Sustaining a shoulder injury after a traumatic accident is common. The shoulder is a very complex part of the body where injuries are not always diagnosed in a timely matter; it can be difficult to determine the source of the pain. Many people suffer from shoulder pain or problems either immediately or shortly after not only an auto accident but also a motorcycle accident, bike accident, slip and fall or work accident. The severe trauma to the shoulder joint caused by the impact of an accident causes the body to absorb a percentage of that impact; resulting in several different types of shoulder injuries. One thing is certain; everyone injures his or her shoulder at some point in life. Therefore, it is crucial for shoulder injuries to be treated .
Symptoms of Shoulder Injuries
The shoulder is a ball-and-socket joint with three main bones. These bones include the scapula (shoulder blade) and clavicle (collar bone) and arm bone (humerus). The bones are joined together by soft tissues such as ligaments, tendons, muscles and joint capsule that form a platform for the arm to function. The shoulder joint also has the greatest range of motion of any joint in the body. Due to this mobility, the shoulder is more likely to be injured compared to other areas of the body. It’s is extremely important to address the pain that may follow a personal injury because of the process and cost of treatment. Recovery time can be prolonged without the proper diagnoses and supplemental treatment. Thus, some common symptoms of shoulder injury to lookout for include:
- An agonizingly tender and stiff shoulder that hurts more at night; may interrupt sleeping
- Tingling, lack of feeling, weakness, or inflammation in shoulder
- Shoulder pain in a precise area that may worsen with physical exertion
- Trouble moving arm or arms in any direction without pain
- Sudden, concentrated pain in the shoulder area
- Pale, blue or otherwise discolored shoulder area
Types of Shoulder Injuries
According to OrthoInfo, there are many types of shoulder injuries that fall under three general categories of physical impairment. These include fractures, dislocations and soft-tissue injuries. Fractures are broken bones that for shoulder injuries, commonly involve the clavicle, proximal humerus (top of the upper arm bone) and scapula. Dislocations occur when the bones on opposite sides of a joint do not line up. Finally, soft tissue injuries are tears of the ligaments, tendons, muscles, and joint capsule of the shoulder such as rotator cuff tears and labral (SLAP) tears. In the following discussion, this blog post will highlight specific injuries that apply to each type of shoulder injury.
Fractures – Clavicle Fracture/Proximal Humerus Fracture
Fractures of the clavicle or the proximal humerus can be caused by a direct blow to the area from a fall, collision or motor vehicle. Most fractures are diagnosed with X-rays of the area and by physical examination. Sometimes, additional imaging techniques, such as CT scans are necessary for a claim.
- For clavicle fractures, swelling at the middle of the collarbone area is apparent. This area tends to have a “bump,” which is actually the prominent ends of the fracture under the skin. The shoulder range is limited—although the limitation is not as stark as with fractures of the proximal humerus.
- For proximal humerus fractures, a severely swollen shoulder will be prominent because it effects a more durable bone when compared to the collarbone area. There is very limited movement associated with this type of fracture for the shoulder and as such, it includes severe pain.
Both of these fractures can be treated without surgery if the compound fracture has not broken through the skin or if the bone is not severely out of place or position. Surgery is required typically for fixing fractured fragments of bone with plates, screws, or pins; is can also involve shoulder replacement .
Dislocations – Acromioclavicular Joint (AC Joint)
The acromioclavicular joint is where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion). It has been resolved through years of injuries that the most common cause for a separation of the AC joint is from a fall directly onto the shoulder. This fall injures the ligaments that frame and stabilize the AC joint. If the power of the fall is severe enough, the ligaments attaching to the underside of the clavicle are torn. This causes the separation of the collarbone and wingbone. The wingbone essentially moves downward, sinking from the weight of the arm. This creates a bump or bulge above the shoulder. An AC joint injury can range from a little change in configuration with mild pain, to a quite deforming and very painful experience.
When it causes deformity, the injury is pretty easy to identity. Conversely, when there little deformity, the location of pain and the help of X-rays help to determine the diagnosis. One of the ways that doctors visualize such deformity, is by having the patient hold a weight in the hand on the side of the possible injury site. In doing so, the deformity is increased and therefore, easier to see. A mild AC injury involves a sprain of the AC ligament that does not move the collarbone and looks normal on X-rays. A more serious form of this injury is when it tears the AC ligament and sprains for slightly tears the coracoclavicular (CC) ligament. This ends up putting the collarbone out of alignment to some extent. The most severe shoulder separation completely tears both the AC and CC ligaments and outs the AC joint noticeably out of position.
The treatment for this type of injury can be nonsurgical or surgical. Nonsurgical treatments, such as a sling, cold packs, and medications can help to manage the pain. The doctor may also come up with another way to support the injury so that it heals correctly with little to no deformity. One of the positive aspects of healing with this injury is in the numbers of people who return to near full function, even with deformity. There may be continued pain over time, but the functionality of the arm is close to normal. If this pain is too persistent to live with, surgical treatment is available to restore not only the look of the injury, but to also minimize long-term effects. Overall, both treatments will necessitate therapy to restore and rebuild motion, strength and flexibility .
Soft Tissue Injuries – Rotator Cuff Tears & SLAP Tears
A soft tissue injury is composed of tears to the ligaments, tendons, muscles, and joint capsule of the shoulder. Both rotator cuff tears and SLAP tears contribute to a variety of reasons for causation as well as contributing to complications following an accident or other personal injury. Shoulder injuries involving soft tissue damage are more common than bony injuries. Yet, the diagnosis is more difficult to distinguish. MRI’s can be used to confirm the diagnosis but there needs to be a correlation of pain to injury. As such, it’s better to know the symptoms and causes to each type of tear.
Rotator Cuff Tears– is when the rotator cuff, a larger tendon comprised of four muscles which combine to form a cuff over the upper end of the arm, forms a tear. These four muscles include the supraspinatus, infraspinatus, subscapularis and teres minor. These muscles may be town from an acute injury, such as a fall or even chronic wear and tear with degeneration of the tendon from activities such as baseball. The pain is normally felt in the front of the shoulder and radiates down the arm. The pain may be felt when trying to sleep on the side of the injury or the pain can be felt when there is difficulty performing routine activities such as combing through one’s hear trying to reach your back. In any case the acute pain can be described as a snapping sensation and a direct weakness of the arm.
This injury can extend or get larger over time if it is not addressed by the right medical professional or corresponding treatment. Whether the doctor recommends anti-inflammatory medication or steroid injections or otherwise recommends surgery following persistent pain or weakness in the shoulder, rehabilitation plays a critical role in both nonsurgical and surgical treatment of a rotator cuff tear .
SLAP Tears– is an injury to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint. SLAP stands for Superior Labrum Anterior and Posterior. This area of the upper arm’s head fits into a rounded socket in the shoulder blade, formally known as a ball-and-socket joint. Surrounding the edge of the socket is a rim of strong, fibrous tissue called the labrum. This tissue’s function helps to deepen the socket and to stabilize the shoulder joint as well as serving as an attachment point for many of the ligaments of the shoulder in addition to one of the tendons from the biceps muscles in the arm. Injuries to this area of the shoulder can be caused by acute trauma or by repetitive shoulder motion. Acute trauma can be caused by auto accidents, slip and falls, forceful pulling of the arm and shoulder dislocation. Repetitive shoulder motion can cause SLAP injuries due to stress. People who participate in overhead sports such as weightlifters can experience this injury. Just as the rotator cuff, this injury has telltale symptoms of its presence such as decreased range of motion and shoulder strength as well as pain with movement. For these injuries, nonsurgical treatment and surgical treatment is available—from non-steroid anti-inflammatory medication to arthroscopy. The doctor will determine the best option depending on the severity of the injury and the pain that follows. Overall, rehabilitation will involve physical therapy to rebuild the strength in the area .
Shoulder Injury Diagnosis
If you are experiencing pain in your shoulder after a car accident, you should see an orthopedic surgeon to fully diagnose the extent of your injury. If you’re not sure if your shoulder is injured or just sore from the accident, think about these three questions:
- Is your shoulder stiff? Can you rotate your shoulder and move your arm in the normal way you would have before the crash?
- Does you feel as if you might pop your shoulder out of socket when moving it around?
- Is your sore shoulder weak enough that daily activities have become difficult?
If any of these scenarios apply to your shoulder, it was probably injured during the accident. Listen to your body, it knows when something is wrong.
Shoulder Injury Test
When an orthopedic doctor is examining a patient for shoulder injuries, they will perform a series of physical examinations, or tests, that are used to determine the extent and location of an injury. This physical examination involves looking for visual abnormalities, moving the shoulder into certain positions, and receiving feedback from the patient about pain and discomfort levels.
When it comes to locating a specific injury in the shoulder, there are over a hundred physical tests that orthopedic doctors perform to evaluate the injury. These include the Mazion Shoulder Maneuver, Dugas, Anterior Load and Shift, Rowe Test, Jerk Test, etc. For a full list of orthopedic shoulder tests and the injuries they diagnose, visit physicaltherapyweb.com.
Most shoulder injury tests involve examining the range of motion of both shoulders. This is likely done in multiple positions: sitting, lying, and standing. These tests include the patient moving the shoulder on their own, as well as the doctor moving the patient’s shoulder for them. They are designed to evaluate resistance, strength, pain levels, and so on, so that the doctor can better assess the injury.
The orthopedic surgeon will also examine the patient’s sense of feeling in their shoulders, arms, and hands, as well as the blood flow to these areas. This light pressure and measuring of pulse can help a physician to locate the injury.
Since shoulder pain can often be a result of other injuries, a good orthopedic doctor will also examine the patient’s neck, spine, and chest to be sure that these areas are not generating the pain.
Shoulder Injury Imaging
Just like any other physical injury to bone or muscle, imaging is commonly used to diagnose shoulder injuries by giving physicians an inside look at the shoulder and any possible injuries. The most commonly used are X-ray, MRI, CT-scan, and ultrasound.
X-raying a Shoulder Injury
A standard X-ray is still a common way to image for injuries, since they are relatively inexpensive and effective. These two dimensional images can be used to view:
- The space between the joints
- Location of cartilage
- Abnormal growths, like bone spurs
- Fractures in the bone
Sometimes, doctors will inject a contrast dye into the shoulder so that it will better appear on the X-ray. This is called arthrography.
MRI of a Shoulder Injury
Magnetic Resonance Imaging, commonly known as an MRI, has mostly taken over x-rays as the imaging method of choice for severe shoulder injuries. That’s because this test can view much more detailed, 3D images of the shoulder structures, including very small tendons, vessels, muscle tears, and fractures. Like with the X-ray, a dye may be used by the radiologist to produce more contrasted images.
CT Scan of Shoulder Injury
‘CT scan’ stands for computed tomography scan. It may also be called a ‘CAT scan’, which stands for computerized axial tomography. This imaging technique combines a traditional X-ray with computer technology to produce multiple images, which are then combined with software to create a cross-sectional view of the shoulder structure. CT scans are helpful for diagnosing minute fractures and soft-tissue damage.
Shoulder Injury Ultrasound
Ultrasonography is most commonly thought of it when viewing the fetus of a pregnant woman. However, this sound wave test can be used on other parts of the body to examine shoulder tendons and muscles as they actively move around; something the other tests have a hard time doing. The ultrasound is limited, however, by its inability to see bone damage.
Auto Injury Attorneys – Dolman Law Group
It is very common for the insurance company to deny claims, saying that the pain that victims are complaining of is actually a result due to a former injury. However, the best course of action for defeating this claim is to seek medical treatment for evidence of alleged injury. Apart from this proof, there are many other resources needed for a shoulder injury case that only an experienced attorney can aid the victim with. There are many misconceptions and false information provided to people injured in car accidents. Don’t be one of them. If anything, contact the Dolman Law Group for the sole purpose of knowing your rights and what benefits you’re eligible for that insurance companies may try to deny you of. Contact us today for a free scheduled consultation and evaluation. Our number is (727) 451-6900.