ACL Tears In Singapore – An Orthopaedic Surgeon’s Guide (2021)

KNEE

Apr 15, 2022

ACL Tears In Singapore – An Orthopaedic Surgeon’s Guide (2021)

Medically Reviewed by Dr. Bryan Tan

Orthopaedic surgeon, MBBS (Singapore), MMed (Ortho), FRCS Ed(Orth)

Here’s What You Need To Know

Shoulder injuries can be caused by a myriad of reasons, ranging from athletic activities to everyday tasks. This may include overhead movements that involve repetitive motions found in sports such as weightlifting, swimming, and a host of racquet sports. Everyday tasks such as household chores, plumbing, or gardening can similarly expose you to the risk of overuse shoulder injuries. Additionally, shoulder injuries can arise from accidents that inflict trauma upon your shoulder joint. You may experience broken bones or soft tissue damage, and in some cases, a combination of both. But this doesn’t mean you should avoid sporting or outdoor activities. In fact, you should seek out injury prevention strategies that can help minimise your risk of injury.

Types Of Shoulder Injuries

To understand the different types of shoulder injuries, we first have to examine the shoulder joint to understand how injuries can occur. You should know that the shoulder is the most mobile joint in the human body, consisting of numerous muscles and tendons which hold the shoulder bones in place. These ligaments are also responsible for stabilising arm movement. To obtain a better picture, let’s take a closer look at the shoulder. Firstly, The bursa is a gel-filled sac that sits across the shoulder joint, providing protection for the surrounding tendons and muscles. When the bursa in the shoulder becomes inflamed, it can cause a great deal of pain. Shoulder impingement syndrome or rotator cuff problems may also arise from bursitis. Secondly, The shoulder is a ball and socket joint whose wide surface area predisposes itself to the possibility of injury. Prolonged trauma exerted on the shoulder can lead to the formation of scar tissue. Other various dysfunctions in movement patterns may also develop over time. There are also degenerative conditions, such as arthritis, which arise due to wear and tear of the joint.. Thirdly, The shoulder joint itself contains a piece of cartilage known as the labrum. The labrum can become torn or strained during impact injuries, which affects the shoulder’s full range of motion. Shoulder dislocations,for example, can result in labral tears that require reconstructive surgery. Fourthly, The tendons connecting the bicep and deltoid can also experience tendonitis, leading to joint pain.Lastly, ligament tears or strains may also occur within the acromioclavicular joint (AC joint) due to traumatic injuries. One thing to note is that most sports place physical demands on the shoulder joint, which is susceptible to injury owing to its remarkable mobility. The shoulder structure itself is not as stable as joints in the legs and hips, making the shoulder much more vulnerable to injury. As mentioned earlier, this shouldn’t scare you away from your favourite sporting activities. Nevertheless, it is important to understand how these injuries come about. Read on to find out more…

Shoulder Dislocation

A dislocated shoulder occurs when the upper arm bone is displaced from the cup-shaped socket of your shoulder joint. This injury is common given that the shoulder is the most mobile joint in the body. Unlike other joints, it is more susceptible to dislocation. Note that a shoulder subluxation, which happens when the shoulder dislocates partially but immediately goes back into the socket, is a type of dislocation.

Causes

Shoulder dislocations can either be anterior or posterior. For the vast majority of cases, dislocated shoulders arise due to trauma from direct force or impact on the shoulder.In some cases, patients may also experience a sudden forceful movement that destabilises and overwhelms the joint, leading to dislocation. This can occur in contact sports such as American football, rugby, basketball, soccer, and water polo due to trauma inflicted from a collision. It can also happen from an accident where there is a forceful and direct impact on the shoulder, such as tripping and falling from a ladder. Anterior dislocations make up 97% of shoulder dislocations. However, the shoulder may not always fully dislocate. In some cases, you may experience a partial dislocation, known as a shoulder subluxation. This occurs when the head of the upper arm bone only partly disconnects and pops back into the socket by itself.

Symptoms

The symptoms for a dislocated shoulder include:

Visibly displaced or out-of-position shoulder
Bruising of the shoulder
Inflammation and swelling
Intense pain
Limited movement of the arm

Rotator Cuff Injuries

The rotator cuff is made up of a group of muscles and tendons which help to stabilise the shoulder joint, supporting regular movement function. Pressing and pulling movements, for example, involve the use of the rotator cuff to stabilise and move the joint. The common types of rotator cuff injuries include tendinitis, bursitis, rotator cuff strains, and rotator cuff tears.

Causes

Not all rotator cuff injuries are equal, as some may be more severe than others. They generally fall into one of three categories. Rotator cuff strains (less severe) or rotator cuff tears (more severe) can be caused by two reasons: overuse injury over time or the sudden onset of acute injury. When this happens, the tendons connecting the shoulder muscles to the shoulder blade can overstretch and become strained or torn, resulting in sharp pain. Tendinitis is a type of rotator cuff injury caused by overuse of the rotator cuff, leading to inflammation and pain in the shoulder. Racquet sports and activities such as weightlifting which require overhead movements can cause this injury. Another common type of rotator cuff injury is bursitis, which is caused by repetitive motions such as a pitcher throwing a baseball over and over. Spending an extended period of time in uncomfortable positions that put pressure on your shoulder can also cause bursitis.

Symptoms

Common rotator cuff injury symptoms include:

Inability to achieve full range of shoulder motion
Pain when sleeping on the affected shoulder
Pain when attempting to reach overhead
Weakness of the affected shoulder
Difficulty in reaching around the back

It is important to note that not all rotator cuff injuries cause pain, as some are the result of long-term degenerative conditions that may not be apparent until years later.

Injury Prevention Strategies

Given the prevalence of shoulder injuries, it can be incredibly frustrating for athletes and those who lead a physically active lifestyle. Unfortunately, shoulders that have been injured before are more likely to become injured again. For this reason, it is important to identify small pains and aches instead of ignoring them until they become a problem. You have to recognise that pain is your body’s indication that something is wrong, possibly due to bad form, muscle tightness, strength imbalance, amongst other problems. Beyond that, it is also paramount to preemptively lower your risk of injury through certain injury prevention techniques. The emphasis here is to take proactive steps to prevent injury before it can happen, focusing on prehab rather than just rehab work. If done right, you should be able to improve your overall shoulder health, thereby minimising the likelihood of injury.

The first step towards shoulder injury prevention is to simply get started.

Now that you’re aware of the different strategies which can help lower your risk of injury, you should make improving your overall shoulder health a priority. Even small habits such as practising good posture or stretching daily can go a long way.

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Dr. Bryan Tan

Orthopaedic Surgeon

Sports have always played a big part in Dr Bryan’s life. His interest in sports and varied sporting activities give him a deep understanding of sports injuries and the mindset of an athlete.

The condition often develops gradually over time and is difficult to detect. This painful condition affects 2-5% of the general population.

Dr Bryan Tan is a fellowship-trained orthopaedic surgeon, based in Singapore. He completed 2 fellowships in Orthopaedic Sports, Shoulder and Elbow Surgery in Sydney, Australia and Nice, France. Prior to private practice, Dr Bryan was a consultant in the Division of Shoulder and Elbow Surgery in National University Hospital (NUH), Singapore. He is currently still a visiting consultant at NUH where he actively teaches medical students and young orthopaedic surgical trainees. In addition, he travels to regional countries to teach advanced arthroscopic surgical techniques.

MBBS(Singapore)
MMed (Ortho)
FRCS Ed(Orth)

Dr. Bryan has a special interest in keyhole surgery and performs most of his surgeries using advanced, modern keyhole surgical techniques. He regularly visits fellow surgeons from other countries to ensure his skills and knowledge are cutting edge.

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