Causes and Management of Shoulder Injuries in Children and Adults

Introduction

The shoulder is a group of joints that attach to tendons and muscles to promote a wide range of arm movements, like rubbing and throwing. As a result, traumatic shoulder injuries cause bone and soft tissue damage, resulting in pain. Diagnosis and treatment differ in adults and children as there is an increased risk of fractures and dislocations in young athletes.

What Are the Common Causes of Shoulder Injuries?

When rotator cuff tendons get caught under the shoulder's bony prominence, it results in discomfort, inflammation, and swelling. There are several causes of shoulder injuries, of which the following seven are common among children and adolescents:

• Bursitis: Bursitis is a fluid-filled sac within the shoulder that cushions and eventually reduces muscle friction and promotes gliding movement. Any traumatic injury to the sac results in inflammation and swelling and significantly affects day-to-day activities like combing and dressing up.

• Tendinitis: Tendinitis is the inflammation of a thin fibrous band that connects muscle and bone. The rotator cuff and biceps tendons are the most affected bands in the shoulder due to contact sports injuries and long-term arthritis.

• Tendon Tears: The partial or total removal of the tendon from the bone is noticed in aging, overuse, and sports injuries. As with tendinitis, the rotator cuff and biceps tendons are most predominantly affected.

• Impingement: Shoulder inflammation caused by repeated or incorrectly performed activities. It is characterized by significant pain that increases with lifting or other shoulder movements. Commonly seen in swimmers, hence called the "swimmer's shoulder."

• Instability: The shoulder dislocation results in instability and is characterized by inflammation of the ligaments, tendons, and muscles around the shoulder. An increased chance of arthritis is suspected in young children who have frequent dislocations.

• Arthritis: The stiffness of the joints results in a painful restriction of movement and can lead to rotator cuff injuries, infection, or irritation of the joint lining. The pain progresses slowly and worsens based on its severity. Sports-related injuries, work-related injuries, and general wear and tear are the most common causes of arthritis.

• Fractures: The shoulder fracture results in discomfort, swelling, and bruising (bleeding under the skin). The collarbone, upper arm, and shoulder blade are frequently affected bones in the shoulder fracture due to contact sports and road traffic accidents.

• Overuse Injuries: The traumatic shoulder injuries after repeated physical activities like throwing a ball and baseball result in inflammation of the growth plate (promotes bones growth)

• Other Causes: Osteophype (bone bump), shoulder separation, nerve injury around the shoulder, improper shoulder posture and mechanics

What Is the Difference Between Traumatic Shoulder Injuries in Children in Comparison With Adults?

Skeletally immature children are more vulnerable to traumatic injuries when actively participating in violent or sporting events. This can affect the growth plate, leading to obstruction of the growth pattern of the bone. Comparatively, the cartilage and the bone are weaker than the shoulder ligaments in growing children, actively promoting growth plate inflammation. Although the inflamed growth plate recovers independently without complications, appropriate care is required to avoid a growth abnormality. On the other hand, adults do not have an active growth plate, and there is no longer any stunting of the growth pattern after an injury.

What Are the Common Symptoms of a Shoulder Injury?

The common symptoms of traumatic shoulder involve

• Significant pain when raising the arm and during the night.

• Redness.

• Fever.

• Red or blue discoloration of the skin.

• Swelling.

• Shoulder weakness.

• Numbness.

• Tingling sensation.

• Restricted shoulder movement.

• Clicking or popping sound during movements.

• Inability to lift any object.

How To Diagnose a Traumatic Shoulder?

The diagnosis is based on medical history, clinical examination, and imaging.

• Medical History: Gathering information is thefirst phase of the evaluation. This can be obtained by asking about the patient's pain status and past medical conditions. For example, pain tendency alters with specific activities.

• Clinical Examination: Evaluation of swelling or edema, muscular weakness, and physical deformity was performed under clinical study by palpating the affected site.

• Imaging: X-rays rule out the fractures in the inflamed site; on the other hand, ultrasound and MRI (magnetic resonance imaging) evaluate soft tissue like ligaments and tendons surrounding the shoulder joint. CT (computed tomography) provides a detailed image of bone in a three-dimensional pattern.

Other diagnostic aids include

• Electromyogram assess impaired nerve function.

• Arthroscopy: A fiber-optic camera is inserted through minor surgical incisions into the shoulder joints to evaluate soft tissue that has gone undiagnosed with non-invasive procedures (X-rays, MRI, ultrasound).

• Arthrogram: The imaging is performed after injecting a contrast medium into the shoulder joints. The muscles and ligaments around the shoulder absorb the dye to produce an accurate image of soft tissue. Usually performed under local anesthesia (LA).

What Treatment Options Are Available for Traumatic Shoulder Injuries?

The treatment modalities are differentiated into three phases

1. Initial Phase: Rest is followed by the modification or withdrawal of excessive physical activity that strains the shoulder during the first phase of treatment.

2. Palliative Phase: Symptomatic treatment is carried out in the palliative phase to relieve pain, inflammation, and swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are administered to depress the symptoms, followed by physical therapy.

3. Surgical Phase: Most shoulder injuries may be treated with physical therapy and exercise; however, some may require surgery based on the severity and recurrence factor. Repeated dislocations and rotator cuff injuries do not recover with rest, exercise, and medication; hence, surgical intervention is applied. The minor defects are corrected with arthroscopy, while major defects require open-hand surgery.

How Can Shoulder Injuries Be Avoided?

It is essential to keep muscles and tendons flexible. The stretching and strengthening exercises improve muscular flexibility and endurance. In addition, repeated surveillance of children's activity at sporting events reduces the overuse of muscles. And it is possible to prevent traumatic shoulder injuries by applying proper techniques in sports.

Conclusion

When the pain persists even after two weeks of trauma, and emergency care is required due to unbearable pain, swelling, immobility of the shoulder joint, and bruises (internal bleeding), pediatric orthopedics advise seeking legal, medical advice.In addition, injuries that occur near the growth plate can be difficult to diagnose. Finally, the appropriate treatment led to a favorable prognosis.