Shoulder Injury

BRACHIAL PLEXUS INJURY

A brachial plexus injury occurs when the nerves that send signals from your spine to your shoulder, arm, and hand are stretched or torn.  This typically happens when your shoulder is pressed down forcefully while your head is pushed in an upward direction away from the shoulder.  These injuries are common in contact sports, but can also result from falls, auto accidents, inflammation, and tumors.  Babies sometimes have this injury when they are born.  For less severe brachial plexus injuries, the body may repair itself, but for more severe injuries, surgical repair may be necessary.

Symptoms of Brachial Plexus Injury

Symptoms of brachial plexus injury vary greatly and depend on their severity and the location of the injury.  Usually only one arm is affected.  For less severe injuries, minor damage occurs during contact sports, like wrestling or football in which the brachial plexus nerves get stretched.  These injuries can cause numbness and weakness in your arm as well as a feeling like a burning sensation or electric shock shooting down your arm.  For more severe injuries, symptoms result from injuries in which a rupture or tear of the nerves occur.  The most serious of these injuries occur when the nerve root is torn away from the spinal cord.  Some symptoms of more serious injuries include severe pain, lack of movement and feeling in your arm, ability to use your arm and not your fingers, and the ability to use your fingers but with no control of your elbow muscles and shoulder.  This injury can cause disability or permanent weakness.  If you have recurrent stingers or burners, neck pain, weakness in your hand or arm or symptoms in both arms, you need to see a doctor. 

Causes of Brachial Plexus Injury

The nerves that construct the brachial plexus leave your spinal cord close to the point where your neck and shoulder join.  They pass behind the collarbone and divide and recombine while they travel down your arms until they reach the tips of your fingers.  The nerves that are higher in your neck serve your elbow and your shoulder, and the nerves that are located lower in your neck serve your hand and your forearm.  The damage to your upper nerves usually occurs when your shoulder is forced down, and this causes your neck to stretch up and away from the shoulder that has been injured.  The lower nerves have a greater chance of becoming injured when your arm is forced above your head.  This type of injury can occur in many ways. 

Athletes participating in contact sports, such as football may experience burners or stingers, which occur when the nerves of the brachial plexus are stretched beyond their limit when there is a collision with another player.  With difficult births, newborn babies can sustain brachial plexus injuries when there are problems during the birth, like a prolonged labor or breech presentation.  Sometimes an infant's shoulders will get wedged within the birth canal and so force may be used in order to pull the baby free.  This can also damage the nerves.  Commonly the upper nerves are injured, which is called Erb's palsy.  Total brachial plexus birth palsy will occur when the upper and lower nerves are both damaged.  Another cause may be trauma.  This happens in motorcycle, vehicular, and boating accidents that result in this type of injury.  Additionally knife, bullet, or animal bite wounds can damage the brachial plexus. 

Treatment of Brachial Plexus Injury

Stretched nerves have a good chance of recovering on their own, but at times the healing process will will form scar tissue that needs to be removed surgically in order to improve the function of the nerves.  Surgical repair is necessary when there is a good amount of surrounding scar tissue.  In many situations, the surgeon will take less important nerves from other locations of your body to restore the arm's function.  With a nerve graft, the damaged portion of the brachial plexus is removed and then replaced with portions of nerves that are cut from other parts of your body.  In a nerve transfer, a less important nerve that is still attached to the spinal cord can be hooked into the nerve that isn't attached any longer.  In many cases, the surgeons will be able to perform this technique at a level that is close to the targeted muscle in an attempt to speed up the recovery instead of doing a repair graft farther away from the muscle.  Nerve tissue does grow slowly, only about an inch a month, which means that it can take a few years to recover after surgery.  While recovering, you have to keep your joints flexible through exercises.  Additionally splints may be used in order to keep your hand from curling in an inward manner.  Surgery to repair brachial plexus nerves should occur within three to six months of the initial injury.  The rate of success does drop quickly if the surgery occurs more than a year after the injury.  If your muscles begin to deteriorate, the surgeon will be able to remove a less important tendon or muscle from another portion of your body and then transfer it to your arm.  The pain from the most severe forms of brachial plexus injuries has been described as a constant burning or crushing sensation.  A variety of medications may be used in order to handle the pain. 

Preventing Brachial Plexus Injuries

You cannot prevent the damage to the brachial plexus, but you can help reduce your risk of complications.  It is therefore important to have regular physical therapy for yourself or your child in order to prevent joint stiffness and to keep the muscles strong and healthy.

DISLOCATED SHOULDER

Your shoulders have your body's most mobile joints; however, the ability to move in a number of directions can leave your shoulders prone to different injuries.  A dislocated shoulder occurs when the upper arm bone pops out of the socket in a cup shape that is in part of your shoulder blade.  A dislocated shoulder involves damage to ligaments of the joint where the top of the shoulder blade will meet the end of the collarbone.  If you think you have a dislocated shoulder, seek medical attention right away.  Most people will be able to use their shoulder normally within a few weeks of experiencing the dislocated shoulder.  Once you have had a dislocated shoulder or joint, it may be prone to more dislocations in the future.

Symptoms of a Dislocated Shoulder

Some of the symptoms of a dislocated shoulder include intense pain in the shoulder area, an inability to move the joint, swelling, bruising, and discoloration, and a clearly out of place shoulder.  A dislocated shoulder can also cause weakness, numbness, and tingling near the site of the injury, such as down your arm or in your neck.  The muscles of the shoulder may also spasm due to the disruption, which will increase the intensity of the pain.  If a dislocated shoulder has occurred, medical attention is needed, but while you are waiting for the medical attention, do not move the joint and be sure to ice the injured joint. 

Causes of a Dislocated Shoulder

The shoulder joint is the most commonly dislocated joint in your body.  This joint is able to move in many different directions, completely, partially, backward, downward, and forward.  Also, the fibrous tissue that joins the bones of your shoulder are able to be torn or stretched, sometimes complicating the dislocation.  A sudden blow of your shoulder dislocates the shoulder, pulling the bones in your shoulder out of place.  The extreme rotation of your shoulder joint can pop the ball of your upper arm bone out of your shoulder socket which is a portion of your shoulder blade.  A partial dislocation can also occur in which your upper arm bone is partially in and out of your shoulder socket.  One possible cause of a dislocated shoulder is a fall.  You can dislocate your shoulder when you fall.  Additionally, trauma can occur related to sports, particularly in football, hockey, sports that involve contact and falls, like gymnastics, skiing, and volleyball.  It is also possible that the trauma could be unrelated to sports, such as during a motor vehicle accident. 

Most commonly, dislocated shoulders occur in people who are between the ages of 18 and 25 since these people usually have higher levels of physical activity.  Adults who are older also tend to be more susceptible to shoulder dislocation since their joints and surrounding ligaments are weaker.  Older people also tend to fall more often, which can increase their chances of having a dislocated shoulder.

Treatment of a Dislocated Shoulder

The treatment of a dislocated shoulder involves putting the shoulder bones back into their place.  Your doctor may use some gentle maneuvers, called closed reduction to help move the bones into the proper position.  This may require a muscle relaxant or sedative.  Once the shoulder bones are back in place, the severe pain will improve right away.  Your doctor may immobilize your shoulder using a special sling or splint for a few weeks.  How you wear the splint or sling will depend on the nature of the dislocation of the shoulder.  Your physician may prescribe a pain reliever or a muscle relaxant in order to keep you comfortable while your shoulder is healing. 

Once your sling or splint is removed, you will begin a rehabilitation program that is meant to restore your range of motion and strength to your shoulder joint.  You should try to avoid strenuous activity that involves your injured shoulder until you can regain full movement and normal strength as well as stability in your shoulder.  Trying to resume your physical activity too early can reinjure your shoulder.  Surgery may be needed if your dislocated shoulder is unable to be manipulated into the correct position.  In this case, surgical manipulation may be necessary.

In order to ease the discomfort you feel in your shoulder and to encourage your shoulder to heal, there are some home remedies you can try.  First, be sure to rest your shoulder and avoid painful movements.  You should certainly limit any heavy lifting or overhead activity until your shoulder is feeling better.  Second, it is important to apply heat and ice.   Applying ice to your shoulder will help reduce the pain and inflammation.  Using a cold pack for 15 to 20 minutes every couple of hours for the first day or two will help with the inflammation.  Using a heating pad may help to relax tight and sore muscles, but be sure to limit the application of heat to about 20 minutes at a time.  Pain relievers, such as ibuprofen, Aspirin, or Tylenol may help you with pain or inflammation.  You should not stop moving your shoulder altogether.  Gentle exercises, as directed by your doctor or physical therapist will help to maintain your shoulder's range of motion.  Stiff joints can be caused by total inactivity. 

Prevention of a Dislocated Shoulder

To prevent a dislocated shoulder, you should take precautions to avoid any falls, wear protective gear when you play contact sports, and exercise regularly in order to keep strength and flexibility. 

ROTATOR CUFF INJURY

Your rotator cuff consists of muscles and tendons in your shoulder.  These tendons and muscles connect your upper arm bone and your shoulder blade.  These muscles and tendons also help hold the ball of the upper arm bone in your shoulder socket.  A rotator cuff injury will include any type of damage or irritation to your rotator cuff tendons or muscles.  The causes of a rotator cuff injury may be lifting, repetitive arm activities, and falling.  Fortunately a rotator cuff injury will heal on its own with some self-care measures or some exercise therapy. 

Symptoms of Rotator Cuff Injury

Some of the symptoms of rotator cuff injury may include a loss of the ability to move your shoulder completely and wanting to keep it inactive, weakness in the shoulder, and pain and tenderness in your shoulder, particularly when you are reaching overhead, reaching behind your back, lifting, pulling, or even trying to sleep on the affected side.  The most common of symptoms is pain.  This pain may be felt when you try to move the shoulder into a new position, such as reaching up or back.  If your injury is severe, you may experience muscle weakness and continuous pain.  If you are feeling severe shoulder pain, especially pain that has lasted for more than a week or you are unable to use your arm, you need to see your doctor. 

Causes of Rotator Cuff Injury

Rotator cuff injuries are caused by an irritation or damage to your rotator cuff muscles or tendons.  One of those causes is tendinitis.  Tendinitis occurs when tendons in your rotator cuff become inflamed because of overload or overuse, particularly if you are an athlete who performs many overhead activities, such as racquetball or tennis.  Another cause is bursitis, which occurs when a fluid-filled sac that is between your shoulder joint and rotator cuff becomes irritated and inflamed.  When a strain or tear is left untreated, tendinitis can weaken a tendon, leading to chronic tendon degeneration or a tear in the tendon.  Additionally, stress from overuse of the tendon can cause it to tear.  At the age of forty, normal wear and tear can lead to a breakdown of collagen in the rotator cuff's muscles and tendons.  This can put them at higher risk of injury and degeneration.  Age can also cause calcium deposits to develop within the cuff or arthritic bone spurs that pinch or irritate your rotator cuff.  Poor posture, such as slouching your neck and shoulders forward can cause the space where the rotator cuff muscles are to become smaller.  This may cause a muscle or tendon to become pinched under your shoulder bones.  Falling can bruise or tear a rotator cuff tendon or muscle.  Lifting or pulling an object that is too heavy or lifting it improperly can cause a strain or tear to the muscle or tendon.  Finally, repetitive stress in which you have repetitive overhead movement of your arms can lead to inflammation and tearing.  This can occur with pitchers in baseball, tennis players, and swimmers, but also can occur in the carpentry and painting industry. 

There are several risk factors for developing rotator cuff injuries.  First, age is a factor as you get older they become more common, particularly in adults over 40 years old.  Being an athlete also increases your risk of having a rotator cuff injury.  Working in construction, such as in painting or carpentry can increase your risk.  Poor posture and having weak shoulder muscles also increases your risk of developing rotator cuff injuries. 

Treatment of Rotator Cuff Injuries

In most cases, rotator cuff injuries are resolved through exercise therapy.  This will help to heal your injury and improve the flexibility of your shoulder muscles and rotator cuff.  Physical therapy may take between three weeks and several months depending on how severe your injury is. 

Other treatments for your rotator cuff injury may include steroid injections, surgery, and arthroplasty.  Arthroplasy can include severe arthritis.  In this case, the doctor may recommend partial shoulder replacement or even total shoulder replacement.  If you have a large tear, it may be necessary for you to have surgery in order to repair the tear.  Sometimes this surgery may require a bone spur or calcium deposits to be removed.  Steroid injections may be necessary in order to relieve inflammation and pain due to the rotator cuff injury. 

There are also some treatments you may want to try at home.  First, it is important to rest your shoulder, so you should avoid the activities that cause pain to your shoulder.  Putting ice on your shoulder will help you to reduce any pain and inflammation you may be feeling.  This is recommended for 15 to 20 minutes at a time for every couple of hours for the first day or two.  After about two or three days and the pain and inflammation improving, hot packs or a heating pad may assist you with relaxing sore and tightened muscles.  You should only use these heat applications for about twenty minutes at a time.  Third, over the counter pain relievers that are anti-inflammatory may also help reduce your pain.  Keeping your muscles limber is also important.  A daily regiment of prescribed shoulder stretches and shoulder strengthening exercises may help prevent the injury from reoccurring.