Shoulder ligament tears

Shoulder Ligament Tears: A Detailed Overview

Any of the ligaments that connect the four bones of the shoulder can be torn or damaged. The most common shoulder ligament tear is at the acromioclavicular joint, often known as shoulder separation. A strong degree of force is needed to damage these ligaments, so usually it is the result of a fall or trauma to the shoulder.

What is a shoulder ligament tear?

A shoulder ligament tear refers to the damage or rupture of the fibrous connective tissues that connect bones within the shoulder joint, providing stability and support. Ligaments are essential for maintaining the proper alignment and function of the shoulder, which is a complex and highly mobile joint.

When these ligaments are torn, it can lead to pain, instability, and a significant reduction in the range of motion, affecting daily activities and athletic performance.

What types of shoulder ligament are there?

The shoulder joint is stabilised by several key ligaments, each playing a crucial role in its overall function. The main ligaments in the shoulder include the glenohumeral ligaments, which are subdivided into the superior, middle, and inferior glenohumeral ligaments. These ligaments are crucial for preventing dislocation of the humeral head from the glenoid cavity of the scapula.

Another important ligament is the coracoclavicular ligament, consisting of the conoid and trapezoid ligaments, which connect the clavicle to the coracoid process of the scapula and help stabilise the acromioclavicular joint. Additionally, the acromioclavicular ligament itself, which connects the acromion to the clavicle, is vital for the integrity of the shoulder structure.

What other shoulder structures are impacted by a shoulder ligament tear?

When a shoulder ligament tear occurs, it often impacts other structures within the shoulder joint due to the interconnected nature of the anatomy. The rotator cuff muscles and tendons, which play a significant role in shoulder movement and stability, can be affected by ligament tears.

The labrum, a ring of cartilage that deepens the shoulder socket, can also suffer damage, particularly in cases where the ligament tear leads to shoulder dislocation. Additionally, the joint capsule, which is a fibrous tissue that surrounds the shoulder joint, may become stretched or torn, exacerbating instability and pain.

With many closely connected structures in the shoulder, it is important to have a professional medical assessment by a shoulder specialist, for a confirmed diagnosis and for the most effective treatment plan.

What causes shoulder ligament tears?

Shoulder ligament tears can result from various causes, typically involving trauma or overuse. Acute injuries, such as a fall onto an outstretched arm, a direct blow to the shoulder, or a sudden, forceful movement, are common causes of ligament tears. These incidents can occur in contact sports such as football, rugby or skiing.

Overuse injuries, on the other hand, result from repetitive stress on the shoulder ligaments over time, which is common in athletes who engage in overhead activities like swimming or tennis. Additionally, age-related degeneration can weaken ligaments, making them more susceptible to tears even with minor trauma.

What are the symptoms of shoulder ligament tears?

The symptoms of shoulder ligament tears can vary depending on the severity and specific ligament involved. Common symptoms include acute pain at the time of injury, which may be followed by ongoing pain and discomfort, particularly during shoulder movements. Swelling and bruising around the shoulder joint are also typical signs.

Patients often experience a feeling of instability or looseness in the shoulder, as well as a decreased range of motion and weakness. In some cases, there may be a noticeable deformity or a popping or clicking sensation with certain movements.

How are shoulder ligament tears and damage diagnosed?

Your London Shoulder Specialist can confirm a diagnosis of ligament damage or a tear after performing several checks. This will be a combination of discussing medical/injury history, a thorough physical examination, and imaging studies. During the physical examination, your London Shoulder Specialist will assess the shoulder’s range of motion, strength and stability of the shoulder joint. Specific tests, such as the apprehension test or the relocation test, may be performed to identify signs of instability or ligament damage.

Imaging studies, including X-rays, can reveal the extent of ligament damage, and can help rule out fractures. In some cases, further investigations including MRI may be used to get a more precise view of the joint and surrounding tissues. This will help inform your Specialist of the most appropriate treatment options.

What are the treatment options for shoulder ligament tears and damage?

The treatment of shoulder ligament tears and damage depends on the severity of the injury and the patient’s activity level. Non-surgical options are often the first line of treatment, especially for mild to moderate tears. These include rest, sometimes including a sling or brace, and activity modification to avoid movements that exacerbate symptoms, along with icing and anti-inflammatory medication for managing pain and reducing inflammation.

For severe ligament tears or cases where conservative treatments fail to provide adequate relief or when there is severe misalignment of the collarbone, surgical intervention may be necessary. Surgery aims to repair or reconstruct the damaged ligaments to restore shoulder stability and function.

What does shoulder ligament tear surgery involve?

Shoulder ligament tear repair may involve arthroscopic or open surgery.

The surgeon uses instruments to repair or reconstruct the torn ligaments, and sometimes they may recommend that the ends of the collarbone are trimmed. In cases of associated injuries, such as labral tears, these may also be addressed during the same procedure.

Will I need rehabilitation after shoulder ligament tear surgery?

Physical therapy following shoulder ligament tear surgery is a critical component of the recovery process. Initially, the focus is on protecting the repaired ligaments and allowing them to heal, which involves wearing a sling to immobilise the shoulder for a few weeks. As healing progresses, physical therapy is gradually introduced to restore range of motion, strength, and stability to the shoulder.

The duration of rehabilitation can vary but generally lasts several months, with full recovery taking up to a year for optimal function and stability. Individuals will gradually return to activities and sports, following a structured rehabilitation program.

A shoulder ligament tear can be diagnosed by your London Shoulder Specialist who can recommend an appropriate treatment plan and ways to effectively manage your condition.