SHOULDER SPRAIN, GLENO-HUMERAL |
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General Information
DEFINITION--Violent overstretching of one or more ligaments in the gleno-humeral joint of the shoulder. Sprains involving two or more ligaments cause considerably more disability than single-ligament sprains. When the ligament is overstretched, it becomes tense and gives way at its weakest point, either where it attaches to bone or within the ligament itself. If the ligament pulls loose a fragment of bone, it is called a SPRAIN-FRACTURE. There are 3 types of sprains:
Mild (Grade I)--Tearing of some ligament fibers. There is no loss of function.
Moderate (Grade II)--Rupture of a portion of the ligament, resulting in some loss of function.
Severe (Grade III)--Complete rupture of the ligament or complete separation of ligament from bone. There is total loss of function. A severe sprain requires surgical repair.
BODY PARTS INVOLVED
Ligaments of the gleno-humeral joint of the shoulder.
Tissue surrounding the sprain, including blood vessels, tendons, bone, periosteum (covering of bone) and muscles.
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SIGNS & SYMPTOMS
Severe pain at the time of injury.
A feeling of popping or tearing inside the shoulder.
Tenderness at the injury site.
Swelling in the shoulder.
Bruising that appears soon after injury.
CAUSESBackward and upward stress that temporarily forces or pries the ligaments and bones of the shoulder joint out of their normal location.
RISK INCREASES WITH
Contact sports such as boxing or wrestling.
"Throwing" sports such as baseball, football and track events.
Skiing.
Previous shoulder injury.
Obesity.
Poor muscle conditioning.
Inadequate protection from equipment.
HOW TO PREVENT
Build your strength with a conditioning program appropriate for your sport.
Warm up before practice or competition.
Tape vulnerable joints before practice or competition.
Wear protective equipment such as shoulder pads.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's diagnosis.
Application of a cast, sling, tape or elastic bandage.
Self-care during rehabilitation.
Physical therapy (moderate or severe sprain).
Surgery (severe sprain).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the shoulder joint to rule out fractures.
POSSIBLE COMPLICATIONS
Prolonged healing time if usual activities are resumed too soon.
Proneness to repeated injury.
Inflammation at the ligament attachment to bone (periostitis).
Prolonged disability (sometimes).
Unstable or arthritic shoulder following repeated injury.
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Ligaments have a poor blood supply, and torn ligaments require as much healing time as fractures. Average healing times are:
Mild sprains--2 to 6 weeks.
Moderate sprains--6 to 8 weeks.
Severe sprains--8 to 10 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CAREIf the doctor does not apply a cast, sling, tape or elastic bandage:
Continue using an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the injured area. Use for 20 minutes at a time.
Wrap the injured shoulder with an elasticized bandage between ice treatments.
After 72 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
Take whirlpool treatments, if available.
Massage the shoulder gently and often to provide comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain.
Injection of a corticosteroid, such as triamcinolone, to reduce inflammation.
ACTIVITYResume your normal activities gradually after clearance from your doctor.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Begin daily rehabilitation exercises when the cast or supportive wrapping is no longer necessary.
Use ice massage for 10 minutes before and after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe shoulder sprain, or a mild sprain persists longer than 2 weeks.
Pain, swelling or bruising worsens despite treatment.
You experience pain, numbness or coldness in the arm or hand.
Blue, gray or dusky color appears in the fingernails.
Any of the following occur after surgery:
Increased pain, swelling, redness, drainage or bleeding in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever).
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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