A shoulder sprain is a term describing tear in the ligaments of the shoulder, most commonly involving the acromioclavicular joint.
Presentation
The clinical presentation depends on the extent of the injury, but sprains are characterized by a milder complaint such as pain and tenderness at the acromioclavicular joint [4]. It is necessary to rule out other accompanying injuries at the glenohumeral joint, as treatment may require more aggressive measures in that case [4]. The patients may complain of restricted joint mobility or even popping in the associated region.
Entire Body System
- Surgical Procedure
This is not a minor surgical procedure, and rehab after surgery can be lengthy. Some of the unique concerns include a nonunion of the bone that is transferred to the shoulder socket. [verywellhealth.com]
However, if it is a surgical procedure, knowing what type of surgery was performed as well as the precautions post surgery. [physio-pedia.com]
Gastrointestinal
- Nausea
Nausea or vomiting. Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms. Lightheadedness or sudden weakness. A fast or irregular heartbeat. [northshore.org]
- Vomiting
Nausea or vomiting. Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms. Lightheadedness or sudden weakness. A fast or irregular heartbeat. [northshore.org]
Musculoskeletal
- Shoulder Pain
Ranging from a small sprain causing minimal shoulder pain to a severe sprain causing extreme pain, instability and deformity, a shoulder sprain in the AC joint can lead to a variety of symptoms. [drjeffpadaleckimd.com]
You can usually do things to ease shoulder pain yourself. See a GP if it does not start feeling better after 2 weeks. How to ease shoulder pain yourself You usually need to do these things for 2 weeks before shoulder pain starts to ease. [nhs.uk]
Shoulder dislocations are characterised by severe shoulder pain and hospital treatment is required to restore normal shoulder anatomy. [physioroom.com]
[…] and needles Recovery from shoulder pain can normally take two to six weeks, and minor examples of shoulder pain can often be treated at home. [physicool.co.uk]
- Frozen Shoulder
A popping or clicking noise when moving the shoulder. Frozen Shoulder The signs and symptoms of a frozen shoulder include: Stiffness in the joint. Tightness. Unable to lift the arm. Fracture The signs and symptoms of a fracture include: Severe pain. [niams.nih.gov]
Frozen shoulder most often occurs as a result of immobility following a shoulder injury. [aafp.org]
COMMON SHOULDER INJURIES Some of the most common shoulder injuries our products can help you with include: Frozen shoulder Shoulder tendonitis Shoulder bursitis Shoulder impingement Recovery from shoulder surgery Shoulder strains Shoulder sprains [physicool.co.uk]
Sometimes shoulder joint tears, rotator cuff tears and frozen shoulder don’t improve with rest and medicine. Your doctor may recommend surgery. [webmd.com]
Frozen shoulder can affect people with diabetes, thyroid disease, heart disease, or Parkinson disease. It can also happen if the shoulder has been immobile for a period of time. [urmc.rochester.edu]
- Stiffness of the Shoulder
Symptoms & Types A shoulder sprain will usually lead to 1 or more of the following symptoms: Pain and stiffness in the shoulder Inability to rotate the arm in all the normal positions Lack of strength in the shoulder to carry out daily activities Presence [texaschildrens.org]
In minor cases of an AC joint sprain, patients may be able to continue activity only to experience an increase in pain, swelling and stiffness in the shoulder after activity with rest (particularly first thing in the morning). [physioadvisor.com.au]
- Muscle Strain
Whether you’re suffering from a simple muscle strain or a chronic condition like repetitive strain injury due to overuse at work or in the gym, our compressive, cooling bandages help reduce swelling and manage pain. [physicool.co.uk]
Strains are described by the severity of damage in three grades: Grade 1 strain usually causes stretching of a few of the muscle fibers. Grade 2 strain has more significant damage, and some muscle fibers are damaged or torn. [medicinenet.com]
- Osteophyte
[…] thickened coracoacromial ligament. 22 Radiographs should be considered if a patient shows no improvement after two to three months of conservative therapy for presumed impingement syndrome ( Table 4 ). 23 Degenerative changes at the AC joint, sclerosis, osteophyte [aafp.org]
Neurologic
- Stroke
[…] when taken through the swim stroke Positive Test Implications Impingement syndrome See Test Jerk Test Steps Patient is lying supine with arm horizontally abucted and elbow flexed to 90° Examiner places stabilizes the opposite shoulder with one hand and [ahn.mnsu.edu]
My ground strokes are generally more about placement and spin than powering someone off court. I don't hit many flat shots at all. [tt.tennis-warehouse.com]
- Forgetful
ZJchao does not forget the people-oriented and honesty-oriented service concept in its management, wins trust with enthusiasm, and builds its brand with integrity. [amazon.com]
Workup
A detailed physical examination is the most important step during workup. Bedside stress testing (crossover test, acromioclavicular joint compression) evaluates passive joint movement beyond the normal range of motion, and reports of pain during the exam makes the diagnosis rather straightforward [2] [3]. Additionally, the Bell-van Riet test, which examines the ability of the patient to maintain the arm in the adduced and elevated position against resistance, was shown to be highly sensitive in the setting of acromioclavicular joint involvement [6].
Treatment
Shoulder sprain rarely requires surgical treatment and symptomatic relief consisting of ice compression, non-steroidal anti-inflammatory drugs (NSAIDs) and the use of a sling for a period of one to three weeks is usually sufficient [1]. Once the pain subsides, exercises that strengthen the shoulder joint and improve the range of motion are detrimental in the rehabilitation process [1]. Some individuals may report clicking and pain when performing specific exercises (eg. push ups), which is why a carefully-designed recovery is imperative in restoring the complete function of the shoulder [1].
Prognosis
Shoulder sprains are considered to be a mild form of injury and the number of days lost to injury was around 10 days in isolated reports [5].
Etiology
Epidemiology
Due to the anatomical structure of the glenohumeral joint, it possesses an extended range of mobility compared to other joints in the body, but it is also more prone to injury, and sprains are particularly common in the athletic population [5]. Shoulder injuries appear at a rate of 9.2 per 1000 person-years, of which 89% were sprains and a significantly higher number of injuries were encountered among male athletes compared to female [5].
Pathophysiology
Direct blow to the shoulder joint seen in high-contact sports causes injury to the ligamental structures that provide stability, resulting in tears of acromioclavicular and/or coracoclavicular ligaments (sprains).
Prevention
Use of a protective foam under the athlete's shoulder pads as a mean of attenuating impact during contact has been recommended by certain authors [3], and a similar principle may be applied in American football and other contact sports.
Summary
Sprains are defined as ligamental tears and shoulder sprain is a term denoting tears in the ligaments that provide structural stability to the shoulder joint, most commonly the acromioclavicular and coracoclavicular ligaments [1] [2]. Direct hit on the acromioclavicular joint (ACJ) or a direct blow to the shoulder in contact sports such as ice hockey, rugby, and American football are the most important causes of shoulder sprains [3] [4], with significantly higher numbers observed in male athletes compared to female [5]. The clinical presentation varies on the presence of other accompanying injuries (clavicular or humeral fracture, glenohumeral dislocation, rotator cuff tears, etc) [1], but pain and tenderness of the acromioclavicular joint is characteristic for shoulder sprain, which is considered to be a milder form of shoulder injury if encountered as an isolated finding [2] [5]. The diagnosis is made by a careful physical examination that includes bedside stress testing, whereas positive history for recent trauma to the shoulder and imaging studies such as radiography are used for confirmation [2]. Treatment depends on the extent of the injury, but shoulder sprains are effectively managed by rest, ice compression, use of slings and proper rehabilitation [1] [2].
Patient Information
Shoulder injuries are common among athletes and a shoulder sprain is a term describing a tear of ligaments, the structures that provide stability to all joints in the body, including the shoulder. The cause of shoulder sprains stems from a direct blow to this part of the body, most commonly during high-contact sports such as ice hockey, rugby, or American football, while falling on the shoulder may also be a mode of injury. Pain and tenderness in the shoulder can be reported by athletes and the diagnosis is made by a thorough physical examination that evaluates the pain-free range of joint motion. Shoulder sprains are considered to be a milder form of injury, and symptomatic relief through the use of non-steroidal anti-inflammatory drugs, bed rest, and ice compression, coupled with restriction of movement for a short duration of time using a shoulder sling is sufficient. Proper rehabilitation is necessary, however, as incompletely healed injuries may cause chronic problems.
References
- Quillen DM, Wuchner M, Hatch RL. Acute shoulder injuries. Am Fam Physician. 2004;70(10):1947-1954.
- Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
- Wolfinger CR, Davenport TE. Physical Therapy Management of Ice Hockey Athletes: From the rink to the clinic and back. Int J Sports Phys Ther. 2016;11(3):482-495.
- Warth RJ, Martetschläger F, Gaskill TR, Millett PJ. Acromioclavicular joint separations. Curr Rev Musculoskelet Med. 2013;6(1):71-78.
- Pallis M, Cameron KL, Svoboda SJ, Owens BD. Epidemiology of acromioclavicular joint injury in young athletes. Am J Sports Med. 2012;40(9):2072-2077.
- Woodward TW, Best TM. Clinical evaluation of acromioclavicular joint pathology: sensitivity of a new test. J Shoulder Elbow Surg. 2011;20(1):73-76.