The Shoulder Joint

Jonathan Hersch, M.D. { Orthopaedic Associates USA }

The shoulder joint is your body’s most mobile joint. It can turn in many directions, making activities such as throwing a football or making a tackle seem effortless. Two injuries that can commonly occur during football include a dislocated shoulder and a separated shoulder. These two very distinct injuries are commonly confused but have very different injury patterns, treatment and outcome.

The shoulder joint consists of the humerus and a socket called the glenoid. It is a ball and socket joint with a large degree of motion. When the ball comes out of the socket this is called a dislocation. A partial dislocation or subluxation can also occur when the humerus only partially comes out of the socket. Both partial and complete dislocations cause pain and unsteadiness in the shoulder. With repeated injury the shoulder can dislocate time and again giving you what we call chronic shoulder instability.

The shoulder joint can dislocate forward, backward or downward. The most common type of shoulder dislocation is when the shoulder slips forward, otherwise known as anterior dislocation. This can happen during tackling or throwing a football. When this occurs, the shoulder will be difficult to move in any position. A prompt reduction should be performed however; if a fracture is suspected then immediate x-rays are needed. After a first dislocation it can take several weeks to return to play.

When the shoulder dislocates, ligaments or tendons in the shoulder may tear. Very rarely the dislocation may damage nerves. After the shoulder is reduced a sling is provided for comfort. Rehabilitation can help prevent the shoulder from dislocating in the future. If the shoulder dislocation becomes a chronic condition, a brace, which can be attached to the shoulder pads under a uniform, can sometimes help. However, if therapy and bracing fail, surgery may be needed to repair or tighten the stretched ligaments to hold the joint in place. Unfortunately athletes under the age of 20 have a very high redislocation approaching 80% in some reports.

A separated shoulder is a common injury that can occur when a football player falls and lands on the tip of the shoulder. It is an injury to an area of the shoulder region called the AC joint. The injury can cause a partial or complete tear of one or both of the main ligaments that connect the collarbone to your shoulder blade. The diagnosis can be made after injury by a physical examination. The shoulder is initially difficult to move becuae of pain, but usually a player can return within a week or two. Rarely does this require surgery or become a chronic problem. It is important to see an orthopaedic surgeon after s suspected AC joint injury for a x-ray, a complete physical examination and recommendations for return to play.