Diagnosing Shoulder Injuries

The shoulder joint is a complex joint that requires highly advanced imaging techniques to diagnose internal injuries. The shoulder joint is the most flexible joint we have and therefore subject to strain, tear or dislocation. Because so many muscles, tendons and ligaments inside the shoulder can be affected, the best diagnosis for shoulder injury is done through Magnetic Resonance Imaging (MRI) scanning with the critical assistance of musculoskeletal radiologists specially trained to supervise and interpret these images. Before we go more into the diagnosis, let's look at types of injury, when treatment should be sought and why accurate diagnosis is important to aid full recovery.

While shoulder injuries are extremely common among athletes, you can injure your shoulder with a simple fall or any activity in which you over extend the joint. There is the temptation to make light of a shoulder injury, living through the pain, but shoulder injuries can be extremely debilitating and need to be treated by a physician so that healing can be monitored. If ignored, a minor injury can turn into something major and you could be facing surgery that could have been avoided if medical treatment had been sought earlier.

When to Seek Medical Treatment

• When you can't move your shoulder normally or in its full range of motion.
• If your shoulder feels weak.
• If your shoulder feels like it is ready to pop out.
• If the pain is intense.
• If you can't move your arm at all.
  

Types of Shoulder Injury

There are many different types of shoulder injury and here we will feature some of the most common types that can benefit from diagnosis or investigation with MRI scanning.

• Dislocated Shoulder
  This happens when the ball joint comes completely out of the socket. You will feel intense pain and your arm will feel like it is hanging. Do not attempt to push the bone back into the socket. Leave this to professionals at the emergency department.
• Acromioclavicular separation
  Rather than the bone, this type of injury involves the ligaments that connect your shoulder blade to your collar bone. They can be strained or torn, which will cause intense pain. Your shoulder will feel loose, weak or even numb. If the ligaments are strained, you will be prescribed rest and exercise. If they are torn, surgery may be required.
• Rotator Cuff Injury/Disease
  The rotator cuff is a group of tendons that connects the four muscles of the upper shoulder to the bones. The strength of the cuff allows the muscles to lift and rotate the bone of the upper arm. The tendons run under the shoulder blade, where they are vulnerable to being damaged. A tear here can result in a painful, weak shoulder. When the tendons or muscles of the rotator cuff tear, you will no longer be able to lift or rotate your arm with your normal range of motion or you may experience significant pain when you move your shoulder.
  
  Rotator Cuff injury can occur through injury, often while trying to lift or catch a heavy object; overuse, especially after a period of inactivity; because of poor blood supply to an area of the cuff which occurs with increasing age; from a fall; or through a gradual weakening of the tendons of the shoulder.

Benefits of MRI Over Other Diagnostic Imaging Tools

Magnetic Resonance Imaging or MRI scanning is a powerful imaging technique which exploits the magnetic properties of hydrogen atoms within the body. This imaging technique uses magnetic fields and radio waves rather than ionizing radiation which normal x-rays use.

MRI scans show soft tissues such as muscles, ligaments, tendons and cartilage extremely well, which is why they are an ideal diagnostic tool for internal shoulder injuries, especially as such injuries involve multiple areas within the shoulder while CT scans and x-rays are better for viewing bones. Ultrasound imaging is restrictive in that it only shows the external part of the joint and the tendons, while MRI scanning shows all injuries inside and out.

MRI scanning can involve a small injection of special dye into the joint before the MRI scan itself to make it easier to see the joint structures. Special views called ABER views can be used. These views are unique, requiring positioning of the hand above the head to simulate tension to the front parts of the shoulder. Reading these scans requires the skills of musculoskeletal radiologists specially trained to supervise and interpret these images. Different types of injuries can overlap, making a difference as to whether the injury should be treated with or without surgery. Accurate diagnosis through accurate reading of the scans also plays a critical role in helping to prevent continuing pain and instability.

Treatment and Healing

For injuries that don't require surgery, treatment typically includes rest, ant-inflammatory medication and physical therapy such as heat, cold, massage and ultrasound treatment or resistance exercise. Your doctor may sometimes ask a radiologist to do a joint injection with ultrasound guidance for greater accuracy.

Some shoulder injuries will heal with adequate rest, conservative care and rehabilitation, but tearing of the tendon can be more problematic. These usually happen at the attachment to bone area and because this area has a poor blood supply, the injury is unlikely to heal by itself. The constant resting tension pulls the fibres away from the bone.

Injury Prevention

Whether you have experienced a debilitating shoulder injury or simply want to avoid one, you need to strengthen the muscles around your shoulder to minimise the risk of shoulder injury. This is best done with weight training. Dips and push-ups are excellent ways to strengthen the shoulder. Be sure to warm up and stretch afterwards to prevent ligament and muscles tears and strains. Keeping your abdominal muscles strong can also help as strong torso support gives more overall shoulder control.