SHOULDER & ELBOW
The main cause of shoulder and elbow injuries is a fall where it is it's natural to put your arms out to catch yourself. The impact of the fall travels through your arm and up into your elbow or shoulder. The type of structure that is injured will depend on the final weight, speed and direction of the force. Commonly seen are: a rotator cuff or biceps tendon sprains, acromioclavicular separations, clavicle fractures, or shoulder joint dislocations.Other causes of shoulder injuries can be from repetitive actions like pole planting or twisting your upper body. A forceful sudden twist to turn can pull on the group of rotator cuff tendons that control rotation and stability in the shoulder. Neck and scapular injuries can also present as shoulder pain and dysfunction.
ROTATOR CUFF INJURIES
The most common shoulder injury, often caused by a fall or collision, or from repetitive movements over time. Symptoms include immediate or severe pain, pain when moving the arm, and weakness in the shoulder.
BICEPS TENDON
There are two attachments of biceps around the shoulder. One of the tendons starts within the shoulder joint so it is at risk of sprains and ruptures during uncontrolled movements and muscle contractions.
ACROMIOCLAVICULAR JOINT SEPARATIONS
This is a common area for injury when landing on an outstretched arm. The force passes through the joint between the collarbone (clavicle) and the shoulder blade (the acromion of the scapula). Due to the remaining forces on the clavicle, the bone will pop up. The treatment will depend on how far the joint has separated and whether there is also a rupture of the ligaments below the clavicle (coracoclavicular ligaments). There is often a choice between operative or non-operative treatment, with initial management in a sling.
CLAVICLE FRACTURES
A common injury caused by a direct impact or falling on an outstretched hand. The position and displacement of the fracture will dictate whether it can be treated in a sling or requires surgery. Surgery is with internal plate and screws fixation. In the majority of cases, even if surgery is required, there is time to plan this.
SHOULDER DISLOCATIONS
If the shoulder joint dislocates, it is most commonly seen with the ball comes out of the front of the socket – termed an anterior glenohumeral dislocations. The socket is relatively shallow compared to the size of the humeral head (think of a marble sitting on a golf tee) and it therefore needs support from surrounding flexible structures: a lip (labrum) and lining (capsule). When the shoulder dislocates these structures tear. The shoulder may reduce back spontaneously but often needs a specialist manoeuvre to reduce it. It is safest if this is done under sedation and muscle relaxants at the resort medical centre.
HUMERAL FRACTURE
The upper arm bone is prone to fractures. These can be close to the shoulder joint and often seen in multiple fragments. If the shaft of the bone fractures this is usually as a spiral after a twisting motion. The end of the bone forms the elbow joint, an area where again multiple fractures can be seen, either across the bone of from avulsions where ligaments attach.
ELBOW DISLOCATION
The elbow can dislocate in a number of different ways, with the potential for associated fractures. Like most dislocations, the emergency treatment is to reduce the joint which is best performed under sedation and muscle relaxants at the resort medical centre. Further surgery is often avoided but depends on associated fractures.
RADIAL HEAD OR NECK FRACTURE
The top of the radius forms the part of the elbow that controls rotation of the forearm (pronation and supernation). If the elbow is flexed upon hand impact, the force can transmit upwards into the neck of the bone or into the joint. Treatment depends on the extent of bone displacement.
Keep in mind that early interventions will influence the speed of recovery.
