Torn ligament of the shoulder

definition

A ruptured ligament of the shoulder is a rupture of the ligament structure located there, which contributes to the stability of the joint.
Depending on the severity of the injury, one or more ligaments can be affected.

Causes of a ruptured shoulder ligament

The ligament structures often tear in a fall with direct force on the shoulder joint and with an outstretched arm.
The resulting leverage can lead to various joint injuries on the shoulder girdle. The ligaments do not necessarily tear, they can also be overstretched or trapped.

You might also be interested in this topic: Ligament stretching of the shoulder

Symptoms of a torn ligament on the shoulder

Splitting the shoulder joint usually causes direct pain. These occur both at rest and under stress.

The area around the shoulder joint can swell. Depending on the extent of the injury, the collarbone moves upwards and can then be seen from the outside. During the clinical examination, patients often report pain on pressure. The collarbone is also movable and can be pressed down like a piano key.

In order to be able to differentiate a torn ligament from a torn capsule in the shoulder area, it is recommended to deal with the following topic: Capsule tear in the shoulder

Appointment with a shoulder specialist

I would be happy to advise you!

Who am I?
My name is Carmen Heinz. I am a specialist in orthopedics and trauma surgery in the specialist team of .

The shoulder joint is one of the most complicated joints in the human body.

The treatment of the shoulder (rotator cuff, impingement syndrome, calcified shoulder (tendinosis calcarea, biceps tendon, etc.) therefore requires a lot of experience.
I treat a wide variety of shoulder diseases in a conservative way.
The aim of any therapy is treatment with full recovery without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

• Lumedis - your orthopedic surgeon
  Kaiserstrasse 14
  60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
You can find more information about myself at Carmen Heinz.

What are the degrees of severity of a torn shoulder ligament?

Classification according to Tossy

Depending on the extent of the injury, these can be divided into 3 forms. The classification according to Tossy is very common in everyday clinical practice.

Tossy I is an overstretching or straining of the two aforementioned ligament structures.

In the Tossy II injury, on the other hand, there is a rupture of the acromioclavicular ligament and an overstretching of the coracoclavicular ligament. This instability leads to an incomplete dislocation (Subluxation) of the shoulder joint.
The joint head is still partially in the leading joint capsule.

On the Tossy III, both ligaments are finally torn and the shoulder joint is no longer secured by the strong ligament structures. Here is a complete dislocation (dislocation) of the acromioclavicular joint.

Further information on this topic can also be found under: Tossy shoulder joint dislocation

Classification according to Rockwood

This classification distinguishes between 6 types of injury.

In type 1 there is a stretching of the acromioclavicular ligament and the patient feels slight pressure and movement pain.

Type 2 has a rupture of this ligament and a slight, incomplete dislocation of the lateral clavicular fragment.

Type 3 describes a tear in the acromioclavicular ligament and the coracoclavicular ligament. There is also a step formation between the acromion and the clavicle.

Type 4 has the same injuries as type 3, but the clavicle is dislocated backwards. The clavicle can run into or even through the trapezius muscle. It can be felt in the area of ​​the shoulder blade.

In type 5 there is a clear gap between the clavicle and the shoulder blade.
There is no longer any hold, so the shoulder sinks down while the clavicle escapes upwards. The trapezius and deltoid muscles are often torn off.

Type 6 is severe dislocation of the torn clavicle under the acromion or shoulder blade protrusion (Proc. Coracoid).
In most cases, this injury is accompanied by broken ribs, clavicle fractures and injuries to the nerve plexus located there.

Similar topics you might be interested in: shoulder dislocated

Therapy of a torn ligament on the shoulder

Conservative therapy

The ligament injuries according to Tossy I and II can be treated conservatively, i.e. without surgery. The treatment includes immobilizing the joint for six weeks using a Gilchrist bandage.
Immobilization reduces the tension on the joint that is generated by the body's weight. This allows the ligament structures to adapt by themselves and heal completely.
Pain medication can also be prescribed to relieve the pain. Physiotherapy can aid healing and prevent contractures from developing.

Read more on this topic at: Therapy of a shoulder joint dislocation

Taping a torn ligament

Lighter injuries such as overstretching or strains on the ligament structures of the shoulder can be treated with the Kinesio tapes.

With the right application technique, the tape has a supporting and stabilizing effect on the shoulder joint. The tape is often attached in the shoulder area along the length of the deltoid muscle.
To do this, the ribbon is split in the middle. The lower contiguous part is attached to the lower end of the deltoid muscle. Now one half of the tape is glued along the front edge, the other half along the back edge of the muscle. The band finally encloses the muscle.

This relieves the injured ligament structures or supports them when moving. After a long period of rest, the straps can also be attached for protection when resuming sporting activities.

Operative therapy

Injuries according to Tossy III or types 3, 5 and 6 according to Rockwood must be treated surgically in the first 12 days due to their instability. There is an indication for an operation, particularly in younger patients with stress in everyday life and at work.
In addition, the raised collarbone is perceived as annoying and should be repositioned.

Operations on the shoulder joint are now performed arthroscopically. An endoscope is inserted through an approximately 3 cm long incision above the acromion, which makes the inside of the joint visible to the surgeon. Finally, the clavicle can be fixed again using appropriate instruments.
Depending on the surgical method, there are wires, screws or artificial tapes to choose from, which are used to fix the clavicle back to the raven beak process.
The anatomical structures are brought back into their original position and the shoulder joint is stable again after healing. This minimally invasive procedure takes about 2 hours or longer, depending on the severity of the injury.

Chronic instability in the shoulder joint can develop if a shoulder joint dislocation is inadequately cared for. This complication can also be treated surgically by inserting a tendon graft made from your own body material. Tendons from the knee flexor area such as the semitendinosus tendon are used for this.
The graft is placed through a borehole between the raven bill and the collarbone. The body's own tissue replaces the previously unstable connecting ligament.
This operation often leads to a significantly better protection of the shoulder joint and the load can be increased again.

Further information on this topic can be found under: Surgery of a shoulder joint dislocation

Follow-up treatment of a torn ligament on the shoulder

After the operation, immobilization using a Gilchrist bandage is prescribed. The duration depends on the information provided by the surgeon and is between 4 and 8 weeks. During this time, the band structures have the opportunity to adapt and heal again.
Physiotherapy can be prescribed to support the healing process, which involves moving the patient through movement exercises in the wrist and elbow joint in order to avoid complications.

However, complete healing is a long process, so that many patients still struggle with residual symptoms 3-6 months after the operation. The time it takes to heal also depends on the severity of the injury, but also on the age and general condition of the person affected.

What are the complications of a ligament tear on the shoulder?

In addition to recurring pain, the complications also include the development of chronic instability despite surgery. Often then, another operation with a tendon transplant must be considered.
Furthermore, osteoarthritis can develop due to poor healing. Calcifications in the shoulder can also occur. The consequences are restricted mobility and increasing wear of the protective cartilage substance. In the longer term, the complications in turn lead to increasing instability in the shoulder joint.

More on this topic: Osteoarthritis of the shoulder

Diagnosis of a torn ligament of the shoulder

In addition to the history of the accident and a clinical examination, the X-ray confirms the diagnosis of a torn ligament and shows the extent of the injury.

When the doctor examines a Tossy III injury, the "Piano key phenomenon" observe. Due to the rupture of both ligaments, the clavicle protrudes very far upwards and can be pressed down like piano keys and then jumps up again.

X-rays of the shoulder joint are taken in 2 planes.
In the pictures taken, one finally sees a clear widening of the joint space and mostly a displacement of the clavicle.
In addition, X-rays can be made under stress to secure the diagnosis. The patient holds a 10-15 kg load on the affected arm. The x-ray shows that the lateral end of the clavicle is clearly rising.

You may also be interested in this topic: Arthroscopy of the shoulder

Duration of a torn shoulder ligament

In the case of more pronounced ligament tears (Rockwood IV-VI and III in young patients), various surgical techniques are used. It will take 3-4 months for the shoulder to be fully resilient again. Strong and excessive exposure to sports and work should not be started before 6 months.

In general, it cannot be assumed that the patient is unable to work. In the first few weeks, however, a sick note can be issued by the treating doctor. For the time after that, it may be necessary to discuss with the employer whether other employment options are possible in the workflow.

The healing time can vary greatly and depends on the size of the injury, the patient's cooperation and the fitness level of the shoulder. If a patient has pronounced musculature and has been doing sports before the ligament rupture, a faster healing can be assumed. Renewed ligament tears are quite possible. Therefore, patients should strengthen their shoulders permanently with self-exercises and thus prevent further problems.

In the case of ligament tears that are less pronounced (Rockwood I-III: overstretching and partial tears), we proceed conservatively.

Structure of the shoulder joint

The shoulder consists of several joints. In addition to the actual ball joint, there is also the shoulder joint. It is formed from the end of the collarbone and part of the roof of the shoulder called the acromion.
In medical terminology, this joint is known as the acromioclavicular joint. It is surrounded by a strong joint capsule and is secured from above, below, in front and behind by thick ligament structures.

The acromioclavicular ligament is located between the acromion and the collarbone, and the coracoclavicular ligament is located between the ravenbill process, a protrusion of the shoulder blade forward, and the collarbone.
The latter takes on around 80% of the force of the shoulder joint, which shows how important these ligaments are for optimal movement in the shoulder area.