In the previous article, we discussed some specific shoulder injuries that can occur and some of the common structures involved with particular injuries. Unfortunately, many of these sporting activities puts the shoulder in its end range of motion and the supporting tissues (rotator cuff, biceps, etc.) in their elongate positions. Therefore, when you try to contract and provide maximal force, the muscle is in an elongated weakened position and more susceptible to injury. In the next article, we will talk about some specific strategies to help increase shoulder range of motion (which helps in reducing risk for injury) and strengthening of the shoulder muscles, so they are less susceptible to injury.
In this article, we want to look at two more injuries, one in the shoulder and one that is often misdiagnosed. In the shoulder is a joint called your AC joint or acromioclavicular joint. We talked about this briefly in our first part of this series, but this is a common enough of an injury that it is worth discussing here in some more detail.
The AC joint is held together by a ligament (depicted in this picture). An AC joint injury is an injury to this ligament where the ligament is torn and allows the clavicle to migrate upwards. One of the most common mechanism of injury of this ligament is a fall on the shoulder or onto an outstretched hand. Most commonly occurs with diving for a ball or having an opponent land on you.
In the case of falling on your shoulder, like in wrestling, this can happen on the person shooting for the takedown or the opponent. For those shooting for the takedown, if they are shooting for a double leg takedown (as depicted here) and their head is in the proper position (head up on the outside) when they drive backwards or at a diagonal, it is not uncommon to land on the shoulder. If this impact is more toward the top of the shoulder, the driving force is directly through the acromion and the clavicle. This puts a lot of stress on the ligamentous structures of the AC joint and can cause an AC separation. AC separations can occur in varying degrees. For a classifications of AC separations, please refer to our previous blog in this series. The other common mechanism of injury for the AC joint is the opponent that is being taken down. Sometimes out of instinct, the opponent being taken down will reach out his arm to break the fall and end up landing on the shoulder.
In either situation, the athlete will commonly feel a sharp pain that will be localized to the small area on the shoulder. If there is separation and depending on the grade, the athlete may see a deformity of the area. The picture below shows two ends of the spectrum. From a low grade level I separation to a grade III - IV. I have included this picture so you can see what this looks like and be able to recognize this when or if you see it in the mirror. Looking in the mirror, you compare your non-involved shoulder to the involved or painful shoulder. You are look at the top of the shoulder where the arrow indicates. Sometimes, it is helpful to have someone else look at as well if you are unsure. 
In the first instance, although painful, this can most likely be treated conservatively. In the second case, this individual should see a health care provider. In either instance, use of an ice massage is very effective at reducing inflammation and pain. For this you can purchase a cyrocup (depicted here) on Amazon or eBay for ~$10. I prefer these over the metal round balls being sold in some circles and here is why. What makes this form of icing so effective is when the ice melts it forms a layer of water between the skin and the ice cube. This layer of water conducts the cold much more efficiently than just ice on the skin or cold metal. This means deeper more effective penetration and colder temperatures are achieved. This results in better inflammation control.
