As one of the body’s major joints, the shoulder is the most dynamic due to its range of motion. But high-intensity sports can put that resilience to the test and make it more susceptible to injury. The force from direct impact or joint strain from bracing a fall can cause serious shoulder injuries. When the speed of skiing and snowboarding meet uneven terrain and changing snow conditions, falls are more likely to happen. The three most common types of shoulder injuries on the slopes are tears, separations, and fractures.
Common Shoulder Injury: Rotator Cuff Injury
Rotator cuff tears are one of the most common skiing and snowboard injuries. The rotator tendon is a collection of four muscles that stabilize the shoulder and support movement. Collisions with skiers, trees, terrain park obstacles, or the mountain can lead to a rotator cuff tear or strain.
Shoulder pain, weakness, and limited range of motion are all signs of possible rotator cuff injuries. Some tears can also cause the shoulder joint to stick or make a clicking noise when you move your shoulder. Pain from overhead motions such as washing your hair is a common sign of a rotator cuff tear.
Rotator cuff tears can worsen over time, so prompt medical attention and diagnosis is important.
Rotator cuff treatments range from anti-inflammatories, steroids, and physical therapy to surgery. The severity of pain and each person’s activity level is among the factors that influence the proper course of treatment. Surgery can improve stability, range of motion, and joint function by reattaching the torn muscle to bone. Activities such as driving, manual work, and even some self-care activities are very limited during the first several weeks as the shoulder recovers in a sling and stabilization is essential.
The AC joint is found at top of the shoulder, where the collarbone and the top of the shoulder blade meet. Impact injuries can cause joint separations or dislocations that can also be painful. Due to the high frequency of backward falls in snowboarding, shoulder separations are more common in snowboarders than skiers. It’s natural to use arms to brace a fall, but when the force from the fall travels through the arm to the shoulder joint, the joint bears the force of that energy.
The severity of this type of shoulder injury ranges by the amount of damage the AC joint incurs, and there are six grades of injury. Surgery is required for ligament tears experienced from more severe separations and is frequently chosen for highly active patients as well as those with physically demanding professions.
- Grade 1 sprains are mild and indicate a slight sprain of AC (acromioclavicular) ligament
- Grade 2 sprains reflect damage to both the AC ligament and the CC (coracoclavicular) ligament. Damage to both ligaments frees the collar bone to move out of place, producing the appearance of a small bump.
- Grade 3 sprains are the most severe and reflect complete tears of both the AC and CC ligaments, marked by a noticeably large bump.
- Grade 4, 5, and 6 are injuries to AC and CC ligaments, including the surrounding musculature, and usually require surgery.
In addition to shoulder separations, the extent of shoulder dislocation can vary. In a partial dislocation, known as a subluxation, the ball portion of the shoulder’s ball and socket joint structure has become partially separated and is treated by pushing the ball back into the socket. Complete dislocations are severe shoulder injuries and reflect the humerus head being completely knocked out of the socket. Younger patients and those diagnosed with shoulder instability generally require surgical correction. Anterior dislocations are more common, but posterior dislocations are common in snowboarding injuries. Almost all shoulder dislocations cause injuries to the labrum (the shoulder’s shock absorber) and sometimes to the rotator cuff as well.
Severe shoulder injuries can result in fractures as well. The three main types of shoulder fractures are clavicle fractures, scapula fractures, and humerus head fractures. Most shoulder fractures are treated without surgery by immobilizing the joint with a sling and limiting physical activity for a period of weeks. If the fracture is severe enough, produces fragments, or is a compound fracture, surgery is required to insert the plates, screws, or rods necessary to stabilize the fracture. Shoulder replacement surgery is also an option for severe humerus head fractures.
Falls are a part of skiing and snowboarding, but falls don’t have to lead to injury. Many injuries can be avoided before you arrive at the slope. Proper preparation includes attention to three key areas: education, equipment, environment. Making good choices about the right level of fitness, the right equipment, the right amount of training, and right degree of risk goes a long way in keeping you upright and on the slopes. Finally, high-intensity sports like skiing also require full attention and good judgment in assessing the conditions, the difficulty of the terrain, and your fatigue level. Always ski or board on terrain that is within your ability so that you maintain control and know when your muscles have had enough.
When to Seek Medical Care for Shoulder Pain or a Shoulder Injury
Shoulder injuries can be painful and significantly limit your activity. If you are experiencing shoulder pain, it’s important to receive medical attention as soon as possible following your injury – even if you are on vacation. Shoulder injuries can worsen so it’s critical that proper diagnosis by a trained orthopedic specialist. The examination will include a physical assessment and imaging (x-rays and MRI scans) to determine the extent of the damage. Many shoulder injuries experience significant improvement in the first several weeks, but, left untreated, the damage and the recovery can significantly increase.
If your day on the slopes leads to shoulder pain, contact the shoulder specialists at Advanced Orthopedic and Sports Medicine Specialists.