Shoulder injuries occur as a result of both acute trauma and chronic overuse and affect both bony and soft tissue structures. Acute injuries as a result of falling or collision are seen mainly in collision, contact, and extreme sports, such as hockey, football, snowboarding, and skateboarding. Overuse injuries are becoming more frequent as a result of year-round competition and sport-specific training. Overuse injuries are seen commonly in sports such as swimming, baseball, volleyball, softball, and tennis. Shoulder pain occurs in 40% to 80% of swimmers and 50% to 95% of baseball players (Starkey, 2002).
Overuse injuries result from microtrauma from repetitive movements of large rotational forces. They are often associated with joint looseness, mobility impairment, or muscle imbalances. Several risk factors contribute to such injuries. These risk factors include poor mobility, muscle weakness, muscle imbalance, and shoulder blade asymmetry. Additional risk factors in children and adolescent athletes include open physeal (growth) plates, joint laxity, and underdeveloped musculature.
Injury patterns to the athlete's shoulder are sport specific. In football, the shoulder is the second most commonly injured body part, next to the knee. Shoulder injuries are most often shoulder dislocations, shoulder separations, and collarbone fractures. Bicycling results in many shoulder injuries, usually collarbone fractures and shoulder separations from falling on the shoulder. Shoulder injuries are the most common injury to the upper extremity in wrestling, with shoulder separations being the most common. Repetitive microtrauma frequently results in multidirectional instability in swimmers and gymnasts (Prentice, 2008).
Fractures are described by their location, the degree of displacement, and whether or not the bone has broken through the skin. In lay terms, it is sometimes assumed that a break is more serious than a fracture; to a physician, both refer to the same thing. A fracture that is incomplete or not fully through the bone may be a stress fracture, which often results from overuse in the foot, leg, or hip of a runner, for example. A complete fracture that is fully through the bone may be described as either nondisplaced (hairline crack) or displaced (the two parts not aligned), ranging from minimally displaced to widely displaced. If a bone is broken into many pieces rather than cleanly, it is referred to as a comminuted fracture. The former term for a broken bone that has gone through the skin was compound fracture; now this is described as an open fracture. A fracture where the bone does not pierce the skin is a closed fracture. Thus, a person with an open, widely displaced, comminuted tibia fracture has a shinbone that is broken into many pieces, is badly out of place, and has gone through the skin.
Fracture healing varies by age, location, severity of the fracture, and treatment method. In general, children's bones heal much faster than those of adults. In a baby a long bone may heal in a few weeks, whereas in a 6-year-old child the same bone may take 6 weeks and in an adult 6 months to fully ...