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Shoulder Ligament/Tendon Strain

The shoulder is a ball-and-socket joint that consists of several interconnected parts. The acromioclavicular (AC) joint connects the upper part of the shoulder blade to the collarbone, or clavicle. The glenohumeral joint connects the shoulder socket, or glenoid, which extends from the shoulder blade, to the arm bone, or humerus.

The shoulder’s flexibility can make it prone to injury. This often happens when stress is placed on the tissues that stabilise the shoulder—the muscles; the tendons, which anchor muscle to bone; and the ligaments, which connect bones. The most common shoulder injuries are sprains, strains, and tears.

A separated shoulder or acromioclavicular joint injury is sometimes referred to as a shoulder sprain. The AC joint is the area where the acromion which is the bony projection at the top of the shoulder blade meets the clavicle or collarbone. In this injury, the ligaments that support and stabilize the shoulder are stretched or torn, and the bones of the AC joint become dislocated or separated. Common causes of a shoulder sprain include trauma directly to the shoulder from a car accident or a fall onto an outstretched arm.

Shoulder sprains are separated into grades, depending on the extent of damage to the ligaments and the degree of separation between the clavicle and the acromion.

– In a Grade 1 sprain, the ligaments of the AC joint stretch or partially tear but the bones do not separate. Mild pain and swelling may interfere with normal daily activities such as putting on a coat.
– In a Grade 2 sprain, ligaments tear, causing pain and swelling.
– In a Grade 3 sprain, the AC joint becomes completely separated. Tears in the AC ligament and the nearby coracoclavicular ligaments which connect the shoulder blade to the clavicle cause the collarbone to dislocate. This leads to bruising, pain and swelling that can prevent one from performing usual activities. The dislocated collarbone usually appears as a bump on the shoulder.
– In Grades 4, 5 and 6, sprains are more severe and less common. In these injuries, ligaments tear, the AC joint separates and muscles detach from the collarbone.

A shoulder strain is a stretching or tearing of a muscle or tendon in the shoulder. It can happen when the shoulder remains in one position for long periods of time such as when carrying a heavy backpack over one shoulder or having poor posture while typing. Playing sports that require repeated overhead movements of the arms, such as swimming or tennis, also increases a person’s susceptibility to shoulder strain.

A shoulder tear is an injury to the soft tissues that give the joint range of motion and stability. A tear can occur in the tendons, the muscles, or the labrum (a rim of fibrous tissue that lines the glenoid). A tear may be partial or it may sever a tendon, muscle, or the labrum completely. Over time, small tears in a tendon can lead to a bigger tear. Shoulder tears can be caused by repeated use or by a sudden injury. Years of repetitive arm motions performed during sports, chores, or jobs can lead to a tear. Athletes who play sports that require repetitive motions, such as baseball, tennis, and weightlifting may experience a shoulder tear. A tear can also occur if one breaks a fall with an outstretched arm. Examples of such tears include rotator cuff tear, biceps tendon tear, and labral tear.

If a rotator cuff tear is suspected following a trauma, seek the attention of a physical therapist to rule out the possibility of serious life- or limb-threatening conditions. Once the serious injury is ruled out, your physical therapist will help you manage your pain and will prepare you for the best course of treatment. A physical therapist can also help manage the symptoms of chronic rotator cuff tears as well as improve how your shoulder works. For large rotator cuff tears that cannot be fully repaired, physical therapists can teach special strategies to improve shoulder movement. However, if physical therapy does not improve your function, surgery may be recommended. If in doubt, seek professional advice.

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