Shoulder injuries can be extremely painful and disabling for the victim. The shoulder is the only joint of the body that rotates and articulates 360 degrees. Surgical repairs, such as repair of a rotator cuff tear, typically call for the patient to undergo physical therapy to restore strength and range of motion. Therapy for the shoulder is often quite painful. Patients who avoid full cooperation with therapy often develop a secondary condition called adhesive capsulitis, or “frozen-shoulder syndrome.” This is a truly painful and disabling condition that requires a subsequent surgery to break loose the adhesions and restore shoulder function. Damage to the shoulder may be isolated to fracture of the bones of the upper arm (humerus), glenoid bone, and the scapula. Any derangement of the bones typically requires surgical repair.
The shoulder or pectoral girdle has no weight-bearing function. The joint structure allows the shoulder to move in more than sixteen hundred positions, providing extensive use and ability for the arms and hands. The downside of the flexibility of this joint is the lack of joint stability and the susceptibility to injury and damage. This ball-and-socket type joint is extremely shallow, with the ball at the upper end of the humerus being 25 percent larger than the socket or glenoid on which it sits. Connective tissue called the labrum connects the head of the humerus to the glenoid. Sudden trauma can easily tear the labrum and surgical repair is necessary to repair this essential connective tissue. Muscles and tendons then cover the bony structure to prevent the shoulder from sliding too far in any direction. This structure is known as the “rotator cuff.”
The rotator cuff functions just as its name suggests. Four short muscles and tendons form a cuff that wraps around the shoulder joint, allowing the arm to rotate through its full range of motion. If the rotator cuff is torn, the patient will experience pain, limited arm strength, and limited range of shoulder motion.
Rotator cuff tears can vary in severity. A slight, partial-thickness tear is often less problematic and can often be addressed through physical therapy alone. A full-thickness tear will prevent proper function of the shoulder. This is also an extremely painful condition until appropriately restored. The most obvious, common symptom of a full-thickness rotator cuff tear is an inability to reach above shoulder level or to perform any meaningful function with the hand when reaching above shoulder level. Severe pain with movement and severe pain when resting on the injured shoulder are also common symptoms of a torn rotator cuff.
While an automobile accident is a common mechanism of rotator cuff injury, these injuries can also result from sports or from repetitive overhead arm movement. The amount of force required to tear the rotator cuff varies depending on the victim’s age, the type of injury, and the extent of degenerative changes in the shoulder joint. Overuse can cause a tear, and a tear can also occur as a result of a dislocation of the upper arm from the glenoid.
Tendonitis of the shoulder is another common cause of shoulder pain. A tendon is a hard fibrous cord that attaches muscle to bone. Tendonitis of the shoulder refers to an inflammation or swelling of the rotator cuff tendons caused by excessive pressure on the acromion (the lump that may be palpated at the top of the shoulder). Tendonitis is typically not caused by sudden trauma. However, there are exceptions and trauma can certainly worsen tendonitis symptoms.
A shoulder dislocation is another common collision-related shoulder injury. The dislocation may be brief and, therefore, not apparent after the bones move back into place. If the shoulder remains dislocated, medical efforts forcing the humerus back into proper anatomical position will alleviate symptoms. Following a dislocation, the shoulder remains vulnerable to reinjury. Ligaments can be torn or stretched during the initial trauma, and the labrum and rotator cuff can also be torn. A full shoulder separation involves the stretching or tearing of the ligaments of the acromioclavicular (AC) joint or the soft tissues that hold the clavicle and scapula together. This condition results from a direct blow to the shoulder or from the patient’s effort to brace for collision impact. Drivers often straighten their arms and brace themselves by clenching the steering wheel to prepare for impact. This can cause severe damage to the wrist and to the shoulder. While the arm is held straight, the arm bones are moved suddenly rearward as the patient’s body comes forward upon impact. This can separate the shoulder joint significantly. There are six degrees of shoulder separation based on the patient’s symptoms.
Early settlements should be avoided in all shoulder injury cases. Insurance carriers often push for early settlements, as they know that shoulder injuries can be persistent. Further, physicians often begin with conservative physical therapy before more expensive diagnostic imaging studies are undertaken. Thus, the true nature and extent of the shoulder injury is often first discovered several months after the accident. Insurance carriers know that an early settlement will allow them to avoid the cost of surgery and their full financial responsibility for medical care costs and pain and suffering.