Post Traumatic Shoulder Injuries: Rotator Cuff and Impingement Syndrome
By Richard H. Adler
April 16, 2008
Three major bones join to form the shoulder joint: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). Four major muscles and their tendons attach to and wrap the front, back, and top of the shoulder joint (subscapularis, supraspinatus, infraspinatus, and teres minor). It is the combination of these muscles and tendons which create a capsule surrounding the three major bones (joints) that compose the rotator cuff. These muscles and tendons hold the humerus in the shoulder socket and allow for the shoulder to move with the greatest range of motion of any joint in the human body.
A traumatic injury to the shoulder capsule occurs when the tendons or muscles get torn. These traumatic tears can be either a partial or complete (fully through the tissue) tear. The symptoms of this injury may include pain upon movement of the shoulder, pain with arm exertion, pain when laying on the side of the damaged shoulder, and/or loss of strength of the affected arm. More severe rotator cuff tears will cause constant aching and pain.
Traumatic tear of the rotator cuff likely result from acceleration-deceleration and rotational forces applied through the arm to the shoulder joint structures. This can occur in a number of ways such as when the occupant of a car is holding onto the wheel bracing for an impact or when a pedestrian or cyclist falls and uses their arm(s) to lessen the impact of the fall.
A rotator cuff injury is often accompanied by impingement syndrome, which occurs when the rotator cuff tendons rub against the “roof” of the shoulder joint, known as the acromion. Disruption of the joint structures and attendant edema (swelling) can cause the rotator cuff tendons to rub against the acromion causing painful symptoms. Sometimes an individual can have a shoulder joint that is degenerating from age or wear and tear but not have any pain or limitations. This asymptomatic impingement syndrome can become symptomatic following trauma to the shoulder.
Rotator cuff tears and impingement syndrome are often first treated conservatively (physical therapy, chiropractic, massage therapy) intending to return mobility to the joint and strengthen the supporting muscle structures. Ongoing pain persisting after conservative therapies might indicate the need for orthopedic surgery to address the tear and/or impingement syndrome.
Shoulder surgery is usually accompanied with arthroscopy, where the surgeon can visualize the joint through small incisions. If there is impingement of the tendons, the surgeon may do an acromioplasty. This surgical procedure decompresses the rotator cuff by shaping or removing bone spurs, to increase space between the tendons and the surface of the acromion.
If the tendon is torn, it may be repaired through the arthoscopic procedure or sometimes will require an incision to better perform the necessary repair. The repair consists of suturing together the tear or reattaching the tendon to the bone.
Depending upon the patient, the extent of injuries, and the amount of surgical repair necessary, the post-surgery healing time can be from 60 days to six (6) months or more. Regardless of post-surgery healing time, recuperation from these surgery is an inconvenient process. Post surgery rehabilitation most often includes conservative manual therapies such as physical therapy, chiropractic care, and/or massage therapy to return mobility and strength to the repaired shoulder.
Physical trauma leads to treatment bills, time loss from work, transportation costs to and from the health care provider’s office, and of course, pain/discomfort and loss of enjoyment of daily activities. The attorneys at Adler Giersch have the in-depth medical, legal, and insurance claim knowledge needed to best represent individuals with their physical, mental and financial recovery from traumatic injuries in automobile, bicycle, motor cycle, trip and fall, dog bite or other types of incidents. Call or email for a free consultation with an Adler Giersch personal injury lawyer.