We discussed in our last article the importance of maintaining adequate mobility in the shoulder to prevent injury. In this article, we will discuss some common shoulder injuries, how you can recognize them and when to seek further professional help.
Let us start with some common injuries I have seen in my chiropractic office and then I will summarize 3 injuries and how I would treat the injury.
I have seen and treated the following:
- AC joint sprains (also known as Shoulder separation) Grades 1-4
- Partial thickness tear to the rotator cuff
- Full thickness tear to the rotator cuff
- Rotator cuff tendonosis, -itis, -synovitis
- Rotator cuff strain
- Clavicular fractures
- Chronic shoulder dislocation
- Subdeltoid bursitis
- Scapular winging due to long thoracic nerve impingement
- Biceps tear
- Transverse humeral ligament tear
As chiropractors, we can clinically diagnose these injuries and treat for the initial pain, rehab and recovery through multiple varying methods. Over the next 3 newsletters, let us take a closer look at 3 of these conditions that are quite common in a chiropractic office; AC joint sprains, partial rotator cuff tears and rotator cuff tendonosis.
AC Joint Sprain
The AC joint, or Acromioclavicular joint, is the main attachment of your arm to your body. There is somewhat of a “ball and socket” joint where the humerus and scapula come together, however, it is a flattened socket that does NOT completely surround the humerus, or “ball” of the joint, making the entire shoulder complex rely on the muscles and ligaments as its’ attachment of the arm to the chest wall. The AC joint is the attachment of the clavicle to the scapula through a thick ligament called the acromioclavicular ligament. Another set of 3 smaller ligaments grouped together, join the clavicle to the coracoid process ( a small hook like structure on the scapula) providing a bit more support. A sprain is the result of minor tears to a ligament, generally graded 1- 3. In the AC joint, the sprains are graded 1-6, which depicts the severity of the sprain.
Grade 1 AC joint sprain- involves minimal tearing to the AC ligament, pain, tenderness and even swelling, but no displacement of the end of the clavicle. There is generally pain with movement of the arm in most directions but little to no reduction in movement.
Grade 2 AC joint sprain- involves complete tearing to the AC ligament as well as irritation to the coracoid ligaments, with no to minimal clavicle displacement (the clavicle at the AC joint will have a bump or stick up slightly). Pain is significant and there is a loss of range of motion.
Grade 3 AC joint sprain- involves complete tearing to the AC ligament as well as the coracoid ligaments, with obvious deformity at the AC joint. Minimal range of motion with significantly more pain will be present.
Grade 4 AC joint sprain- is the same ligament damage as above, with a posterior displacement of the distal end of the clavicle which may or may not damage the supraspinatus muscle as the clavicle moves to the back.
Grade 5 AC joint sprain- involves full tears of all ligamentous attachments but also a larger displacement of the distal clavicle.
Grade 6 AC joint sprain- involves full tears of all ligamentous attachments but also a displacement of the distal clavicle inferiorly either under the AC joint or the coracoid process.
Grades 4-6 are definitely surgical candidates, but Grade 1-3 can be managed conservatively with acute pain reduction methods and rehabilitation of the shoulder complex.
Phase 1- Treat the pain and inflammation
Treatment for an AC joint sprain grades 1-3 will first follow the PRINCE protocol:
- Protect– use a sling or brace for the first 72 hours if needed to help support the weight of your arm.
- Rest– refrain from physical activity that involves the use of your arm. Even walking puts a lot of stress on the AC joint as your arm sways with each step.
- Ice– Use ice or a cold gel pack to help ease pain and reduce swelling, 15min ON, 30min OFF x3
- NSAIDS– if needed, for pain and inflammation
- Compress– wrapping the shoulder with some moderate compression will help increase pressure and drive fluid from the area.
- Elevate– keeping the shoulder above the level of the heart, lying on your good shoulder, will help excessive fluid drain down and improve swelling.
Phase 2- Increasing range of motion
Start with range of motion exercises by moving through your shoulders regular motions to the point where you feel pain. Initially, you may not be able to move far in each direction, but as the pain settles, you will be able to move better. An assisted way to do this is to use a stick or a broom stick to help push your arm into the various positions as below. Likewise you can use your fingers to walk up the walls. Avoid excessive motions into adduction (bringing your arm across your chest), forward flexion (raising your arm forward and up) and extension (bringing your arm out towards the back) as all these motions put excessive stretch on the the AC joint ligaments which are trying to heal. Stretching them further will pull them apart.
Once pain free range of motion has been achieved, you can work on strengthening within all the motions of the shoulder including pushing, pulling, internal and external rotation. These exercises should be guided and individualized based on specific movement capabilities and strength. Some exercises may include, bicep curls, tricep extensions, over head press, rows, lifts and chops. And often, exercise should include sport specific motions for those that are athletes. Here are a couple of exercises that I like to eventually add into a rehab program for shoulder injuries, once motion has been improved.
Grades 1-3 AC joint sprain injuries generally take 4-6 weeks to heel, but may take upwards of 12 weeks, depending on the severity. Injuries graded 4-6 will have a recovery time dependent on the surgical procedure performed.
If you or someone you know has been diagnosed with an AC joint injury or have hurt your shoulder and would like a further assessment, please CLICK HERE to book your appointment with Dr. Marnie.