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The shoulder injuries in the sport are much more complicated than it seems. How to understand, after which you can continue the match, and where does the operation need?

"In the news or club reports, we often see the laconic news ""shoulder injury"", but often everything is not so simple: under this wording there may be a huge number of shoulder injuries and a shoulder belt. Tactics of treatment can be very different with different severity of the same injury. For example, we will analyze a typical injury in contact sports - damage to the acromial-clearable joint.

A little anatomy

Acromal-key joint (AKS) is a place of compound of acromion, one of the processes of the blades, and clavicle. This joint is needed to make the maximum volume of movements in the shoulder joint: first, it is the point of ""the stop"" of the clavicle that does not give shoulder too close to the chest. In such a retractable position, the hand can make the maximum volume of movements, as it will not interfere with neither a chest, nor the bone of the shoulder belt. Secondly, the compound of the clavicle and the blades increases the mobility of the blade, which allows you to make a greater volume of movements, using how the lever is already the spatula itself, since most of the muscles of the shoulder belt are attached to it.

The capsule of this joint is quite thin and without the tendons of the muscles of the shoulder belt and other ligaments, it would simply be able to perform their function. Such interrelation has two sides: with one this allows us to lift a large weight with one hand, transferring part of the load on the shoulder belt, on the other - if the load is too big, that is, the risk that it is in this place that the injury will happen in the first place.

Mechanism of injury

From jerks and other injuries, the joint insures a sufficiently large amount of muscles, but not always from direct strike. All the surrounding joints of the structure is much more and more stronger, so with direct contact, for example, falling on the shoulder, often does not withstand exactly the AKS. Such a trauma is typical with the unsuccessful landing right on the shoulder due to the high speed or foul rival.

For example, everyone remembers Foul Sergio Ramos on Salah. Then many have thought that the defender of Real walked Mohammed right shoulder, which grabbed, but it was not. In the screenshot you can see that Salah falls with all the body on the left shoulder, and Ramos also adds part of its own. And, by the way, the doctors examined the left shoulder.

Therefore, Ramos's fault here is only that he did not give Salah to group and land more mildly, which was the cause of injury. The doctor at the photo inspects how much the collar is shifted, and also painfully pressing it and, in principle, any impact on the shoulder belt. When the AKS is ruptured, the clavicle, since it does not hold anything already, it rises up - it is almost immediately striking when inspection. If the symptomatics is not so bright, then you can check the symptom of the keys - when pressed on the collar, it fails, as if the piano key, hence the name. It will be extremely painful - a healthy clavicle when pressed almost fixed.

Naturally, such a patient needs to be immediately removed from the game, to introduce an anesthetic, ideally impose a bandage to unload the hand and hospitalize to clarify the diagnosis.

Salah managed to avoid the worst

Mohammed was relatively lucky, such injuries could end in hockey. In the game against ""Carolina Harrrikenses"", the Washington Capitals player Ti Jay Oshu flew into full-time in the opponent's foul and went straight to the hospital with a fracture of the clavicle.

Given the huge speed, multiplied by the weight of the athlete in equipment, no protective outfit would save his shoulder from severe injury, except for a two-meter airbag.

There are less severe cases - Chris Paul after the fall continued the match and even went to the next

In May of this year, Chris Paul failed on the shoulder and the mechanism was very similar to the Salah injury, but in this case everything cost. Doctors checked the symptom of the key and checked there with no shower joint and, after anesthesia, allowed the floor to finish the match on the floor and even go to the next day after 2 days.

In the basketball, the shoulder injury is not uncommon, only the floor itself faced such an injury for the first time in his career.

So what do these cases differ and how to understand when a player can be seated again?

First of all, it is necessary to make an x-ray to assess how damaged by the joint and how strongly shifted the clavicle.

To establish a more accurate diagnosis, you can use x-ray with a load - the patient is given in hand cargo weighing a few kilograms and take a snapshot of both joints. Thus, the doctor sees the degree of shift of the clavicle is not alone, but with the load, which is more reliably, and can compare with a healthy hand. It helps to exclude erroneous diagnostics, as there are individual features that can be taken for dislocation.

The degree of damage is a fundamental moment when choosing treatment tactics. To do this, use Rockwood classification.



I will briefly explain how every degree of damage is different. No offset, stretching AKS, the rest of the ligaments are not affected. As a rule, damage to the first degree is found only on MRI, in the diagnosis of other injuries in this area, or when they did not find anything on the x-ray.

A slight offset up (less than 50% of the joint size), the discrete of the AKS, the stretching of the beak-cleaned ligament (CCS).

Pronounced shift up (100% of the size of the joint), the gap of the AKS and KKS

The same as at 3, but with a shift of the clavicle back, which breaks the trapezoid muscle.

The same as at 3, but the clavicle is stronger than shifted up (up to 300% of the joint size).

The clavicle is shifted down with the rupture of the ligaments described above.

Treatment and return time

The most difficult for solving and diagnostics is 3 degree in Rockwood, but about everything in order. 1 and 2 degree are treated strictly conservatively.

The 1st degree in professional sports, few people consider for a serious injury, and after a small pause in a couple of days and anesthesia, the athlete returns to training. Of course, it all depends on the involvement of their hands, but in general it can be classified as no more than a strong injury.

The 2nd degree is more serious injury. The athlete is freed from loads for 1-2 weeks, again, depending on the sport. Further, with the help of exercises on rehabilitation and physiothery, doctors are struggling with pain, edema and other signs of inflammation, and also strengthen the muscles of the shoulder belt. This should sufficiently stabilize the acromi-clavical joint, so that in 2-4 weeks already return to sports.

But with the injuries of the 3rd degree everything is quite difficult. First, they are very often disguised as easier injuries. On an x-ray without a load, it seems that they are not so significant, but on MRI and you can see the fibers of the stored ligaments. But these fibers will no longer cope with their function and only hold the joint from the exacerbation of the dislocation before damage to the level of the 5th degree.

In such a situation, operational treatment is already necessary, especially if it is a football goalkeeper, a hockey player, a basketball player or any other athlete, where the shoulder is actively involved in the training process. Some studies describe a successful conservative treatment with the help of strengthening the muscles of the shoulder belt, as at a 2nd degree, but it lasts such a treatment of about 8-10 weeks, and accurate numbers, how effective it is, not. Simply put, the rejection of the operation in this case is a rather risky decision.

An injuries of the 4th degree and are topized only with the operation - the clavicle is returned to normal and fixed with the help of metal structures and / or anchors. The technician is very much and they can differ much in different situations, here is an example of one of them.

After such intervention, about 2 weeks goes to fight inflammation, then projected by rehabilitation. Depending on the severity and volume of interventions, the return time is 6-8 weeks and more.

After that, the athlete fully returns to training and can use a hand without any restrictions, and the metal is cleaned after 6-10 months.

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Photo: GettyImages.ru/michael regan, Christian Petersen, Patrick Smith; Frames broadcast"