Symptomatology: Shoulder Injuries

Shoulder injuries – Falling on the shoulder

After a fall onto the shoulder, whether it is off a bicycle or injury playing sport, there are a large number of injuries that need to be considered. These can include the following:

Clavicle (collarbone) fracture

with the increasing popularity of cycling, clavicle fracture is very a common condition and is caused by a fall on the outside of the shoulder. There is immediate pain and crepitus, swelling and bruising around the clavicle. X-rays will be required and the general consensus today is if there is a lot of comminution (multiple fragments around the fracture site) or there is significant overlap of the broken ends of the bone, then the outcome is better with surgical fixation. Surgery is done under general anaesthetic and an incision is made over the clavicle, the fracture ends are held together back in an anatomical position and a plate placed on the clavicle. This is secured with screws. An overnight stay in hospital is required and you will need to wear a sling for up to six weeks and further x-rays will be needed. Union of the fracture (healing) can take up to three to five months for complete union on x-ray. There are risks of infection, bleeding and it is quite common to have some degree of numbness around the edge of the scar, problems with metalwork and non-union (non-healing) of the fracture can occur in 6 and 8% of cases. In very slim patients and the younger population removal of the metalwork may need to be considered.

Detailed explanation

AC joint injury

A fall onto the outside of the shoulder or even outstretched hand can cause an AC joint injury. Patients normally have instant pain over the top of the shoulder and a large lump over the AC joint. The AC joint is where the collarbone (clavicle) meets the scapula. There are ligaments holding the clavicle down in line and these will have ruptured. A small degree of displacement may not require any intervention but it can still take up to three months for the pain to settle and function to return to normal. It is often advised to remain in a sling for six weeks.
If the displacement is significant, or there is a prominent lump and the patient is getting significant pain and functional restrictions, one may consider reconstructing the AC joint. This again requires open surgery under a general anaesthetic. Approximately a three inch bra strap (in line with the typical bra strap) incision is made over the top of the clavicle and the clavicle is pushed down into its normal position. My preference currently is to use an artificial ligament which raps around the coracoid (a bony beak of bone which projects from the scapula) and the ligament is passed up through the clavicle and secured with two screws to maintain stability of your clavicle and alignment. Soft tissues are then repaired over the top of the shoulder. This is again carried out as an overnight stay and you will need to remain in a sling for six weeks and will need physiotherapy. Recovery is usually around three months.

Detailed Explanation