Shoulder Injuries

I often contemplate why there are straps on poles. They are a hazard, in my opinion. I’d rather replace a pole any day than a shoulder. 

One tenth of all alpine skiing injuries go to shoulders and 22-41% of upper extremity injuries. Whereas in snowboarding, the shoulder injuries account for 15% of all injuries and 20-34% of upper extremity injuries. Making both sports to be fairly comparable in terms of incidence of shoulder injuries. 

Let’s walk through some of the most common injuries that is seen up on the hill when it comes to the shoulder.

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Broken Bones

 Fractures of the humerus or clavicle bone can occur when you fall with a force onto the arm. Like when hitting a tree. Fractures can present with an immediate deformity and are super painful. X-rays are diagnostic and can pick up even hairline or small fractures. 

Dislocation

The ball comes right out of its socket. The shoulder is a shallow joint, making it susceptible to dislocation. It is super painful until the shoulder is relocated. Sometimes this can be done in the field, but often needs medical assistance. If dislocation becomes a repeated event, tossing the pole straps, Prolotherapy, Platelet Rich Plasma and Surgery are all steps to consider. 

Soft Tissue Injuries 

The rotator cuff is susceptible to injuries. The rotator cuff consists of four tendons that surround the shoulder joint. These tendons act as stabilizers and control smooth joint movement. Strains of these tendons impact movement and lead to pain. It’s that outstretched arm on falling or during a direct blow that rotator cuff injuries are sustained. Afterwards these types of injuries create nagging persistent pain and weakness in movement.

Like any injury sustained on the ski hill, early treatment improves outcomes. Don’t just brush it off, pop another ibuprofen and head up the hill. Injuries also often occur when we are skiing or shredding beyond our comfort. With all of these tight tree runs on Apex, keep in mind that trees don’t move. 

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A great tool in my clinic for deciphering what is occurring in the shoulder region is a Musculoskeletal Ultrasound. Ultrasound works by using sound waves to produce images of muscles, tendons and ligaments. Ultrasound can show sprains, strains and tears in the soft tissue.  Musculoskeletal ultrasounds have come a long way. Images have gotten clearer. Colour doppler can be added to look at presence of new blood vessel growth — often occurs when the body is in hyper healing mode — termed “neovascularization”. I primarily use my ultrasound machine to guide my injections to accurately place the needle at the site of injury and away from unwanted areas. It can also be used to look for tears, calcifications and tendonopathy. If you are a person who feels pain with movement of the shoulder, images can be taken while doing that particular movement to see if there is any injury there. 


Let’s think about the mechanism of injury. Shoulder injuries typically occur when we try to break our fall. It is natural to extend the arms. Going against the intuitive extension, tucking the arms inward will reduce injury to the shoulder. 

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The severity of injury often correlates to the force or velocity. The faster you go, the harder you fall. Keep your speed in check and look at the gaps, not the trees.

 

Outside of ditching your poles, if you are a skier, there are other steps you can take to keep your shoulders intact. Consider practicing falling. Getting on the trampoline with your kids. You can also try taking it to the mat in a martial arts class. Learning how to fall safely can help you react appropriately on the hill.

 

Above all, have fun out there. Snow is finally here!!

 As seen in Apex Matters March Edition

References:

McCall D, Safran MR; Injuries about the shoulder in skiing and snowboarding; British Journal of Sports Medicine 2009;43:987-992.