Using a Massage Gun for better sleep with frozen shoulder

Massage can be done by self through massage guns or a lacrosse ball. Massaging the small muscles of the shoulder like the pectorals, deltoid, and trapezius, with a massage ball can be painful in the inflammatory phase of the frozen shoulder. In this case, a low-intensity massage with a flat device head can help to soothe the muscles, improve flexibility for a short time and flush out the inflammatory metabolites. 

Best sleeping position for the frozen shoulder:

Sleeping on the other side of the affected shoulder with a pillow under the armpit of the affected one. This is the easiest solution, but if you are turning frequently in sleep, the painful side gets compressed intermittently and that again disturbs the sleep.This can be managed by sleeping on a recliner or using the support of pillows on the affected side.

Using pillows and cushions to improve your sleep:

Sleeping in supine or on the straight back position: 

This position can also be supported well with the pillows under the arm.

Sleeping in a quarter-turn reclined/side-lying position by keeping the pillows under the affected side:

This position elevates the affected side up and even if you tend to turn sides, the pillows would be there to block it.

Modified Foetal Position

Most of us tend to sleep in this easy-to-go position. Sleeping on the non-affected side in this position can be well supported with the pillows between the knees, under the head, and one supporting the arms.

In case of acute pain and swelling, biofreeze spray can be the preferred modality. But for any muscle spasm and fascial tightness issue, moist heat or a heating pad before you sleep generally works the best

Sleeping Positions to avoid:

• Sleeping side lying on the aching shoulder gives the utmost pain. 
• Also sleeping on the stomach frequently puts the shoulder in an elevated position which further strains the upper trapezius and increases the shoulder pain. 

Using a TENS Machine for better sleep

TENS machine helps in numbing down the pain by blocking the thinner pain carrying neural fibres. It is not a treatment modality but definitely can help to tone down the pain just before one sleeps. 

Read more about TENS machines for frozen shoulder

Magnesium Oil:

Magnesium has been used to relieve muscle cramps and facilitate recovery of the overworked muscles.Transdermal application of magnesium oil, helps in rapid absorption and  avoids any gastrointestinal distress symptoms which come with oral ingestion.  A warm water ipsum salt bath combines the dual benefits of magnesium and heat therapy and gives full body relaxation. Magnesium supplementation can also help in easing pain, but it should be taken according to the recommended dietary allowance along with a physician consultation.

THC/Cannabis Edibles:

Depending on where you live and applicable laws, THC, the active ingredient in cannabis, can help with sleep and pain management. 

THC edibles are not approved by FDA and frequently the composition of the compounds are not stringently regulated by the sellers.THC a derivative of Cannabis is the main psychoactive substance responsible for sense of giving a high. Used as a potent sedative and pain reliever in neuropathic pain and intractable cancer, it may have a longer sleep inducing effect.It has potential side effects of varying intensities on those who consume it. The research on use of THC edibles, specific to shoulder pain is lacking and may have some benefit in chronic cases not responding to other modalities of treatment. It is very important with regards to safety  to take any psychoactive substance with a prior consultation with a doctor in accordance with the legal laws of the country.

CBD (Cannabidiol):

Cannabidiol (CBD), also a derivative of cannabis, does not contain any psychoactive substance giving a high. CBD oil, through its anti-inflammatory effects, can be used as an adjunct to improve sleep and reduce pain. Though high-level evidence lacks for the use of CBD, specific to the frozen shoulder, it can be used with precaution and as an adjunct  when available as a well-regulated product.

Melatonin:

Melatonin is a sleep inducing hormone naturally produced by the body through the pineal gland in the night when the darkness sets in. Melatonin is available as a supplement and not controlled as drug by FDA and also as a drug Ramelteon, which is basically a melatonin receptor agonist.  Both of them influence the melatonin action and help in sleeping.Melatonin has a fewer side effects like drowsiness, headaches and dizziness and are seen when it is overdosed. It can be a good supplement for short term use for sleep induction.

Medications:

Anti-inflammatory/OTC Drugs:

Naproxen and acetaminophen, the OTC drug helps in controlling inflammation and blocking the pain and also have some effect on relaxing the muscles.

Muscle relaxants:

Muscle relaxants are generally not sold over the counter and when prescribed by the physician can surely help.

Timing the medications:

These medications especially in the inflammatory phase should be taken an hour before the sleep. Medications taken too early can lose their effect in the middle of the night due to their short half-life and bring back the pain. Hence the medications need to be timed well with the sleep schedule, following with the dosage and physician’s advice.

Cortisone:

A steroid shot coupled with physiotherapy has been shown to reduce the inflammation and pain with a long term effect. It is important to avoid repetitive steroid shots in shoulder as it affects the tendon health in long term, hence the use of exercise is important to sustain the effects of the steroid and maintain the pain free range of motion. Getting a cortisone shot isn’t a decision you make before going to bed tonight, but getting a shot can help you reduce pain and inflammation for several weeks, helping you get some sleep. 

You can find out more about Cortisone Injections and Frozen Shoulder here. 

Hydrodilatation:

Hydrodilatation is the infusion of combination of saline, steroid and local anaesthetic in the shoulder joint capsule to distend it and cause micro-ruptures. It can help in giving good short term results and improving function, but long term evidence for its use is inconclusive and deficient.

Sleep Hygiene:

Good sleep hygiene which incorporates environmental and behavioral modifications helping to facilitate a deeper sleep. Like:

1. Following regular sleep timings which affect your circadian rhythms
2. Reducing the use of bright lights and screen time
3. Abstaining from caffeine use near sleep time 
4. Avoiding alcohol use to facilitate sleep as it slows down the healing
5. Managing stress well and not ruminating at night by following relaxation techniques, mindfulness, and breathwork techniques like box breathing before you sleep.
6. Avoiding noise and making use of soothing music or the podcast  of choice to fall asleep.

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A cortisone shot in the shoulder is usually as painful as regular immunisation injections. The site of the injection and the size of the needle are two elements that can affect how painful a shot may be. It should come as no surprise that larger needles typically hurt more than smaller ones. However, your doctor might also apply an anaesthetic spray to numb the area of the shot where the needle will be inserted. Thus only some pressure is felt upon the insertion of the needle.

After the shot

The site of the shot may be tender and painful for a few days, similar to the after-effects of taking any jabs. Avoid any heavy lifting with the arm until the pain subsides. However, what is important is to monitor for signs of infection. Pain out of proportion, redness, swelling, and fever should all be immediately reported to your doctor.

Corticosteroid shots are used when shoulder pain is significant and has not reduced by over-the-counter medications. Although the injection may be uncomfortable, the treatment should be worth it to reduce pain and inflammation in the shoulder, so you can continue with your rehabilitation exercises effectively. 

Are You Suffering from Shoulder Pain?  Download Reflex: Shoulder Mobility App

Shoulder pain can be all-consuming. Recovery can seem so far away without having the tools to track your progress, or know that you’re doing the right exercises. Reflex if your physio in your pocket. Accurately measure your shoulder range of motion without visiting a clinic.

More on Cortisone Shots

1. What happens if a cortisone shot in the shoulder doesn’t work?

2. How long does a cortisone shot last in the shoulder?

3. Side effects of a cortisone shot in the shoulder

4. How soon can I exercise after a cortisone injection in the shoulder?

5. Will a cortisone shot help a torn shoulder labrum?

6. How painful is a cortisone shot in the shoulder?

The post How painful is a cortisone shot in the shoulder? appeared first on Siphox Health.

Intra-articular corticosteroid injections quickly relieve shoulder pain by effectively controlling the swelling brought on by the SLAP tear. Corticosteroid injections are less intrusive, more patient-acceptable, and more affordable than surgery. The quick and long-lasting pain relief provided by these injections promotes the early initiation of muscle-strengthening exercises and yields greater satisfaction among patients. 

SLAP injuries can cause rotator cuff and scapular muscular weakness and dyskinesis, as well as change the intricate role the labrum plays in glenohumeral kinematics. In order to treat this illness and lessen the mechanical symptoms linked to SLAP lesions, shoulder strengthening exercises may be beneficial.

Non-operative management using an appropriate regimen of combined intra-articular corticosteroid injection with rotator cuff and periscapular strengthening exercises has proven to provide satisfactory clinical outcomes in patients with a symptomatic SLAP (superior labrum from anterior to posterior) lesion. 

Speak to your doctor about finding the best treatments for your shoulder. Cortisone shots may be advised if shoulder pain does not subside after regular pain killers. Your doctor, surgeon, or physio will examine your shoulder through flexion, abduction, extension, and rotation ranges of motion and where you feel the pain the most.

Measure Your Shoulder Range of Motion and Track Pai  from Home for Free.

The Reflex App allows you to measure your shoulder’s range of motion and track pain simply using the front-facing camera of your iOS device. Take control of your recovery and gain insights into your shoulder health.

More on Cortisone Shots

1. What happens if a cortisone shot in the shoulder doesn’t work?

2. How long does a cortisone shot last in the shoulder?

3. Side effects of a cortisone shot in the shoulder

4. How soon can I exercise after a cortisone injection in the shoulder?

5. Will a cortisone shot help a torn shoulder labrum?

6. How painful is a cortisone shot in the shoulder?

The post Will a cortisone shot help a torn shoulder labrum? appeared first on Siphox Health.

However, the best time to resume exercising or even begin exercising is multi-factorial. It would depend on your primary aetiology, age, overall health status, secondary medical problems, and most importantly, pain. 

Once you are comfortable to start exercising, gentle range of motion exercises can be started. 

Range of motion exercises to do after a cortisone shot in the shoulder;

1. Flexion and extension range of motion exercises for the elbow, wrist, and fingers should be started. These can be started a day or two after your shot depending on your symptoms.
2. Shoulder pendulum exercises.
3. Active-assisted Shoulder flexion. This can either be done using your other arm or with the help of a stick.
4. Similarly, Active-assisted Shoulder extension.
5. Gentle scapular retractions.

Are you ready to start exercising your shoulder? Reflex: Shoulder Mobility App 

The Reflex App allows you to measure your shoulder’s range of motion and track pain. As your shoulder recovers from the cortisone shot, you can keep track of your pain levels and monitor your range of motion recovery. You can access gentle shoulder exercises in the app and move on to strength and mobility exercises as your shoulder heals.

More on Cortisone Shots

1. What happens if a cortisone shot in the shoulder doesn’t work?

2. How long does a cortisone shot last in the shoulder?

3. Side effects of a cortisone shot in the shoulder

4. How soon can I exercise after a cortisone injection in the shoulder?

5. Will a cortisone shot help a torn shoulder labrum?

6. How painful is a cortisone shot in the shoulder?

The post How soon can I exercise after a cortisone injection in the shoulder? appeared first on Siphox Health.

The most common adverse effects of cortisone shots in the shoulder are:  

• Pain: Pain after a cortisone shot at the area of insertion of the needle is a common temporary side effect
• Skin atrophy and Depigmentation: Cortisone use induces skin atrophy, leading to thinning and fragility of the skin
• Gastrointestinal reactions: Multiple gastrointestinal effects correlate with corticosteroid therapy, including gastritis, peptic ulcer disease, and abdominal distention may occur
• Cartilage damage: Cortisone shots cause damage to the cartilage forming cells with destruction and thinning of joint cartilage with a decrease in cartilage cell growth and repair
• Hyperglycaemia: Cortisone injections are the most common cause of drug-induced diabetes mellitus. Corticosteroid treatment also increases insulin resistance in patients with diabetes mellitus.
• Osteoporosis: Corticosteroids have also been shown to cause a decrease in bone formation

Reflex: Shoulder Mobility App 

Monitor pain and shoulder range of motion using the Reflex app on iOS.

More on Cortisone Shots

1. What happens if a cortisone shot in the shoulder doesn’t work?

2. How long does a cortisone shot last in the shoulder?

3. Side effects of a cortisone shot in the shoulder

4. How soon can I exercise after a cortisone injection in the shoulder?

5. Will a cortisone shot help a torn shoulder labrum?

6. How painful is a cortisone shot in the shoulder?

The post Side effects of a cortisone shot in the shoulder appeared first on Siphox Health.

That being said, patients’ responses to corticosteroid injections vary significantly. Patients with diabetes may find less relief from the corticosteroid injection as compared to non-diabetic patients. 

Another factor affecting the duration of the cortisone shot is the technique of delivery. It is currently unclear whether image-guided injections relieve shoulder pain more effectively than landmark-guided injections. More high-quality prospective studies are needed to define the role of ultrasound guidance.

Research has also found that combined corticosteroid injection and physiotherapy treatment may result in more significant improvements in SPADI score (a questionnaire used to measure shoulder function. Higher the score, better the function of the arm) and range of motion of the shoulder. 

This would make sense because the steroid simply reduces inflammation and helps with pain relief. If the primary cause of pain is muscle imbalance or weakness, it needs to be corrected.

Measure your shoulder range of motion over time using our App

More on Cortisone Shots

1. What happens if a cortisone shot in the shoulder doesn’t work?

2. How long does a cortisone shot last in the shoulder?

3. Side effects of a cortisone shot in the shoulder

4. How soon can I exercise after a cortisone injection in the shoulder?

5. Will a cortisone shot help a torn shoulder labrum?

6. How painful is a cortisone shot in the shoulder?

The post How long does a cortisone shot last in the shoulder? appeared first on Siphox Health.

What happens if a cortisone shot in the shoulder doesn’t work?

It is not uncommon for the cortisone shot to not work. Every patient responds differently to different treatments and thus, this does happen.

The main reason for this could be that the injection has failed to reach the specific target tissue. Usually, to avoid this, doctors use X-ray or ultrasound-guided techniques.

Since cortisone is primarily an anti-inflammatory, it will work only if there is an inflammation to suppress. If the primary aetiology of the pain is not inflammation, a cortisone shot may not prove to be beneficial.

Sometimes, a single dose of cortisone is not enough. In this case, the doctor may decide to try a second injection. This is usually done four to six weeks after the first injection. However, it must be noted that cortisone does not heal the underlying pathology so symptoms may flare up after the effect of the steroid subsides.

Cortisone shots should reduce pain and inflammation in the shoulder, which means increasing your shoulder’s range of motion.

Click here to measure your shoulder range of motion using Reflex: Shoulder Mobility App

More on Cortisone Shots

1. What happens if a cortisone shot in the shoulder doesn’t work?

2. How long does a cortisone shot last in the shoulder?

3. Side effects of a cortisone shot in the shoulder

4. How soon can I exercise after a cortisone injection in the shoulder?

5. Will a cortisone shot help a torn shoulder labrum?

6. How painful is a cortisone shot in the shoulder?

The post What happens if a cortisone shot in the shoulder doesn’t work? appeared first on Siphox Health.

Here are a range of exercise videos for frozen shoulder in the thawing stage. The isometric exercises from the frozen stage should have helped you build strength in your shoulder. Now with increased range of motion as your shoulder starts to thaw, you can move to more exercises that promote range of motion recovery, strength, and mobility in your shoulder joint.

As you’re starting to see your range of motion return, check out our iOS app Reflex that allows you to accurately measure your shoulder range of motion just using the front-facing camera. It’s a great tool to see your progress and highlight which movements are returning faster and which ones you can work on to get better results. In the premium version you can get all the frozen shoulder exercise videos in the app.

Click here to download Reflex from the App Store.

Signs that frozen shoulder is starting to thaw

Entering the thawing stage is a process that happens gradually over weeks or months. You’ll be relieved to be out of the frozen stage and feel like there is hope after what may seem like an endless lifetime of reduced mobility.

Here are some signs that your frozen shoulder is thawing:

– You have more range of motion in your shoulder

– Your pain is decreasing

– You feel achy or stiff instead of sharp pain

– Your shoulder feels “looser”

As the adhesions in you shoulder start to break up, you’ll feel an increase in range of motion. This is followed by a decrease in pain as the tissue starts to heal. Some people do experience fluctuations in pain during the thawing stage.

Your frozen shoulder will likely thaw on its own given enough time, but there are some things you can do to speed up the process.

• Physical therapy: A physical therapist can help break up the adhesions in your shoulder and stretch the tissue.
• Massage: Massage can help increase blood flow and loosen the muscles around your shoulder.
• Heat: Applying heat to the area can help increase blood flow and loosen the muscles.
• Exercise: Exercising the shoulder, within the limits of your pain, can help break up the adhesions, and strengthen your muscles.

Exercises for the thawing stage are designed to increase your range of motion and strength in the shoulder. You are more likely to be injured if you have limited range of motion and limited strength in your shoulder. Increasing your strength and flexibility will also mean you can return to sports and other activities you may have had to give up during the frozen stage.

These exercises are designed to help with that.

Stabilization Flexion and Extension

Equipment Required: Resistance Band

Steps to follow:

1. Tie a band in front of you at waist level.

2. Firmly hold each end of the band with each hand.

3. Place your hands and arms in line at shoulder level with your palms facing down.

4. Move one arm over your head, keeping it straight, while the other moves close to the body downwards simultaneously.

5. Slowly return to the starting position, and repeat going the opposite way.

Scapula Retraction

Equipment Required: Mat

Steps to follow:

1. Lie on your stomach, face down with your hands on the back of your head.

2. Lift your elbows off the surface while squeezing your shoulder blades together.

3. Let your elbows down and repeat.

Supine Chest Stretch with Hands Behind Head

Equipment Required: Mat

Steps to follow:

1. Lie on your back.

2. Place your hands behind your head with your elbows bent.

3. Let your elbows drop gently towards to the floor, as low as possible.

4. Hold the position.

Shoulder Internal Rotation with Elastic

Equipment Required: Resistance Band

Steps to follow:

1. Stand and tie an elastic behind you at head level.

2. Hold the end of the elastic, bend your elbow to 90 degrees and lift your arm out to the side to 45 degrees.

3. Rotate your forearm downward, keeping your elbow bent.

4. Slowly return to the start position and repeat.

Shoulder Flexion Stretch with Swiss Ball

Equipment Required: Swiss Ball

Steps to follow:

1. Stand facing a wall and hold a ball against the wall with one hand. The arm is straight horizontally in front of you.

2. Roll the ball upward by getting closer to the wall and by raising your arm as high as possible until you feel a gentle stretch.

3. Maintain the stretch and lower your arm.

Shoulder Abduction with Elastic

Steps to follow:

1. Tie an elastic beside you at hip height and hold it firmly with one hand.

2. Straighten your arm on the side and raise it overhead as high as you can, keeping the elbow straight.

3. Lower your arm slowly and repeat.

Shoulder Flexion with resistance band

Equipment Required: Resistance Band

Steps to follow:

1. Tie an elastic in front of you at waist level and hold it in your hand.

2. Straighten your arm in front and raise your arm forward as high as you can, keeping it straight.

3. Lower your arm slowly and repeat.

External rotation, 90° Abduction with Resistance Band

Equipment Required: Resistance Band

Steps to follow:

1.Tie a resistance band in front of you at shoulder level.

2. Hold the end of the band, bend your elbow to 90 degrees, and lift your arm out to the side to 90 degrees.

3. Rotate your forearm upwards, keeping your elbow bent.

4. Slowly return to the initial position and repeat.

Pectoralis stretch, mid fibers – Right Shoulder Exercise (Shorts)

Equipment Required: None

Steps to follow:

1. Stand next to a wall and put your hands on the wall behind you at shoulder level, with your fingers pointing backwards.

2. Without turning the trunk, take a few small steps forward until you feel a comfortable stretch in the pectorals major.

3. Hold the stretch.

Tennis Backhand with Elastic Band

Equipment Required: Resistance Band

Steps to follow:

1. Tie an elastic behind you at waist level and hold it with your hand in a tennis backhand position.

2. Pull the elastic forward in a tennis backhand motion.

3. Return your arm slowly to the start position and repeat.

Tennis Forehand with Elastic Band

Equipment Required: Resistance Band

Steps to follow:

1. Tie an elastic behind you at waist level and hold it with your hand in a tennis forehand position.

2. Pull the elastic forward in a tennis forehand motion.

3. Return your arm slowly to the start position and repeat.

Thoracic Extension Mobility with Roller

Equipment Required: Mat and Roller

Steps to follow:

1. Place your foam roller on the floor and take a kneeling position with your wrists on the foam roller in front of you.

2. Roll the foam roller forward by lowering your chest towards the floor and stretching your spine.

Throwing Motion with Elastic Band

Equipment Required: Resistance Band

Steps to follow:

1. Tie an elastic behind your head and hold it with your hand in a “ready to throw” position.

2. Pull the elastic forward and down in a throwing motion.

3. Return your arm slowly to the start position and repeat.

The post Frozen Shoulder Exercises – Thawing Stage appeared first on Siphox Health.

Most common rugby injuries in the shoulder affect the following structures:  

Soft tissue around the shoulder

The shoulder complex, which consists of the clavicle, scapula, and humerus, connects the upper extremity to the thorax by a carefully crafted arrangement of three joints- the glenohumeral, acromioclavicular, and sternoclavicular. The articular structures of the shoulder complex are largely intended for mobility, enabling us to move and position the hand within a large range of space.

While being a primary joint responsible for the movement of the upper limb, stability is very important for the joint. Passive stabilization is provided by the bony architecture, the ligaments, the capsule, and the labrum. Additionally, muscles around the shoulder complex also provide dynamic stabilization to the joints.

Figures 1 and 2 below show the soft tissues present around the shoulder. (Images taken from Magee, David J. (2014). Orthopedic Physical Assessment (6th. Ed). St. Louis, Missouri: Elsevier Saunders.)

Acromioclavicular joint (AC joint injuries)

The acromioclavicular (or AC joint) is a joint that connects the clavicle (collarbone) to the acromion (a bony projection on the top of the shoulder blade). It is a gliding joint that allows the shoulder blade to move up and down.

Acromioclavicular injuries are found to be the most common shoulder injury in rugby players.

Mechanism of injury

Most common mechanism of injury is a direct fall on the shoulder, especially with the area above the shoulder blade striking the ground first. This causes a dislocation of the AC joint as the ligaments that keep the joint in place get torn by the impact.

Symptoms

Pain, limited motion in the shoulder, swelling, bruising, tenderness at the top of the shoulder.

Rotator cuff injuries

Rotator cuff injuries encompass a range of severity, from mild cuff contusions to partial and full thickness tears and can all occur in players. Rotator cuff tendinitis is also a common issue in rugby players.

Mechanism of injury 

These types of injuries are mostly sustained by a direct blow to the shoulder from direct contact with an opposing player or a fall. Usually, the mechanism of injury is an impact or less commonly, could be an ABER (abduction-external rotation) dislocation.

Symptoms

Difficulty and pain caused by raising your arm, popping, or clicking sounds or when moving your arm, shoulder weakness and struggling to lift items.

Sternoclavicular joint

The sternoclavicular joint is a joint located in the middle of the chest, between the sternum (breastbone) and the clavicle (collarbone). It allows the shoulder to move up and down, and helps to keep the shoulder in its socket. The Sternoclavicular joint is also responsible for rotated shoulder movements.

Mechanism of injury

A compressive or violent force either directly over the medial clavicle or to the posterolateral aspect of the shoulder can cause a sternoclavicular injury.

Symptoms

Bruising, pain, swelling or tenderness over the joint, a deformity where the clavicle or scapula has moved, limited range of arm motion.

Glenohumeral joint

The glenohumeral joint is the primary shoulder joint, and is responsible for a wide range of motions. The glenohumeral joint is made up of three bones: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone). The humerus is attached to the scapula at the shoulder joint, and the clavicle attaches to the scapula at the acromion process.

Mechanism of injury

Tackle injury is the most common cause of dislocation. The rugby player tackling are more prone to have a dislocation as opposed to the players being tackled. The five-eight position on the field are at the highest chance of enduring this injury. For all rugby players, player-to-player contact results in trauma with the elbow in an extended position forcing the shoulder to exceed the limits of the normal range of motion causing anterior shoulder dislocation. Trauma with the elbow in a flexed position and the direction of the injuring force along the longitudinal axis of the humerus causes posterior shoulder dislocation. Fall, ruck, and impact are the lesser common mechanisms of injury. 

Symptoms

A visibly deformed shoulder, inability to move your shoulder joint, excruciating pain, swelling, and tingling sensation from your neck that can radiate to your arms.

Superior labrum anterior-to-posterior lesion (SLAP) tears

The superior labrum is a cartilage that attaches the shoulder blade to the humerus (upper arm bone). It helps to keep the shoulder in its socket and allows for a wide range of movement. The superior labrum can be injured in a number of ways, including a direct blow to the shoulder.

Superior labrum anterior to posterior (SLAP) tears are the most common labral tears in rugby players.

Mechanism of injury

The typical mechanism of injury is usually a direct blow, consisting of a tackle where the shoulder is driven into an opposing player or, more commonly, landing on the ground directly onto the adducted shoulder while holding the ball or an opponent. Less commonly, an injury can occur if the arm is in an abducted internally rotated position for a tackle, with a direct blow to the upper arm, forcing the arm into hyperextension and internal rotation.

Symptoms

Shoulder pain along with mechanical symptoms such as locking, catching, popping, or snapping in the shoulder.

Biceps tendon injury

The bicep tendon attaches the bicep muscle to the shoulder blade. The bicep muscle is responsible for bending the arm at the elbow, and the bicep tendon helps to keep the muscle in place.

Mechanism of injury

Traction forces on a flexed elbow can cause injuries to the long head of biceps.

Symptoms

Swelling in the front of the elbow, bruising in the elbow and forearm, weakness in bending the elbow, weakness in twisting the forearm (supination).

Fractures

Fractures are a minority injury type in rugby players. However, upper limb fractures are more common than lower limb fractures in rugby players.

Mechanism of injury

Most commonly, a tackle injury causes a fracture. The clavicle (collar bone), proximal humerus, scapula (shoulder blade) are most commonly fractured.

Symptoms

Pain, swelling, discolouration at the site of the fracture.

Brachial plexus traction lesion

The brachial plexus is a network of nerves that runs from the neck to the arm. It controls the movement and sensation in the arm and hand.

The Brachial plexus traction lesion is a type of shoulder injury that occurs when the nerves that run from the neck to the arm are damaged. This injury is often caused by a direct blow to the shoulder, such as in a rugby tackle.

Mechanism of injury

Traction and/or compression forces acting on the brachial plexus are the primary means of injury, with traction accounting for 95% of injuries. Such injuries most commonly occur in players playing the fullback position. The injuries result from a tackle causing a depression of the shoulder and lateral flexion of the head to the contralateral side. Less commonly such an injury can occur from a direct compressive force onto the supraclavicular region. 

Symptoms

Numbness or loss of feeling in the hand or arm, inability to control or move the shoulder, an arm that hangs limply, burning, stinging or severe and sudden pain in the shoulder or arm.

Pectoralis major tears

A rare but serious injury is a rupture of the pectoralis major muscle. Given the demands placed on the shoulders of these players, when such an injury occurs, it will usually require surgical repair, and an extended period of rehabilitation before return to professional play is possible.

Mechanism of injury

A tackle that involves a relative increase in the amount of shoulder abduction, a higher point of contact on the attacking player, and an initial point of contact from the defending (injured) player more distal on the arm than is usual.

Symptoms

Pain in your chest and upper arm, weakness when you push your arms out, bruising in your chest and arm, a dimpling, or pocket, just above your armpit where the tear is located.

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