By Kerry Glendon – Physiotherapist, Perform at St. George’s Park
In the latest blog from the team at Perform St. George’s Park, Physiotherapist Kerry Glendon discusses Mark Cavendish’s recent shoulder injury and the processes he is likely to go through during his recovery.
Mark Cavendish has reportedly injured his acromioclavicular joint, reports state the joint has dislocated and will require need surgery to heal properly. This injury is common in sport and occurs when there is a fall onto the side of the shoulder, the acromioclavicular joint is a small joint at the top of the shoulder where the clavicle (collar bone) joins the scapula (shoulder blade). The force of the fall causes the joint to separate, the injury is classified by the degree of damage to the ligaments surrounding the joint.
Grade one injuries are where the ligament around the joint (acromioclavicular ligament) is sprained and grade two is when the ligament is torn, grade three injuries involve the ligament attached to the clavicle and another bony prominence on the scapula (coracolavicular ligament). In grade three injuries the clavicle moves upwards due to the acromioclavicular and coracolavicular ligament tearing, you may see a bump at the top of the shoulder in with this degree of injury.
As surgery was the chosen option, it is likely Mark Cavendish has an injury that is likely to be worse than a grade three. Grade four injuries are a little more severe as the clavicle moves upwards and backwards into the muscle (trapezius), more severe injuries are classified as grade five in these injuries the joint completely ruptures with a definite bump at the top of the shoulder. In this classification of injury both ligaments have torn (acromioclavicular and coracolavicular ligaments) and the trapezius and deltoid muscle detach from the end of the clavicle. Grade six injuries are rare; the clavicle moves downwards and under a bony prominence of the scapula (acromion and coracoid process).
There are many different techniques used by surgeons. The technique used depends on the severity of the injury, what ligaments have been damaged and the physical demands the shoulder will need to be able to withstand. It is likely it will take 12 weeks to return to sport following these surgeries, physiotherapy will help to regain movement, strength and control of the shoulder.
The rehabilitation process is likely to entail managing swelling, regaining range of motion with exercises and gentle manual therapy, exercises to regain strength, control of the scapula and proprioception (the ability of the joint to know where it is in space, like, balance in the ankle). Later stages of rehabilitation should include exercises that test the shoulder control during quick movements, like throwing, and during unexpected movements. For Mark Cavendish, this is likely to involve weight bearing exercises so he is able to control the handlebars of his bike.