Shoulder Contusion

SHOULDER

Anatomy

The shoulder joint is the second largest and most mobile joint in the human body and can be easily understood if divided into three layers. 

Shoulder Contusion

Trauma is the term used to describe injury. Trauma is classified by its severity depending on the amount of force used to cause the injury.

Shoulder Fractures

Shoulder Fractures or breaks in the shoulder can occur in the humeral bone, collar bone or the in shoulder blade.  view  

Shoulder Dislocations

A shoulder dislocation is classified according to the direction of the dislocation (Anterior, posterior or multi-directional), the amount of force it took to dislocate the shoulder (Traumatic or Atraumatic), and whether it is accompanied by a fracture (fracture dislocation).  view  

Shoulder Arthiritis

Shoulder Arthritis is the loss of the cartilage cushion in the joint surfaces (blue section) that allows the smooth pain free gliding required during shoulder motion. view

Shoulder Nerve Compression Syndromes

Nerve compression syndromes are normally found in adults of all ages and it is rare to find nerve compression syndromes in patients younger than 20 years of age.view 

Shoulder Tendon Disorders

Shoulder pain is the most common presenting shoulder complaint in an orthopedic practice.view 

Shoulder Infection

The shoulder is one of the most well perfused areas of the human body and because of this ample blood supply to the shoulder which carries circulating white blood cells, offers excellent protection against infection, consequently making a shoulder infection a rare occurrence. view 

Frozen Shoulder

A Frozen shoulder also called adhesive capsulitis is a condition presenting with shoulder stiffness and severe shoulder pain when shoulder motion is initiated. view 

Shoulder Tumor

Tumors are divided into benign and malignant types.  view 

SHOULDER CONTUSION

Pathology

Trauma is the term for injury to the body from an external source. Severity of trauma is classified by the amount of force used to cause the injury. Trauma can be caused by a single major force or minor repetitive, smaller forces over time (Cumulative Trauma Disorder (CTD)). Other injury classifying features:

  • If the skin was breached (open injury)
  • If skin layer remained intact (closed injury)

Minor injuries, where soft tissue is bruised or stretched, but not torn are called a contusion. A contusion means the injury was closed and requires only symptomatic treatment of the soft tissues (alone of in combination) such as:

  • The skin
  • Subcutaneous tissue
  • Muscles
  • Tendons
  • Ligaments
  • Arteries
  • Nerves

The same force of trauma sustained by different patients will result in different injury severity because of changes occurring in our bodys internal structure with aging. Below is a graph divided into 20- year increments depicting an identical force sustained by individuals at different ages. It compares the time it takes for each group to heal and become symptom-free. The white section is when the patient is symptom-free and the yellow section is when the patient has symptoms including pain, stiffness, weakness, and poor function. Note, the curve does not come back to baseline and shifts to the right with aging. contusion42

Treatment

There are three common approaches to symptomatic treatment for all types of soft tissue injuries:

  • R.I.C.E. treatment (Rest, Ice, Compression, Elevation)
  • Anti-inflammatory treatment
  • Controlled early motion
  • Therapy

The stages of R.I.C.E. are used to treat injuries such as a strain (muscle injury) and a spring (a ligament stretch injury). The Rest stage is usually done for 24-48 hours and can include the use of slings, splints or other types of immobilizers unless otherwise advised by a physician. The Ice stage is used for no more than 20-30 minutes, three to four times per day. Icing treatment functions by causing the arteries to narrow the size of their lumen, which in turn decreases swelling and the pain from the subsequent increased pressure. Ice treatment is best applied by using an ice slush. Ice slush is made by mixing crushed ice with water in a bag. This The ice bag should not be placed in direct contact with the skin but instead use a buffer layer between the skin and ice bag like a towel to prevent skin freezing. The Compression stage is the wrapping of a body part to further assist in minimizing swelling and is used in conjunction with elevation. The best compressive wrapping has multiple layers providing a cushion effect. The compression wrapping should not cause constriction of the blood supply. Constriction is recognized by increasing pain to the body part wrapped. Other signs of a tight compressive dressing are:

  • A cold sensation in the wrapped limb
  • Blue discoloration of the body part
  • Any change in color from the natural skin color of the body part

The Elevation stage of treatment is best done by elevating the limb to the level of the heart. If elevation is lower than this, the effects of gravity on the veins will increase vein pressure and cause the blood to have difficulty traveling back to the heart. This can result in limb swelling. The use of anti-inflammatory medication helps treat the pain, swelling, and inflammation occurring after injury. Examples of anti-inflammatories include:

  • Aspirin products
  • Naprosyn
  • Mobic
  • Indocin
  • Arthrotec
  • Celebrex
  • Ibuprofen: Motrin/Advil

All of these medications have side effects and should be taken with this knowledge in mind. Prescriptions should be discussed with your pharmacist and physician. Controlled early motion and therapy to the involved limb decreases the effects of prolonged immobilization. Prolonged immobilization results in stiffness, muscle atrophy, weakness and also shortens the time to return to the pre-injury state. The type of therapy recommended will depend on the type of tissue injured and the severity of the injury. Consult your surgeon for the best advice. An example of therapy is the Six Pack Shoulder Program. This is a home exercise program targeting the elbow. The program is progressed from exercise one through six and focuses first on obtaining motion in all planes and concludes in strengthening. contusion5 Shoulder Muscle injuries are closed injuries from the application of an excessive force in the various motions the shoulder can perform. For example, the rotator cuff muscles can sustain a strain from lifting excessive unaccustomed weight overhead, or shoulder rotation movements. The exact muscle strain can be diagnosed in a physical exam. Physical exams work by demonstrating pain in a muscle that is resisting in normal motion, coupled with tenderness of the muscle. The most common shoulder muscle to rupture is the pectoralis major muscle. This usually occurs when doing a bench press against excessive weight on the muscle, causing it to rupture from its attachment site on the humeral bone. The most common shoulder tendons to rupture is the rotator cuff tendons and the long head of the biceps tendon. These shoulder injuries are covered under the tendon section of the shoulder, along with shoulder bursitis and tendonitis.