Climbing Physios
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About a month ago I was bouldering in the gym and fell with my left arm overhead and internally rotated (in a gaston position). I had been transferring my weight onto that hand on a roof and trying to hold a lock-off so that I could move my feet, but ended up rapidly loading my shoulder as I fell. I felt popping and had immediate pain and tenderness over my acromion. Over the next week, I was surprised to find that resisted testing of my rotator cuff was pain-free. I still had shoulder pain with horizontal adduction (active/resisted end range), reaching hand behind back, and lying on my opposite side or sitting prolonged without support. I asked a coworker to test my AC joint and I had pain and laxity upon testing of the AC ligaments (acromioclavicular only, conoid and trapezoid ligaments stable and pain-free). I have never heard of an AC joint traction/rotation injury, which I am assuming is what occurred. Has anyone else seen an AC joint injury from a climbing fall before, in themselves or a patient? Any insight into the mechanism of how this occurred? Thank-you! Hello Skye, I guess your shoulder is feeling better as it's now March, but I'm interested in the mechanism also. Tell me, when you say that it was painful with active resisted adduction, what position was the shoulder in for that test? 90deg of flexion? Are we talking about an O'Brien or scarf type test position? James @james thanks for your interest! My shoulder pain has now resolved. The painful testing was in a scarf test type position. @skye-fi Glad it's better. The injury here seems likely to have been caused by a torsion force through the AC ligament, if you agree that its resting position is when the GH is also in its resting position. In this case, while the ligament is twisted it cannot tolerate simultaneous traction and/or shear forces. In this scenario the other two ligaments are unaffected because there was very little scapulothoracic elevation. Interesting biomechanics for sure. I guess one of those situations in which you want to keep the shoulder complex moving as much as possible without causing any aggravation to the AC joint, which is fairly delicate at the best of times.
