Joint Injuries

There are several common joint injuries that occur in car accidents. For shoulders, sometimes injuries arise from the interaction of the arm and shoulder during the crash while other times this joint is injured from the deployment of the driver's airbag. Although shoulder injuries from motor vehicle crashes include dislocations, SLAP tears of the labrum, impingement syndrome, the most frequent injury we see our clients sustain are rotator cuff tears. Although called the "rotator cuff" it is not one cuff within the shoulder but rather the rotator cuff refers to a group of muscles that surround the shoulder joint and stabilize the round end of the arm bone in socket formed by the clavicle and the scapula. The supraspinatus, infraspinatus, teres minor, and the subscapularis muscles are the components of the rotator cuff. In the absence of frank instability, shoulder injuries are typically treated with medications, physical therapy, and in some cases steroid injections. Sometimes a rotator cuff tear can be see on an MRI (although a MR arthrogram is better. These imaging studies reveal muscle tears, tendon tears, detachments, retractions of the components of the shoulder. Frequently, we see rotator cuff tears requiring arthroscopic surgery. While shoulder surgery many sound intimidating, we commonly see surgeons approaching shoulder surgery from the "inside-out." What this refers to is the surgeon's approach to the arthroscopic procedure such that the inner most portions of the joint are inspected and corrected where necessary (such as stitching a torn labrum or cleaning out loose bodies), then the middle portions are attended to such as the subclavian bursa and acromion, lastly the outer portion of the joint is inspected and corrected such as the tendons and ligaments that make up the rotator cuff. Another common shoulder injury is A/C joint dislocation (referring to the acromion-clavicular joint). We frequently see this injury in side-impact crashes and where a bicyclist is knocked off of their ride by a motorist and then lands on their shoulder. A/C joint injuries can have painful separation of the joint requiring resection of the clavicle and reduction. Following any shoulder surgery, a solid course of post-surgery physical therapy is appropriate in order to rehabilitate the joint and prevent adhesive capsulitis (frozen shoulder). Many clients chose to sleep in a recliner chair for a few weeks following the surgery in order to avoid rolling over onto their shoulder. Even with a "successful" surgery, some patients have shoulder weakness, pain, and instability following shoulder surgery.

For knees, an mva can result in an impact of the knees into the underside of the dash. This type of blunt trauma can result in a tibial plateau fracture. More frequently, we see injuries to the ligaments within the knee joint or trauma to the meniscus. This injury can result from overloading the knee when the driver slams on the brakes while the impact is occurring. Knee injuries are also frequently sustain in auto versus pedestrian impacts. Like shoulder injuries, these injuries are also sometime visible on MRI studies and like shoulder injuries, the symptoms are treated with medications, physical therapy and sometime steroid injections. However, for tears of the meniscus or the internal ligaments of the knee, the derangement is unlikely to fully heal without surgical correction. In the absence of a fracture, knee surgery is typically approached arthroscopically.

Hip injuries can be caused by motor vehicle collisions, too, even though the hip is one of the more stable joints in the body. Like shoulders, hips have a labrum. The head of the femur sits inside the socket portion of the pelvic bone and the labrum acts as a glide between the two surfaces while holding the head of the femur in place. This labrum can become torn or pulled off the pelvis in an impact where the femur forced backward and up into the socket during a collision. Although more difficult to access than a knee or shoulder joint, a torn labrum can also be surgically repaired.

Ankle injuries also occur during collisions. Often the driver is slamming on the brake while preparing for an impending impact from another vehicle. When the impact is too great, the driver's foot rolls off the brake pedal so quickly that the ankle can fracture, dislocate, or sprain. When there is a fracture or displaced dislocation, the victim is almost always immediately elevated in the ER setting to an admission with sedan, reduction of any dislocation, reduction of any displaced fracture, and hardware such as metal plates, screws, and rods are mounted to rebuild the ankle. Typically the patient's ankle is immobilized and placed on temporary total disability. In the event of a sprained ankle, the joint is also immobilized and the patient starts a course of medications, physical therapy, and RICE (rest, ice, compression, elevation).

On occasion, we see clients with elbow injuries from collisions. This most commonly arises in the setting of blunt trauma to the lateral (outside) elbow from striking the door or armrest during a side-impact crash. Typically, this type of injure is treated with medication and therapeutic modalities. Occasionally, the patient will be given a steroid injection and rarely a simply release surgery will be indicated.