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  • Acromioclavicular Joint Separation

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    Acromioclavicular Joint Separation

    Definition:
    The acromioclavicular (AC) joint is formed at the junction of the clavicle (collar bone), the part of the shoulder blade called the acromion, and the humerus (arm bone). The end of the clavicle meets the acromion, which is a bony extension that curves forward from the upper part of the scapula (shoulder blade). Together they form a socket, into which the round head of the humerus fits. There are also several ligaments associated with the joint, with the most important being the acromioclavicular ligament. This helps to hold the bones in position. An acromioclavicular joint separation, also known as a shoulder separation, occurs when the joint between the clavicle and the acromion is damaged. It is not the same as a dislocated shoulder.

    AC separations are graded according to severity and the extent of bone displacement, with grade 1 being a relatively mild strain to the ligaments and capsule of the joint, and grade 6 being torn ligaments and a complete disruption of the bones with the clavicle being displaced downwards and behind part of the scapula. Grade 1 and 2 shoulder separations are by far the most common. Grade 6 separations are rare.

    AC Separation Causes:
    An injury to this joint is normally the result of landing heavily, or receiving a strong blow, on the shoulder or the elbow. Falling onto an outstretched hand might also cause a shoulder separation. People playing contact sports are obviously at increased risk of this type of injury.

    AC Joint Separation Symptoms:
    Pain is the main symptom of an injury of this type. The pain is commonly felt at the outer end of the clavicle, nearest the arm, at the moment of impact. Pain may also be felt all over the shoulder, particularly if any movement is attempted, and especially when trying to lift the arms above shoulder height. Later such pain may become more localized to the site of injury. There may be swelling and bruising. If the injury is severe, a noticeable lump, made by the tip of the collarbone, might be visible on the front or top of the shoulder.

    AC Joint Separation Diagnosis:
    A physical examination and detailed questioning usually provides a clear diagnosis of a shoulder separation. The doctor will also take your pulse to check for damage to blood vessels, test the range of motion of your shoulder and test muscle strength in your shoulder and arm. An x-ray is useful in assessing the extent of the damage.

    AC Separation Treatment:
    For mild cases of shoulder separation, gentle exercise should be started once the initial pain has lessened, usually after a couple of weeks. Commencing exercise reasonably quickly minimizes the danger of developing shoulder stiffness (frozen shoulder). More serious injuries will take longer to heal. Be guided by your doctor or physiotherapist. A physiotherapist can supervise and advise on suitable exercises to restore normal motion of the joint and to build up muscle strength. Gradual resumption of normal activity as the pain reduces is usually the most effective way to heal.

  • A mild injury can be treated with ice to reduce inflammation. Use ice on the joint for 15 minutes at a time, every 4 hours.
  • Using a sling to restrict movement will ease the pain and allow healing. There are several types of collarbone supports and shoulder supports available.
  • Pain medications such as Tylenol will help, and NSAIDs such as ibuprofen will assist in reducing inflammation.
  • The joint can be taped to provide further restriction of movement and support while it heals. The tape will probably have to stay in place for at least a couple of weeks.
  • A physiotherapist might apply ultrasound or TENS, depending on the severity of the injury.

    Occasionally surgery will be needed for grade 3 separations, as there is some evidence that certain people (athletes, manual laborers) benefit from early surgical intervention. Surgery will almost certainly be necessary for grade 4, 5 and 6 shoulder separations, but these are rare injuries.

    What to look for in a brace to help a shoulder separation injury:
    A comfortable brace, made with breathable fabric, and which provides good support and protection to the shoulder. You might prefer a brace that does not have restrictive straps, which can be uncomfortable.

    AC Separation Rehabilitation Exercises:
    Do not undertake any exercise without prior approval from your health care provider, unless the joint separation was very mild and that you are free from significant pain, usually after 1 to 2 weeks.

    To restore mobility you can try the following:
    Pendulum
    While lying on your front on a bench or bed, or bending forward, gently swing the arm backward and forward. Increase the range gradually. Repeat with the arm moving from side to side.
    Front shoulder stretch
    With one forearm resting against a doorframe, carefully turn away from the arm to feel a gentle stretch in the front of the shoulder. There should be no pain. Hold for 10-20 seconds. Repeat 3 times.

    For strengthening:
    External rotation
    With your side to a wall and the upper arm against your side, bend your elbow to a 90 degree angle and place the back of the wrist against the wall. Push gently against the wall with the back of the wrist. Your shoulder should not move. Hold for 10 seconds, release for 5 seconds. Do this 10 times.
    Internal rotation
    Use a wall with a corner for this exercise, or a doorframe. Facing the wall, with your upper arm against your side, bend your elbow to form a 90 degree angle. Place the front of your wrist against the doorframe and press, as though trying to turn your arm towards you. Hold for 10 seconds, release for 5 seconds. Do this 10 times.
    Abduction
    Standing sideways to the wall, straighten the arm and place the back of the wrist and hand against the wall. Push against the wall. Hold for 10 seconds, release for 5 seconds. Do this 10 times.

    AC Joint Separation Prevention:
    Because injuries of this nature are caused by traumatic events, there is not a lot that can be done to prevent them. However, people playing contact sports such as football, hockey or rugby should wear shoulder pads to protect the tip of the shoulder. Maintaining muscle strength and stability of the shoulder may help to prevent injury.
  • Broken Collar Bone / Clavicle Fracture

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    Broken Collarbone

    The collarbone (clavicle) is one of two long, slender bones found on either side of the chest. Each clavicle is attached to the breastbone (sternum) at one end and to the shoulder blade (scapula) at the other end. They connect the arms to the trunk of the body. 

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  • Dislocated Shoulder

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    Dislocated Shoulder

    The shoulder is a highly mobile joint, allowing the arm to move in almost any direction. The joint is formed by the connection of the humerus (the upper arm bone) and the scapula (shoulder blade). The articular end of the humerus is rounded and fits into a shallowly concave surface of the scapula called the glenoid fossa, forming a flexible ball-and-socket joint. Helping to stabilize the joint are ligaments running from bone to bone, tendons that connect bone to muscle, and a ring of cartilage surrounding the glenoid.

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  • Distal Humerus Fracture

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    Distal Humerus Fracture

    A distal humerus fracture is the term used to describe a type of elbow fracture where the lower end of the upper arm bone (humerus) has been broken. It is a relatively uncommon injury in adults, accounting for only about 2% of fractures. Children are more likely to suffer this type of injury.

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  • Erbís Palsy

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    Erbís Palsy

    Erbís palsy, also known as brachial plexus paralysis, is a condition of partial or complete paralysis of the arm caused by damage to a network of nerves near the neck. It is a condition most often found in newborns, although trauma to an older person can also result in Erbís palsy.

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  • Forearm Fracture

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    Forearm Fracture

    A break in one or both of the bones in the lower part of the arm is called a forearm fracture.The two bones in the forearm are the radius and the ulna. The radius is the bone nearest your thumb and the ulna nearest the little finger. A strong membrane between the two bones holds them close together but allows them to rotate around each other to a certain degree. At the proximal (upper) end of the bones, the ulna articulates with the radius and the humerus (upper arm bone) to form the elbow joint, and at the furthest (distal) end, the radius articulates with the ulna and three of the wrist bones. Together they allow a great deal of mobility in the arm, wrist, and hand.

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  • Frozen Shoulder

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    Frozen Shoulder

    Frozen shoulder is a condition of stiffness and pain in the shoulder that limits normal movement of the joint. It is also known as adhesive capsulitis.

    The shoulder has two joints. The glenohumeral joint is a highly flexible ball-and-socket joint, formed by the connection of the humerus (upper arm) and the scapula (shoulder blade). The upper end of the humerus has a rounded shape that fits into a shallow concavity of the scapula called the glenoid fossa. There is a strong capsule of connective tissue that surrounds the joint, partially formed from ligaments. Contained within the capsule is synovial fluid, a nourishing and lubricating substance. If the capsule becomes too tight, the range of motion of the shoulder is restricted, causing pain and immobility.

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  • Lymphedema

    Lymphedema

    Lymphedema is an abnormal accumulation of protein-rich fluid
    in the interstitial space. This not only can cause swelling, but can also
    result in changes to the skin, infection, and decreased wound healing where
    wounds are present.

  • Radial Head Fracture

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    Radial Head Fracture

    The two bones in the forearm are the radius and the ulna. The radius is the bone nearest your thumb and the ulna nearest the little finger. A fall onto an outstretched arm can result in a fracture of the upper end of the radius (the radial head). Radial head fractures are relatively uncommon injuries that can happen in isolation but frequently occur during an elbow dislocation, when the realignment of the humerus and ulna cause a piece of the radial head to be broken off.

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  • Rotator Cuff Injury

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    Rotator Cuff Injury

    A rotator cuff injury refers to damage sustained by any part of the rotator cuff structure in the shoulder.

    A collection of muscles and tendons form the rotator cuff, connecting the humerus (upper arm) to the scapula (shoulder blade). Each of the four muscles of the cuff has an insertion into the scapula, and a tendon that originates in the muscles and attaches to the humerus. The muscles and associated tendons are the supraspinatus, infraspinatus, teres minor, and subscapularis. Together they form a cuff that allows extensive movement of the arm and shoulder while helping to stabilize the shoulder joint.

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  • Shoulder Bursitis

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    Shoulder Bursitis

    A bursa is a fluid-filled sac that lies between various tissues and structures to allow smooth movement. If the bursa is injured or inflamed it causes the space within which other tissues move to become restricted, leading to friction, irritation, and pain. Shoulder bursitis is a condition of inflammation of the bursa in the shoulder, and is also known as impingement syndrome.

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  • Shoulder Dislocation

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    Dislocated Shoulder

    The shoulder is a highly mobile joint, allowing the arm to move in almost any direction. The joint is formed by the connection of the humerus (the upper arm bone) and the scapula (shoulder blade). The articular end of the humerus is rounded and fits into a shallowly concave surface of the scapula called the glenoid fossa, forming a flexible ball-and-socket joint. Helping to stabilize the joint are ligaments running from bone to bone, tendons that connect bone to muscle, and a ring of cartilage surrounding the glenoid.

  • Shoulder Labral Tear

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    Shoulder Labral Tear

    A labral tear is an injury to the glenoid labrum of the shoulder joint. Three bones, the clavicle (collarbone), scapula (shoulder blade), and the humerus (arm bone), form the shoulder joint. The upper end of the humerus is large and rounded, and it sits in a shallow concavity of the scapula called the glenoid fossa. It is the shallowness that allows for such extensive mobility of the shoulder joint, but it makes the joint fundamentally unstable. There is therefore a rim of thick fibrous tissue around the edge of the glenoid fossa that deepens the socket and helps to keep the humerus in position. Several ligaments (bands of strong connective tissue) have their attachments on the glenoid labrum.

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  • Shoulder Separation

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    Shoulder Separation

    Definition:
    A shoulder separation is an injury to the ligaments that connect the clavicle (collarbone) to the highest part of the scapula (shoulder blade), the acromion. The connection of these two bones is known as the acromioclavicular joint hence a shoulder separation can also be called an acromioclavicular separation or an AC separation.

    Ligaments are strong bands of connective tissue that attach bones to bones, helping to stabilize joints. There are several ligaments attaching the clavicle to the scapula, both around the AC joint and also further along the clavicle. A severe injury to the shoulder can cause the ligament to tear, partly or completely, which can result in the two bones separating. Sometimes the injury includes a broken bone.

    Causes:
    The most likely causes of a shoulder separation are a fall onto the shoulder or a heavy blow to the top of the shoulder that forces the clavicle downwards and away from the scapula. This might typically happen in a sporting injury or a vehicle accident.

    Symptoms:
    • Depending on the severity of the injury, there may be a visible deformity on the top of the shoulder. The end of the clavicle, having been separated from the acromion, would form a lump under the skin.
    • Pain is usually present, with the desire to support the affected arm with the other hand.
    • Tenderness at the acromioclavicular joint site.
    • Possible swelling or bruising on the top of the shoulder.
    • Numbness or muscle weakness in the affected arm.
    • Decrease in mobility of the shoulder.
    Diagnosis:
    It is possible that a severe injury may only produce relatively mild symptoms, so it is important to seek medical advice if you suspect you may have a shoulder separation.

    Your doctor will ask about your medical history, particularly any previous injuries to your shoulder. You will also be asked about your general lifestyle and activities. Your shoulder will be physically examined, and X-rays will be taken in order to assess the condition of the acromioclavicular joint. Other diagnostic scans, such as MRI or ultrasound, that show the soft tissues in more detail than X-rays, may be performed at a later date.

    Treatment will depend on the grade of injury that is diagnosed. Types I and II shoulder separations usually respond to conservative (non-surgical) treatment. Type III injuries are a little more complicated in terms of which treatment is best; people whose occupations require heavy labor or overhead movements may be more appropriate candidates for surgery. Types IV, V, and VI are less common and may include damage to associated muscles. Surgery is the likely treatment for these injuries.

    Treatment:
    Immobilize the joint by placing the shoulder in a sling or shoulder brace. This is to prevent further damage to the joint caused by the weight of the arm pulling on the joint, and also to restrict movement. Once the acute stage of the injury is over, usually after a few days, it is helpful to begin moving the shoulder gently to minimize stiffness and decrease the risk of developing a frozen shoulder (adhesive capsulitis).

    Apply ice, crushed in a bag and wrapped in a towel, to the top of the shoulder. You can apply ice for as long as is comfortable, several times a day. It will reduce swelling and help to relieve pain.

    Over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil), naproxen (Aleve), or aspirin can be taken to help reduce swelling, or acetaminophen (Tylenol) for pain relief.

    Physical therapy to rehabilitate the joint will probably begin after a few days, when the initial swelling and pain has diminished. Your doctor or physical therapist will design a program specifically for you, based on your particular injury.

    Some of the most severe shoulder separations require surgical repair, as might injuries that fail to respond to conservative treatment, and deformities of the shoulder that cause irritation. Surgery to reattach ligaments can be very successful even if performed some time after the injury, so in many instances it is sensible to wait to see if other treatments resolve the problem. Surgery might also be performed to trim the end of the clavicle so that it no longer rubs against the acromion.

    Prognosis:
    Most people recover well from a shoulder separation and can return to normal activities within two to three months. Sometimes a deformity remains, but does not affect shoulder mobility. If pain persists, it is usually due to the ends of the bones in the acromioclavicular joint continuing to rub against each other, or the development of arthritis, or the joint cartilage between the bones has been injured.

    Exercises:
    When your doctor advises that it is safe to do so, you may begin some gentle rehabilitation exercises. These should be done on a daily basis to gradually increase the range of motion of your shoulder. Strengthening exercises will begin once you have been performing range of motion exercises for a few days. You will be prescribed specific exercises, but you can begin with the following:

    Pendulum:
    Bend forward at the waist and allow your injured arm to hang straight down towards the floor. Gently move your hand in small circles, both clockwise and anticlockwise. The momentum will cause your arm to move.
    Wand flexion:
    Standing, hold a stick in both hands with your palms facing down. Slowly, keeping your elbows straight, lift your arms above your head. Hold the stretch for 5 seconds then lower your arms. Repeat 10 times.
    Wand extension:
    Standing, hold a stick behind your back, using both hands. Slowly lift the stick away from your back. Hold the stretch for 5 seconds then lower. Repeat 10 times.
    Shoulder flexion:
    Stand with your arms at your sides; keeping your elbows straight, carefully raise your arms out to the side and as high as they will go without pain. Hold for 5 seconds. Repeat 10 times.
    Scapular range of motion:
    Standing, shrug your shoulders up. Hold for 5 seconds. Squeeze your shoulder blades back towards each other. Hold for 5 seconds. Drop your shoulder blades down as though putting them in a back pocket. Hold for 5 seconds. Repeat exercise 10 times.

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  • Shoulder Subluxation

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    Shoulder Subluxation

    A shoulder subluxation is similar to a shoulder dislocation, the difference being that a subluxation is temporary and partial. It can be described as shoulder joint instability. A study of over 4,000 West Point cadets showed that shoulder subluxations are much more common than dislocations, and often happen in conjunction with other injuries such as Bankart lesions.

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