Trauma – Shoulder Muscle and Ligament Damage
The rotator cuff is one of the most important components of the shoulder, and is comprised of 4 muscles and tendons, that hold the bones of the shoulder joint together.
As it is one of the most used parts in the body, it is highly susceptible to muscle and tendon tears caused by trauma, overuse or aging. Both muscle and tendon tears present similar symptoms such as swelling, bruising, weakness, limited motion and a clicking or popping sound.
Minor tears often heal on their own, however larger tears with persistent symptoms often require physiotherapy or surgery.
- Shoulder exercises – Orthopaedic surgeon, Dr James Mclean may prescribe a series of shoulder strengthening exercises.
- Anti-inflammatory medication – prescribed to reduce pain and swelling.
Types of Muscular and Ligament Damage in the Shoulder
Rotator Cuff Strain / Supraspinatus Tendon Tear
A tear to any of the four rotator cuff muscles in the shoulder, often caused by over stretching or rapid twisting of the joint (common to racket sports and any sports that involve throwing such as cricket).
Best diagnosed with either an ultrasound or MRI scan.
- Sudden pain in the shoulder sometimes accompanied by a tearing feeling.
- Pain radiating down into the arm
- Difficulty sleeping on the arm
- Signs of shoulder impingement (pinching between the ball and socket of the shoulder joint when moving the arm above head height.)
- Pain gradually increasing over time
- Weakness in the shoulder
Reduce the pain and inflammation allowing the rotator cuff tear to heal followed by rehabilitation consisting of mobility, strengthening and functional sport specific exercises.
It is recommended that you rest the arm – often a sling is used to immobilise the shoulder.
In some cases, where the tear is severe or you have a complete rupture, rotator cuff surgery may be necessary – this surgery is often done arthroscopically, but depending on the injury type may be done as open surgery using sutures and bone anchors. The goal of the surgery is to relieve pain and return your shoulder to optimal function.
Recovery time varies depending on your individual situation, and are discussed in more detail here.
Glenoid Labrum Tear
A tear to the fibrous ring of tissue which attaches to the rim of the glenoid shallow hold or socket of the shoulder blade (scapula) where the ball of the arm bone (humerus) sits. Glenoid labrum tears may often occur with other shoulder injuries, such as a dislocated shoulder. Often caused by repetitive overhead throwing, lifting or catching heavy objects below shoulder height or falling onto an outstretched arm.
- Pain in the shoulder joint
- Increased pain with overhead activities or when the arm is held behind the back
- Shoulder weakness and instability with specific tenderness over the front of the shoulder
- Pain upon resisted flexion of the biceps or bending the elbow
It is recommended to rest the shoulder and apply cold therapy to reduce pain and inflammation. Additionally, you may be prescribed anti-inflammatory medication.
A comprehensive and gradual rehabilitation program with be required to restore the shoulder to full function.
In the case of unstable injuries, surgery will be required to reattach the labrum to the glenoid and any underlying causes contributing to the injury should be addressed.
The shoulder will usually be kept in a sling for 3-4 weeks after surgery, and full mobility may take up to 3-4 months.
Shoulder Dislocation / Shoulder Instability
Where the upper arm bone (humerus) pops out of the shoulder joint, or where the humerus partially comes out of the joint and back in again (subluxation). When the shoulder dislocates, it causes significant damage to the surrounding soft tissue, i.e. muscles, tendons and ligaments.
It is important to seek professional medical assistance in the case of a dislocation to put the bone back into the joint, as attempting to do this yourself can cause serious and permanent damage to the joint surfaces or arm nerves. Shoulder dislocations are known to reoccur and lead to long-term shoulder instability which is only addressed through surgery. Often caused by impact to the shoulder, a fall onto an outstretched arm or twisting.
- Sudden severe pain at the time of the injury along with swelling
- Bruising will develop later
- The shoulder pops out of the joint and looks different/lower than the uninjured shoulder
- If there is any nerve damage, there may be pins and needles, numbness or discolouration through the arm or hand.
There are two stages to immediate shoulder dislocation treatment –
- Protect the shoulder to prevent further damage by immobilising it in a sling if possible.
- Seek medical assistance to relocate the shoulder as soon as possible. The longer the shoulder is left out of place, the harder it becomes to relocate as swelling sets in.
Once the shoulder has been relocated, you will be required to wear a sling with your arm across the body (in medial rotation) until the tissues have healed, usually a minimum of 5-7 days. This will then be followed by extensive rehabilitation to regain mobility and strength of the shoulder.
If the shoulder is dislocating regularly, there is a fracture, or damage to muscles, tendons, nerves, blood vessels or the labrum, shoulder surgery may be required.
AC Joint Injury/shoulder separation
Separation of the two bones forming this joint is often caused by damage to the ligaments connecting them and should not be confused with a shoulder dislocation. The most common cause of the injury is falling onto an outstretched arm or through direct trauma in contact sports.
- Pain in the shoulder, specifically where the collar bone meets the shoulder
- Possible lump or bump on the top of the shoulder joint
- Pain increases when trying to move the arm overhead
Immediate first aid includes rest, ice, compression and elevation (RICE).
Wear a sling to immobilise the shoulder and ease the pain by taking the weight of the arm.
Dr Mclean will diagnose the injury and assess its severity, he may also prescribe an anti-inflammatory to reduce pain and inflammation.
AC Joint taping is important for early treatment and support, and will help avoid long-term problems or shoulder deformity. The joint may need taping for 2-3 weeks.
Once pain has subsided, it is recommended that a rehabilitation program is commenced.
Surgery is only required for grade 4-6 injuries and grade 3 sprains that do not respond to conservative treatment.
It is important that the injury is attended to and allowed to heal properly to avoid increased wear and tear on the joint and future problems.
When to See the Doctor James Mclean
If you are experiencing any of the following, it is advised that you book an appointment with Dr James Mclean:
- Severe pain or a large loss of motion and strength – a sign of a serious injury and should be treated immediately.
- Trauma due to a fall and a shoulder muscle tear is suspected. With trauma, other injuries are also possible, including bone fractures, dislocations, ligament tears and damaged cartilage.
- Difficulties with daily activities due to a non-traumatic, degenerate tear.
- A large bulging muscle visible at the front on the upper arm.
Early detection of shoulder injuries can help prevent serious injuries in the future.
How Dr James McLean can help:
Dr James McLean has extensive upper limb experience, including soft tissue and bone injuries. He will work with you to develop a treatment plan that will have the best possible outcome for your shoulder injury.