Acromioclavicular Joint Arthrosis

 Had a young player come by with Right shoulder pain and restriction of overhead movement recently. His main complaint was he couldn't scratch his back unlike previously. Apparently he slept wrongly and woke up with the pain the next day. He had a Diclofenac sodium injection (Non-steroidal Anti-Inflammatory Drug) from a local doctor and felt better. However, there was some residual pain which lasted for 2 months. He was still able to play competitively but needed kinesiotaping. 

We did an ultrasound scan to find out that the had sclerotic changes and bursitis at his Right Acromioclavicular joint. Upon discussing the options of treatment, he decided that he would try focal shockwave treatment instead of intra-articular corticosteroid injection. 

 He left without the kinesiotape and with the possibility of full overhead movement and was able to scratch his back. Will see him again after 2 weeks to see how he is, but it will be highly unlikely that he will need another treatment so soon. 

Shoulder myofascial pain syndrome

Ever though that computer bag is just too heavy? You might just be right. 

Had a chap walk in to relieve his misery which had been troubling him for a few days. We looked at his posture and he had a lower affected painful shoulder with an elevated other shoulder. The movements of both shoulders were not well coordinated. 

He felt some pain doing shoulder shrugs and retraction. He had pain on palpation of his trapezius and levator scapula. He was started on physiotherapy and underwent focal shockwave with joint mobilisation. 

He was given the advice to carry his bag on both shoulders, resume rhomboid and trapezius strengthening along with regular stretching exercises. Will see him again soon to review his progress. 

Anterior Shoulder Dislocation after Epileptic Seizures

A known epileptic in his twenties came in with complaints of fainting (with epileptic seizure) and sustaining a left shoulder stifness and severe pain upon 'waking-up'. There was a bulge in front of his left shoulder and a small depression (sulcus sign) under the left acromion (see photo). He could not lift his left arm at all due to the pain and stiffness.

We iced his shoulder and gave him an analgesic injection for the severe pain. He was then referred to an Orthopaedic Surgeon for imaging and to reduce the dislocation since it was already several hours after the incident. If he is an athlete who requires vigorous upper limb strength and mobility, he has a high risk of recurrent shoulder dislocation and would usually need surgery.

Supraspinatus tendon partial rupture and mild impingement

Simon (not his real name) was playing hockey 3 days earlier when he decided do hit a slapshot across a longer distance during a training match. After the hit he felt pain in his right shoulder and he could not lift his shoulder above the level of his shoulder. He continued playing but he refrained from lifting up his shoulder.

He saw me today and I found that he had a painful arc (abduction > 70 degrees), a positive "Empty Can Sign" (resisted abduction) and loss of power of abduction against resistence. He still had tenderness at the tip of the right shoulder.

I informed him that he needed an X-ray ( to rule out bony impingement) and an Ultrasound of his shoulder (to rule out tendon rupture).

I advised him to continue apply RICE treatment for another 1-2 days to allow the inflammation to resolve. He was also advised to avoid abducting his shoulder > 90 degrees. I encouraged him to do active pain-free diagonal movements against the wall or panel (Closed-Chain Exercises) and start strengthening exercises progressively using Theraband. Later, he may proceed to do some wobble board exercises to assist coordination and balance. I was concerned as he has had several similar episodes in the past due to inadequate rehabilitation treatment and possibly incomplete investigation.

Fractured Clavicle

Mohamed came in last Saturday holding onto his right elbow with a deformed 'collar-bone' (see photo) after a fall from his motorbike. He was in severe pain and requested for immediate 'painkiller' injection. I examined him and found that he had a fracture of the midshaft of his clavicle (commonest site) with the proximal part displaced upward. We splinted the left upper limb with a triangular bandage. His peripheral pulses were normal and his ribs and lungs were not injured. I referred him to my Orthopaedic colleague to reassess the need for surgery due to the displacement and overlap. Usually, non-displaced fractures of the midshaft are treated non-surgically with a triangular or figure of eight bandage (see how to apply) and NSAIDS.

In a retrospective study, 132 patients with united fractures of the middle third of the clavicle and a follow-up of up to 30 months after conservative management were reviewed. Of the patients, 34 (25.8%) were dissatisfied with the result of their management possibly due to shortening of the clavicle.J Shoulder Elbow Surg. 2006; 15(2):191-4



A small study in Belgium suggests that semi-professional athletes may benefit from surgical plate fixation of the fractured clavicle with a possible early return to sports (45 days)at the expense of a significant risk for complications (e.g. infection, non-union, refracture) which would not be considered acceptable in patients with lower functional demands. Acta Orthop Belg. 2005; 71(1):17-21

The patient actually had surgery done and was having full function of his right shoulder within 2 weeks. He was advised to return to his surgeon for removal of the plate after 1 year.

Josiah fractures his clavicle?

Josiah Ng, who currently ranks 7th in the world suffered a hip contusion after hitting the training motor-pace bike on the 22nd March 2007. Just a week later he had a terrible mishap after an illegal technique used by an Italian rider caused him to loose control and crash. It was reported by the Star newspaper that he suffered a 'broken collar-bone.

Rotator-Cuff Injury

Ahmad has been playing for several weeks in preparation for a major badminton competition in 2 months time. His coach wanted him to perfect his skills with multi-shuttle drills involving lobs and smashes. He would be sore in the right shoulder tip after each training session. Moreso after repetitive smashing. His coach asked him to ice after training but yesterday despite icing his shoulder he had persistent pain and his smashes were getting weaker.

I saw him and found out that if he abducts his shoulder (brings his shoulder up on the sides) more than 90 degrees and rotates it backwards, he has some pain. He also has pain in front of his shoulder lifting his arm behing his back. He was able to do the empty can test (where he pushes his abducted shoulder upwards with the thumb pointing downwards)with some pain. Between 1 and 10, the painscore was 5-6.

Our radiology colleague did an ultrasound scan for him showing some inflammation of the rotator cuff and grade I strain of the supraspinatus tendon. He was lucky not to have any impingement demonstrated clinically or on X-rays.

We talked with the player and his coach and decided that he was going to concentrate on his footwork and aerobic fitness for 3 to 4 weeks. He was allowed to do skills without 'overhead' work. Part of his training programme would involve work with theraband and core stability. THe physiotherapist got him to do some 'car-wash' wiping movements diagonally to improve his shoulder proprioception (sense of position and balance).

Within 2 weeks his shoulder was feeling much better and he was able to swing his shoulders without pain. At 4 weeks he regained most of his strength and was able to smash even harder without pain.