Shoulder, elbow and hand
Every third sports injury affects arms and hands. The shoulder joint is often affected in accidents with mountain bikes or snowboards.
The collarbone is especially at risk whilst mountain biking or snow boarding. Falling on the shoulder can result in a fractured collarbone. This injury is very painful and not completely harmless, because often a chipping of the bone occurs. Thereby the vessels under the collarbone may be injured. Most frequent is a fracture of the collarbone in the middle of the bone shaft, sometimes near the beginning of the sternum or at the outer end.
Often a visual diagnosis is sufficient, but a fractured collarbone is not always recognized immediately. The radiological examination provides information.
➠ First Aid
It is important to hold the injured person still at the accident site, to prevent a state of shock. A triangular scarf provides support for the arm.
Many collarbone fractures can be treated without surgery. In using a „rucksack bandage” the shoulder is pulled backwards and the fracture is stretched. A drawback of this treatment is the two weeks continuing pain and the physical handicap. If the bandage is removed in the meantime for personal hygiene, a shifting of the fracture may occur. If there is a decreased blood circulation in the arm the patient has to undergo surgery. The bone is set and stabilized by using a plate. However a noticeable scar is left.
Dislocation of the acromioclavicular joint
By falling on the shoulder during certain types of sport (cycling and motorsport, judo, handball, snowboarding, ice hockey, horseback riding), a dislocation of the acromioclavicular joint may occur. The severity of the injury ranges from a ligamental strain to a complete rupture of all ligaments in the shoulder area. In the worst case you can clearly see that the collarbone is raised and a lump stands out (piano keys phenomenon).
Severe pain and a swelling in addition to the raised collarbone are often the results of this injury.
➠ First Aid
Bring the arm in front of the body into a relieving posture by using a scarf, cloth or belt. Ice may be used against the swelling.
If the ligaments of the joint are slightly ruptured (grade 1) they are allowed to scar over. Methods of physical medicine accelerate healing. If the ligaments of the joint are completely ruptured (grade 2), but the ligaments between clavicle and coracoid process ot the scapula are intact, an arthroscopy of the shoulder joint is advisable. That is because the so called discus aerticularis which acts as a shock-absorber in the joint often ruptures as a result of this injury. This may cause an arthrosis of the shoulder.
In many cases the strong ligaments between shoulder blade and collarbone will rupture during the dislocation (grade 3). The type of treatment of this injury is not undisputed. A correct position of the shoulder joint can only be achieved by surgery – however connected with a postoperative scar. The pros and cons have to be considered individually. The surgery is not a very large intervention, however is this area very precarious because under the collarbone the large vessels and nerves run to the arm and may be injured. During surgery the ruptured lingaments are sutured and the joint is temporarily stabilized using screws and/or wires.
As long as the stabilizing metals are still inside the shoulder, mobility is significantly limited. If the arm is raised more than 60°, strong demands in the joint will occur. The metals may break. Thus they will be removed as soon as possible. Movable implants have to be removed only when they lead to a foreign body reaction or in the event of an infection. During physiotherapy the musculature is strengthened and the exercise capacity is enhanced. The ability to do sports during which the arms are raised over the head is achieved after 3 months.
During a dislocation the joint surfaces are separated from each other. This dislocation occurs most frequently with the shoulder joint, the most movable joint of the body. The humerus head jumps forward and downward out of its socket – sometimes as well backwards. Thereby often the ligaments or parts of the joint capsule may rupture. Sometimes an injury of nerves or blood vessels may occur. A dislocation of the shoulder is often the case when doing professional sports and leisure sport. The risk is significantly in skiing, football, motorcycling or when riding or when doing all kinds of martial arts.
Severe pain and an obvious inability to move the shoulder joint develop immediately after the sports accident.
➠ First Aid
A specialist for accident injuries should be visited immediately and preferably in a lying position. Never try to set the shoulder joint by yourself!
Before the doctor is setting the shoulder it is necessary to exclude a bone fracture by x-ray examination. Possible accompanying damage may be clarified by carrying out a magnetic resonance tomography.
Dislocated shoulder joint must be set as quickly as possible. However, a damage to the tissue remains and thereby the risk for further dislocations. To prevent a permanently unstable joint situation a surgical intervention is advisable. This may be implemented by using minimally invasive techniques which involve no stress for the patient. With an arthroscopy the severed ligament or the front edge of the joint surface will be fixated either by seams or soluble surgical pins. Thus the severed tissue can heal.
After the surgical intervention the arm is immobilized with a sling bandage. Important: Care must be taken to ensure that the arm is not turned outward respectively raised outward. Nevertheless the rehabilitation already starts at the day after the surgical intervention. Physiotherapy tries to strengthen the muscles which surround the shoulder joint.
Falls during sport are inevitable. However a well-trained muscular system in the shoulder area may reduce the risk for dislocations. It is advisable to let a physiotherapist or experienced fitness trainer show you suitable exercises and to conduct these on a regular basis.
Bones are harder than granite. And yet their physical resilience may be exceeded: Bone fractures caused by falls are common in almost all sport activities. Often it is a fracture of the forearm. Example: Riding a bicycle, losing the balance and trying to soften the fall using the arms.
Every bones fracture causes severe pain after the first minutes of shock.
Often the defective position is visible from the outside. An x-ray examination provides more precise information.
➠ First Aid
The initial treatment at the accident site consists of splinting and supporting the arm - for example with a ski pole or wooden stick. In case of open fractures it is necessary to cover the wound using an aseptic bandage.
If the fracture heals or surgery is needed depends from the kind of fracture. During surgery the bone parts are fixated with a bone pin or plate. Both treatments options have advantages and disadvantages. An advantage of the operation is the considerably quicker subsequent treatment and movability of the arm.
Fracture of the upper arm
A fracture of the upper arm bone during sport is often caused by a fall with immense impact power (skiing). The upper arm can fracture at several points. An injury of the joint surface of the elbow joint may also occur - often during childhood.
In the case of fractures which are not displaced and which are located in the area of the humeral head or at the connection to the bone shaft, the arm may be immobilized for four weeks in a shoulder-arm-bandage. Physiotherapy may prevent muscular atrophy and stiffening of the shoulder.
In the case of displaced fractures in the area of the humeral head, the fractured parts should be stabilized with screw(s) or wires. If there is a fracture in the area of the shaft of the upper arm, it is always recommended to operate because this fracture is very unstable. That means that despite immobilization further displacements or nerve damage may develop. Often there is soft tissue between the fractured parts, which may delay healing significantly, whereby the bone shaft generally requires a longer recovery period.
An intense tennis match and all of a sudden the outer side of the elbow hurts. Primarily amateur players know the pain of the „tennis elbow“. Sometimes the pain develops slowly and increases constantly, until all of a sudden the weight of a coffee cup or a telephone handset is too much. The cause is the overburdening or improper burdening of the muscular system. After a certain time occurs a painful inflammation at the contact point of the muscle. The tennis elbow is not an acute injury, but more an overstrain symptom. Sometimes a change of the used racket, the string or the tennis balls may trigger such a pain symptomatic.
Therefore a careful analysis and cause study is very important. The treatment is based on this. Alongside the medical consultation the MRI diagnosis is necessary.
In the early stages physiotherapy is crucial. Various manual therapy techniques, as well as osteopathy and especially a nuclear spin resonance therapy MBST (see also overloading defects) have proven to be effective. By using an ice back it is possible to ease acute pain. During sleep an anti-inflammatory ointment or curd wraps may help to soothe local pains. Tape bandages may used momentarily to relieve the tendon attachment.
Only when a conservative treatment fails, surgery is necessary. In doing so the tissue is removed during a minor operation and the nerves surrounding the attachment will be severed.
Even after a surgical intervention and with regards to the healing process it is absolutely necessary to carry out physiotherapy. For approximately two weeks the patient will have a physical handicap in his everyday life. After six weeks it is possible to start with gentle physical activity. But only after three month the patient is fit to go in for sports.
A new strain of the muscle insertion has to be avoided. A careful analysis of the daily activities and a check of the tennis equipment are recommended. Preventive stretching may be also helpful.
In case of the so called „golfer‘s elbow“–also called thrower’s elbow – the pain develops on the inner elbow. Often the adjacent flexor muscles of the forearm are rock-hard and also associated with pain. A loosening of the collateral ligament is by no means rare.
Alongside with chronical pain develops an increasing weakness of the wrist. A lowering of the hand against resistance as well as an inward rotation of the outstretched hand is extremely painful.
Inflammation and/or loosening of the collateral ligament may be determined by using a magnetic resonance examination.
During the acute phase it is possible to give pain-relieving medications and as well cortisone injections. But this is not to be seen as a permanent solution. Is a freedom from pain not achieved after several months by using physiotherapy, a particular training of the muscles and anti-inflammatory measures, surgical intervention is inevitable. Often the loosened collateral ligament is responsible for a failure of the therapy.
Surgery on the inner side of the elbow is significantly more extensive and more complex than the surgical intervention on the outer side. Hereby the ligament apparatus must be reconstructed. Sometimes a replacement with an upper arm tendon is necessary. An active athlete has then to undergo about six months of therapy and rehabilitation before he may consider to go in for sports again. Therefore this operation is done only in extreme cases.
Avoid acute and chronic overstress of the arm muscles.
A typical injury resulting from skiing is a rupture of the ulnar collateral ligament within the thumb basal joint. This is caused when the bent thumb gets caught within the loop of the ski pole. By high speed during skiing high forces are released, which may lead to an injury of the collateral ligament in the joint. Here the ligament itself may rupture or the ligament may be detached with its bony anchoring from the bone. Thus this injury is also called „skier’s thumb“.
The loosening in the joint is immediately obvious. It is not possible to hold something between the thumb and the forefinger.
Careful evaluation by means of an MRI examination is important.
If the ligament with its bone attachment is severed, it is possible to achieve a sufficient stability by using a thumb splint for about four to six weeks. The bone fragment will heal and thereby stabilize this so important thumb basal joint. In the past plaster casts were used. Nowadays there are modern splints which cover the wrist and fixate the thumb.
If there is a dislocation of the bone fragment or a rupture of the ligament, then surgery is advisable. Doing this, a small cut above the ruptured ligament will be made. A large bone fragment may be fixated by using a screw. If the ligament itself is severed from the bone, a small titanium anchor will be recessed into the bone. The ligament is fixated on the bone. To avoid a persistent disability, the thumb must not be strained to early.