Shoulder Sprain: Classification & Types, Symptoms, Diagnosis, Treatment, Exercise

Shoulder Sprain: This is a pathological condition of the shoulders in which there is rupture of shoulder ligaments resulting in numerous painful symptoms.

in this article, we will discuss about:

• What is Shoulder Sprain?
• Classification & Types of Shoulder Sprain
• Symptoms of Shoulder Sprain
• Diagnosis of Shoulder Sprain
• Treatment for Shoulder Sprain
• Exercises for Shoulder Sprain

A Shoulder Sprain results from a rupture of the ligaments around the shoulder joint. The ligaments are structures, which connect muscles to bone. Any tear in the ligaments may result in pain and decreased range of motion of the shoulders. There is a belief that the shoulder joint is a single joint between the humerus and the torso, but in actuality the shoulder comprises of several smaller joints which are located outside of the arm’s socket. The shoulder ligaments connect four bones, which are absolutely vital to smooth functioning of the shoulder. These bones are:

• The scapula or the shoulder blade
• The acromion
• The clavicle or the collarbone
• The sternum or the breastbone

Any type of sprain that rupture the ligaments in the shoulder usually occurs at the joint called as the acromioclavicular joint which is situated between the acromion and the collarbone. This rupture or injury is also called as Shoulder Separation. Some of the types of Shoulder Sprain are:

Acromioclavicular Joint Sprain: The Acromioclavicular Joint is made up of the acromioclavicular ligament and coracoclavicular ligament near the shoulder at the outer part of the clavicle or the collarbone. They join together the clavicle and the scapula tightly; hence, it requires a considerable amount of force to tear these ligaments. The common causes which can result in an Acromioclavicular Sprain are a direct trauma to the shoulder due to a fall or in competitive contact sporting activities like football, rugby etc. . Shoulder Sprain can also result due to a collision with a stationary object like a pole or a lamppost etc. while skiing or skateboarding etc. Such sprains are quite common in athletes who are involved with high impact contact sports like skiing, football, rugby, wrestling etc. Based on the severity of the injury, Acromioclavicular Joint Sprains are graded into three categories:

• Grade I: In grade I Acromioclavicular Sprain, the acromioclavicular ligament gets ruptured but the coracoclavicular, ligament remains intact and hence the Acromioclavicular Joint overall remains unaffected.
• Grade II: In this type of strain, the acromioclavicular ligament is totally ruptured and the coracoclavicular ligament is partially ruptured. In such instances, the clavicle or the collarbone gets angulated and gets displaced from its normal position.
• Grade III: In this type of strain, the acromioclavicular ligaments as well as the coracoclavicular ligaments are totally ruptured resulting in clavicular separation.

Sternoclavicular Joint Sprain: The Sternoclavicular Joint is situated at the junction where the clavicle or the collarbone joins the sternum or the breastbone. Since this joint is even more secured and well connected than the acromioclavicular joint, thus injury to this part of the joint is very rare. Such injuries mostly occur during motor vehicle injuries where the chest of the driver hits the steering wheel with force or as a result of a crush injury. A sprain to the sternoclavicular joint can also occur in sportsmen involved in football and rugby if they are tackled the wrong way and get kicked in the breastbone directly.

• Grade-I: In this type of tear, there is very mild rupture of the ligaments and the Sternoclavicular Joint remains virtually intact.
• Grade-II: In this type of tear, there is a visible tear between the clavicle or the collarbone and the sternum or the breastbone. There is slight damage to the Sternoclavicular Joint.
• Grade III: In this type of tear, there is severe damage to the ligaments and the Sternoclavicular Joint gets separated and deformed and also there is displacement of the clavicle or the collarbone from its natural position.

An individual with Grade I Acromioclavicular Sprain will have slight swelling along with tenderness at the outer tip of the clavicle. There will also be pain with movement of the arm or shrugging of shoulders. In severe case of Acromioclavicular Joint Sprains, on visual inspection there will be swelling and deformation of the joint with severe palpable tenderness. There will be significant pain with any type of movement of the shoulder.

In cases of Sternoclavicular Sprains, the symptoms experienced are similar to that of Acromioclavicular Joint Sprains except that the location of swelling and tenderness will be in the mid-chest area.

For a diagnosis of Shoulder Sprain, the treating physician will conduct a detailed physical examination of the shoulder comparing the injured to the uninjured shoulder and looking for differences. The physician will look for swelling, deformation, bruises and will also check range of motion. The physician will also palpate the injured site to look for pain and tenderness.

If there is a suspicion on examination of a shoulder sprain or a fracture, then the physician may also order x-rays. In severe instances of shoulder joint injuries, an MRI or a CT scan may also be ordered.

Treatment of Shoulder Sprain is dependent on the category of the sprain.

Acromioclavicular Joint Sprain Treatment: For grades I and II of Acromioclavicular Joint Sprains, the treatment is usually conservative with rest, application of ice to the affected area, use of NSAIDs, like ibuprofen etc for relief of pain and swelling, and immobilization for a few weeks. Surgical treatment may be required for some cases of Grade III sprains, especially where there is significant displacement of the bone.

Sternoclavicular Joint Sprains Treatment: Grade-I and II Sternoclavicular Joint Sprains are usually treated with application of ice, use of NSAIDs, and wearing a shoulder immobilizer for a few weeks. Grade-III sprains are generally treated with a procedure called as closed reduction in which the displaced bone is aligned back into its normal position followed by a period of immobilization for a few weeks for the wounds to heal.

Empty Can Exercise: This exercise is done for strengthening the muscles which are used for abduction and internal rotation of the shoulders. This exercise is done by doing a movement like when taking out liquid from a can. To do this exercise, you need to stand straight with a weighted object in the affected hand. Now, lift the arm to shoulder height as shown in the picture and turn the thumb downwards as if you are inverting a can of liquid. Get back to the starting position slowly and then repeat the exercise once again. Do this about 10 times.

Push-Ups: Push-up exercise, just after getting cleared from the physician for performing exercises, is begun by doing them against the wall and then when you are able to do about 15 push-ups against the wall without aggravation of symptoms then you can advance to doing push-ups from the floor.

Shoulder Extension: This exercise is aimed at strengthening the muscles which facilitate movement of the arm behind the back and in front of the chest. To do this exercise, you need to lie prone on a bench with the injured arm hanging on the side of the bench. Now, lift the arm along the side of the body and then lower it down. Repeat the same maneuver about five times. First do the exercise without any weights placed on the hand and then advance to holding a dumbbell for resistance.

Also Read:

• 8 Causes of Shoulder Joint Pain: Trauma, Arthritis, Sprain, Tendonitis, Bursitis
• Deltoid Strain: Classification, Causes, Diagnosis, Symptoms, Treatment
• Thoracic Sprain: Causes, Symptoms, Treatment, Prevention, Exercises
• Diagnosis of Shoulder Joint Pain: Symptoms, Physical Exam, Investigations, Tests
• Treatment for Shoulder Joint Pain: Conservative, Medications, PT, Surgery