At first glance, trauma to any area of the human body does not seem to be as serious a condition as soft tissue wounds, bone fractures or dislocations. However, it is shoulder bruises that, if treated incorrectly, often lead to various complications and, as a consequence, to an increase in the duration of therapy and rehabilitation of a person.
In traumatology, it is customary to divide the shoulder injury into a bruise of the shoulder joint (due to direct impact on it, for example, when falling on an outstretched arm) and a bruise of the shoulder area (in this case, only soft tissues are injured, functions are not impaired). Although the main measures for treating such damage will be similar, however, understanding the mechanism of development of the pathological process and the mechanism of injury allows the doctor to avoid complications associated with dysfunction of the shoulder joint.
Classification of injuries
Bruises of the shoulder girdle are common in orthopedics, but without an accurate determination of the type of injury, it is impossible to offer effective therapy. The classification is formed taking into account the clinical picture (symptoms), causes of the problem and diagnostic results. Thus, there are various options, including damage to soft tissues, rotator cuff, and sprained ligaments. Only an experienced orthopedic surgeon can accurately determine the diagnosis.
Soft tissue bruise
With soft tissue bruises, the function of the shoulder is usually not impaired. This is a closed form of injury, the severity of which depends on the characteristics of the traumatic agent (type, speed of movement, weight and other parameters) and the size of the affected area. Bruising of the soft tissues of the shoulder can be accompanied by damage to the subcutaneous fat, dermis and epidermis, as well as small vessels, muscles, and ligaments.
Damage without disruption of structures is diagnosed in the majority of all cases. But it is a mistake to believe that this problem does not require medical supervision. In case of a bruise without fractures or dislocations, minor injuries to the peripheral nervous structures are determined, which is why numbness and a slight tingling feeling are often disturbing.
Shoulder injury from a fall
People often get shoulder injuries at home. Injuries in everyday life can be caused by falling on your hand. The main reason for the problem is a jerky movement, a sharp impact on the tissue. At risk are athletes, lovers of entertainment at ski resorts, dancers, children, and people with pathologies of the musculoskeletal system. But no one is immune from injury, so it is important for everyone to seek medical help without exception. And if, for example, a woman hurt her shoulder when falling on the steps, a man experiences painful discomfort after a fight, he needs to make an appointment with a doctor right away.
Rotator cuff injury
When diagnosing a severe shoulder contusion, an orthopedic surgeon will always consider the possibility of damage to the rotator cuff. This is a functional group consisting of four muscles and tendons that help the upper limb to fully rise and rotate with stabilization of the joint. With such injuries, acute pain, loss of mobility and strength appear.
Shoulder sprain
Overstretching, partial rupture of ligaments without accompanying severe injuries is a closed-type injury that requires immediate response. Make an appointment to muffle symptoms, eliminate complications, apply effective therapy, and achieve a speedy recovery.
Degree of injury
The clinical picture of injury to the shoulder girdle has different intensity of manifestation:
- Grade 1 - it hurts to raise your arm for 3-4 days. The presence of abrasions and other minor damage is possible.
- Grade 2 – hematomas and swelling are present. There is redness on the skin on the side of the injury. There is acute pain that does not subside even with complete immobility of the limb.
- Grade 3 – there is obvious redness of the skin. Tendons and muscle structures. Complications such as shoulder dislocation occur.
- Grade 4 – there is a pronounced bruise on the shoulder and there is a complete loss of motor functions. In this case, it is difficult to independently determine whether it is a bruise or a fracture. The hematoma can be large and even reach the elbow. Treatment takes at least 2-3 weeks.
Symptoms of a shoulder injury
The main circumstance that will allow one to suspect it is the presence of a previous injury. In other cases, all the symptoms that are characteristic of a shoulder bruise, but were not accompanied by damage, may indicate a disease of the joint or its surrounding structures. The main symptoms are:
- Pain in this area at rest, which intensifies with palpation, physical activity, and also when attempting to move the joint.
- Change in color of soft tissues, formation of skin and subcutaneous hematoma (impregnation and accumulation of blood in the skin and subcutaneous tissue).
- Swelling of the skin and affected area
- Decreased function of the shoulder joint, but with preservation of full range of motion. If the range of motion is impaired (the patient’s inability, for example, to raise his arm above his head), it is highly likely that we will be talking about a dislocation.
Shoulder contusions in children and the elderly
Shoulder injuries in children are common and require close parental supervision. But a much greater danger for children is dislocation of the elbow joints - the result of an unfortunate fall on the playground, playing with a ball, or the desire to spin while holding hands.
As a rule, the situation is saved by examining a doctor and applying a fixing bandage for 10-14 days. Severe bruises of the shoulder, ignored by parents, can cause the development of traumatic bursitis - the mobility of the arm of an adult child will be pathologically limited.
Shoulder bruises in the elderly, especially those in which the arm cannot be raised, are a very alarming symptom. The situation is aggravated by the age-related limitation of the resource for tissue restoration - the injury will take longer to heal.
The generation of cartilage tissue is almost impossible; joint replacement surgery (endoprosthetics) may be required. Neither children nor the elderly should have shoulder bruises left without medical supervision. Uncontrolled use of painkillers is unacceptable.
In the future, older people may require longer rehabilitation than younger patients of a traumatologist. But it must be completed, following all medical instructions.
Diagnosis of bruises of the shoulder joint
The main task of the doctor when examining a patient is to exclude more severe pathology:
- humerus fracture;
- rupture of the acromioclavicular joint;
- dislocation.
This is due to the fact that for more severe injuries, special treatment measures are necessary. To exclude them, if a shoulder injury is suspected from a fall, an x-ray of the injured area is performed in at least two projections. This allows you to quickly and accurately answer the question - is it simply soft tissue damage or another, more severe case.
To exclude severe injuries, which were written above, an x-ray of the shoulder joint and humerus is performed.
If there is a suspicion of fluid accumulation in the shoulder joint, a diagnostic puncture may be performed to determine the type of fluid. It also allows you to reduce intra-articular pressure, thereby easing the patient’s condition.
If there is any doubt about the diagnosis, an MRI study is indicated, which will show the pathology of not only bone tissue but also soft tissue structures, such as tendons, ligaments, muscles, and even the thickness of joint cartilage.
4.Treatment
For any injury to the shoulder joint, after pain and swelling are relieved, the mobility of the arm is restored using physical therapy methods, gradual development of the joint, passive and strength training. A rehabilitation program should be prescribed by an experienced doctor. At the same time, the patient regularly undergoes intermediate diagnostics to assess the effectiveness of the measures taken.
The following modern techniques can speed up the recovery process:
- UHF therapy;
- massage;
- magnetic therapy;
- electrophoresis;
- Ultrasound therapy;
- warm wraps with paraffin and ozokerite;
- procedures using diadynamic current.
First aid for a shoulder injury
It is not difficult to provide, however, most patients often either ignore the symptoms or radically incorrectly provide first aid for this type of injury. All this, in turn, can affect the duration of treatment and the degree of manifestation of symptoms.
First aid for a shoulder injury is:
- Immobilization of the injured limb. For the shoulder, a bandage (scarf) is enough to support the right or left arm and reduce the load on the injured limb.
- Taking nonsteroidal painkillers (nimesulide, ketorolac, etc.).
- Apply cold for 15 minutes 3-4 times during the first 6-12 hours (on the second day the cold is no longer effective, since the swelling has already grown);
To exclude a more serious injury, if pain or tissue swelling is severe, it is necessary to consult a doctor and conduct diagnostic tests.
Diagnostics
During diagnosis, an initial examination of the patient is carried out and symptoms are recorded. Also at this stage, the victim is questioned in detail about the incident that resulted in the injury, and it is noted whether he has any concomitant pathologies.
To avoid the development of complications, it is important to seek medical help in a timely manner.
Next, an external examination is carried out with palpation of the injured area - checking for bone fragments, joint deformation, bruises, scratches or loss of sensitivity.
If severe damage to muscles, joints, bones or ligaments is suspected, the patient is referred for additional instrumental studies, which include:
- Magnetic resonance imaging;
- CT scan;
- ultrasonography;
- angiography;
- arthroscopy;
- arthrography;
- X-ray.
If a fracture is suspected, an x-ray is prescribed
In rare cases, when there is an unsatisfactory general condition of the victim, nervous tension, or there is a suspicion of infection of the wound cavity with further infection of the blood, joints, etc., a referral is given for laboratory tests. Usually a coagulogram, biochemical and clinical blood test are performed.
Algorithm for applying a bandage for a shoulder injury
Before treating a shoulder bruise with medications (ointments, creams, balms), or physiotherapy, it is important to understand the technique of applying a special bandage. Usually the oblique type is used, taking into account the following steps:
- The patient's arm is lowered down along the body.
- The bandage (optimal width is 20 cm) is placed directly on the shoulder region, in the lower third of the affected shoulder.
- The dressing material is applied in the direction from the healthy part to the affected one.
- Fix the bandage around the upper third of the shoulder.
Use a classic or elastic bandage depending on the type of injury. The second option is not suitable for bruises that have a wound surface.
Surgery to treat joint damage
The most popular and expedient method to cure damage to the ligaments of the shoulder joint, the treatment of which should be considered as indicative of all types of damage, is surgery. During it, a special probe is inserted into the joint, which allows you to examine the damage, as well as a surgical instrument that removes protruding bone fragments and regulates the shape and position of the cartilage tissue.
In case of damage to the capsule of the shoulder joint, special titanium clamps are used, which prevent the bones from moving beyond the amplitude of their movement provided by nature. As a result, the cause of the injury and its primary impact are eliminated, and the patient can safely begin the rehabilitation complex.
In some cases, when the shoulder joint is damaged, it becomes necessary to pump out blood or lymph fluid that enters the joint as a result of injury. It occurs through a special puncture made by the surgeon, and, if necessary, is repeated several times, after preliminary diagnosis on a magnetic resonance imaging scanner.
Rehabilitation procedures that are performed after surgery are an important set of measures, without which recovery after damage to the joint capsule is impossible. It is necessary to radically change your diet, to include in it all the necessary minerals and trace elements, vitamins that are necessary to start regenerative processes in the body’s tissues. In addition, the most important factor is physical therapy exercises, which are aimed at strengthening the joint and muscles.
Treatment of a shoulder injury
How to treat a shoulder bruise is described below:
- Apply a bandage, thereby creating peace and limiting movements (in case of severe bruises and severe pain);
- Kinesiotherapeutic tapes;
- Painkillers (NSAIDs), for example one of the drugs: Movalis, Nise, Nurofen, Ketorol, 1 tablet up to 2 times a day, no more than 5 days;
- Anesthetic ointments, for example: Dolobene gel, Traumeel, Voltaren, apply topically 2-3 times a day until the symptoms stop (disappear);
- Physical therapy may be prescribed to help reduce swelling and pain;
The importance of accurate diagnosis of joint damage
After a bruise, you must consult a doctor who will take a history of the injury and conduct a physical examination. With partial ruptures, movement is possible, but there is severe pain. To determine the location and severity of the injury, radiography is performed.
In order to prescribe competent treatment and prevent the development of possible complications, a medical opinion should be made by carrying out the following diagnostic measures:
- Differentiate a bruise from a sprain, dislocation and fracture.
- Take x-rays in 2 projections.
- Perform a CT scan to visualize the extent of damage to soft tissues and bone structures.
Possible consequences if left untreated
Untimely qualified medical care or the absence of it at all, firstly, leads to an increase in the duration of treatment and rehabilitation. When a shoulder is bruised, complications may develop, a deterioration in the clinical picture, including the appearance of additional unpleasant symptoms (hematoma, tissue swelling, redness (hyperemia), itching, cutting and aching pain, difficult to treat with analgesics, antispasmodics). Also, due to a bruised shoulder, hemarthrosis (accumulation of blood in the joint) and bursitis (inflammation of the synovial bursa) are often diagnosed.
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Complications of bruises of the upper shoulder girdle
- Hemarthrosis is a reactive filling of the joint cavity with blood due to rupture of small periarticular vessels;
- Traumatic bursitis is a promising lifelong complication that limits joint mobility;
- Periarthrosis is a pathological growth of periarticular structures in advanced injuries that are not observed by a traumatologist;
- Synovitis is excessive filling of the joint capsule with the synovial component, leading to painful swelling. Occurs immediately after a bruise or in the first hours;
- Rupture of ligaments or nerves - urgent surgical intervention is required;
- Traumatic myositis is acute muscle pain caused by significant muscle damage.
Correct provision of first aid and subsequent medical supervision to the victim helps to avoid serious complications. To summarize briefly, let's summarize the algorithm of actions. So…
What Causes Rotator Cuff Injury?
As mentioned above, the most common cause of rotator cuff injury is trauma. Most often, ruptures occur in older people, but in young people, ruptures can also occur due to serious injuries, such as a fracture of part of the humerus or dislocations.
- A fairly common cause of rotator cuff injury is permanent tendon injury
, which is chronic. This mainly applies to people whose professional activities involve heavy physical labor. Tension and heavy stress on the joints, accompanied by repeated motor operations, leads to chronic inflammation and pain.
- Spontaneous tendon rupture or damage is usually preceded by period of degenerative-dystrophic changes
. Lack of blood supply is the main cause of tissue degeneration or tendinopathy. Many doctors attribute genetic predisposition to another possible reason for the development of degeneration.
- Another reason may be individual anatomy
. Sometimes, insufficient space between the head of the humerus and the tip of the scapula leads to constant friction and injury to the rotator cuff tendons. In addition, the hook-shaped shape of the acromion process and the presence of an accessory bone at the tip of the scapula that damages the tendons are anatomically determined.
Rotator cuff
The supraspinatus muscle is located highest in the rotator cuff, while its tendon passes in a narrow space between the acromion process of the scapula and the head of the humerus, which determines the tendency for the tendon to be injured.
Rotator cuff: general appearance, tenopathy and entrapment of the rotator cuff tendons in the subacromial space (impingement syndrome)
You can learn more about the anatomy of the rotator cuff and the anatomy of the shoulder joint on our website (click to go to articles about anatomy).
Causes of diseases and injuries of the rotator cuff
The rotator cuff tendons, like all tendons, have a relatively poor blood supply. Insufficient blood supply to the rotator cuff tendons leads to the frequent development of degenerative changes: so-called tenopathy occurs. It is worth noting that the development of tenopathy is promoted not only by insufficient blood supply (a number of scientists generally deny the role of blood supply in the development of tenopathy). Another reason for the development of tenopathy is hereditary pathology of connective tissue. Tendons are mainly composed of a special protein - collagen, which comes in 4 types. With an abnormally high percentage of collagen types 3 and 4, tenopathy develops more often. In general, tenopathy can develop in any of the rotator cuff tendons (and in several tendons at the same time), which can lead to pain in the shoulder joint during movements in which the corresponding muscle is involved. For example, with tenopathy of the supraspinatus tendon, the pain intensifies when moving the arm to the side, with tenopathy of the subscapularis muscle - when bringing a spoon or fork to the mouth, when combing one's hair, or when placing one's hand behind the back. Often these tenopathies are called glenohumeral periarthritis , but this is an absolutely illiterate diagnosis, which was already abandoned throughout the world several decades ago. “Humeral periarthritis,” manifested by pain in the shoulder, may in fact be not only tenopathy of a particular rotator cuff tendon, but also a number of other diseases, which deserves consideration in a separate article. In addition, the development of tenopathy is facilitated by the use of certain antibiotics (fluoroquinolones).
The most common reason contributing to the development of tenopathy is chronic tendon injury, which is possible in two fundamental scenarios:
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Three types of anatomical shape of the acromion process (lateral view). The hook-shaped shape of the acromion process contributes to traumatization of the rotator cuff tendons
With age, degenerative changes in the tendon progress, tenopathy becomes more pronounced, the tendon weakens and rupture may occur. Tendon rupture most often occurs between the ages of 35 and 55 years. However, with a sufficiently severe injury (fractures of the greater tubercle of the humerus, other fractures of the proximal part of the humerus, dislocations in the shoulder joint, etc.), a rupture can occur without previous tenopathy, i.e. in relatively young people.
Complete rupture of the supraspinatus tendon and partial rupture of the subscapularis tendon
Symptoms
As we have already noted, most often rupture of the rotator cuff tendons due to injury occurs against the background of previous degenerative changes (tenopathy). The rupture is characterized by a sharp increase in pain and weakening of the arm, up to the complete inability to move the arm. Ruptures can be partial or complete when the tendon of a particular muscle is completely torn from its attachment to the humerus. The intensity of the pain depends on the size of the tear - as a rule, the larger the tear, the greater the pain, and the greater the limitation of movement. With partial ruptures, the ability to move the arm is preserved.
The location of the pain depends on which rotator cuff tendon is damaged. Most often, the supraspinatus tendon is damaged, which usually manifests itself as a complete inability to abduct the arm to the side (with a complete rupture) or increased pain when abducting the arm to the side in an amplitude of 30 to 60 degrees. Many patients note that they cannot sleep on the side of the sore shoulder joint.
Diagnostics
To make a diagnosis, the doctor will ask you about the mechanism of the injury, how long ago the injury was, the nature of the pain in the shoulder, whether and how long the shoulder hurt before the injury. Let us remind you once again that with significant tenopathy, tendon rupture can occur without any injury at all.
Next, the doctor conducts an examination, during which he performs special tests (moves your arm or asks the patient to make a special movement), during which it is highly likely to find out which tendon is damaged.
As a rule, when a tendon is completely ruptured (or separated from its attachment to the bone), the movement for which this muscle is responsible is impossible.
With partial ruptures, the ability to move the arm is preserved, but movement is painful.
It is necessary to perform an x-ray, in which, in case of ruptures of the rotator cuff tendons, characteristic signs can be detected on the lower surface of the acromion process - the so-called subchondral sclerosis. It is formed as a protective reaction of the bone from repeated impingement of the head of the humerus and the lower surface of the acromion (impingement syndrome), and these impingements lead to damage to the rotator cuff tendons, causing their tenopathy, and ultimately rupture. Of course, the absence of these signs on the x-ray does not mean that the rotator cuff tendons are not damaged, but the presence of these x-ray signs most likely indicates problems with the rotator cuff tendons. It is important to evaluate the acromioclavicular joint on the radiograph: arthritis of this joint can cause similar pain.
X-ray: Impaction of the humeral head (blue arrows) and the inferior surface of the acromion process (red arrows) leads to damage to the supraspinatus tendon running between them.
In case of an unclear diagnosis and in order to clarify the extent of the damage, an ultrasound examination or magnetic resonance imaging is performed, which allows using magnetic waves to see and capture soft tissues and bones in the form of layer-by-layer sections.
Magnetic resonance imaging showing a complete rupture of the supraspinatus tendon
Treatment
Initial treatment
Initial treatment for an acute, recent rotator cuff tear is to relieve pain. As a rule, non-steroidal anti-inflammatory drugs are used, such as aspirin, Voltaren, Xefocam, etc. Also in the acute period, it is necessary to keep the sore arm at rest - the arm is immobilized in a scarf or on a special abductor splint. Applying ice packs wrapped in a towel to the shoulder is effective in reducing pain and swelling.
Rules for applying a scarf bandage
A special abduction splint used to treat rotator cuff tendon tears. Most often, the supraspinatus tendon is torn from its attachment to the humerus. Immobilizing the arm in abduction position brings the end of the severed tendon closer to its attachment to the humerus. The same abduction splint is also used after operations for rotator cuff tendon ruptures.
Complete rupture of the supraspinatus tendon and partial rupture of the subscapularis tendon. When the arm is moved to the side, the torn ends of the tendon come closer together. The red arrow shows the axis of the humerus. On the left - the shoulder is brought to the body, on the right - the shoulder is abducted to the side.
Conservative therapy
For tenopathies and minor, small tears, when movements in the shoulder joint are preserved, conservative therapy is prescribed. After reducing the pain, light physical exercises are prescribed to develop the joint. In a later period, strength exercises aimed at strengthening the muscles of the upper limb are added to these exercises. This will allow the sore arm to gradually return to its previous range of movements. Typically, the duration of conservative therapy is from 6 to 8 weeks. During this time, pain in the shoulder completely stops, and strength in the arm muscles is partially restored.