Trailside Medicine: Shoulder Injuries

The shoulder and clavicle (collarbone) may be the most frequently injured body parts while mountain biking. During a fall, the arms reflexively reach out in an attempt to absorb impact and protect our head and torso. Whether the arm hits the ground first, or the shoulder absorbs the brunt of the impact, lots of force can be transmitted through the shoulder.

The shoulder actually consists of several joints. The obvious joint is between the humerus (upper arm bone) and its socket. This joint has an incredible range of motion, but consequently it is at risk of getting knocked out of socket, called dislocation. This is painful and there will be difficulty moving the arm. Assistance may be required to put it back in place. The dislocation could injure other important structures, such as the rotator cuff.

Another notable part of the shoulder is the AC joint, which connects the end of the clavicle to the outer end of the shoulder blade. If this joint gets stretched or injured, it is called an AC sprain, or can be referred to as a shoulder separation. Severity can range from mild to severe.

A third injury is fracture of the clavicle. This is usually painful and may be visibly obvious because the clavicle is located just underneath the skin. After falling off the bike, it can be difficult to know immediately if there is serious injury beyond scrapes and bruises. Looking at the area might reveal an obvious abnormality. Using the hand of your uninjured arm, press all along the collarbone and the shoulder to check for abnormalities or tenderness. Then try to move your arm in all directions. Does that all seem OK? An ice pack later might be all you need. However, if something appears abnormal or swollen, or you are having significant pain or difficulty moving the arm, it might be time to see the doctor.

It is helpful to know how to convert your shirt into a sling if needed. Remove both arms from their sleeves. Then put the injured arm into the shirt, until the hand has just entered the opposite side’s sleeve. The weight of the elbow and forearm will be supported by the body of the shirt.

Dr Jesse Coenen lives in Duluth to take advantage of the awesome natural areas and trail access. He practices family medicine and sports medicine.

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