Understanding Various Shoulder Injuries

October 19, 2011
Posted in Alberta Edition, Development

By Dr. Phil Conway /

Shoulder injuries are very common in hockey and are often the result of an awkward check, collision, fall or unexpected, unusual movement. This can result in ligaments and/or the muscles that connect the collar bone, the shoulder blade, the shoulder joint and surrounding area being stretched, sprained and torn or the shoulder joint being dislocated.

The immediate concern of a shoulder injury is to determine the extent of the injury and any loss of function that may have occurred. Injuries where the shoulder joint remains intact and the ligaments and muscles are either stretched or torn, is known as a sprained shoulder and/or separated shoulder, and may or may not require a trip to the emergency room. When the upper arm bone (humerus) of the shoulder joint has popped out of its socket, it is known as a dislocated shoulder. This requires a trip to the local emergency room to put the humerus back into the joint socket.

Signs and Symptoms

Symptoms of a shoulder injury may include:

• Shoulder pain, bruising and/or swelling
• Restricted or loss of joint movement
• A feeling of popping or tearing inside the joint
• Extremely tender to touch
• Weakness in the shoulder and arm
• A deformed shoulder or a bump on top of the shoulder

Injury Classification

Depending on the complexity of the shoulder injury, classification can range from mild to severe and include varying degrees of separation or dislocation. These range from a partial separation (Grade I) to a complete separation (Grade III) or partial dislocation to a full dislocation. Each region of the shoulder also has an injury classification based on the anatomy of that area of the shoulder. For example, you could have a Grade I AC (Acromioclavicular) Joint Separation or a Glenohumeral Dislocation. Classification of the injury will dictate how the rehabilitation plan is developed.

Treatment

Having a qualified health care provider who is well versed in shoulder injury treatment and rehabilitation determine the extent of the injury as soon as possible is imperative. Once the extent of the injury has been assessed, initial treatment can begin and may consist of:

Stopping the activity that caused the injury

The use of a sling in order to rest and take the pressure off of the shoulder

Icing for 15 minutes every hour over a wet towel to reduce pain and swelling

Soft tissue therapy such as active release, Graston, laser therapy, kinesiological taping, ultrasound, acupuncture and muscle stimulation

After 48 hours, depending upon the severity of the injury gentle range of motion exercises may begin

Rehabilitation  

Having a proper shoulder rehabilitation plan can make the difference between a quick return to hockey or an ongoing injury resulting in a frustrating season. Make sure your plan consists of:

Basic Rehabilitation

Basic rehabilitation starts from the 48-hour mark after the injury. The goal of Basic Rehabilitation is to gently re-establish range of motion and further reduce swelling and inflammation. Basic Rehabilitation consists mostly of gentle range of motion exercise and soft tissue therapy.

Advanced Rehabilitation

This phase consists of advanced stretching, strengthening, soft tissue therapy and the re-introduction of complex active movement patterns.

Prevention

As always, prevention is a key aspect of reducing shoulder injuries. Ensuring a proper warm up before you play or practice. Establish a pre-season and season long shoulder strengthening and range of motion program.

Dr. Phil Conway BPE DC FCCRS(C) is a Board Certified Rehabilitation Specialist. He is the Director of the Calgary Hockey Injuries Clinic, The Back and Sports Injury Clinic, and the Calgary Runner’s Clinic. Visit our Website: www.hockeyinjuriesclinic.com

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