What is a Throwing Injury?

Throwing injuries are common in athletes who participate in sports that often require repetitive overhead throwing. These include baseball, volleyball, tennis, and track and field.

Overhand throwing places a great amount of strain on the shoulder and elbow, leading to an acute or chronic injury or a progressive structural change.

Throwing Injuries in the Shoulder

The most common throwing injuries that affect the shoulder include superior labrum anterior to posterior (SLAP) tears, bicep tendinitis and tendon tears, rotator cuff tendinitis and tears, internal impingement, instability, glenohumeral internal rotation deficit, and scapular rotation dysfunction.

Throwing Injuries of the Elbow

Throwing injuries usually affect the inner part of the elbow. Some examples of these injuries include flexor tendonitis, ulnar collateral ligament injury, valgus extension overload, ulnar neuritis, and olecranon stress fracture.

Symptoms of a Throwing Injury

The symptoms of a throwing injury vary and depend on the affected site. But usually, people with a throwing injury, whether it affects the shoulder or the elbow, suffer from pain and weakness of the affected site. There may also be numbness or tingling sensation of the affected site and neighboring areas such as the forearm or hand.

Diagnosing a Throwing Injury

A throwing injury is diagnosed only after careful review of one’s medical history, thorough physical examination, and the result of imaging tests.

During the physical exam, the doctor will evaluate the affected site’s range of motion as well as its strength and stability. The affected area may be placed in different positions to determine if there is pain. In some cases, sensation and muscle strength will also be checked.

Depending on the results of the physical exam, the doctor may order additional tests to confirm the diagnosis. These may include x-rays, magnetic resonance imaging (MRI), computed tomography (CT) scan, and ultrasound.

How It Is Treated

Initially, a throwing injury is treated through nonsurgical methods.

Nonsurgical Treatment

Nonsurgical treatment options for throwing injury include activity modification, application of cold compress, anti-inflammatory medication, physical therapy, change of position, and cortisone injections.

Surgical Treatment

Surgery is only recommended if there is no relief from symptoms after trying the nonsurgical treatment.

The type of injury to be performed will depend on several factors such as the type of injury, area affected, and the patient’s age.

Arthroscopy is a common surgical option for throwing injuries. In this procedure, the surgeon makes a small incision on the patient’s skin and inserts pencil-sized special instruments to repair the damaged tissues. The arthroscope is attached to a miniature television camera to enable the surgeon to see the interior of the affected site.

What is Shoulder Sprain?

A shoulder sprain occurs when the shoulder ligaments are torn. Ligaments are the fibrous connective tissues that connect the four bones that are important to the shoulders function. These bones are the triangular shoulder blade, the bony knob at the top of the scapula, the collarbone (also known as the clavicle), and the breastbone (also known as the sternum).

Categories of Shoulder Sprain

Acromioclavicular Joint Sprain

Acromioclavicular joint sprain is the most common type of shoulder sprain. It occurs when the ligaments at the acromioclavicular joint are torn. It’s the joint between the acromion and the shoulder.

A direct blow to the front or top part of the shoulder can lead to this type of shoulder sprain. This can happen from a fall or from an injury sustained from sports training or event.

Sternoclavicular Joint Sprain

The sternoclavicular joint is the joint where the collarbone meets the breastbone. This joint is more tightly connected and hence, this type of sprain is rare.

A sternoclavicular joint sprain can occur when a person is crushed by an object. An example of this is a vehicular accident when the driver’s chest strikes the steering wheel so hard. It can also happen in sports like football and rugby where players experience a direct kick to the breastbone.

Symptoms of a Shoulder Sprain

The signs and symptoms of a shoulder sprain could vary, depending on the severity of the injury.

Pain is the most common symptom of a shoulder sprain. It’s felt when the arms are moved and when the shoulder is in contact with anything. There can also be slight swelling and tenderness at the outside tip of the collarbone, a popping sound when the shoulder is moved, and bruising on the surface of the skin.

In severe cases of a shoulder sprain, there can be a distortion of the normal contour of the joint and the affected area will be very tender.

Diagnosing a Shoulder Sprain

If a shoulder sprain is suspected, the doctor will thoroughly assess both shoulders and compare the affected site from the unaffected one. Aside from the physical appearance of the shoulders, the doctor will also test for the patient’s ability to move the shoulder and any pain the patient may be having.

Muscle strength, sensation, and pulses at the wrist and elbow will also be checked as important blood vessels and nerves pass through the shoulder area.

Additional tests may be ordered if the doctor suspects severe shoulder sprain. These tests may include X-rays, magnetic resonance imaging (MRI) scan, or computed tomography (CT) scan.

How It Is Treated

Treatment for shoulder sprain depends on the type of sprain and its severity.

For mild cases of acromioclavicular joint sprain (Grades I or II sprains), the affected site is treated with rest, ice compress, and nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen. The arm is also placed in a sling for one to three weeks. For severe cases of acromioclavicular joint sprain (Grade III), the arm is placed in a sling for four weeks. The patient may also be advised for surgery especially if the collarbone is displaced for more than 2 centimeters and if the person has a job that requires lifting.

For a sternoclavicular joint sprain, milder cases (Grade I) are treated with ice compress, nonsteroidal anti-inflammatory drug, and the arm is placed in a sling for one to two weeks. Arm sling will be worn for three to six weeks if it’s a Grade II sprain. For more severe sternoclavicular joint sprain (Grade III), a procedure called closed reduction will be advised.

What is Shoulder Separation?

Shoulder separation is not really an injury to the shoulder joint. It is a condition that involves the acromioclavicular joint (also known as the AC joint), the joint at the top of the shoulder.

In a mild case of shoulder separation, the ligaments are just stretched. But in severe ones, the ligaments are torn.

Causes

The most common cause of shoulder separation is a fall directly into the shoulder. This kind of fall injures the ligaments that surround and support the AC joint. If the force of the fall is severe, the ligaments could get torn, causing a separation of the collarbone and the shoulder blade.

Symptoms of Shoulder Separation

Pain is the most common symptom of shoulder separation. Aside from pain, there can also be swelling and bruises on top of the shoulder, tenderness or soreness felt at the site of the AC joint, and a lump pointing upward on top of the shoulder.

If there is nerve damage, there can be numbness or muscle weakness in the shoulder or affected arm. And in severe cases, there can be limited shoulder movement.

Diagnosing Shoulder Separation

The diagnosis for shoulder separation is only made after careful medical history taking and physical exam.

X-rays are usually ordered as part of the process. Sometimes, the doctor will ask the patient to hold a weight in the hand to help confirm the diagnosis.

How It Is Treated

Most people with shoulder separation experience a full recovery after conservative treatment. This may include over-the-counter pain medications, physical therapy, rest, and application of cold compress.

If pain persists or if there is severe separation or fracture of the collarbone, then surgery may be recommended. Surgery can help in stabilizing the injured bones and reconnect torn ligaments.

Rehabilitation is needed for those with shoulder separation, whether they heal through conservative methods or surgery. The rehabilitation can help in restoring and rebuilding strength, motion, and flexibility.

What is Rotator Cuff Tear?

A rotator cuff tear is a common injury especially in sports. It’s one of the most common causes of disability and pain among adults. In fact, in 2013, over 2 million adults in the United States sought medical help for their rotator cuff tear.

About the Rotator Cuff

The rotator cuff refers to the group of muscles and tendons surrounding the shoulder joint. It helps in keeping the head of the upper arm bone within the socket of the shoulder.

Common Causes

Rotator cuff injuries such as a tear usually happen as a result of repeated overhead motions. This is why it’s common in sports like baseball and tennis and in certain jobs like carpentry and painting.

Tear in the rotator cuff may also occur as a result of degenerative changes such as the wear and tear of tendons.

Symptoms of a Rotator Cuff Tear

The most common symptom of a torn rotator cuff is pain. Initially, it is just a mild discomfort only felt when lifting the arm over the head. Over time, the pain can become more noticeable even at rest.

Aside from pain, a person with torn rotator cuff may also complain of weakness in the shoulder, difficulty in raising the arm and in lifting objects, and hearing a popping sound when the arm is moved.

Diagnosing a Rotator Cuff Tear

A torn rotator cuff is only diagnosed after taking one’s medical history and a thorough physical examination.

During the physical exam, the doctor will check one’s range of motion and muscle strength. The patient will be asked to move his/her arm in different directions. This is a way for the doctor to see which movements are causing pain.

The doctor may require other tests to help him/her confirm the diagnosis. These tests may include X-rays, magnetic resonance imaging (MRI) scan, or ultrasound.

How It Is Treated

Most cases of torn rotator cuff can be managed through nonsurgical interventions such as rest, modification of activity, taking of nonsteroidal anti-inflammatory drugs (NSAIDs), steroid injections, and rest.

If the pain continues or worsens even with the nonsurgical intervention, then the doctor is most likely to recommend surgery. A common surgical intervention for a torn rotator cuff involves the re-attachment of the tendon to the head of the humerus.

What is a Frozen Shoulder?

A frozen shoulder is a common shoulder condition that causes the shoulder to stiffen, making it very hard to move. Also known as adhesive capsulitis, frozen shoulder affects about 2 percent of the general population. It commonly affects people between the ages 40 and 60 and occurs more in women than in men.

Causes

The exact cause of a frozen shoulder is not fully understood but it is thought to occur as a result of scar tissue that forms on the shoulder. This causes tightening and thickening of the shoulder joint’s capsule, leading to limitation in movement.

There are some factors that can put one at greater risk of having frozen shoulder. These include conditions like diabetes, cardiac disease, Parkinson’s disease, and thyroid problems (hypothyroidism and hyperthyroidism). Patients whose shoulder have been immobilized for a period of time are also at risk of developing frozen shoulder.

Symptoms of a Frozen Shoulder

Pain and stiffness are the common symptoms of frozen shoulder. The pain is usually dull or aching and usually felt in the shoulder muscles that wrap around the top of the arm. This can get worse with movement and at night, making it difficult to fall asleep.

Diagnosing a Frozen Shoulder

A thorough physical exam is needed to diagnose a frozen shoulder. During the physical exam, the doctor will move the shoulder carefully in all directions (passive range of motion). This is to see any limitation in movement and if there is pain with movement. The patient will be asked to move his/her shoulder on his/her own (active range of motion) to also determine the range of motion. Patients with a frozen shoulder will have limited range of motion both actively and passively.

Other tests may be ordered to rule out other possible causes of pain and stiffness. Some of these tests include X-rays, magnetic resonance imaging (MRI) scan, and ultrasound.

How It Is Treated

Majority of the cases of a frozen shoulder get resolved over time. Simple management techniques such as the use of nonsteroidal anti-inflammatory drugs (NSAIDs), steroid injections, and physical therapy are often enough to control the pain and restore motion.

Surgery is only recommended when there is no relief from medications and physical therapy. The purpose of the surgery is to release the stiffened shoulder joint capsule.

Some of the surgical options for a frozen shoulder include manipulation under anesthesia and arthroscopy.

Elbow dislocation is a common joint dislocation, second to the shoulder. It occurs when the bones of the forearm (also known as the radius and the ulna) move out of place compared with the bone of the upper arm (also known as the humerus).

An elbow dislocation can either be simple or complex. It is classified as a simple dislocation when there is no major bone injury. It is a complex dislocation when it involves severe bone and ligament injuries.

What causes elbow dislocation?

There are several things that can lead to elbow dislocation. The most common cause is a fall, with the arm all the way out. Traumatic injuries such as those sustained during a vehicular accident can also lead to elbow dislocation.

Signs and Symptoms of Elbow Dislocation

Severe pain in the elbow, swelling, and inability to bend the arm are the most common signs and symptoms of a dislocated elbow. In some cases, it can also lead to loss of pulse and sensation in the arms.

When arteries or nerves are damaged, there can be an abnormal sensation or lost of normal hand function below the dislocated elbow.

When To See A Doctor

When you had an injury and suspect that you have dislocated your elbow, then you must see your doctor immediately.

The doctor will perform a thorough physical exam to confirm the diagnosis. Part of the physical examination is checking your pulse and hand mobility. On top of this, the doctor may order an X-ray to see possible breaks in the bone. If the doctor suspects that the injury had caused damage to the artery, he/she may recommend further tests such as arteriogram, a form of X-ray for your artery.

Managing Elbow Dislocation

Nonsurgical Treatment

The normal alignment of the elbow is usually restored through a procedure called closed reduction. In this process, the doctor puts the elbow back into its place by pulling down on the wrist. It’s a painful procedure and thus, requires pain medication or sedatives before it is done.

After closed reduction, the elbow is placed in a splint and sling to keep the arm at the elbow from moving. It is placed at a 90-degree angle for 2 to 3 weeks. Physical therapy is usually recommended to help you gain back your elbow’s full range of motion.

X-rays may be taken periodically during the recovery period to ensure that the bones of the elbow joint are well aligned.

Surgical Treatment

Closed reduction is only done for simple stable elbow dislocation. For complex elbow dislocation, surgery may be needed to restore the bone alignment.

Open reduction internal fixation (ORIF) is a type of medical procedure that can be done for complex elbow dislocation. Performed under general anesthesia, ORIF involves an incision at the site of injury. The bones are carefully re-aligned before internal fixation devices such as rods, pins, screws, or plates are placed to hold them together.

This surgical treatment can take hours, depending on the severity of the dislocation. Physical therapy is usually recommended to help you move during your recovery.

As the body’s most mobile joint, the shoulder joint can be turned in different directions. However, it’s also its mobility that makes it more susceptible to injuries like dislocation.

What is Dislocated Shoulder?

A dislocated shoulder is a form of injury wherein the upper arm bone pops out of the socket. It can either be a partial dislocation wherein the head of the upper arm bone is partially out of the socket or a complete dislocation wherein it’s totally out of the socket.

Common Causes of Dislocated Shoulder

A strong force or blow on the shoulder is enough to pull the bones out of place. Injuries from contact sports like football and hockey, falls, and a hard blow or trauma on the shoulder during a vehicular accident are the most common causes of a dislocated shoulder.

While anyone can have a dislocated shoulder, this injury is more common in physically active males in their teens and 20s and elderly patients. Due to age-related changes in the body specifically with the breakdown of collagen fibers, a small amount of trauma such as a fall on an outstretched hand can easily dislocate the shoulder of an elderly.

The Signs and Symptoms

The most common signs and symptoms of dislocated shoulder include pain in the shoulder and upper arms, deformation of the shoulder, numbness, weakness, and bruising.

Diagnosing and Treating Dislocated Shoulder

When a shoulder injury occurs and there’s a possibility of dislocation, one should seek medical attention immediately.  If a dislocated shoulder is left untreated, it can lead tearing of the muscles, ligaments, and tendons and damage on the nerves and blood vessels which may require surgery.

To diagnose a dislocated shoulder, an orthopaedic doctor has to do a health history check and careful physical examination of the affected site.

Aside from health history check and physical assessment, the doctor may also order an X-ray. This is to confirm the diagnosis of shoulder dislocation and to make sure that there are no broken bones associated with the shoulder injury.

There are several techniques used for managing a dislocated shoulder; one of which is called closed reduction. In this method, the doctor will place the ball of the upper arm bone into the socket joint. One’s the shoulder is back in place, the patient will be sent home in a sling to immobilize the affected site. The doctor may prescribe pain medications to help in controlling the pain.

Depending on the severity of the dislocation, a patient may be recommended for physical therapy once the swelling and pain subsides. During rehabilitation, a patient will be working with a physical therapist. He/she will be assisted in different forms of passive exercises to strengthen the shoulder muscles and restore the shoulder mobility.

What is a Clavicle Fracture?

A clavicle fracture (also known as a broken collarbone) is a common shoulder injury. It accounts for about 5 to 10 percent of fractures in adults. It can be very painful and can make it difficult for a person to move his/her hand.

Most cases of clavicle fracture occur in the middle portion of the bone. A fall on an outstretched arm or unto the shoulder is a common cause of a broken collarbone. Depending on how the injury is sustained, the bones may either crack slightly or break into many pieces.

Symptoms of a Clavicle Fracture

A broken collarbone can be easily detected. Pain is the most common symptom of clavicle fracture. It can be accompanied by swelling, difficulty in moving the shoulder and the arm, a grinding sensation when the arm is raised, a bump or deformity around the area of the break, sagging in the shoulder, and tenderness and/or bruising over the collarbone.

Diagnosing a Clavicle Fracture

A clavicle fracture is diagnosed after a review of one’s medical history, a thorough physical exam, and through imaging studies.

During the physical exam, the doctor will carefully examine the shoulder. When there is a break, there’s usually an obvious bump or deformity on the affected site. In some cases, it can cause “tenting” of the skin over the fractured site.

X-rays are often ordered to confirm the diagnosis and determine the location and severity of the fracture.

How It Is Treated

The treatment plan for clavicle fracture will depend on the severity of the patient’s condition. If the broken bones have not shifted significantly out of place, then conservative management is advised. These include the use of arm sling for immobilization, pain relievers such as ibuprofen, and physical therapy to maintain arm motion. In many cases, broken collarbones heal even without surgery. One would need to see the doctor regularly until the fracture heals.

Surgery is recommended if one has broken bones that significantly shifted out of place. Open reduction and internal fixation is the most common procedure used for a clavicle fracture. In this procedure, the bone fragments are first repositioned into their normal alignment before being held in place using special metal hardware.

What is Chronic Shoulder Instability?

The shoulder is the most mobile joint of the body. Instability to this joint can happen when the head of the upper arm bone is forced out of the shoulder socket.

Frequent shoulder dislocation is the most common cause of shoulder instability. However, it can also happen as a result of sudden injury or overuse. People who are into sports like swimming, tennis, and volleyball are vulnerable to this kind of injury. The repeated overhead motion can eventually weaken the shoulder ligaments, leading to instability. Certain jobs like painting can also make people more prone to having shoulder instability.

Symptoms of Chronic Shoulder Instability

Pain is the most common symptom of chronic shoulder instability. People with shoulder instability may also feel a persistent sensation of their shoulders feeling loose, slipping in and out of the joint, or just hanging there.

Diagnosing Chronic Shoulder Instability

Like most shoulder injuries, chronic shoulder instability is only diagnosed after taking the medical history and a thorough physical exam.

During the physical exam, the doctor will assess the shoulder and may do some tests to determine the looseness of the ligaments.

Aside from the physical exam, imaging tests like X-rays and magnetic resonance imaging (MRI) scan may be ordered to help confirm the diagnosis.

How It Is Treated

Nonsurgical intervention is the initial approach to chronic shoulder instability. This treatment plan includes activity modification, taking of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin for pain, and physical therapy to strengthen the shoulder muscles.

In many cases, surgery is recommended to repair the torn or stretched ligaments so they can better hold the shoulder joint.

Arthroscopy is one of the surgical options for chronic shoulder instability. In this procedure, the surgeon uses a tiny camera to help him/her perform the surgery using pencil-thin instruments. It’s a minimally-invasive procedure that can be done on an outpatient basis.

What is arthritis of the shoulder?

Shoulder arthritis is a debilitating condition, making it difficult to do activities like throwing a ball or lifting an object from a high cupboard.

Types of Arthritis that Affect the Shoulders

There are five different types of arthritis that can affect the shoulder. These are osteoarthritis, rheumatoid arthritis, posttraumatic arthritis, rotator cuff tear arthropathy, and avascular necrosis.

Osteoarthritis

Osteoarthritis (also known as the degenerative joint disease) is a condition that occurs when the cartilage, the whitish, flexible connective tissue that covers the bones degenerates or wears down. It can cause pain, swelling, and at times, may lead to the development of osteophytes.

Rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory condition that can affect more than just the joints of the body. It can result in painful swelling of the joints that can eventually lead to bone erosion and joint deformity.

Post-traumatic arthritis

Post-traumatic arthritis results from a wearing of a joint that has sustained any type of physical injury. It can be from fall, vehicular accident, sports-related, or any form of physical trauma.

Rotator cuff tear arthropathy

This is a form of arthritis that develops after a long-standing rotator cuff tendon tear. The torn rotator cuff can lead to damage in the surfaces of the bone, which can cause arthritis to develop.

Avascular necrosis

Avascular necrosis refers to the death of the bone tissue as a result of the lack of blood supply. Since bone cells die without a blood supply, avascular necrosis can eventually lead to the destruction of the shoulder joint and arthritis.

Symptoms of Arthritis of the Shoulder

Pain is the most common symptoms of shoulder arthritis. It worsens with activities especially those that require the arms to reach over the head.

Aside from the pain, those with shoulder arthritis also complain of loss of motion and crepitus, the grinding sound when bones rub one another.

Diagnosing Arthritis of the Shoulder

Arthritis of the shoulder is diagnosed after discussing the symptoms and medical history with the doctor. The doctor will also have to do a thorough physical exam. During this examination, the doctor will look for any signs of injury, areas where it is tender to touch, weakness of the muscles, crepitus, and the quality and severity of pain when pressure is applied on the joint.

Additional tests may be ordered to confirm the diagnosis. These include X-rays, blood tests, and magnetic resonance imaging (MRI) scans.

How It Is Treated

Initially, the doctor will recommend nonsurgical methods for alleviating the pain and other symptoms. These nonsurgical interventions may include rest, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, use of heat/cold compress, and if the underlying cause is rheumatoid arthritis, the doctor may prescribe a disease-modifying drug.

Surgery is only recommended when there is no relief from pain and other symptoms with the nonsurgical methods.

Arthroscopy is the suggested procedure for those with mild cases of shoulder arthritis. And for severe ones, it is shoulder joint replacement.