Trauma to the shoulder is common. Injuries range from a separated shoulder resulting from a fall onto the shoulder to a high-speed car accident that fractures the shoulder blade (scapula) or collarbone (clavicle). One thing is certain: everyone injures his or her shoulder at some point in life.
Anatomy
The shoulder is made up of three bones:
- Scapula (shoulder blade)
- Clavicle (collar bone)
- Humerus (arm bone)
These bones are joined together by soft tissues (ligaments, tendons, muscles, and joint capsule) to form a platform for the arm to work.
The shoulder is made up of three joints:
- Glenohumeral joint
- Acromioclavicular joint
- Sternoclavicular joint
This illustration highlights the bones and other major components of the shoulder.
The shoulder also has one articulation, which is the relationship between the scapula (shoulder blade) and the chest wall.
The main joint of the shoulder is the glenohumeral joint. This joint comprises a ball (the humeral head) on a golf-tee-shaped joint (the glenoid of the scapula).
The bones of the shoulder are covered by several layers of soft tissues.
- The top layer is the deltoid muscle, a muscle just beneath the skin, which gives the shoulder a rounded appearance. The deltoid muscle helps to bring the arm overhead.
- Directly beneath the deltoid muscle is sub-deltoid bursa, a fluid-filled sac, analogous to a water balloon.
Types of Shoulder Injuries
There are many types of shoulder injuries:
- Fractures are broken bones. Fractures commonly involve the clavicle (collar bone), proximal humerus (top of the upper arm bone), and scapula (shoulder blade).
- Dislocations occur when the bones on opposite sides of a joint do not line up. Dislocations can involve any of three different joints.
- A dislocation of the acromioclavicular joint (collar bone joint) is called a"separated shoulder."
- A dislocation of the sternoclavicular joint interrupts the connection betweenthe clavicle and the breastbone (sternum).
- The glenohumeral joint (the ball and socket joint of the shoulder) can be dislocated toward the front (anteriorly) or toward the back (posteriorly).
- Soft-tissue injuries are tears of the ligaments, tendons, muscles, and joint capsule of the shoulder, such as rotator cuff tears and labral tears.
The following discussion will focus on fractures and dislocations.
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Cause
Fractures
Fractures of the clavicle or the proximal humerus can be caused by a direct blow to the area from a fall, collision, or motor vehicle accident.
Because the scapula is protected by the chest and surrounding muscles, it is not easily fractured. Therefore, fractures of the scapula are usually caused by high-energy trauma, such as a high speed motor vehicle accident. Scapula fractures are often associated with injuries to the chest.
Shoulder Dislocations
- Anterior dislocations of the shoulder are caused by the arm being forcefully twisted outward (external rotation) when the arm is above the level of the shoulder. These injuries can occur from many different causes, including a fall or a direct blow to the shoulder.
- Posterior dislocations of the shoulder are much less common than anterior dislocations of the shoulder. Posterior dislocations often occur from seizures or electric shocks when the muscles of the front of the shoulder contract and forcefully tighten.
Shoulder Separations
Dislocations of the acromioclavicular joint can be caused by a fall onto the shoulder or from lifting heavy objects. The term "shoulder separation" is not really correct, because the joint injured is actually not the true shoulder joint.
Symptoms of Fractures
Symptoms of fractures about the shoulder are related to the specific type of fracture.
General Findings
- Pain
- Swelling and bruising
- Inability to move the shoulder
- A grinding sensation when the shoulder is moved
- Deformity -- "It does not look right"
Specific Findings: Clavicle Fracture
- Swelling about the middle of the collarbone area
- An area that may have a "bump," which is actually the prominent ends of the fracture under the skin
- Shoulder range of motion is limited, although not as much as with fractures of the proximal humerus
Specific Findings: Proximal Humerus Fracture
- A severely swollen shoulder
- Very limited movement of the shoulder
- Severe pain
(Left) Fractured clavicle (collarbone).
(Right)Fractured head of the humerus.
Specific Findings: Scapular Fracture
- Pain
- Swelling
- Severe bruising about the shoulder blade
Specific Findings: Shoulder Separation (Acromioclavicular Joint Separation)
- Pain over the top of the shoulder
- A prominence or bump about the top of the shoulder
- The sensation of something sticking up on the shoulder
(Left)Fracture patterns in the scapula. (Right)An acromioclavicular joint dislocation with extreme elevation of the clavicle.
(Left) From Zuckerman JD, Koval KJ, Cuomo F: Fractures of the scapula, in Heckman JD (ed): Instr Course Lect 42. Rosemont, IL, Amer Acad of Orthop Surg, 1993, pp 271-281. (Right) From Nuber GW, Bowen MK: Acromioclavicular joint injuries and distal clavicle fractures. J Am Acad Orthop Surg 1997;5:11-18.
Specific Findings: Shoulder Dislocation (Glenohumeral Joint Dislocation)
- A prominence about the front of the shoulder
- Inability to move the arm
- An arm rotated outward
- The sensation of a "dead arm"
Shoulder instability (shown here) can result in a dislocation of one of the joints in the shoulder.
Diagnosis
Most fractures are diagnosed with X-rays of the area and by physical examination. Sometimes, additional imaging techniques, such as computed tomography, are necessary.
Treatment Options
Clavicle Fractures
Most clavicle fractures can be treated without surgery. Surgery is necessary when there is a compound fracture that has broken through the skin or the bone is severely out of place. Surgery typically involves fixing of the fracture with plates and screws or rods inside the bone.
Proximal Humerus Fractures
Most fractures of the proximal humerus can be treated without surgery if the bone fragments are not shifted out of position (displaced). If the fragments are shifted out of position, surgery is usually required. Surgery usually involves fixation of the fracture fragments with plates, screws, or pins or it involves shoulder replacement.
Scapula Fractures
Most fractures of the scapula can be treated without surgery. Treatment involves immobilization with a sling or shoulder immobilizer, icing, and pain medications. The patient will be examined for additional injuries.
About 10% to 20% of scapula fractures need surgery. Fractures that need surgery usually have fracture fragments involving the shoulder joint or there is an additional fracture of the clavicle. Surgery involves fixation of the fracture fragments with plates and screws.
Shoulder Separations (Acromioclavicular Joint)
Treatment of shoulder separations is based on the severity of the injury as well as the direction of the separation and the physical requirements of the patient.
Less severe shoulder separations) are usually treated without surgery.
Severe separations in an upward direction or dislocations in the backward or downward directions often require surgery. Surgery involves repair of the ligaments.
Professional athletes and manual laborers are often treated with surgery, but the results are often unpredictable.
Shoulder Dislocations (Glenohumeral Joint)
The initial treatment of a shoulder dislocation involves reducing the dislocation ("putting it back in the socket"). This usually involves treatment in the emergency room.
The patient is given some mild sedation and pain medicine, usually through an intravenous line. Often, the physician will pull on the shoulder until the joint is realigned. Reduction is confirmed on an X-ray and the shoulder is then placed in a sling or special brace.
Additional treatment at a later date is based on the patient's age, evidence of persistent problems with the shoulder going out of place, and the underlying associated soft-tissue injury (either to the rotator cuff or the capsulolabral complex).
Patients who are 25 years of age or younger generally require surgery. Persistent instability (repeat dislocations) of the shoulder usually requires surgery. Surgery involves repair of the torn soft tissues.
Life After a Shoulder Injury
Life after a shoulder fracture, separation, or dislocation can be greatly affected for several weeks or even months. Most shoulder injuries whether treated surgically or nonsurgically require a period of immobilization followed by rehabilitation.
If the injury was not severe, there is fairly rapid improvement and return of function after the first 4 to 6 weeks. Shoulder exercises, usually as part of a supervised physical therapy program, are usually necessary. Exercises decrease stiffness, improve range of motion, and help the patient regain muscle strength.
What Should You Discuss With Your Orthopaedic Surgeon?
Some of the information you should discuss with your orthopaedic surgeon includes the following:
- The exact type of your injury
- The severity of the injury
- The treatment plan
- The possible complications
- Whether surgery will be necessary
- When it is expected that you will be maximally improved
- What is the expected outcome will be both in the short term and in the long term
FAQs
What are 3 different traumatic injuries that can occur at the shoulder? ›
- Sprains and strains.
- Dislocations.
- Separations.
- Tendinitis.
- Bursitis.
- Torn rotator cuffs.
- Frozen shoulder.
- Fractures (broken bones)
The most common fractures seen with a shoulder dislocation are fractures of the humeral head, the greater tuberosity, or fractures of the edge of the glenoid.
What is traumatic shoulder dislocation? ›A traumatic dislocation occurs when the head of the humerus is forcefully pushed out of its socket due to an impact, such as a tackle in football, or a traumatic injury, like a fall. The shoulder can become dislocated in one of two directions: Anteriorly (through the front of the joint)
How long does it take to recover from a shoulder fracture and dislocation? ›Recovery time
You can stop wearing the sling after a few days, but it takes about 12 to 16 weeks to completely recover from a dislocated shoulder. You'll usually be able to resume most activities within 2 weeks, but should avoid heavy lifting and sports involving shoulder movements for between 6 weeks and 3 months.
A rotator cuff tear occurs when any tendon of the rotator cuff rips, either partially or completely. Rotator cuff tears are among the most common types of shoulder injuries.
What is the most painful shoulder injury? ›One of the more painful scenarios that can develop in the human body is frozen shoulder. Officially referred to as adhesive capsulitis, frozen shoulder significantly decreases the shoulder's pain-free range of motion as the joint stiffens up.
Which nerve is in most danger when the shoulder joint is dislocated? ›Whilst all nerves of the brachial plexus are at risk of injury during glenohumeral dislocation, the most commonly injured is the axillary nerve.
What is the most common shoulder dislocation? ›Shoulder dislocation
Because it moves in several directions, your shoulder can dislocate forward, backward or downward. The most common variety is a forward (anterior) dislocation.
It can take four to six weeks to recover fully from mild shoulder pain. There are some things you should and shouldn't do to help ease shoulder pain. See information below for what these include.
Which nerve is most commonly injured with traumatic anterior shoulder dislocation? ›The axillary nerve was most commonly affected, both as a single nerve and in combination with other nerves. Older patient age, higher energy of the initial trauma and longer period from dislocation to its reduction have been postulated as risk factors.
How is shoulder trauma treated? ›
To help ease pain and swelling, apply ice right after the injury. Keeping the arm in a sling to limit the movement of the shoulder lets ligaments heal. This is often followed by physical therapy exercises. Sometimes, surgery is needed.
How long do you wear a sling for a fractured shoulder? ›Slings are more commonly prescribed for people with a shoulder fracture. For a fractured clavicle, a sling may be worn for four to six weeks. For a fractured proximal humerus, a sling may be needed for up to two weeks.
Can a fractured shoulder heal without surgery? ›Shoulder Fracture Treatment Options
Most non-displaced shoulder fractures can be treated with conservative techniques, such as: Icing. Immobilization with an arm sling or wrap while bones heal. Oral medications to help alleviate pain.
You can stop wearing the sling after a few days, but it takes about 12 to 16 weeks to completely recover from a dislocated shoulder.
What not to do with a shoulder injury? ›People with shoulder injuries should initially refrain from exercises that encourage any movement or movement overhead. Forget about activities like throwing a ball or specific weight training at the gym like overhead presses and pull-ups.
What shoulder injuries do not heal by themselves? ›The shoulder is a unique and complex joint that is more susceptible to strains and tears than other joints. In most rotator cuff tears, the muscle partially or fully tears away from the bone. Rotator cuff tears won't heal on their own. You'll need rotator cuff repair to restore your shoulder joint.
What are the 2 most common causes for shoulder injuries? ›Shoulder injuries are frequently caused by athletic activities that involve excessive, repetitive, overhead motion, such as swimming, tennis, pitching, and weightlifting. Injuries can also occur during everyday activities such washing walls, hanging curtains, and gardening.
What is the best painkiller for shoulder pain? ›To relieve minor shoulder pain you might try: Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) may help.
What are red flags for shoulder pain? ›Urgent if any red flags are identified: Trauma, pain and weakness, or sudden loss of ability to actively raise the arm (with or without trauma): suspect acute rotator cuff tear. Any shoulder mass or swelling: suspect malignancy.
What is the most painful type of dislocation? ›Hip dislocation. Sudden hip dislocation is a medical emergency when it occurs in adults. It is very painful and can result in significant bleeding into the joint and tissues.
What movements to avoid after shoulder dislocation? ›
Do not move your shoulder. Keep your arm close to your body. You can move your wrist and elbow while in the sling. Do not place rings on your fingers until your doctor tells you it is safe to do so.
What are the two most commonly dislocated joints? ›This injury can be very painful and can temporarily deform and immobilize the joint. The most common locations for a dislocation are shoulders and fingers, but can also occur in elbows, knees and hips.
Is a dislocated shoulder worse than a broken arm? ›Dislocated joints, unless they are realigned quickly, are more likely to damage blood vessels and nerves than are fractures. Some complications (such as blood vessel and nerve damage and infections) occur during the first hours or days after the injury.
Can MRI show nerve damage in shoulder? ›Imaging, especially MRI, plays an important role to detect the underlying causes of nerve damage (extrinsic mass, rotator cuff tear, etc.), the precise topography of injury (involvement of both supraspinatus and infraspinatus muscles if the nerve is injured at suprascapular notch and isolated denervation sign of ...
What are 2 warning signs of a rotator cuff tear? ›- Be described as a dull ache deep in the shoulder.
- Disturb sleep.
- Make it difficult to comb your hair or reach behind your back.
- Be accompanied by arm weakness.
A knee dislocation is the worst of the worst. In broad terms, the knee is stabilized by four ligaments -- the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament.
Which surgery is best for shoulder dislocation? ›Arthroscopic Shoulder Surgery
Surgery for a dislocated shoulder is often required to tighten torn or stretched tendons or ligaments. A surgeon may also repair a torn labrum, the ring of cartilage that surrounds the shoulder socket and stabilizes the humerus.
Fortunately, most instances of shoulder dislocation do not require surgical intervention! When your orthopedic specialist manually replaces the arm bone into its socket, pain relief is almost instantaneous.
How can I speed up the recovery of a shoulder injury? ›- Wear Shoulder Sling or immobilizer: ...
- Participate in Regular Exercise: ...
- Eat properly: ...
- Take Medications On Time: ...
- Change Your Sleeping Position: ...
- Use Ice Compresses: ...
- Avoid Certain Shoulder Positions And Arm Movements.
For a diagnosis of chronic shoulder pain, you'll likely be living with the pain for more than six months. The most common source of problems is the rotator cuff, a capsule of muscles and tendons that surround, stabilize, and support the shoulder joint. However, it's not always the problem.
How long before you can drive after a fractured shoulder? ›
Regarding return to contact sports, it usually takes 3-6 months and depends on the severity of injury. You should be able to resume driving in 6-12 weeks.
What is the fastest way to heal a dislocated shoulder? ›Doctors recommend using a sling or brace to immobilize the affected arm and shoulder for four to six weeks to allow the muscles and other soft tissues to rest and heal. During the first 2 days, applying an ice pack to the shoulder 3 times a day for 15 to 20 minutes may reduce swelling and ease pain.
What are the symptoms of nerve damage after shoulder dislocation? ›Nerve Damage
The primary symptom of this type of damage is numbness on the outside of the upper arm. Untreated, nerve damage to the circumflex axillary nerve can result in weakness of the deltoid muscle and restricted shoulder movement.
Klumpke's palsy, or Klumpke's paralysis, is a form of brachial plexus palsy – a paralysis of the arm due to an injury of the network of spinal nerves that originates in the back of the neck, extends through the shoulder and armpit and gives rise to nerves in the arm.
What are the types of traumatic shoulder injury? ›Traumatic shoulder injuries include a separated shoulder (AC joint dislocation), shoulder dislocation (glenohumeral joint dislocation), and fractures of the proximal humerus, collarbone (clavicle), and shoulder blade (scapula). Rotator cuff tears also frequently occur as a result of trauma.
How do you rehab a shoulder injury without surgery? ›- Do physical therapy. Certain types of shoulder pain are actually better suited to physical therapy than surgery. ...
- Maintain your weight. What does weight management have to do with shoulder pain? ...
- Take medication. ...
- Control inflammation. ...
- Penn Sports Medicine.
One-and-a-half months after surgery, patients who did not wear a sling had increased shoulder motion, including external (outward) rotation and active elevation.
What not to do with fractured humerus? ›Do not try to raise your arm A fractured Humerus can be very mobile. You may feel or hear the bone moving; this is not unusual but by allowing your arm to relax from the shoulder and hang loose may reduce or even prevent this from happening.
Why is a fractured humerus so painful? ›When the proximal humerus breaks, the attached rotator cuff tendons often pull the fracture fragments in different directions to cause displacement. A broken proximal humerus is generally very painful; patients develop significant bruising and swelling that can go into the chest as well as down the arm.
Can a fractured shoulder get worse? ›Displaced fractures often require surgery and may result in injury to the adjacent muscles. This can result in more shoulder pain, weakness and residual discomfort.
Do you have to wear a sling for a fractured shoulder? ›
If you don't need surgery you will wear a sling at first to help keep your arm still to let the fracture start to heal and the callus start to form. How long you wear the sling may be slightly different depending on your injury but most fractures mean you will need to wear a sling for 3 to 4 weeks.
How painful is a fractured shoulder? ›Pain, swelling, and bruising may occur around a fractured shoulder blade. You'll find it very painful to move the arm in any way, and to lift it will be impossible. Other symptoms include difficulty breathing due to movement of the chest wall with each breath.
Does a dislocated shoulder ever fully heal? ›Recovery time
You can stop wearing the sling after a few days, but it takes about 12 to 16 weeks to completely recover from a dislocated shoulder. You'll usually be able to resume most activities within 2 weeks, but should avoid heavy lifting and sports involving shoulder movements for between 6 weeks and 3 months.
Should I Wear a Sling While Sleeping? Yes. You should only be removing your sling for dressing and bathing. This helps keep you from unconsciously putting your arm in a bad position and waking up in a world of pain.
How long does it take for an elderly person to recover from a dislocated shoulder? ›Therapy may include exercises to strengthen the muscles that surround the shoulder and to maintain the range of motion of the shoulder joint. The total rehabilitation and recovery time from a shoulder dislocation is about 12-16 weeks.
What are the 3 most common injuries? ›The most common sports injuries are: Sprains and strains. Knee injuries. Swollen muscles.
What are the 4 types of lesions in the shoulder? ›Bony Bankartt - a fragment of bone breaks off with the Bankart tear - Bony Bankart at arthroscopy. Hill-Sachs lesion - a dent in the back of the humeral head which occurs during the dislocation as the humeral head impacts against the front of the glenoid. SLAP Tear - a tear at the top of the labrum.
What are the 3 types of injuries that are the most common reasons for people seeking medical care? ›Dislocated joints or broken bones. Uncontrolled bleeding. Repeated vomiting. Serious burns.
What is the hardest injury to recover from? ›Serious injuries that are long-term or permanent in nature are considered “catastrophic injuries,” and they are the most difficult to recover fully from. Examples of catastrophic injuries include, but are not limited to, the following: Traumatic brain injuries. Spinal cord injuries.
What is the deadliest injury? ›Traumatic Brain Injuries
One of the most catastrophic types of injuries that can occur is a traumatic brain injury.
What are the 5 life threatening injuries? ›
Hidden Six ... Major thoracic injuries are known as the Deadly Dozen. The Lethal Six (airway obstruction, tension pneumothorax, cardiac tamponade, open pneumothorax, massive hemothorax, and flail chest) are immediate, life-threatening injuries that require evaluation and treatment during primary survey.
What two lesions are associated with shoulder dislocation? ›Associated injuries – Posterior shoulder dislocations are commonly associated with tuberosity and surgical neck fractures of the humerus, reverse Hill-Sachs lesions, and injuries to the labrum and rotator cuff [32,40].
Which is worse torn labrum or rotator cuff? ›Pain levels can differ in rotator cuff vs.
SLAP tears. A rotator cuff injury often leads to excruciating pain, especially at night. This pain can restrict daily activities such as reaching above the head and holding heavy objects. On the other hand, a SLAP tear can lead to dull, consistent pain and a weakened shoulder.
A glenoid labrum tear in the anterior joint is called a Bankart lesion. When the labrum is torn, the shoulder joint is less stable, and allows the humeral head to move around more than normal. Posterior dislocation (when the arm is forced backwards) can also lead to a tear in the labrum, though less commonly.
What are 4 injuries that require immediate attention? ›- Concussions. Concussions are probably one of the most common, most dangerous, and most overlooked injuries, especially among athletes. ...
- Hand Injuries. ...
- Severe Burns. ...
- Eye Injuries.
The liver is the most commonly injured organ in blunt abdominal trauma and the second most commonly injured organ in penetrating abdominal trauma [3-6]. The liver is a highly vascular organ located in the right upper quadrant (figure 1) of the abdomen and is susceptible to injury from traumatic mechanisms.
What is the difference between trauma and injury? ›A trauma refers to a serious—and possibly life-threatening—injury that requires immediate medical attention. These are the most critical injuries, which is why many hospitals are equipped with trauma centres to help treat time-sensitive traumas.