Shoulder Injuries Caused By Force and StressIn this article, orthopedic surgeons discuss the evaluation and treatment of five neurologic conditions that can affect athletes. All are seen in players involved in repetitive overhead or throwing activities. They include:
Pain, weakness, or other symptoms of the shoulder from any of these problems occur as a result of injury to the neurovascular bundle. This bundle is a group of nerves and blood vessels that travel from the spinal cord to the neck and down the arm. Extreme force and stress on the shoulder can cause damage to this bundle.
In order to diagnose and treat these conditions, the surgeon must understand the anatomy and recognize the type of injury that can cause each one of these problems. Patient history, symptoms, and clinical findings are key to making the right diagnosis.
When neck and arm pain occur together, the doctor must ask about trauma, cause of symptoms, and the presence of other symptoms. Pain at night with certain positions is more likely to be caused by shoulder problems. A lack of tenderness in the muscles around the shoulder points to a neck problem. Range of motion in the neck and shoulder should also be compared.
Specific tests can help sort out the exact cause of the problem. For example, X-rays, MRIs, CT scans, and EMG studies offer a wide range of different information. The doctor can also conduct many different hands-on tests to help identify the specific nerve(s) involved.
Treatment for all of these problems is nonsurgical at first. Pain relievers, rest, and change in activity are advised. Many patients benefit from physical therapy. The therapist can help with pain control, muscle strengthening, and nerve gliding. For patients with more than one problem, the area of greatest symptoms is addressed first.
Symptoms that persist beyond the expected time for healing may require surgery. Decompression or removing bone from around the nerve may be needed to take pressure off the nerve tissue. Sometimes cervical spine fusion is needed to stabilize the neck. Surgery to transfer one muscle to function for another may be needed when there is permanent damage to muscles.
The authors conclude that an accurate diagnosis made as quickly as possible yields the best results. Recovery from neurologic problems in overhead throwing athletes that affect the neck and shoulder can take a year or longer. Early treatment may be able to return the athlete to sports activities sooner than later.
Soheil M. Aval, MD, et al. Neurovascular Injuries to the Athlete's Shoulder: Part I. In Journal of the American Academy of Orthopaedic Surgeons. April 2007. Vol. 15. No. 4. Pp. 249-256.
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