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SHOULDER INJURIES

Our orthopedic doctors treat painful shoulder problems occurring in babies, children, teenagers, and adolescents. As doctors, we see more common shoulder injuries accompanied by pain for children who participate in organized sports involving baseball, volleyball, football, and swimming.

We understand how a shoulder injury can also injure the growth plate in your child. Our goal is to help children recover and heal successfully. We have had extra training in children’s growth plates and can factor them into our treatment plans. This allows children’s and adolescents’ bones to grow as successfully as possible.

The Shoulder

The shoulder, as most people know it, is a collection of joints that work together with tendons and muscles to allow the arm to move in a wide range of motion, from rubbing your back to throwing the excellent pitch. However, there is a cost to mobility. It may worsen shoulder instability or impingement of soft tissue or bony structures, leading to pain. You may experience pain solely when moving your shoulder, or you may experience pain all of the time. The pain could be transient or it could last longer, necessitating medical attention.

This article discusses some of the most prevalent causes of shoulder pain, as well as treatment alternatives. More information concerning your shoulder pain can be obtained from your doctor. Your shoulder is comprised of three bones: the Humerus (upper arm bone), the scapula (shoulder blade), and the collarbone (collarbone) (clavicle). Your upper arm bone’s headrests in a spherical socket in your shoulder blade. The glenoid is the name given to this socket. Your arm bone is kept centered in your shoulder socket by a complex system of muscles and tendons. The rotator cuff is the name given to these issues. They connect your shoulder blade to the head of your upper arm bone.

Shoulder Injury Causes

Most shoulder issues fall into four major groups:

  • Instability
  • Arthritis
  • Fracture (broken bone)
  • Tumors, infection, and nerve-related disorders are some of the less prevalent reasons for shoulder pain.

Bursitis

Bursae are fluid-filled sacs that can be found in all joints of the body, including the shoulder. They serve as cushions between bones and the soft tissues that cover them, as well as reducing friction between gliding muscles and the bone. The bursa between the rotator cuff and the region of the shoulder blade known as the acromion can become inflamed and swollen as a result of overuse of the shoulder. Subacromial bursitis is the result of this situation. Bursitis and rotator cuff tendonitis are frequently seen together. Inflammation and pain can occur in the shoulder’s many tissues. Many ordinary tasks, such as combing your hair or getting dressed, may become challenging.

Tendinitis

A tendon is a strand of tissue that connects a muscle to a bone. Inflammation of the tendon is the most common cause of tendinitis. Tendonitis is classified into two types:
Acute. Acute tendonitis can be caused by excessive ball throwing or other overhead actions at work or in sports.

Chronic. Chronic tendinitis can be caused by degenerative disorders such as arthritis or age-related wear and strain. The four rotator cuff tendons and one of the biceps tendons are the most usually afflicted tendons in the shoulder. A rotator cuff is a group of four tiny muscles and tendons that cover the upper arm bone’s head and hold it in the shoulder socket. The rotator cuff is a ligament that serves to stabilize and move your shoulder.

Tendon Tears

Acute injury, degenerative changes in the tendons due to aging, long-term misuse, wear, and tear, or a sudden injury can cause tendons to split and rip. These tears can be partial or total, causing the tendon to be separated from its bone connection. The tendon is torn away from its attachment to the bone in the majority of cases of complete tears. The most prevalent of these injuries are rotator cuff and biceps tendon tears.

Impingement

When the arm is raised away from the body, the top of the shoulder blade (acromion) presses against the surrounding soft tissues, causing shoulder impingement. The acromion scrapes on the rotator cuff tendons and bursa as the arm is raised, or “impinges.” Bursitis and tendinitis might develop as a result, causing pain and restricting movement.

Instability

When the upper arm bone’s head is driven out of the shoulder socket, shoulder instability develops. Overuse of a sudden injury might cause this. Shoulder dislocations can be partial, with the upper arm’s ball just partially protruding from the socket. A subluxation is a term for this. The ball comes completely out of the socket when it dislocates completely. When the ligaments, tendons, and muscles that surround the shoulder become loose or injured, dislocations can occur repeatedly. When you elevate your arm or move it away from your body, recurrent dislocations, which can be partial or full, cause pain and unsteadiness. Subluxations or dislocations that occur frequently raise the chance of developing arthritis in the joint.

Arthritis

Shoulder pain can be caused by Arthritis. Arthritis comes in a variety of forms. Osteoarthritis, sometimes known as “wear and tear” arthritis, is the most frequent type of arthritis in the shoulder. In middle age, swelling, pain, and stiffness are frequent problems. Osteoarthritis progresses slowly, and the pain it causes progressively worsens. Osteoarthritis can be caused by sports or work-related accidents, as well as general wear and tear. Other types of arthritis can be caused by rotator cuff injuries, infection, or joint lining irritation. In order to alleviate arthritis discomfort, many people avoid shoulder motions. This can cause the soft tissue components of the joint to tighten or stiffen, resulting in a painful restriction of motion.

Fracture

Bones that have been shattered are known as fractures. The clavicle (collarbone), Humerus (upper arm bone), and scapula (shoulder blade) are all involved in shoulder fractures (shoulder blade). In elderly persons, a fall from standing height is a typical cause of shoulder fractures. A high-energy event, such as a car accident or a contact sports injury, is frequently the cause of shoulder fractures in younger patients. Fractures in the shoulder area can result in extreme discomfort, edema, and bruising.

Doctor’s Examination

When you have an acute injury that is causing you a lot of pain, you should get medical help as soon as possible. If the discomfort is mild, it may be safe to rest for a few days to see if the problem will go away on its own. If the signs continue, see a doctor. Your doctor will perform a comprehensive examination to establish the source of your shoulder pain and discuss treatment options with you.

Medical History

An in-depth medical history is an initial stage in the evaluation. To determine both your general health and the likely causes of your shoulder problem, your doctor may inquire how and when the pain began, if it has occurred before and how it was handled, and other inquiries. Because most shoulder disorders are increased and relieved by specific activities, a medical history might be helpful in determining the reason for your pain.

Physical Examination

To determine the source of your shoulder pain, you’ll need to undergo a thorough examination. Physical anomalies, edema, deformity, or muscle weakness, as well as painful regions, will be examined by your doctor. He or she will assess your shoulder strength and range of motion.

Tests

  • Your doctor may order tests to figure out what’s causing your discomfort and if there are any underlying problems.
  • X-rays. Any damage to the bones that make up your shoulder joint will be seen in these images. Ultrasound and magnetic resonance imaging (MRI). These imaging studies produce more accurate images of soft tissues. Your doctor may use an MRI to look for damage to the ligaments and tendons that surround your shoulder joint.
  • A CT scan is a type of imaging that uses a computer to create a three-dimensional image. This machine combines x-rays and computer technology to provide a very detailed image of the bones in the shoulder area.
  • Electrical research. Your doctor may recommend a test to assess nerve function, such as an EMG (electromyogram).
  • Arthrogram. Dye is injected into the shoulder during this x-ray scan to best match the joint and its surrounding muscles and tendons. It could be used in conjunction with an MRI.
  • Arthroscopy. A fiber-optic camera is used by your doctor to view the joint during this surgical operation. Soft tissue injuries that are not visible on physical examination, x-rays, or other tests may be revealed via arthroscopy. In addition to assisting in the detection of the source of discomfort, arthroscopy may also be utilized to remedy the issue.

Treatment

Activity changes: Rest, modifying your activity, and physical therapy are all common treatments for improving shoulder strength and flexibility. Preventing shoulder discomfort can be as simple as avoiding overexertion or overdoing activities in which you generally do not partake.

Medications: To relieve inflammation and pain, your doctor may prescribe medication. If pain medicine is recommended, it should be taken exactly as prescribed. To ease discomfort, your doctor may prescribe numbing drugs or steroid injections.

Surgery: Some shoulder disorders may necessitate surgery to be resolved. However, simple therapy strategies such as changing activities, rest, exercise, and medication will help the vast majority of patients with shoulder pain. Exercise may not be beneficial for certain types of shoulder issues, such as repeated dislocations and some rotator cuff injuries. Surgery may be recommended early in certain circumstances. Arthroscopy can be used to remove scar tissue or repair injured tissues, or open procedures can be used for major reconstructions or shoulder replacements.

More About the Shoulder

The shoulder is the most movable joint in the human body, consisting of three bones, many muscles, ligaments, and tendons. Its appropriate operation is vital for daily tasks since it allows for a wide range of motion. Shoulder injuries account for more than four million visits to the doctor each year, making shoulder pain one of the most common orthopedic issues in the United States. Inflammation, instability, arthritis, or a fracture can all cause shoulder pain or reduced function.

Medical City Children’s Orthopedic and Spine Specialists specialize in the treatment of shoulder injuries and disorders. Our board-certified orthopedic doctors are experts in making accurate diagnoses and developing individualized treatment plans for each patient. Conservative treatment methods, including injections or physical therapy, may be available, as well as sophisticated surgery to restore function to this vital joint. If your shoulder is preventing you from living an active lifestyle, schedule an appointment with one of our shoulder specialists at Medical City Children’s Orthopedic and Spine Specialists.

Shoulder Injuries

Shoulder injuries usually occur in the shoulder joint. Injuries that occur as a result of one particularly traumatic episode are referred to as acute injuries. In fact, when children’s skeletons are still growing, acute injuries can occur. Sometimes children’s injuries can affect the growth of the bone by injuring the growth plate. For example, shoulder growth plate fractures can occur when a child falls on the shoulder or the outstretched hand. These fractures commonly involve the upper part of the humerus bone or the clavicle. Sometimes, they are in fact clavicle fractures. Normally, growth plate injuries happen because the growing cartilage/bone become the weakest structure compared to the surrounding shoulder ligaments. Most growth plate fractures heal without complications, but these injuries often require special attention to avoid future problems with growth.

A parent’s first stop when their child has a broken shoulder bone and is in pain, is to ensure the child gets evaluated by a pediatric orthopedic physician. A pediatric Orthopedic with several years of training, like those at Medical City Children’s Orthopedic and Spine Specialists.  Our experienced surgeons understands growth plates and how to address them when contemplating the right diagnosis and treatment. Other examples of acute injuries to the shoulder include dislocation or  separation (AC Sprain). Either of these two injuries can occur with a blow to the shoulder or with a fall on the outstretched arm. Shoulder dislocations can result in a cartilage tear in the shoulder, otherwise known as a labral tear.

Overuse Injuries

Thus, injuries that occur over time because of repetitive activity are known as overuse injuries. For instance, Little League Shoulder also referred to as chronic kids’ shoulder pain, occurs in a ball-throwing sport. For example, a shoulder injury in a baseball player may be related to overuse and inflammation. If this condition happens around the growth plate in the upper part of the humerus bone is also referred to as proximal humeral epiphysiolysis.

Secondly, overuse injuries can also occur in the soft tissues of the shoulder (tendons, ligaments, capsule, etc.) and growth plate. Depending on the symptoms, doctors may refer to this condition as the following:

  • Rotator Cuff Injury
  • Rotator Cuff tendonitis
  • A Rotator Cuff impingement
  • Rotator Cuff tear
  • Rotator Cuff problem

Some young athletes suffer from recurrent shoulder instability that interferes with their ability to continue with their sport or daily activities.

Shoulder Pain Symptoms

Usually, a child or teenager’s shoulder pain and swelling occur after a traumatic injury. The pain may occur in a specific area or to a specific particular location. Also, severe pain, numbness, tingling, and restriction of range of motion may indicate a more serious injury. Additionally, chronic (or overuse) injury may present more gradually, with more vague complaints of pain that are made worse with overhead activity. Overhead athletes may notice a decline in their performance due to the pain. 

Girl with sling on her arm
Boy with hurt shoulder

Shorter Recovery Times

“Hospital stays for my patients after surgery are shorter than most. I prepare the child for the surgery in advance. The preparation helps the children recover quicker after surgery, shortening their hospital stay. This may be a win-win for the children and their families.” Shyam Kishan, MD

Shoulder Surgery

In conclusion, consulting a pediatric orthopedic specialist is warranted when pain and swelling persist when using one of their arms. Especially when home treatment such as RICE (Rest, Ice, Compression, Elevation) did not help the symptoms.  If your child is unable to return to activities or sports. Or if he or she has joint swelling, locking or instability, seeking timely professional assistance becomes essential. Consulting a pediatric orthopedic professional is especially important if your injured child is still growing. In summary, injuries that occur near the growth plate can be challenging to recognize. Finally, appropriate treatment is necessary to ensure adequate management and successful healing.

Medical City Children’s Orthopedic and Spine Specialists’ board-certified physicians specialize in a growing skeletal system. This includes the diagnosis and treatment of a wide range of injuries that affect school-age athletes. Subsequently, should surgery become necessary required, our pediatric orthopedic physicians will discuss specialized, age-appropriate, and minimally invasive surgical options.

Services available:

  • Surgical and non-surgical treatment of musculoskeletal injuries/sports injuries
  • Full-spectrum orthopedic care: complex fractures, ligament and cartilage trauma/injury, limb deformity, hand/upper extremity conditions, spine, and hip disease/conditions)
  • State-of-the-art EOS low radiation X-ray (new imaging technology with low-dose radiation and enhanced clinical imaging)

Our experienced and skilled physicians at Medical City Children’s Orthopedic and Spine Specialists diagnose and treat shoulder conditions.

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at four
convenient locations: Arlington, Dallas, Frisco and McKinney.