Shoulder Injuries

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Acromio-Clavicular Joint Separation

Hairline Fractures in Clavicle, Ruptured AC Ligaments, Torn Pectoralis Major.

Causes: This type of injury is generally caused by contact sports like Rugby and American Football, where one player collides with another and is made worse if the ground is hard.

Symptoms: Pain on the collar bone and swelling. There may be bruising. A bony protrusion may be seen or felt.

Treatment: Go to hospital for X-Ray, immobilise bone. Pain relief may be prescribed by doctor. An operation may be necessary depending on the type of fracture. The bone must be held immobile for four to eight weeks depending on severity. After this period a physiotherapist or sports massage therapist can help with rehabilitation exercises and massage.

What Client can do: Consult a sports injury expert. Practice exercises to maintain range of movement. Maintain forearm & grip strength with hand therapy exercises. Use resistance bands for shoulder strengthening exercises. Wear a shoulder support for reassurance.

Acromio-clavicular Joint Separation is one of the most common shoulder injuries seen (usually from a sporting accident). It is particularly common in cycling, snowboarding, skiing, or football. The injury results from a fall onto the point of the shoulder and can be mild, moderate or severe.

In a mild or moderate separation, the ligaments involved are stretched. In a severe injury, the ligaments that hold down the collar bone or clavicle are ruptured and the end of the collar bone appears very prominent.


In the severe injury (called a Grade 3 injury) both the Coraco Clavicular ligaments and the Acromioclavicular capsule are torn (This leads to the deformity or bump on top of the shoulder). Unfortunately these ligaments never completely heal. The severity of the injury is determined from the clinical examination and xrays (which may need to be done with you holding a weight).

A mild or moderate separation (grade 1 or grade 2) can be successfully treated in a sling for a few weeks followed by a course of physiotherapy and gradual mobilisation. Most people do well without surgery.

The severe injury ( Grade 3) can be treated either non-operatively or operatively.

Non-operative treatment involves immobilisation in a sling for two to three weeks followed by a course of physiotherapy. The bump on top of the shoulder always remains prominent and occasionally arthritis of the acromioclavicular joint develops some years after the injury. The latter can be addressed at a later time with a small operation. The injury can be associated with ongoing pain in a small number of cases and also may lead to some permanent weakness in those persons who do heavy overhead work or do a lot of throwing.

Surgery involves a small incision over the top of the shoulder. The end of the collar bone is cut out because it is always damaged and the torn Coraco Clavicular ligament is replaced by an artificial ligament (made out of a strong synthetic material called Dacron or by using a tendon from another part of the body).
 
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