Shoulder Injury – Shoulder Tears

What Is A Shoulder Tear?

Shoulder tears are a common accident related injury. There are many soft tissue structures within the shoulder that can be damaged as a result of the forces associated with an accident. Some of the more common soft tissue injuries to the shoulder include labrum tears, SLAP tears, rotator cuff tears as well as a condition known as frozen shoulder. Each of these tears is different but can be equally disabling.

What Is A Labrum Tear?

A labrum tear involves a tear of the glenoid labrum which is necessary to keep the scapula and humerus in proper placement. It most often is associated with shoulder dislocation. This tear compromises the integrity of the glenohumeral joint, and impairs the use of the attached biceps muscle. There are several types of labrum tears.

Avulsion labrum tears occur when the labrum is torn away from the edge of the glenoid fossa, or the socket of the shoulder joint. This occurs when the head of the humerus partially or completely dislocates out of the fossa. Anterior tears are more common, and most often associated with rotator cuff injuries. The shoulder may feel stiff, painful, and unstable with this type of tear.

A physical examination may elicit laxity of the shoulder. While a dislocation is detected on an x-ray, the labrum is better visualized by MRI. Depending on the severity, these tears may heal after four to six weeks of physical therapy. If the affected shoulder repeatedly dislocates, however surgical stabilization may be necessary.

What Is A SLAP Tear – Shoulder Injury ?

A tear of the superior labrum anterior posterior, or SLAP tear as it is commonly known, involves tearing of the portion of the labrum that is attached to a biceps tendon. It can be sustained during a forceful impact, like a fall onto an outstretched arm. Partial SLAP tears are associated with pain and reduced shoulder mobility. Complete tears, however, cause a loss of biceps muscle function.

This loss becomes evident in the inability to lift, carry, and do other daily activities. An MRI may be used to determine whether or not a SLAP tear is present, but 20% of them may be missed. A special type of CT scan during which dye is injected into the joint can help make the diagnosis. Arthroscopic surgery is usually recommended to re-attach the labrum and biceps tendon.

Shoulder Injury – Rotator Cuff Tears & Treatment

Rotator cuff tears can involve one or more of the four supportive muscles of the shoulder. Jobs that require repetitive lifting or moving a raised arm are associated with this type of injury. The risk of such a tear is greater over the age of 60, and can result from a fairly minor injury. High impact trauma, however is more likely to cause full thickness tears, and to affect more than one muscle.

In theses cases, shoulder fractures or dislocations are often associated. Full thickness tears account for up to 40% of cases. The classic symptom of a rotator cuff tear is pain while lifting or raising the arm. This pain extends from the outer shoulder area to the elbow. Shoulder pain that interrupts sleep is also common.

Physical therapy helps to improve the function of the injured shoulder, and a treatment course of three to six months is typically recommended. If the pain is unresponsive to oral and topical medications, temporary relief may be provided by a steroid injection. Caution must be exercised, however, because repeated injections can weaken the rotator cuff tendons, and increase the risk of poor healing.

For full thickness or multiple rotator cuff tears, surgery is often necessary, usually by an orthopedist. Many cases are done arthroscopically. This involves making a few small incisions through which surgical instruments are inserted into the shoulder. A camera assists with the visualization and repair of the injury. When multiple injuries are present, including fractures, an open surgical procedure may be the best option. Severely damaged tendons may require a grafted tendon from another body location

Frozen Shoulder Stages

The term “frozen” shoulder refers to a decrease in mobility and range of motion of the shoulder joint. It is caused by a thickening and tightening of the bursa that surrounds the joint. Although the exact etiology is unknown, it can occur after periods of immobility, following shoulder surgery, or as a complication of rotator cuff tears or shoulder fractures.

It is most often seen in patients over the age of 40, and especially in women. Certain chronic diseases may cause “frozen shoulder” such as diabetes mellitus, thyroid disorders, and cancer. Acute onset of pain is the first sign, followed by a progressive inability to rotate or lift the arm away from the body. This makes performing daily activities very difficult. Diagnosis is primarily made by a physical exam, and imagining studies are helpful to rule out other causes. However, there is no specific test that can identify this condition.

The treatment plan for a frozen shoulder Injury is based on a three-tiered classification system:

Stage I or Freezing

This is the most acute phase of the illness, and pain is the primary symptom. It is most severe during sleep periods. This phase may last from two to nine months during which the range of shoulder motion gradually worsens.

Pain management is essential during this period as it can influence compliance with physical therapy. In most cases, the pain responds to over-the-counter medications, but opioids and steroid injections may be prescribed for severe symptoms. Cryotherapy, ultrasound, and transcutaneous electrical nerve stimulation (TENS) are additional therapeutic modalities.

Stage II Frozen

Shoulder immobility is the hallmark of this phase. It may last from four to 12 months. Because the pain is minimal, more intensive physical therapy is used to improve shoulder mobility. If, after six months, there is little change, other procedures are considered. These may include stretching the bursa with a transcutaneous saline injection, or manipulation of the bursa under general anesthesia. Surgery is rarely necessary, but may be considered for refractory cases.

State III or Thawing

This is considered a recovery phase, and mobility gradually improves over the course of one to four years. By this time, any necessary procedures have been performed to promote the best out outcome. Continued physical therapy is essential to recovery.