (arm bone) joined together by ligaments, tendons and muscles that help the arm function properly with speed and precision. Layers of soft tissue cover the bones of the shoulder; the top layer being the deltoid muscle, which helps extend the arm overhead, and underneath that is a fluid filled sac, called the sub-deltoid bursa.
The shoulder has three ligaments (glenonumeral, coroclavicular and corocoacromnal), but most injuries affect the Glenohumeral, which comprises of a ball (humerus) on a ball shaped joint (glenoid).
Types and Causes of Shoulder Injuries
The main types of shoulder injuries are:
Fractures are broken bones commonly involving the collar bone, top of the upper arm bone, or the shoulder blade. The collar bone or the upper arm can get fractured by a direct blow to the area from any accidental fall, impact or a vehicular accident. Shoulder blade fractures are uncommon because it is better protected by the chest and surrounding muscles. Therefore, only very high impact trauma, like high speed car accident can cause a fracture of the scapula.
Fractures can be displaced or non-displaced but most shoulder fractures are generally non-displaced, which means that the broken pieces lie very near their actual anatomic position and are therefore easier to fix. The bone fractures can naturally heal when immobilized in a sling in about six weeks. Shoulder fractures that are displaced do require some type of manipulation to restore normalcy.
When bones on opposite sides of the joint don’t align properly dislocations occur. Shoulder dislocations can involve the collar bone joint, which is called a ‘separated shoulder’, or the connection between the collarbone and the breastbone and finally the ball and socket joint of the shoulder. The glenohumeral joint can be dislocated toward the front (anteriorly) or toward the back (posteriorly).
A fall or a direct blow to the shoulder can forcefully twist the arm outward (exterior rotation) and cause an anterior dislocation of the shoulder. Whereas posterior dislocations of the shoulder are less frequent and may happen from seizures or electric shocks, when the frontal muscles of the shoulder tighten and contract forcefully.
Sometimes when the shoulder is fractured, there may also be soft-tissue injuries, such as tears of the ligaments, tendons, muscles or rotator cuff tears or labral tears. These are extremely painful and can further complicate the treatment.
General symptoms of shoulder injuries
- Shoulder Pain
- Swelling, tenderness and bruising
- Inability to move the arm without feeling pain
- Signs of deformity or bump at the site of the fracture
- Grinding sensation on any shoulder movement
Symptoms of Shoulder Fracture
- Swelling at the site of injury, such as collarbone or shoulder
- Severe pain and bruising
- Visible lump under the skin at the fracture location
- Shoulder range of motion is very limited
Symptoms of Shoulder Separation
- Severe pain over the top of the shoulder
- A bulge about the top of the shoulder
- Feeling something sticking up on the shoulder
Symptoms of Shoulder Dislocation
- Swelling and lump about the front of the shoulder
- No arm movement possible
- An arm rotated outward
- No sensation along the affected arm or feeling of a dead arm
How to treat shoulder injuries?
Shoulder fractures are usually diagnosed with X-rays of the area and by physical examination and sometimes, additional imaging techniques may be used.
Treatment for most non-displaced fractures involves immobilization in a sling or shoulder immobilizer, frequent icing, and pain medications until the fracture heals enough to allow motion without risk of dislodging the fracture fragments.
NSAIDS medication, such as Advil or Aleve are often used for pain control.
X-rays will be used to determine if there are additional injuries and if sufficient healing has taken place to start motion exercises. Surgery is recommended only in the case of compound fracture, where the bone has been dislodged completely from its place or if bone fragments have been displaced. Surgery will typically involve fixing the fracture with plates, screws, rods or pins in the bone. When the ball of the upper arm is broken then a shoulder replacement surgery may be in order. With the surgeon’s guidance, full recovery is possible till the shoulder regains motion and function.
Post-surgery there may be stiffness in the shoulder. Your doctors may recommend physical therapy to strengthen your muscles and help increase mobility. Your doctor and therapist will work together to get you on the path of recovery and advise you when to progress your activities and exercises to improve outcome.