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Your shoulder and the slopes

03 April 2018

Jeremy Granville Chapman, our Consultant Orthopaedic Surgeon specialising in shoulder, elbow and trauma, tells us about three common shoulder injuries on the slopes.  

"As I pack my bag for my ski trip this Easter I am prompted to think about skiing and shoulder injuries. Every year, physiotherapists and orthopaedic surgeons, like me, see and treat countless patients who’ve taken a tumble on the slopes. Of course, the clear majority of us enjoy a trouble-free holiday and celebrate our wipe-outs with pride and even a sense of competition, but I expect most of us know someone who has been injured skiing. A significant number will have sustained injuries to their shoulders, elbows and wrists.

Whilst I certainly don’t want to dwell on injuries, and I have always loved skiing, it’s worth having a quick look at three common shoulder injuries that skiers may sustain so you might be better able to decide what to do should you or a friend have a problem on the slopes.

1. Shoulder dislocation
Your shoulder is a shallow ball and socket joint. The shallowness gives it the advantage of an excellent range of motion, but also renders it vulnerable to instability (a bit like knocking a golf ball off a tee). Falling whilst skiing or snowboarding is a relatively common mechanism of shoulder dislocation at this time of year.

  • If you do suffer a dislocation, something will feel very wrong in your shoulder, it will be extremely painful, you may have numbness in your arm or hand and you will be desperate to have your shoulder relocated.
  • This should happen as an emergency at a medical facility where safe sedation can be given, and X-rays taken before and after relocation.
  • After your shoulder has been put back into its joint, your pain will begin to settle, but it will remain sore for a week or two. You should wear a sling for a week and then seek out a shoulder physiotherapist on return to the UK. They will guide you through your recovery towards normal shoulder movement and function.
  • If this is your first dislocation, your chance of having a recurrent problem with your shoulder (further dislocations) depends on your age (higher risk if below 25yrs old), your occupation, sports played and the degree of injury your shoulder sustained when it came out.
  • If you have had problems before, then you may well want to consider surgery to stabilise your shoulder and prevent further damage in the future.
  • In general, after a dislocation, I’d recommend that you see a shoulder specialist who can assess you and your imaging and help to explain your risks of future problems and the options available to you. You can then decide whether you want to try to rehabilitate your shoulder with or without stabilisation surgery.

2. Fracture (a broken bone)

A broken collarbone (clavicle)
This is fairly common after a skiing accident. This bone acts as a strut holding out your shoulder blade and arm from the centre of your body. It behaves a bit like a crumple zone when you fall.

  • The vast majority of collarbone fractures do not need emergency surgery, so if your skin is intact and you are otherwise uninjured, it is better to get back home and seek advice in the UK on your return. You can come home safely in your sling.
  • Many fractures of the collarbone will heal without surgery, but some higher energy injuries, or displaced fractures may benefit from early surgery to optimise your chance of healing, speed your recovery and return to function.
  • Sometimes the joint at the outer end of your collarbone displaces: this is the acromioclavicular joint (AC joint). Again, this does not normally require emergency surgery and you can come home safely in a sling. Some injuries will benefit from early surgery (within three weeks) so seek an orthopaedic opinion on your return to guide you.

Broken upper end of humerus (arm) bone
This injury becomes more common as we get older, so skiers above the age of 40 are more likely to suffer this problem.

  • A direct blow onto a shoulder can break the upper end of the bone. This is the region where your rotator cuff tendons insert onto your arm bone and where the joint surface of the ball rests. Patients often develop bruising in their upper arm and chest and it is very sore. Occasionally there can be numbness in the upper arm.
  • If you have fallen and are worried about your shoulder you can usually access an X-ray at a clinic in resort and this will tell you whether you have a break. If you have broken your shoulder and your skin is intact and the ball is in joint, then a simple sling will make it safe for you to return to the UK.
  • Do seek an orthopaedic surgeon’s advice on your return: while many of these injuries can be treated without surgery, some patients will do better with early surgery to fix or replace the damaged parts. You may require a CT scan (special X-rays that generate a 3D image of your injury) to help your surgeon give you the best advice about the need for surgery.

3. Rotator cuff tendon injury 
This can occur after a fall or a sudden forceful movement of your shoulder. Skiing can obviously cause both of these mechanisms.

  • Rotator cuff tears become increasingly common as we age and are uncommon below 40 years.
  • These tendons connect four muscles from your shoulder blade onto your humerus (arm bone). They are important for controlling the movements and stability of your shoulder. If you have an acute tear in these tendons from an injury, then it is often very painful (patients grip their upper arm as the site of discomfort) and you may well notice weakness in movements of your arm, particularly those movements that involve elevating or controlling your arm away from your body. If this happens to you then you should rest your shoulder and, if it hasn’t settled by your return home, seek advice. Alongside an X-ray (to exclude a fracture), you may require imaging such as an ultrasound or an MRI scan to assess the damage in your shoulder.
  • Acute rotator cuff tears are normally treated with early surgical repair to improve your pain and function but also to optimise the chance of your tendon healing.

For further information on skiing injuries or to book an injury assessment, please call us on 01753 665 404 or contact us enquiries@spirethamesvalley.com. No GP referral or private healthcare insurance necessary.

 

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