Footy shoulder injury

[The Full Nelson]

I'm a physio myself, and I injured my right shoulder about 6 weeks ago, and just want some opinions and advice.

I was at (Australian Rules) Football training, and was practicing head-on tackling. I had my arms stretched out in front of me, and copped a blow to my hand, which pushed my right shoulder back into it's socket. I felt and immediate clunk, but no dislocation. My arm felt dead for about 1minute, and very weak, not to mention about 8/10 pain.

I retained full AROM flexion, rotation, but had about 50% hand behind back. It was not tender to palpate. The pain was deep, intermittent, and sharp. Aggs were hand behind back, and sleeping on the painful side.

Now, I don't notice it, until my hand is behind my back (ext, IR). My HBB is about to the inferior angle of my scap (P1), compared with to the scapular spine on my left side.

I have subluxed both shoulders once each. My brother has had surgery on a chronically unstable shoulder. I am 27.

Thoughts on what exactly I injured?
Thoughts on treatment?
Cheers,

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[theshoulderguy]

Hi TFN, the most vulnerable structures are the glenoid, the labrum, the superior biceps anchor to the labrum and of course the rotator cuff tendons and muscles. It is hard to say exactly but a lack ROM or pain with IR or HBB could be related to a pathologic or inflamed biceps tendon and/or superior labrum (SLAP), pathology or weakness of subscapularis, or just protective spasm and inhibition within the rotator cuff as a result of the trauma to the shoulder. Your ROM despite the pain you experience is very good compared to myself say for example. Based on your brief history and that of your brother you may be one who is susceptible to ongoing shoulder instability especially if AFL is your game. In the absence of significant pathology the activation, control and then strengthening of the rotator cuff is the key to shoulder stability. Your cuff right now will be inactive, inhibited and only partially functional during active movements and will struggle to control those movements at end of range positions. The best advice I can give is start now but also don't forget the scapula as it's position during cuff loading is very important to achieve stability also. At the end of the day you may need someone who is solely focused on the shoulder for the best results.
All the Best!
Luke

[HeidiMills]

My thoughts are also a labrum injury, also injury to the rotator cuff shouldn't be overlooked. Start isometric r/c strengthening alongside massage therapy. Also postural muscles such as lower traps and subscap should be worked to ensure good scapulothoracic rhythm.
You can find more on this here: Common Causes of Shoulder Pain / Injuries

[alophysio]

hi,

1. I was thinking Labrum as well. However, if it isn't progressing like a labral tear, then the next area to look at is the thorax and the thoracic rings...As it was an apparent AP injury, then you also want to check your posterior shoulder instability tests.
2. Depends on what is wrong. In my opinion, you need to find the supported/active-assisted/MWM type of movement to confirm what is wrong. E.g. if holding the humeral head anteriorly during HBB helps to inc your range, then you need posterior control etc. Don't forget that HBB includes SC and AC joints as well (towards EOR)

All the best and let us know how you get on

[msk101]

Another thought, ??impact posteriorly to the joint if you've had your arm forwards and taken a solid hit... i'd get an xray to check for compression injuries of the humeral head - just to clear something like that if it's not labral in progression.. check for Hill-Sachs Reverse lesions as this could be similar to a posterior dislocation injury with the impact you describe and your arm out stretched, shoulder flexion and some degree of internal rotation if you were defending a head on tackle. Just an idea though...?

msk 101
let us know how it goes!