Management of Ligament Damage in Shoulder Blade in Athletes

What Is a Shoulder Blade?

The shoulder blade is a broad, triangular-shaped bone in the upper back. The bone joins the upper arm bone to the collar bone, which is stabilized by a sophisticated structure of muscles that aid arm movement and shoulder stabilization.

What Causes Injuries to the Shoulder Blade's Ligaments?

The ligament damage can be produced by a rupture induced by strain in the shoulder, injury to muscle or tendon around the shoulder, or by acute events such as trauma caused by accidents, direct falls, sports injury, or blow to the shoulder blade. The contributing causes are discussed further:

1) Injury Resulting From Physical Trauma:

• Muscles that regulate the shoulder blade (scapula) are weak, unbalanced, tight, or detached.

• Loss of muscular function due to damage to the nerve that supplies it.

• Shoulder dislocations and fractures of the scapular wing bone.

2) Overuse of Muscles Due To:

• Poor posture.

• Weight lifting.

• The statutory position causes strain.

• Practicing sports activity.

What Diagnostic Procedures Are Used?

• The Physical Checkup: The comprehensive medical histories of the patients are reviewed during the physical examination, and a list of the symptoms that the patients are experiencing as a result of the ligament injury and any associated disorders is also collected. Even the scapula and the shoulder are examined to look for any signs of injury, weakness, or tightness.

• Observation: The affected side of the scapula and the unaffected side will be examined in detail during the test to elicit any change, such as inflammation, and to determine muscle tension.

• The Examination of Muscles: A strength test has been carried out on the scapular and shoulder muscles to identify the weakened muscle that is the root cause of the aberrant scapular motion.

Specific Tests: Certain tests that include corrective maneuvers will enable the physician to elicit the ailment, which may include the following:

• Evaluation of Scapular Assistance: The test is performed to evaluate the scapular motion that results in shoulder pain. During the test, light pressure is applied to the scapula to identify the tilting movement.

• The Test of Scapular Retraction: This test identifies the scapular retraction, which helps pull the shoulder blade towards the spine because this test indicates the integrity and strength of the muscle surrounding the shoulder blade, which helps move the shoulder blade closer to the spine.

• Radiographic Examination: Radiographic images are captured to diagnose the relationship between the bones and conduct a structural examination of the skeletal system.

• MRI Scan: The magnetic resonance imaging (MRI) scan is the gold standard for diagnosing shoulder injuries in athletes, whether they affect the soft tissue or the bony structure. Since magnetic resonance imaging (MRI) is used to plan surgery and to clarify the condition, radiographic imaging can be utilized to evaluate intrinsic injury.

• CT Scan: The computed tomography (CT) scan can assemble a three-dimensional reconstructed bone that depicts the contour and bone margins.

• Ultrasound: In order to make an accurate assessment of the rotator cut-off tendon and the structural alignment of the muscle to the bone structure, ultrasound is the major modality utilized.

What Are the Treatment Methods?

The treatment, which includes non-surgical and surgical approaches, is designed to restore the scapular position so the activity can continue. The objective of conservative treatment is to restore scapular retraction and other movements. Specific scapular rehabilitation exercises include flexibility exercises to reduce scapular traction and stability exercises to optimize scapular kinematics. Primary treatments involve:

• Pain-relieving medications and ice compressions.

• Strengthening and flexibility training.

• Adjustment of the activity that caused the injury.

Exercise: Increasing the muscles' flexibility makes it possible to decrease the amount of traction that the scapular muscles exert. The goal of the scapular stabilization exercise, which consists of stretching and strengthening, is to enhance the position of the joint while also increasing muscular strength. The anterior portion of the trapezius muscle, which originates at the bottom of the neck, would serve as the scapular rotator and stabilizer. The workout consists of closed, open, and closed kinetic chain exercises and push-ups on stable and unstable surfaces.

The anterior stretch can be increased by using push-ups, which also aid in developing muscle strength. Upper rotator shrugs can repair the weakness in the trapezius muscle. Particular shrugs will enhance the amount of work done by the trapezius muscle as well as the upward rotation of the ankle. The regular interval displacement treated with a non-operative technique provides greater outcomes than elite athletes.

Rest: Shoulder blade injuries necessitate a cessation of all activities and a period of full rest.

Medication: Several medications, such as nonsteroidal anti-inflammatory drugs, could help alleviate pain and discomfort in the region between the shoulder blades. In addition, muscle relaxants, even antidepressants, are prescribed for pain management. However, taking the medication for an extended period may produce other side effects, such as gastrointestinal and other conditions.

A Combination of Hot and Cold Therapy: As it slows the blood flow, applying cold can alleviate pain and lessen inflammation and the damage inflicted on tissue. Heat is provided to an area before stretching and strengthening exercises because it relieves muscle tension, increases blood flow, and relaxes the muscles in that area. This is especially helpful for tight muscles, which heat can relieve.

Therapy: Physical treatment would increase the patient's mobility range and strengthen the muscles that support the joint. In addition, physical and massage treatment can help alleviate the pain caused by an injury or nerve compression. As in physical therapy, it targets the stiffness of the muscles and ligaments on the rear of the shoulder and helps to strengthen the front shoulder.

Adjustment of Position: As this approach reduces the repetitive stress on a specific muscle, it can provide long-lasting relief.

Operative Therapy: Surgical intervention would be initiated if conservative treatment fails or intrinsic joint injury occurs.

Surgical options for shoulder ligament injury are reviewed below:

• Arthroscopy: During this operation, the surgeon will put a small camera into the patient to display an image of the internal structure. This image serves as a directing tool for the subsequent surgical treatment.

• Open Surgery: The joint is evaluated through an incision created above the shoulder joint, which aids surgical procedure and in healing the torn tendon, ligament, or bone and its associated structures. For bone surgery, bone grafting is performed and surgically implanted.

• Rehabilitation: The mending of the muscle should be covered for healing once either the conservative or surgical method has been completed. The rehabilitation emphasizes the patient's range of motion and flexibility to prevent the shoulder from becoming rigid. As the muscle begins to mend and shows signs of improvement, the rehabilitation activity will be increased proportionately. It will continue to do so until the individual reaches their full range of motion and flexion.

Conclusion

Acute trauma to the muscles, joints, bones, or associated tendons and ligaments of the shoulder blade might be one of the many factors that lead to a damaged shoulder blade ligament. The diagnosis would be challenging and requires a detailed medical history in addition to undergoing a comprehensive physical examination and certain tests. However, the therapy should be individualized; in most cases, it is not complicated.