Sports Injuries of the Shoulder

Shoulder injuries are common in sports that involve the use of shoulder, repetitive throwing and overhead movements (tennis, swimming, volleyball etc).

Mostly the shoulder comes out in the front, and this is called anterior dislocation. Posterior dislocation is when the shoulder comes out in the back, but this is quite rare. In some cases, the shoulder does not come out of the joint completely, and this partial dislocation is called subluxation.

Most of the time, the cause of injury is

• Improper Exercise - This leads to tightness of the back portion of the shoulder joint, which leads to many problems like SLAP lesions, rotator cuff injury. A typical feature of SLAP tear is the "Dead arm syndrome", in which the patient feels sudden pain, following which he is unable to throw or play with previous force and velocity. A neglected SLAP lesion can lead to leak of shoulder joint fluid into the tissue and result in cyst formation. The cyst can compress the surrounding nerves to produce pain and weakness.
• Repeated Overhead Movements, Particularly in volleyball, stretches a nerve called suprascapular nerve, which leads to weakness and wasting of a muscle over the shoulder. Repeated use of the shoulder results in muscle fatigue of the shoulder muscles. The fatigued muscles cannot support the shoulder properly and thus lead to drooping of the shoulder (Tired shoulder / SICK shoulder). The drooped position places the shoulder in a precarious position, which can lead to shoulder pain.

Treatment: Firstly, attention is given to physiotherapy and exercise. The aim in treatment is to restore the muscle balance and full range of motion. However, in patients who have already developed labral tears, arthroscopic surgery is the only choice. Neglecting these injuries not only leads to complications but also to poor performance.

Specialist Doctors

Dr. David V Rajan MS Orth MNMS
Sports Injuries, Arthroscopy, Knee & Shoulder Surgery

Dr. KARTHIK M. SELVARAJ
MS Ortho (AIIMS)., DNB (MRCS).,
FAOA (NZ & AUS).,
Shoulder & Elbow Surgery, Joint Replacement, Sports Medicine

Dr. M. SHYAM SUNDAR
MS Ortho., FIA (India)., FASM (India)., FSSM (South Korea).,
FAOA (Australia)., PGR (USA).,
Shoulder & Elbow Surgery, Joint Replacement, Sports Medicine

The Department of Orthopaedic Surgery has been providing highly specialized services to patients with various orthopaedic problems. The Shoulder Clinic aims to give one stop carte for all related problems. Most shoulder problems do not require surgery. They can be treated with simple medications, properly directed exercise and physical therapy program and modification in day to day activities. However, our specialists are highly skilled in the latest techniques of arthroscopic surgery, joint replacement surgery and fracture fixation. They are all well supported by an excellent team of well trained physiotherapists. The services provided in this clinic are:

• Comprehensive shoulder evaluation
• Physiotherapy and evaluation
• Key hole surgery (arthroscopy) to treat dislocations
• Treatment for rotator cuff problems
• Total and partial shoulder replacements
• Treatment for shoulder problems in athletes and sports person
• Fractures and complications of fracture care.

When should you approach?

• Fallen down and sustained a fracture
• Repeated shoulder dislocation
• Pain in the shoulder while exercising
• Pain in the shoulder after exercising
• Hear noises while moving the shoulder
• Pain while raising arms
• Pain when touching the opposite shoulder
• Difficulty sleeping due to shoulder pain
• Pain while doing all shoulder related activities
• Having slipped, unable to raise the arm
• Stiff shoulder

What is shoulder instability?

The ball and socket shoulder joint is a versatile joint and is held together by ligaments and muscles. When these structures are torn or stretched, the shoulder becomes unstable. The most common cause of instability is trauma, which may be sports related, motor vehicle accident or simple household trauma like tripping and falling. However, there are many, who are born with loose ligaments and therefore are prone for instability of the joint. The shoulder may completely dislocate or may partly come out and go in. The typical symptom of instability is a feeling of apprehension or fear when using the arm for overhead activities. Majority of patients are treated with a regimen to strengthen the muscle around the shoulder. Those who have persistent symptoms and those having repeated dislocations are treated with artroscopic stabilizing surgeries.

What is rotator cuff tendonitis?

Inflammation of the tendons around the shoulder and or inflammation of the lubricating mechanism around the shoulder (bursitis) are generally referred to as rotator cuff problems. Prolonged inflammation of the tendons can lead to attenuation and rupture of the tendons. The condition is associated with repetitive activities like throwing, over-head sporting activities and many other domestic activities. The typical symptom is a constant ache radiating down the outer aspect of shoulder and below. It may get worse on lying on the affected shoulder. If conservative treatment like simple anti inflammatory medications, physical therapy and local injections fail, arthroscopic decompression reduces pain and improves the range of movement. This procedure is done through two small 1cm incisions and is followed by post operative physiotherapy.

When is shoulder joint replacement done?

When arthritis which may be, wear and tear arthritis or rheumatoid arthritis destroys the shoulder joint, the joint becomes very painful and the movements are grossly reduced. Total shoulder replacement in these conditions gives remarkable pain relief and considerable improvement in movement and overall function. The concept of shoulder replacement is similar to hip and knee replacements which are more commonly done. Here the arthritic bone is removed from the humerus (upper arm bone). The socket is prepared and a special kind of plastic liner is fixed using bone cement. Then a metal ball with stem is inserted into the top end of the arm bone which articulates with the bone. Partial shoulder replacement is occasionally performed when the top end of the upper arm bone is badly damaged due to trauma.

Authored By : DR. DAVID V RAJAN