A guide to shoulder injuries from skiing

‘Tis the snowiest time of the year. You may be considering taking the family to have fun in a winter wonderland, but be sure to keep in mind the dangerous possible accidents that oft happen to skiers when they quite literally hit the slopes. In this article, a consultant orthopaedic shoulder and elbow surgeon describes the kinds of shoulder injuries that may occur while skiing – and how to avoid them.

Understanding the shoulder

The shoulders are a group of joints in the torso that connect each humerus (upper arm bone) to the clavicle (collarbone) and scapulas (shoulder blade) by a network of muscles, ligaments, and tendons. The ‘main’ shoulder joint – which allows us to move our arms up down, side to side, and rotate back to front in a large range of motion – is a shallow ball-and-socket joint called the glenohumeral joint, and there are others such as the sternoclavicular, acromioclavicular, and scapulothoracic joints. Working all together, they enable us to lift things, extend our arms, swing them around, or tuck them into the body.

One of the biggest disadvantages of the shoulder joint is even though it is capable of much, its shallowness makes it vulnerable to instability, and the function of the shoulder can easily be disrupted by injury, trauma, or strain.

Types of skiing shoulder injuries

Shoulder dislocation

A shoulder dislocation is when the humerus is forced from its socket, causing abrupt and intense pain, swelling, inability to use the arm, and a visible distortion to the shoulder, and requires immediate care to ‘pop’ it back into place. Function should be restored once reset, but patients are likely to feel soreness for a week or two afterwards. Patients are advised to follow up on their condition by going to a physiotherapist or an orthopaedic specialist once back at home.

This type of injury is most common during falls, collisions, or sudden twists while skiing.

Fracture

Fractures of the shoulder can happen along the clavicle, scapula, or on the upper end of the humerus. A bone fracture tends to be accompanied by numbness, bruising, swelling, and pain. Most fractures won’t need surgery; the bone can be reset and the arm can be put in a cast or a sling to protect it from shifting and to reduce movement while it heals. Sometimes, the bone can splinter or break through the skin, which may require more intensive care. These kinds of injuries do not normally necessitate emergency medical attention at the scene, allowing patients some breathing room to get back home and see a doctor or surgeon for further advice. They may conduct a CT or X-ray scan to get a better look at the fracture and decide if further surgery is needed.

They often are due to collisions with other people or structures such as trees or poles.

Rotator cuff injury

This is the most common type of skiing injury. The rotor cuff consists of a group of muscles that encompass the shoulder, stabilising and providing strength. A rotator cuff injury will likely feel painful, the shoulder will be weak and have limited motion, and patients may feel or hear clicking when trying to move it. Surgery is not always necessary, but if the injury is a complete, sudden tear, obstructing patients from performing their daily activities, or if the injury has not responded to conservative treatment and medications, then it is recommended. Surgery is not suitable for those with wear-and-tear damage over time as the tendons will be too weak. Doctors will decide the best course of action after they have scanned the area with an ultrasound or an MRI to visualise the damage to the soft tissues.

Tears or damage can happen due to acute trauma while skiing in instances such as too much pressure on the shoulder from impact (for example, stretching out the hands to grab something or to protect yourself from a fall), or twisting the shoulder sharply. These injuries can occur after a long time of stress and overuse of the joint, so longtime skiers, even if they are very skilled, can suffer from them.

How to avoid skiing shoulder injuries

To avoid a shoulder injury while skiing, skiers should:

• Learn the proper skiing techniques, and beginners should not go out onto the slopes alone without professional supervision. It is important to master how to turn, distribute weight and balance, and how to stop properly.
• Warm-up before engaging in physical activity, to loosen and stretch the muscles and joints, preparing them for intensive use, pressure, or impacts. Arm circles, chest expansions, and shoulder rolls are some of the stretches they can do.
• Invest in high-quality protective gear, with padding around the shoulders to protect against impact (and against the cold!).

If you have experienced a shoulder injury and are seeking medical treatment, you can consult with an orthopaedic specialist on Top Doctors.