Mark Adickes, MD - Speialist in Sports Medicine

Shoulder Sports Injuries

Sports injuries occur when playing indoor or outdoor sports or while exercising. Sports injuries can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises. The most common sports injuries are sprains and strains, fractures, and dislocations.

The most common treatment recommended for injury is rest, ice, compression and elevation (RICE).

  • Rest: Avoid activities that may cause injury
  • Ice: Ice packs can be applied to the injured area which will help to diminish swelling and pain. Ice should be applied over a towel to the affected area for 15-20 minutes four times a day for several days. Never place ice directly over the skin
  • Compression: Compression of the injured area helps to reduce swelling. Elastic wraps, air casts, and splints can accomplish this
  • Elevation: Elevate the injured part above heart level to reduce swelling and pain.

Some of the measures that are followed to prevent sports related injuries include:

  • Follow an exercise program to strengthen the muscles
  • Gradually increase your exercise level and avoid overdoing the exercise
  • Ensure that you wear properly-fitted protective gear such as elbow guards, eye gear, facemasks, mouth guards, and pads, comfortable clothes, and athletic shoes before playing any sports activity which will help to reduce the chances of injury
  • Make sure that you follow warm up and cool down exercises before and after sports activity. Exercises will help to stretch the muscles, increase flexibility, and reduce soft tissue injuries
  • Avoid exercising immediately after eating a large meal
  • Maintain a healthy diet which will nourish the muscles
  • Avoid playing when you are injured or tired. Take a break for some time after playing
  • Learn all the rules of the game you are participating in
  • Ensure that you are physically fit to play the sport

Shoulder Trauma

Shoulder injuries most commonly occur in athletes participating in sports such as swimming, tennis, pitching, and weightlifting. The injuries are caused due to the over usage or repetitive motion of the arms.

Shoulder injuries cause pain, stiffness, restricted movements, difficulty in performing routine activities, and popping sensation.

Some of the common shoulder injuries include sprains and strains, dislocations, tendinitis, bursitis, rotator cuff injury, fractures, and arthritis.

  • Sprains and strains: A sprain is stretching or tearing of ligaments (tissues that connect adjacent bones in a joint). It is a common injury and usually occurs when you fall or suddenly twist. A strain is stretching or tearing of muscle or tendon (tissues that connect muscle to bone). It is common in people participating in sports. Strains are usually caused by twisting or pulling of the tendons.
  • Dislocations: A shoulder dislocation is an injury that occurs when the ends of the bone is forced out of its position. It is often caused by a fall or direct blow to the joint while playing contact sport.
  • Tendinitis: It is an inflammation of a tendon, a tissue that connects muscles to bone. It occurs as a result of injury or overuse.
  • Bursitis: It is an inflammation of fluid filled sac called bursa that protects and cushions your joints. Bursitis can be caused by chronic overuse, injury, arthritis, gout, or infection.
  • Rotator cuff injury: The rotator cuff consists of tendons and muscles that hold the bones of the shoulder joint together. Rotator cuff muscles allow you to move your arm up and down. Rotator cuff injuries often cause a decreased range of motion.
  • Fractures: A fracture is a break in the bone that commonly occurs as a result of injury, such as a fall or a direct blow to the shoulder.
  • Arthritis: Osteoarthritis is the most common type of shoulder arthritis, characterized by progressive wearing away of the cartilage of the joint.

Early treatment is necessary to prevent serious shoulder injuries. The immediate mode of treatment recommended for shoulder injuries is rest, ice, compression and elevation (RICE). Your doctor may also prescribe anti-inflammatory medications to help reduce the swelling and pain.

Your doctor may recommend a series of exercises to strengthen shoulder muscles and to regain shoulder movement.

Fracture of the Shoulder Blade (Scapula)

The scapula (shoulder blade) is a flat, triangular bone providing attachment to the muscles of the back, neck, chest and arm. The scapula has a body, neck and spine portion.

Scapular fractures are uncommon but do occur and require a large amount of force to fracture. They are usually the result of intense trauma, such as a high speed motor vehicle accident or a fall from height onto one’s back. They can also occur from a fall on an outstretched arm if the humeral head impacts on the glenoid cavity.

Symptoms of a scapular fracture include the following:

  • Pain: Usually severe and immediate following injury to the scapula.
  • Swelling: The scapular area quickly swells following the injury.
  • Bruising: Bruising occurs soon after injury.
  • Impaired Mobility: Decreased range of motion of the joint occurs, often with inability to straighten the arm.
  • Numbness: Numbness, tingling, or coldness of the hand and forearm can occur if blood supply is impaired or nerves are injured.
  • Popping Sound: A cracking or popping sound, also referred to as crepitus, can often be heard or felt at the time of the fracture.

Scapular fractures should be evaluated by an orthopedic surgeon for proper diagnosis and treatment.

Your surgeon will perform the following:

  • Medical History
  • Physical Examination

Diagnostic Studies may include:

  • X-rays: A form of electromagnetic radiation that is used to take pictures of bones.
  • CT scan: This test creates images from multiple X-rays and shows your physician structures not seen on regular X-ray.
  • MRI: Magnetic and radio waves are used to create a computer image of soft tissue such as nerves and ligaments.

Most scapular fractures are not significantly displaced due to the strong supporting soft tissue structures surrounding it. Therefore, a majority of scapular fractures are treated conservatively and with early motion to reduce the risk of stiffness and will usually heal without affecting shoulder movement.

Conservative treatment options include:

  • Immobilization: A sling is used for comfort and to support the shoulder to allow healing to take place. This is usually worn about 3-6 weeks depending on the type of fracture and how well you heal.
  • Prescription Medications: Pain medications will be prescribed for your comfort during the healing process.
  • Physical Therapy: Early progressive range of motion exercises is essential in restoring full shoulder function. Your physician will most likely refer you to a Physical Therapist for instruction on proper exercises and early motion of the shoulder to prevent complications.

Surgical Introduction

Fractures of the scapula involving the neck or glenoid or with severe displacement have been associated with poor outcomes when treated non-operatively, will usually require surgical intervention to realign the bones properly and restore a functional, pain free range of motion to the shoulder joint.

Scapular fracture repair surgery has historically been performed through a large, open incision. Newer, minimally invasive techniques have evolved and surgery to repair scapular fractures can now be performed through arthroscopy.

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