SHOULDER

SHOULDER

The shoulder is one of the most complex parts of the human body in design and functionality and is considered the joint with the greatest range of motion.

It allows us to perform simple actions like lifting objects or scratching our back as well as large, complex movements like swimming, climbing, and throwing objects long distances. Many different structures play a role in the process of granting us such mobility; these same structures open the door to a wide range of possible injuries.

The shoulder is formed by the humerus, shoulder blade, and clavicle, however this is only the bony frame. The joint’s functional mobility is due to a complex musculotendinous unit, which is why the shoulder suffers such a high rate of sports-related injuries or degenerative injuries caused by daily activities. The main culprit behind shoulder injuries is mechanical. That is to say that what went wrong, be it in the part of the shoulder that creates stability or mobility, is due to trauma, a fall, or from overuse.

The type of injury depends as much on the activity the patient is engaged in as on the patient’s age and timeframe in which the injury developed.

 

SPORTS INJURIES

Sports injuries are most commonly caused by a lack of stability due to falls or trauma, or to overuse in certain activities as is the case with throwing (like pitchers, javelin throwers, football players).

What follows is a short list of some of the most common sports-related shoulder injuries:

Instability (dislocated shoulder)

It is defined as the injury where the humeral head losses its anatomical relation with the scapula (glenoids). It may occur in a variety of ways, depending on the direction of the dislocation (anterior, posterior, inferior), the progression of the injury (acute or chronic), and the number of times it has been dislocated (first time or recurring).

It’s important to understand that for the humeral head to leave its position many structures must be injured; therefore the objective of the treatment is to repair said structures with the goal of reestablishing shoulder stability.

Instability has a direct relationship with age. In young patients (<20) the probability that it will recur is 100%, in comparison to adult patients (>40), with whom it’s less likely to recur.

Treatment for shoulder dislocation requires that the joint first be put back in place (correct the dislocation). Commonly, this is done by urgent care or trained professionals. Then, different clinical and imaging tests must be run to establish the number and type of structures injured, so it can be determined the correct treatment, be it surgical or other. 
Surgical options for instability are the following:

  • Arthroscopic:
    Minimally invasive procedure through small incisions (portals) in the skin.
  • Open:
    For specific cases where arthroscopy is not an option, open treatment stabilizes the shoulder through a bone graft and fixes it in place with screws of the same material (Latarjet procedure).
 

Acromial-clavicular dislocation

The upper part of the shoulder is comprised of the area where the clavicle meets a bony projection called the acromion.

This joint is often injured through falls or trauma to the shoulder in sports like soccer, football, hockey, and skating among others. The intensity of the impact can hurt the structures that hold these bones together.

There are different degrees of injuries and in a large number of cases treatment may not involve surgery, however it’s important to identify the degree and possible complications of the injury.

This injury may result in an observable deformity in the shoulder and long-term change in the shoulder’s mechanics causing pain.

 

Long biceps tendon injury (biceps pulley, SLAP injury)

The biceps muscle has two tendons that insert into the shoulder. The short head connects outside of the joint to a structure called coronoid apophysis, whereas the long head enters the shoulder girdle turning 90 degrees on its axis. This 90-degree turn at the humeral head acts like a leverage point.

In patients who partake in sports that involve overusing this tendon, such as pitchers, climbers and swimmers, the tendon may become injured both at the level of the 90-degree turn (known as biceps pulley) or at the point of insertion into the glenoids (SLAP injuries).

These are injuries of overuse due to specific rotation mechanisms in the long tendon biceps. They usually manifest as specific pain along the long tendon biceps, eventually rendering the patient incapable of performing athletic activities due to the pain.

The diagnostic includes a specific physical examination of these structures as well as imaging studies, most commonly Nuclear Magnetic Resonance, being necessary to use contrasting agents inside the joint in some cases.

The treatment may, depending on the case, be conservative, using physical therapy, anesthesia infiltration, and anti-inflammatories, or be a surgical solution.

 
Slide background
Slide background
Slide background
Slide background
Slide background
Slide background
Slide background
Slide background
Slide background
Slide background
Slide background