Shoulder trauma – injury to the shoulder – is generally one or a combination of the following:
- Dislocation – there are three joints in the shoulder, although the most common dislocation is of the main glenohumeral joint where the ball of the humerus bone in the upper arm comes out of its socket in the shoulder.
- Fracture – broken bone/s in the shoulder joint.
- Soft tissue injury – where other components of the shoulder e.g. muscles, ligaments, tendons, or cartilage are damaged.
Most shoulder injuries are sustained either while playing sport or in some form of accident such as a vehicle accident, a fall from a height on to the shoulder, an electric shock or while having a seizure.
High risk sports for shoulder trauma include rugby / football, hockey and skiing. In older people with osteoporosis the likelihood of bone fracture from less high energy impacts is increased, and often a simple fall from a standing position can be enough.
The most common fracture points in people with osteoporosis are around the humeral head (the ball joint at the end of the bone in the upper arm). Stress fractures can also be caused by overuse of the shoulder over long periods of time, either in a sport or work setting.
The primary symptom of shoulder trauma is pain, generally accompanied by bruising, swelling and an inability to move the affected arm. In many cases there is a noticeable deformity of the shoulder and there can also be a grinding sound from inside the joint when moving the arm or shoulder (this is common when the collarbone i.e. clavicle has fractured).
Where the shoulder blade (scapula) has fractured, in addition to the symptoms above, there may also be a popping or cracking sound known as 'crepitus'.
Tests / Diagnosis
Most cases of trauma require immediate medical attention at the emergency department of a hospital. A physical examination is in most cases followed by x-rays to determine the extent of any injury. Additional scans such as a CT scan and/or MRI scan may be necessary to view the fracture in greater detail (CT scan) or review any damage to soft tissue (MRI scan).
Many dislocations and simple fractures can often be treated without surgery – dislocations can be relocated back into the socket and fractures that are aligned may simply need immobilisation in a brace or sling. More complex fractures where the bones are misaligned or the bone has broken into several fragments invariably require surgery. 'Open' fractures where broken bones have come through the skin require urgent medical treatment.