Hockey has always been a very physically demanding contact sport with all too many opportunities for players to injure their shoulders, either from getting hit or checked by another player or falling on the ice. Two of the most common shoulder injuries in hockey are shoulder separations (AC joint separations) and shoulder dislocations.
An acromioclavicular joint separation (AC separation) is an injury to the ligaments that attach the clavicle (collar bone) to the coracoid (small bone in the front the shoulder), causing the clavicle to separate from the shoulder blade. The most common causes are either a strong, direct blow to the front or top part of the shoulder or trauma from a fall. In hockey, these often occur when a player crashes into the boards shoulder-first. Disruption of the AC joint can result in pain and instability of the entire shoulder and arm – the severity depends on which supporting structures are damaged and the extent of that damage. The majority of AC joint injuries can be treated conservatively with the RICE protocol, wearing a sling, and physical therapy, with discomfort lasting from a few days up to 12 weeks. Athletes can return to play when they have full and painless range of motion, no tenderness when touching the AC joint, and painless manual traction. More severe separations may require surgery to reconstruct the torn ligaments, with a 6-9 month recovery.
Dislocations occur when the humerus (or ball part of the shoulder) is forced out of the socket (glenoid) and is typically the result of trauma, such as getting hit or falling on the ice. When the shoulder dislocates, athletes feel sharp pain, have difficulty raising their arm, and see obvious signs of its improper shoulder positioning. It’s imperative that the shoulder is put back into place as soon as possible. In many cases, the athlete or team trainer can do this; if the pain is too severe, a trip to the hospital is required. Once the joint is back in place, pain usually disappears quickly, and an athlete can return to play as soon as they have their full range of motion and strength. Since young athletes with shoulder dislocations have a very high likelihood of another dislocation, many surgeons have become more aggressive about fixing first time dislocators. Bracing the shoulder can help prevent another dislocation but it does not completely obviate the risk of a repeat dislocation. Athletes should be able to return to play with a brace at about 2-3 weeks after the dislocation. When surgery is required, it may take 5-8 months before the athletes are cleared for return to hockey with full contact.
Hockey coaches and trainers should be aware of these two common injuries and the treatment protocols to help assist their players when they get injured on the ice.
Dr. Joshua Dines is an orthopedic surgeon and a member of the HSS Sports Medicine Institute. He currently serves as an assistant team physician for the New York Mets.
