What's wrong with my shoulder after an accident?


FRACTURES AND DISLOCATIONS OF THE SHOULDER JOINT

After an accident the shoulder can be injured. Usually the more violent the injury the more damage occurs. It is common sense that falling off building or a fast moving bicycle is likely to do more damage than a simple fall.

Immediate and very severe pain in the shoulder after injury especially if the arm appears altered in shape often suggests a fracture or break of the bone. The other possibility is that the shoulder joint has dislocated or gone out of place. Both of these events are associated with extreme pain and it is likely the patient would require and demand immediate transfer to hospital for treatment. In most shoulder fractures the skin around the injury remains undamaged and treatment either with slings or by surgery can be planned in a calm and methodical manner. Xrays will diagnose the fracture. If surgery is required this can often be delayed for a number of days until all factors are optimised. More information can be obtained in the section on treatment of fractures.

In the case of dislocations the problem is readily diagnosed by a doctor trained in treating injuries. The diagnosis is usually confirmed by X-ray and then the shoulder should be reduced to normal position as soon as possible. The process of reducing the shoulder joint may often need a general anaesthetic. More information on the treatment of dislocated shoulder can be founnd on the section on instability.


WHERE IS THE PAIN?

photo-8


The pain from fractures and dislocations is extreme and the patient will know something very severe has happened. Other injuries can occur which produce pain of a lesser extent and in these circumstances the site of the pain can be very helpful in indicating the cause.



thinker cuff

Patients often fall and put out their arm to break the fall. Alternatively they can fall and try and grab a bannister to save themselves. If this type of injury is followed by pain as indicated in this diagram often the patient has torn one or more of the tendons of the rotator cuff. Usually pain increases over a few days and is worst at night. Usually the more weakness evident the larger the tear. Increased pain on lowering the arm is very likely to be related to a torn tendon. Diagnosis is best done using an ultrasound scan of the tendons. Tendons often require repair to recover power.


thinker acj

Patients can injure the AC joint in falls. Commonly these injuries involve falls from bicycles or motorbikes resulting in a violent impact to the point of the shoulder. They are also seen often in contact sports. Pain will be felt in the area indicated. With increased force of injury his small joint can stretch out of place or dislocate producing a lump at the end of the collar bone. Often patients can be treated in a simple sling but the larger the lump the larger the risk of requiring surgery. The surgery performed at the Upper Limb Centre involves implanting a new artificial ligament.



thinker biceps


After a violent twisting injury of the shoulder patients can develop pain associated with clicking in the joint with movement. This may suggest a tear of the labrum. if it is the superior part of the labrum that is torn this is called a SLAP tear and can be debilitating. The pain is often as suggested in the diagram.

© Peter James Hughes 2015