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Common Acute Shoulder Injuries
Robert Filice, M.D.
Because it is the most mobile joint in the human body, the
shoulder takes on a disproportionate chance of injury. The boney
components of the joint include the clavicle, the scapula, and
the upper portion of the
humerus. There are also
interconnections that will be found as far away as the sternum
and the rib cage in the back. Here are the most common injuries
we see in no particular order:
1. Clavicle fractures: These usually occur when a person
attempts to break a fall by extending an outstretched arm or by
a direct fall on the lateral shoulder itself. Most clavicular
fractures (80%) occur in the middle third of the clavicle, and
are called group I. These are not casted, but simply treated
with an arm brace, even if there is displacement of the two ends
of the bone. Group II fractures occur in the outer third of the
clavicle and can sometimes produce arthritis in the AC joint
(the junction of the clavicle with the
acromion
process of the scapula)while group III occur at the sternal
side of the bone. Group III is often associated with other more
serious injuries to organs or vessels of the chest. Any of the
three groups of fractures are treated conservatively with a
sling without casting when there is no displacement. Whenever
bones are fractured,
ligaments and tendons which attach to the
area of the fracture can be torn or damaged and result in
chronic pain
which persists beyond the normal healing time of the fracture
itself. Such soft tissue damage and pain is best treated with a
course of
Prolotherapy.
2. Proximal humerus fractures: These occur at the top portion of
the upper arm bone which comprises part of the shoulder joint,
and usually affect elderly people who attempt to break a fall by
extending an outstretched arm. In younger adults they usually
occur from blunt trauma directly to the area. After careful
orthopedic evaluation, here again
tendon or nerve tissue can also be collaterally damaged,
account for prolongation of pain or disability, and usually
responds to prolo or
Neural Therapy.
3. Dislocated Shoulder: In most cases the head of the humerus
dislocates in an anterior (towards the front of the body)
direction out of the
glenoid cavity in which it is supposed to lie. Falls are the
most common cause. Occasionally there is a genetic weakness in
connective tissue which predisposes the patient to repeated
dislocations. These patients normally are unwilling to move
their arm, and will usually cradle the affected arm in the
opposite arm. Simple inspection often cinches the diagnosis,
because of the noticeable anterior bulge of the head of the
humerus with emptiness at its usual location. Reduction
(replacement) of the humerus back to its usual position can be
performed immediately after the injury in the field, but it must
be remembered that muscle spasm sets in quickly after a
dislocation, and can make the reduction process difficult as
well as painful, and necessitate hospitalization with general
anesthesia. After traditional treatment, here again
Prolotherapy
can be very valuable in strengthening the
ligaments and tendons
which hold the humerus in place. Traumatic dislocations are
usually accompanied by tendon and ligament injuries, so
Prolotherapy is often needed as an adjunct to simple reduction
of the dislocated bone. Prolotherapy will reduce the pronounced
tendency (67-97%) for recurrent dislocations.
4.Acromioclavicular
strain or separation: The
ligaments which hold the end of clavical to the acromion process at the tip of the scapula are
frequently torn as the result of football related trauma. If all
ligaments are disrupted, the outer third of the clavicle’s
position will rise from the front more towards the top of the
shoulder.
5.
Rotator
Cuff tendon tears:: The four muscles of the rotator cuff
hold the head of the humerus in its position in the glenoid
cavity of the scapula. Traumatic injuries can occur at any age,
but overuse
tendonitis is increasingly common in the elderly,
and in those who occupationally or athletically put undo strain
on the shoulder joint. The symptoms usually involve pain on
rotating or lifting the arm toward the overhead position. This
is an injury which we treat commonly and extremely successfully
at
Caring
Medical. I would go so far as to say that Prolotherapy is
the first line therapy that should be tried, and constitutes the
definitive treatment for
rotator cuff tendonitis,
assuming no structures have suffered a complete tear. Review
articles of multiple studies of therapeutic modalities
previously employed by orthodox practitioners (surgery,
non-surgical, conservative, and pharmaceutical) failed to show
the superiority of any one approach over the others.
Prolotherapy is a non surgical conservative therapy that was NOT
included in that review, yet it is by far the most effective
treatment for rotator cuff tendinopathy. Abnormal MRI’s that do
NOT show complete tears are NOT in and of themselves an
indication for a surgical approach.
Readers should be aware that the standard treatment recommended
for all of these injuries is
RICE treatment: rest,
ice, compression, and elevation. Although there may be a limited
role for temporary
anti-inflammatory drugs
in fractures, in general,
Prolotherapists
recommend
MEAT
instead: movement, exercise, analgesics, and treatment
(Prolotherapy). MEAT produces better result through faster
recovery time and less residual disability. Our case files are
full of patients who have recovered full functionality of the
shoulder through Prolotherapy. My recommendation is to NEVER
accept a surgical approach without first seeing a Prolotherapist. |
