Introduction:
Floating shoulders are the bone injuries affecting the shoulder joint. Three bones consist of the shoulder girdle: clavicle, humerus, and scapula. The center that joins the scapula, clavicle, and humerus bones is the acromioclavicular joint (AC joint). In this joint, the lateral part of the clavicle joins with the scapula acromion process. The tendons, ligaments, and surrounding tissues help stabilize the joint and maintain its function. Any traumatic injury or direct blow to the joint can result in a floating shoulder. The person may experience pain and swelling. Several diagnostic tests are indicated to diagnose the condition. Management of the condition is based on the characteristics of the injury. The treatment modalities help in fixing the joint. The article discusses floating shoulder, its causes, pathophysiology, symptoms, diagnosis, treatment, and prevention.
What Are Floating Shoulders?
Any trauma or injury to the acromioclavicular joint or shoulder region can result in a floating shoulder. The floating shoulders are classified into lateral clavicle fractures or acromioclavicular joint dislocations based on the type of injury.
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Lateral Clavicle Fractures: When the person falls and the pressure of the person is on the arm, it can lead to a fracture of the lateral clavicle.
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Acromioclavicular Joint Dislocations: In this type of fracture, the acromioclavicular joint is involved. The clavicle bone displaces from the scapula acromion process. This joint helps in the stability of the shoulder region. Any sports injury, direct trauma, or fall can result in acromioclavicular joint dislocations.
What Are the Causes of Floating Shoulders?
The causes of floating shoulders are described below:
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Direct Trauma: Direct trauma can result in the fracture of the collarbone and displacement or dislocation of the acromioclavicular joint.
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Sports Injuries: The sportsperson faces regular sports injuries. This may occur during sports activities like cycling, football, skating, wrestling, hockey, and rugby. During these activities, there can be a direct injury to the region, or the sportsperson may fall, resulting in floating shoulders.
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Falls: During any activity, such as falls from a height, slips, playing, or accident, the person may fall on the arm, which can result in transmitting the force or pressure to the shoulder. This can result in a fracture of the shoulder region.
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Accidents: A vehicle accident can lead to the fracture of the shoulder region, resulting in floating shoulders.
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Occupational Injuries: A fracture of the shoulder region can occur at the workplace, such as in any heavy lifting activity, exposure to trauma, or repetitive shoulder movements.
What Is the Pathophysiology of Floating Shoulders?
In the case of lateral clavicle fracture, a direct blow to the shoulder region or clavicle can result in a simple or complex fracture. The trauma or injury may affect the structure of the shoulder region, its normal function, and stability.
The joint between the collarbone and scapula is disrupted or displaced in acromioclavicular joint dislocations. The ligaments that support the shoulder structures are coracoclavicular ligaments, and the muscles involved are trapezius and deltoid. The ligaments, tendons, and surrounding supporting tissues may tear, leading to joint dislocation.
What Are the Signs and Symptoms of Floating Shoulders?
The common signs and symptoms associated with floating shoulders are described below:
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Pain: The person with floating shoulders may experience pain in the affected shoulder. The pain may get triggered by putting extra pressure on the affected joint.
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Swelling: There may be swelling in the affected area. The person may also feel discomfort.
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Misalignment of the Shoulder: Due to the injury to the shoulder region, there can be misalignment of the shoulder region, leading to floating shoulders.
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Joint Tenderness: There can be tenderness on touching the affected joint.
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Limited Mobility: An individual may experience difficulty in moving the affected shoulder. Weakness in the arm can affect the normal functioning of the shoulder.
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Bruising: Due to an injury, there can be bruising or discoloration around the affected area in the acute phase.
How Are Floating Shoulders Diagnosed?
The diagnostic process of floating shoulders is described below:
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Clinical Examination: The healthcare provider may ask the patient about the injury and any associated symptoms, such as pain, swelling, and limited mobility. They may also ask the patient about any relevant medical history. The doctor may also physically examine the patient for tenderness, pain, deformity, and limited mobility. The physical examination can be done by palpating the clavicle bone and acromioclavicular joint.
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Imaging Tests: The imaging tests used to diagnose the condition are X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans. X-rays are done to check the fracture of the collarbone and AC joint. CT scan is done to assess the joint displacement and complex fractures. MRI scan checks soft tissues, such as ligaments, tendons, and muscle injuries.
How Is Floating Shoulder Treated?
The treatment approaches to manage floating shoulders are as follows:
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Orthopedic Management: The healthcare provider may immobilize the affected shoulder by using a brace or sling to stabilize the joint, reducing the pain. The brace or sling allows for initial healing.
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Medical Management: The doctor may prescribe pain relief medications to alleviate pain.
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Physical Therapy: This therapy is advised after the acute phase. It involves therapeutic exercises that can help in restoring the affected joint function and strength.
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Surgical Intervention: If the above treatment approaches fail, surgical intervention is recommended.
The patient is positioned in a deck chair, beach position, or lateral decubitus. It is a foldable chair in which the patient's trunk is almost upright, and the armrests on the chair's handle. Surgical intervention, such as open reduction fixation, is used in severe or displaced fractures. This is recommended to stabilize and realign the fractured segments. In case of AC joint instability, surgical reconstruction is done to repair and reconstruct the ligaments.
What Are the Preventive Measures for Floating Shoulders?
The preventive measures for floating shoulders are as follows:
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Use protective gear, such as helmets or other protective equipment, while playing and playing.
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Regular exercise to stabilize the shoulder muscles.
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Avoid unsafe situations, such as uneven surfaces.
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Do proper stretching routines.
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Take proper calcium and vitamin D to help maintain bone health.
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Regular health checkups.
Conclusion:
In conclusion, floating shoulders are traumatic injuries to the shoulder region or the clavicle bone. The person may experience pain and limited mobility of the affected shoulder. X-rays, CT scans, and MRI scans can diagnose the condition. Management of the condition can be done by using braces, physical therapy, painkillers, and surgical interventions. To prevent the condition, people should wear protective gear and follow safety protocols. Early diagnosis and use of treatment protocols can improve the patient outcome.
