Brief Outline of Biceps Brachii Tendon Rupture

Repetitive strain, particularly due to overlifting, can lead to irritation and microscopic tears in the biceps brachii tendon, which connects the biceps brachii muscle to the shoulder joint at the proximal end and the elbow at the muscle’s distal end. A biceps brachii tendon rupture results from sudden trauma to the biceps brachii tendon causing its detachment from the bone. Injury at the proximal (shoulder) end of the tendon is most common. Biceps brachii tendon ruptures can occur from weight lifting or throwing sports, but are generally uncommon, particularly young athletes.

Shoulder Biceps Rupture Symptoms

 

Anatomy and physiology

The biceps brachii muscle is located on the front of the upper arm, and operates over three joints. Its function is to allow bending of the arm and to support loads placed on the arm. This muscle has two parts, known as the long head and short head, both connected to bone via the biceps brachii tendon. Rupture of the tendon prevents the muscle from pulling on the bone, thereby restricting movement. In older individuals, it is often the result of degenerative change in the tendon.

Cause of Biceps Brachii Tendon Rupture

Weakness due to tears in the rotator cuff. Throwing activities. Weightlifting.

Signs and symptoms

Bulge in the upper arm. Inability to turn the palm upward or downward. Sudden, sharp pain at the shoulder.

Complications if left unattended

Generally, little functional loss accompanies rupture of a proximal biceps brachii tendon, as two tendinous attachment occur at the shoulder, one compensating the other in most cases. For this reason, surgery is rarely required and complications are rare, though without proper healing, re-tearing and degeneration of the tendon are more likely.

Treatment

  • Immobilisation for partial tear to the biceps tendon rupture
  • Surgery for full tear

Rehabilitation and prevention

Following rest and recovery of the tendon, flexibility and strengthening exercises should be undertaken to restore full mobility in the shoulder. Avoidance of sudden lifting beyond normal capacity and other sudden violence to the biceps brachii tendon as during throwing sports may help prevent the injury.

Long-term prognosis

Most biceps brachii tendon ruptures resolve themselves without medical intervention if given proper time for healing. In younger athletes with demanding training schedules, surgery may be contemplated to repair the rupture. Tears and ruptures to the distal end of the biceps brachii tendon at the elbow are more rare, but can be more severe, requiring surgery. However, in both cases the prospects for full recovery are excellent.

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Brief Outline of Acromioclavicular Separation

Acromioclavicular separation is a separation of the ligaments that connect the clavicle (collar bone) to the shoulder bones (known as the acromion process). Acromioclavicular (AC) joint injuries generally occur in the course of upper-extremity strength training, various throwing sports, and collision sports (particularly, football and hockey). The injury is common among athletes in their 30’s and 40’s.

 

AC Joint Dislocated

Anatomy and physiology

The arm is linked to the axial skeleton by means of the acromioclavicular joint, which connects the lateral end of the clavicle, and the medial border of the acromion of the scapula. A fibrocartilage articular disc partially divides the articular cavity, and absorbs forces and compression in the acromioclavicular joint is stabilised by anterior deltoid muscle, the trapezius muscle arising from the acromion, and additionally, by stabilising ligaments.

Cause of Acromioclavicular Separation

Fall onto the point of the shoulder. Fall onto an outstretched hand. Direct blow to the shoulder.

Signs and symptoms

Pain, tenderness, and swelling at the AC joint. Deformity of the injured joint. Pain or discomfort during cross-body adduction (turning the injured arm inward toward the opposite shoulder).

Complication if left unattended

Degenerative joint abnormalities, chronic pain and stiffness and limitations in mobility requiring surgery are possible, should the condition not be given prompt medical attention and allowed proper healing time.

Treatment

Immobilisation of the injured arm with a sling.

Rehabilitation and prevention

AC separations of a less severe nature are successfully treated without surgery, though a thorough healing period of 6-8 weeks us generally required, following which, range-of-motion exercises should be used to avoid stiffness. Exercises directed at maintaining strength and stability of the shoulder and upper back muscles may help prevent the injury and use of padding around the AC joint, particularly during contact sports, may help avoid re-injury.

Long-term prognosis

Given adequate healing time and rehabilitation, most AC separations are resolved without surgery. Should surgery be required, risks of infection and continued pain exist, and recovery time for the athlete is lengthened.

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Brief Outline of Shoulder Subluxation

The shoylder complex enables extreme mobility due to its anatomical structure, but provides little stability. Shoulder subluxation is a partial dislocation of the ball-and-socket joint of the shoulder. A group of ligaments securely hold the humerus (upper arm bone) in the socket of the shoulder-blade or scapula. Should these ligaments be torn, subluxation may result, in which the ball of the humerus slips partially out of the shoulder socket.

Dislocated Shoulder

Anatomy and physiology

The shoulder region is actually composed of five joints: the sternoclavicular (SC) joint, the acromioclavicular (AC) joint, the coracoclavicular joint, the glenohumeral joint, and the scapulothoracic joint, where the shoulder-blade glides on the chest wall. The articulation referred to specifically as the shoulder joint is the glenohumeral joint, whereas the other articulations are joints of the shoulder girdle. The structure of the shoulder permits a wide arrange of motion, allowing the positioning of the arm and hand. Instability in the shoulder joint complex, particularly following dislocation, can result in subluxation.

Cause of shoulder subluxation

A direct blow to the shoulder. A fall onto an outstretched arm. Strenuously forcing the arm into an awkward position.

Signs and symptoms

Sensation of the shoulder going in and out of joint. Looseness of the shoulder joint. Pain, weakness, or numbness in the shoulder or arm.

Complications if left unattended

Untreated subluxation can cause wear, and ultimately damage the internal structures of the shoulder, sometimes requiring surgery. Loss of mobility, ongoing pain, and osteoarthritic complications may result from untreated subluxation.

Treatment

  • Physiotherapy
  • Surgery to repair the labrum

Rehabilitation and prevention

Following immobilisation and healing, strengthening exercises should be undertaken. Recovery depends on factors including the athlete’s age, health, history of previous injury, and severity of subluxation. If the shoulder subluxes frequently during activity, significant physical rehabilitation will be needed and possibly invasive surgery.

Long-term prognosis

Normal sports activity may be resumed once a full range of motion without subluxation has been achieved. Prognosis is dependent on the severity of the subluxation and the athlete’s particular history. Subluxation is often due to previous shoulder injury and returning to athletics before full recovery can lead to further and worsening subluxation.

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Brief Outline of Dislocation of the Shoulder

Dislocation of the shoulder may occur when a person falls  on an outstretched hand or during abduction and external rotation of the shoulder. Significant force is required to dislocate a shoulder, unless the athlete is experiencing re-injury. A shoulder dislocation occurs when the upper portion of the arm bone (humerus) pulls free of the socket of the shoulder-blade or scapula.

Anatomy and physiology

While several types of shoulder dislocation exist, the most common is anterior dislocatio, which represents ninety-five percent of all cases. In this dislocation injury, the structures responsible for stabilising the anterior shoulder, including the anterior capsule and the inferior glenohumarl ligament, are torn free from the bone. A compression fracture of the posteromedial humeral head is known as Hill-Sachs lesion. More commonly, avulsion of the anterior glenoid labrum can occur, which is known as Bankart lesion. Most commonly, avulsion of the anterior glenoid labrum can occur, which is known as a Bankart lesion. Both often occur as a result of anterior dislocation of the shoulder.

Cause of Shoulder Dislocation

Violent contact with another athlete or solid object. A fall on an outstretched hand. Sudden, violent torsion of the shoulder.

Signs and symptoms

Severe pain in the shoulder. Arm held away from the body at the side, with the forearm turned outward. Irregular contour of the deltoid muscles.

Dislocated Shoulder

Complications if left unattended

Dislocation of the shoulder causes tearing of the shoulder ligaments, resulting in the shoulder joint becoming less stable. This results in the shoulder capsule being considerably more prone to successive dislocations during athletics. Immobilisation of the shoulder during the healing phase does not fully prevent such re-injury, which may require surgical intervention, since the immobilised ligament often fails to heal in the proper position.

Treatment

  • Realignment or reduction of the dislocated joint.
  • Immobilisation and oral anti-inflammatories

Rehabilitation and prevention

Most initial shoulder dislocations are treated without resort to surgery, although subsequent dislocations may require surgical care, and many athletes suffer a range of disabilities following dislocation. An alternative to surgical treatment – prolotherapy – involves injections directed at the anterior shoulder capsule and the insertions of the middle and inferior glenohumeral ligaments. This may offer better relief from pain, restoration of mobility, and a speedier return to athletic activity. Further, the technique avoids the formation of scar tissue common after surgery.

Long-term prognosis

A large percentage of athletes may be unable to continue sports following a shoulder dislocation without subsequent injuries or the need for surgical treatment. Furthermore, athletes who undergo surgery following shoulder dislocation are often unable to perform at their former level. The alternative method of prolotherapy may offer relief and more effective healing.

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Brief Outline of Fracture (Collar Bone, Humerus)

Fractures of the shoulder usually involve a break in either the clavicle (collar bone) or the neck of humerus (arm bone), or both. Impact injuries involving a sudden blow to the shoulder or a fall are usually responsible. Contact sports including football and rugby can result in shoulder fractures following a violent collision of two players.

Anatomy and physiology

The clavicle (collar bone) is a slender, doubly curved bone that attaches to the manubrium of the sternum medially (the sternoclavicular joint) and to the acromion of the scapula laterally (the acromioclavicular joint). The clavicle protects the underlying brachial plexus, pleural cap, and great vessels of the upper extremity. Clavicle fractures are common, often resulting from a fall on the lateral shoulder or on an outstretched arm. The humerus (arm bone) is the longest and largest bone of the upper limb. It articulates proximally with the scapula (at the glenoid fossa). Fractures to the humerus are generally the result of a fall on an outstretched arm.

Broken Collarbone

 

Cause of Fracture (Collar Bone, Humerus)

Fall on an outstretched arm. Sudden blow to the clavicle. Collision of two athletes in sports, e.g. football.

Signs and symptoms

Severe pain. Redness and bruising around the site of the injury. Inability to raise the arm.

Complications if left unattended

Complications are uncommon, although pneumothorax, haemothorax, and injuries to the brachial plexus or subclavian vessels are possible, requiring medical intervention. Chronic pain due to osteoarthritis may result should the injury be given insufficient time to heal.

Treatment

  • Immobilisation using an arm sling if the fracture is undisplaced
  • Surgery if the bones are displaced

Rehabilitation and prevention

Bones of the clavicle and humerus must first be realigned following fracture, so that proper healing may ensue. Healing occurs while the clavicle and arm bones are held in place with a strap or sling. After healing, physical therapy, including range of motion and strengthening exercises should be undertaken to restore full movement and flexibility.

Long-term prognosis

Most shoulder fractures are successfully treated without resort to surgery, although this is occasionally required for fractures of the clavicle. For less severe fractures, full recovery and restoration of mobility may be expected. In the case of more severe fractures and particularly in older patients, some loss of motion and possibility of osteoarthritis exist.

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