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Shoulder Sprain

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.

Camping
  • Bart may be the story of camp, although he is destined to begin his season with High-A San Jose.[nbcsports.com]
  • Given how good he has looked so far in camp, it is likely that the Colts will be overly cautious with him, which means that the remaining receivers will get more opportunities to show their abilities with the 1s.[stampedeblue.com]
  • Tuel was with the team in training camp. Chad Henne will handle the first-team reps until Bortles is cleared.[jacksonville.com]
Chills
  • When to seek medical advice Call your healthcare provider right away if any of these occur: Shoulder pain or swelling in your arm that gets worse Fingers become cold, blue, numb, or tingly Large amount of bruising of the shoulder or upper arm Fever or chills[fairview.org]
Sighing
  • The Hawks organization and fan base can breathe a sigh of relief. The shoulder injury to Paul Millsap is not serious and the All-Star forward will not miss significant time.[ajc.com]
Insect Bite
  • bite or sting, venomous ( T63.4 ) Injuries to the shoulder and upper arm S43 ICD-10-CM Diagnosis Code S43 Dislocation and sprain of joints and ligaments of shoulder girdle 2016 2017 2018 2019 Non-Billable/Non-Specific Code Code Also any associated open[icd10data.com]
Shoulder Pain
  • AC Joint Sprain Symptoms The most common symptom of an AC joint sprain is a sudden onset of shoulder pain located at the top of the shoulder joint.[drjeffpadaleckimd.com]
  • When to seek medical advice Call your healthcare provider right away if any of these occur: Shoulder pain or swelling in your arm that gets worse Fingers become cold, blue, numb, or tingly Large amount of bruising of the shoulder or upper arm Fever or[fairview.org]
  • Commonly known as a separated shoulder, this injury usually occurs when an athlete falls on the tip of the shoulder. Pain is localized to this area and shoulder motion is painful.[web.eccrsd.us]
  • Symptoms include sudden shoulder pain and a feeling that something has torn. Pain may also radiate down into the arm. Rotator cuff strains can range from mild to very severe.[sportsinjuryclinic.net]
Frozen 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. Redness. Bruising.[niams.nih.gov]
  • shoulder and bicipital tendinitis.[dynamicchiropractic.com]
  • I now have a Frozen Shoulder. He said it could take up to a year to have full motion again. The morale? Appreciate and use what you have (I've still already won a singles tournament since coming back.)[tt.tennis-warehouse.com]
  • Frozen Shoulder Adhesive capsulitis, or frozen shoulder, results from thickening and contraction of the capsule around the glenohumeral joint and causes loss of motion and pain.[aafp.org]
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]
  • It can also cause pain and stiffness in your shoulders. Referred pain. Sometimes your shoulders hurt when there’s nothing wrong with them. This can be a sign of trouble with your gallbladder, liver or another organ. Heart attack.[webmd.com]
Musculoskeletal Pain
  • Topical NSAIDs for acute musculoskeletal pain in adults. Cochrane Database Syst Rev.2015;(6):CD007402. Shoulder problems. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: ...[health.cvs.com]
  • Topical NSAIDs for acute musculoskeletal pain in adults. Cochrane Database Syst Rev.2015;(6):CD007402. Shoulder problems. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: . Updated April 2014.[winchesterhospital.org]
Impulsivity
  • When a person falls on the shoulder the impulse pushes the tip of the shoulder down and in the process ligaments get affected. Direct impulse on the shoulder in all these events may injure your Acromioclavicular joint during collision.[paincare.org]
Poor Coordination
  • coordination Poor balance Lack of flexibility and strength in muscles and ligaments Loose joints or connective tissue problems Having this problem may cause: Pain and swelling around the shoulder Redness, warmth, or bruising around the shoulder Problems[health.cvs.com]
  • coordination Poor balance Lack of flexibility and strength in muscles and ligaments Loose joints or connective tissue problems Symptoms Having this problem may cause: Pain and swelling around the shoulder Redness, warmth, or bruising around the shoulder[winchesterhospital.org]

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].

Staphylococcus Aureus
  • NF caused by Staphylococcus aureus as a single pathogen, however, is rare.[ncbi.nlm.nih.gov]

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

Tears of the acromioclavicular and coracoclavicular ligaments are most commonly caused by direct trauma during contact sports - rugby, ice hockey and American football [1] [2], while falling on the acromioclavicular joint may also cause shoulder sprain [3] [4].

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].

Sex distribution
Age distribution

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

Article

  1. Quillen DM, Wuchner M, Hatch RL. Acute shoulder injuries. Am Fam Physician. 2004;70(10):1947-1954.
  2. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  3. 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.
  4. Warth RJ, Martetschläger F, Gaskill TR, Millett PJ. Acromioclavicular joint separations. Curr Rev Musculoskelet Med. 2013;6(1):71-78.
  5. 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.
  6. Woodward TW, Best TM. Clinical evaluation of acromioclavicular joint pathology: sensitivity of a new test. J Shoulder Elbow Surg. 2011;20(1):73-76.

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Last updated: 2019-06-28 12:12