fred jackosnShoulder injury comes in a variety of flavors.  Sometimes it develops insidiously from wear and tear; and sometimes it comes for acute shoulder injury.  The Buffalo Bills have been severely bitten by the injury bug as of late. Not only have they lost running back Fred Jackson to a groin injury, they have also lost fellow backfield mate C.J. Spiller to injury, in the same game no less. While Fred Jackson is likely to return in about four weeks, C.J. Spiller is likely done for the season. C.J. Spiller got tripped up from behind and fell hard onto his left shoulder at the tail end of a 52-yard run. He immediately reached for his left collarbone.

fred-jackson-shoulder-injuryThe clavicle, more commonly known as the collarbone, connects the arm to the body and is located between the rib cage and shoulder blade.  As with the case of C.J. Spiller, broken clavicles are typically caused by a direct blow to the shoulder. A broken clavicle can cause extreme pain, sagging shoulder, inability to lift arm, grinding sensations, deformity, bruising, and swelling.Diagnosing a broken clavicle can typically be done via a physical examination; however, x-rays are taken to determine the location and severity of the break. Occasionally an orthopedic physician will also order a CT scan as well to get a better look at the broken bone.This injury can heal completely witho

broken-shoulder-collar-boneut surgery as long as the bones are not out of place. Non-surgical treatment typically involves the use of an arm sling and pain medication at first. Once the pain has been reduced and the bone begins to heal, gentle shoulder and elbow exercises can be used to prevent stiffness and weakness. Eventually, after follow-up x-rays reveal that the bone has completely healed, you can start doing more strenuous exercises.If the bones of the clavicle are out of place and not properly aligned, surgery may be required to assure proper healing. The orthopedic surgeon will manipulate the bones to get them into proper alignment. Once aligned, plates, screws, or pins can be utilized to hold the bone in place while it is healing. Pins are removed after healing, while screws and plates are typically kept in unless there is discomfort associated with them. As with any surgical procedure, there can be complications such as infection, bleeding, pain, hardware irritation, and nerve damage. Following successful surgery the recovery is much the same as the non-surgical method of treatment.

shoulder bone fracture



Shoulder injury in a young athlete is usually a result of overuse, barred a distinct traumatic event. One of the types of overuse shoulder injuries that results in severe shoulder pain is called acromial apophysiolysis. Pediatricians often diagnose the condition in young baseball pitchers.

baseball-pitcher-shoulder-injuryIncomplete fusion and tenderness of the acromion is responsible for the shoulder injury, according to the Radiological Society of North America. The acromion forms the bone at the top of the shoulder. It actually consists of four bones that join during a person’s teen years.

In its online journal “Radiology,” the RSNA described the results of a study which found that “young baseball pitchers who throw more than 100 pitches per week are at risk” of suffering acromial apophysiolysis. Some sustain rotator cuff tears and other shoulder injuries, as well.

Another study, also posted at, concluded that acromial apophysiolysis is characterized in part by edema (too much watery fluid accumulating in body cavities or tissues).acromial apophysiolysis shoudler injury

Patients 25 years of age and younger were found to be most susceptible to “superior” shoulder pain  due to the shoulder injury. Researchers confirmed that pitching “is a risk factor (because) it predisposes the patient to the development of an osacromiale and rotator cuff tears after age 25 years.”

The study is titled “Acromial Apophysiolysis: Superior Shoulder Pain and Acromial Nonfusion in the Young Throwing Athlete.” The authors were Johannes B. Roedl, MD, PhD; William B. Morrison, MD; Michael G. Ciccotti, MD; and Adam C. Zoga, MD.

“We kept seeing this injury over and over again in young athletes who come to the hospital at the end of the baseball season with shoulder pain and edema at the acromion, but no other imaging findings,” Roedl, a radiologist, said in a news release. “We believe that, as a result of overuse, edema develops and the acromion bone does not fuse normally.”

The research took place at Thomas Jefferson University Hospital’s Department of Radiology in Philadelphia. It involved 2,372 patients between 15 and 25 years of age who had undergone MRIs to diagnose the cause of their shoulder pain. The imaging tests detected edema of the acromial apophyses in 61 (2.6 percent) of the cases.

“Association of acromial edema with incomplete fusion, pitching and clinical findings was determined in the study group, and in an age- and sex-matched control group,” the researchers wrote.

The patients included men and women, most of whom were baseball pitchers. Roedl said they were chosen for the study because “among high school athletes, pitching is the most common reason for shoulder injury.”

Forty percent of one group of study participants had thrown more than 100 pitches per week, compared with 8 percent in the other group. All the patients were diagnosed with acromial apophysiolysis.

According to, baseball pitchers are not the only athletes at risk. The shoulder injury also happens to those who play softball, tennis, golf, handball, volleyball and other sports that require throwing or hitting an object. Even weight lifters and yoga practitioners are vulnerable.

The best advice for avoiding acromial apophysiolysis and other overuse shoulder injuries is to practice moderation. The shoulder joint needs time to rest and heal. When the arm starts to hurt, it is time to take a break.

The American Academy of Orthopedic Surgeons recommends that pitchers reduce the number of times they throw a ball in a game. The organization supports pitch-count limits set by the USA Baseball Medical Safety Advisory Committee.

Strengthening exercises, and stretching and warming up before workouts, are helpful. Ice and anti-inflammatory medication reduce swelling and discomfort.

If you or your child are faced with unabating shoulder pain, contact our nationally recognized sports medicine physicians at Orthopedic Surgery San Diego.


AC Joint sprain Shoulder injury is extraordinarily common for over-head athletes.  This includes the best La Jolla tennis players and the recreational Carlsbad yoga enthusiasts alike.

There are very few players in the NFL who are as explosive as Washington Redskins’ wide receiver Desean Jackson.  Fortunately for Desean Jackson, his most recent injury should not have any affect on his explosiveness. Unfortunately, it is very hard for a wide receiver to catch the ball when he has a “separated shoulder.” Desean Jackson’s injury occurred during the game against Jacksonville last week and the diagnosis of was a sprained AC joint. However, he was surprisingly, able to play and perform very well despite the injury. But let’s take a look at the injury that threatened his Week 3 availability.

The AC joint connects the shoulder blade (acromion) and collarbone (clavicle). Ligaments surround and act to stabilize the AC joint. These ligaments are typically damaged if you fall and land directly onto the shoulder. This is a very typical injury in sports and often happens when players dive to make a play and cannot flip onto their back for the landing. Like many sprains the severity of the injury can vary. Grade I sprains would involve tears of microscopic fibers of the AC ligaments. Grade II sprains are more severe but typically only have cause slight alignment issues. Grade III sprains are complete tears and often involve both the AC ligament and the CC ligament. A severe sprain would put the AC joint significantly out of position. Symptoms of an AC joint sprain include pain at the top of the shoulder, swelling, bruising, decreased range of motion, and deformity.

AC Joint Sprain Shoulder injury Treatment:

Mild AC joint sprains do not require surgery and generally can heal completely with time and use of ice packs and slings. Grade II sprains, the AC joint can heal without surgery as well, but if there is any deformity involved with the injury, there may be ongoing pain in the AC joint. This pain could be due to arthritis development, injury to cartilage between the bones, or abnormal bone-to-bone contact. Grade III injuries with severe deformity typically require orthopedic surgery for complete return to form. The surgeon can reconstruct the damaged ligaments surrounding the AC joint. After a period of immobility and rehabilitation most people are able to return to form without much trouble, although as discussed above, lingering pain may persist. Even in mild AC joint sprains, shoulder exercises should be utilized to regain flexibility, strength, and range of motion. Some of these exercises include shoulder blade squeezes, pendular exercises, wall crawls, and static rotator cuff extensions. As the AC joint becomes stronger, more intermediate and advanced exercises can be utilized.

Desean Jackson and the Washington Redskins got pretty lucky that Jackson’s injury was not more serious. His injury was likely somewhere in between a grade I and grade II sprain. Through limiting weekly activity and pain management, Jackson was able to tough it out this weekend against his former team, the Philadelphia Eagles. He managed to have a very good game and the Washington training staff will likely install a similar regimen for this upcoming week, although the Redskins have a short turnaround, playing on Thursday night.

If you are faced with a shoulder injury, have our nationally recognized sports medicine physicians at San Diego Orthopedic Surgery Clinic care for you.  Call for an appointment.


Many of the kids playing pop warner or teens playing high school football in the Carlsbad and North County area may have sustained shoulder injuries or neck pain, similar to Pro NFL players.  St. Louis Rams officials described Rodger Saffold’s recent shoulder problem as a “stinger,” a term familiar to people who play contact sports.

Saffold suffered the injury in his left shoulder during training camp, ESPN reported. It took nearly a month for symptoms to subside to the point that the offensive lineman was ready to return to action.  This is unusual.

Technically called a brachial plexus injury, a stinger afflicts about one in two college football players. Wrestlers, gymnasts, snow skiers and martial-arts enthusiasts also are vulnerable. A stinger can occur when a collision or fall causes the shoulder and head to snap in opposite directions. It also may result from the head being forced to the side, or from blunt-force trauma of the collarbone.

Such violent movements and impacts compress and excessively stretch nerves in the neck and shoulder, causing an electric stinging sensation that may extend to the arm and hand. Some patients describe the pain and discomfort as “burning” or “tingling.” Others feel weak or numb in the shoulder or arm. Neck pain can be an indication of another type of injury or disorder.

Many experience the symptoms for only a few seconds or minutes. Others need treatment for several days or weeks. Sometimes, there is a nerve injury that continues to cause shoulder pain and weakness. People who have had one stinger are more likely to suffer more of them. Each time it happens, the joint gets weaker and nerves sustain additional damage.

Nerves function like electrical cables in the spinal canal, allowing the brain to send messages to the muscles. Nerves that branch from the spine, where it meets the neck, form the brachial plexus (a bundle of nerves). All the nerves that permit a person to feel and move the arm travel through the cord.

Most patients get stingers on one side of the body, though full contact with another person or an unmovable object can injure both shoulders. In some cases, people have stingers on both sides because of spinal-cord damage.

Treatments for the pain and burning include resting the shoulder and arm, alternating applications of ice and heat, and taking anti-inflammatory drugs. When the discomfort continues longer than several weeks, medical tests are needed to diagnose the problem. There might be nerve damage that cannot heal on its own.

Doctors study patients’ medical histories, and conduct physical exams, to diagnose stingers. They determine the extent to which the brachial plexus has been stretched, and evaluate nerve function and reflexes. More tests are ordered if a patient appears to have a cervical spine injury. Diagnostic methods include x-rays, MRIs and EMGs.  It is important the player seek medical attention so that a doctor can unmask any latent anatomic risks that puts a player at risk.

Some patients wear cervical collars to take pressure off the nerves until they can recover. Doctors often give cortisone to reduce the swelling. They advise patients to refrain from strenuous activity until the pain is gone, full range of neck motion returns, and testing has confirmed there is no nerve damage. Strengthening neck muscles and improving posture can help prevent recurrences.

Surgery becomes necessary when a herniated disk or bone spur compresses and injures a nerve. Without the procedure, a patient is likely to continue experiencing severe pain and weakness.  Let our Orthopedic Surgery San Diego award winning orthopedic sports medicine specialists evaluate you to help you maximize your recovery.


Separated Shoulder Injury Sidelines Another Athlete……

Whether a soccer player in Carlsbad, mountain biker in San Diego,  or an ice hockey player on the ice, shoulder injury such as a separation are a dime-a-dozen but need to be taken seriously.  Pittsburgh Steelers’ rookie Martavis Bryant is the latest professional football player to suffer an AC joint sprain, commonly known as a shoulder separation.sports-shoulder-injury

The wide receiver could miss much of the season, depending upon the extent of the damage in his shoulder, ESPN reported.The source of the shoulder pain resulting from such a shoulder injury is the acromioclavicular (AC) joint, between the shoulder blade (scapula) and collarbone (clavicle) on the top of the shoulder. The scapula and clavicle form the joint socket, which holds the rounded end of the arm bone (humerus). A shoulder separation happens at the point where the shoulder blade (acromion) attaches to the clavicle.

Falling on a shoulder while the arm is extended is often responsible for an AC joint separation. This shoulder injury can happen while playing sports, or when riding a horse or bicycle.  Extraordinarily common with mountain bikers going over the handle bars.  A collision or direct blow to the shoulder also may cause this shoulder injury.


The impact of falling or getting hit damages ligaments that stabilize the joint. When the ligaments under the clavicle tear, a separation of the collarbone and wingbone occurs. The wingbone shifts into a lower position, producing a bulge above the shoulder.

The severity of AC sprains varies. In some cases, people feel only slight shoulder pain, along with some swelling and bruising. More serious shoulder injuries involve additional pain and physical deformity. The more a joint is distorted, the longer it takes for the patient to recover.

Shoulder separations are classified in six categories, based on the degree of damage. A Type 1 separation, in which the bones are not forced out of alignment, is only an injury to the capsule that surrounds the AC joint. Patients feel pain, but typically recover quickly.

A person with a Type II separation also has an injured AC joint capsule, as well as a partially torn coracoclavicularone ligament (which supports the clavicle). The injury is often characterized by a small bump. A Type III sprain is similar to a Type II separation, but more extensive. The bump on the top of the shoulder is pronounced.shoulder-injury-types

A less common diagnosis, Type IV shoulder separation, features a clavicle that has been forced behind the AC joint. In a Type V separation, the end of the clavicle punctures the muscle above the joint, causing a large bump. A Type VI separation is rare. It involves the clavicle being pushed down, below the corocoid (a section of the scapula).


Treatments for AC joint separations include rest, ice and medication. Patients often wear slings, and refrain from intense physical activity, until the pain subsides and normal joint mobility returns. Most people, even those who suffer deformities, regain shoulder function. Some continue to experience pain, because the AC joint has been misshapen in a way that causes bones to rub together. Cartilage damage and arthritis also can cause persistent pain.


If a patient’s condition does not improve, surgery is an option. A common procedure entails trimming the end of the collarbone to prevent it from irritating the shoulder blade.  Dedicated shoulder surgeons like the award winning doctors at Orthopedic Surgery San Diego can perform even more cutting edge procedures that reconstruct the damaged shoulder ligaments.  To correct deformities, orthopedic surgeons reconstruct the ligaments that support the bottom of the collarbone.  Call Orthopedic Surgery San Diego for an appointment to discuss your injury.

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow