Soft tissue injury of the shoulder

A soft tissue injury is an injury that is sustained to the muscles, tendons and ligaments that are found in and around the joints in our bodies.

A common reason for someone to seek treatment for a musculoskeletal problem is for injuries that have occurred to the shoulder.

The shoulder is made up of four separate joints:

  1. The glenohumeral joint is the ball and socket joint that connects the humerus bone (upper arm bone) to the scapula (shoulder blade).
  2. There is then the acromioclavicular joint which is the attachment between the end of the clavicle (collarbone) and the scapula.
  3. The sternoclavicular joint is where the sternum (breastbone) and the clavicle join.
  4. And finally the scapulothoracic joint is the joint between the scapula and the ribcage.

All of these are connected by a multitude of ligaments and function by various muscles which are attached by tendons. 

A common injury to the shoulder is a rotator cuff sprain or tear. The rotator cuff is made up of four important muscles that stabilise, control and move your shoulder joint. These muscles are called supraspinatus, infraspinatus, teres minor and subscapularis. The rotator cuff can be injured at the tendons, where the muscle attaches to the bone, or in the muscle bulk.

With a rotator cuff injury you can experience pain, weakness and a lack of range of movement. The severity of the symptoms will depend on the severity of the tear.

If a muscle has experienced a full thickness tear there can be a complete loss of movement in a certain direction. This can then require surgical intervention to repair this tear.

The labrum is a fibrocartilaginous rim that attaches around the glenoid (socket) of the shoulder. The actual socket of the shoulder is fairly shallow so the labrum helps to deepen it and therefore makes the joint stronger and more stable. It is a thick structure not dissimilar to the meniscus in the knee.

You can sustain an injury to the labrum in the shoulder, either from a trauma or sometimes from throwing or pulling injuries.

If a labral tear is present then you may have feelings of instability in the shoulder, decreased range of movement and strength and also an increased risk of actually dislocating the shoulder.  

Ligaments are short tough bands of fibrous connective tissue. There are many ligaments found in the shoulder due to the number of joints involved in the shoulder complex. They are attached to bones or cartilage and are responsible for holding bones together and stabilising the joints.

Although ligaments are relatively strong and rigid by nature, it is possible to injure them.

Ligament injuries, also known as ligament sprains, are caused when the fibres become stretched or torn, or even when a ligament completely ruptures. The worse the sprain or injury the more it will affect the ligament.

Ligaments sprains or injuries can be classified into three grades: 

  • Grade 1 - is a stretching of the ligament or very mild tear. There is little to no instability of the joint resulting from this type of sprain and whilst there may not be much pain or inflammation, a mild sprain can increase the risk of re-injury.
  • Grade 2 - is a more severe but still incomplete tear of the ligament. This results in some joint laxity or loss of stability. Swelling and bruising are usually present with this grade of ligament injury and use of the joint can be difficult.
  • Grade 3 - is a complete tear or rupture of the ligament. This will result in severely swelling, bruising and bleeding under the skin. As a result of a grade 3 ligament injury the joint is unstable and unable to bear weight resulting in a severe loss of function. 

In your joints there are many fluid filled sacks found called bursas. These bursas are there to help cushion and lubricate, therefore helping to reduce the friction in a joint. In the shoulder you have several bursas however there is one in particular called the subacromial bursa that can become inflamed.

This inflammation can be due to an impact injury to the shoulder or by repeated micro-trauma from an over-use injury. It can be treated conservatively with physiotherapy or possibly with a corticosteroid injection. Sometimes if this fails they can be surgically removed.

Soft tissue injuries can be sustained by three main ways; trauma, over-use and degeneration. The prevalence of how injuries occur usually depends on age, leisure activities and general health.  

Trauma to the shoulder can occur in a variety of ways. One common trauma is when a person experiences a fall. Many injuries to the shoulder are from direct impact from the fall or falling onto an outstretched arm. Another possibility is after a road traffic accident, either from impact, the seat belt or airbags.

A large number of soft tissue injuries are from a sporting injury, for example, a tackle in rugby, a fall in skiing or strain from weight lifting. Or finally it can be possibly an accident at work or in the home. 

Other reasons for soft tissue injuries to the shoulder are from over-use. Tendinopathies or ligament injuries can be associated with over-use. The most common activities associated with this are overhead activities such as throwing or pitching.  

Degeneration is another cause of soft tissue injuries in the shoulder. It is a normal part of the aging process and does not always cause pain or dysfunction.

Your recovery and healing time from a soft tissue injury will all depend on the severity of the damage caused. Treatment for the injury can vary from simple rest and ice to surgical intervention.

Grade one level soft tissue injuries normally heal in one to two weeks and don't require much intervention.

Grade two level injuries can take three for four weeks to recovery and sometimes need more assistance. However grade three level injuries may require more intentional intervention and possibly surgery. These will then take longer to fully recovery and will vary depending on any complications.

Overall, recovery will always depend on the individual's age, fitness and general health. If a person has any co-morbidities such as diabetes, their healing times can be a lot slower. A person may also find with degenerative conditions that they have to learn to manage the pain if they do not merit surgical intervention. 

RICE is a common abbreviation used for the treatment of most soft tissue injuries, normally injuries that do not require surgery. It stands for rest, ice, compression and elevation. These factors all help aid the reduction of swelling, bruising and pain that are often found with soft tissue injuries. This commonly carried out straight away after an injury for the first few days.

Physiotherapy can also aid in the recovery of soft tissue injuries in the shoulder. After an examination and diagnosis, your physiotherapist can give you advice and exercises to aid in the healing of your injury and the rehabilitation of it afterwards. They will aim to recover full range of movement, strength and function of the joint.

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Circle Health Group, 1st Floor, 30 Cannon Street, London, EC4M 6XH