What is an upper body injury in hockey?

Upper body injury is commonly reported in NHL injury reports.  What does that mean?  Is it a shoulder injury?  Something more specific such as an AC joint or labrum? 
The term "upper body injury" is purposely vague to leave some question as to the exact nature of the injury. Years ago, while I was serving as team physician for the Philadelphia Flyers, accurate reporting of injuries was required. Now teams are permitted to not disclose specifics and instead report vague injuries such as upper body injuries. The reason to not report the specific injury is to keep opposing players from directing their attention to that part of the body that was compromised.

It was the last game of the season and I was called to the opposing team’s locker room to see an injured player.  By the time I arrived, the player indicated that he was fine even though he was still clutching his right chest. During my examination of the player I lightly touched his ribs and I felt crumbling bones beneath the skin on the right side of his chest. Clearly he had fractured several ribs. The player did not want this information made known. There were two reasons for this. One was he did not want to draw attention to himself and the other was that the Flyers were going to begin a playoff series with the same team the following week. He played the entire playoff series as if he had no injury.

So what upper body injuries would cause a player to carry his arm off the ice as we saw with Sean Couturier Thursday night? The most common injuries in hockey that occur from impact like Couturier had are shoulder separations, shoulder dislocations, stingers and fractures.

A shoulder separation is not actually a shoulder injury but an AC joint (acromioclavicular) where the collarbone meets the top of the shoulder (scapula). The collarbone is held onto the scapula by three ligaments. When you hit the boards or the ice hard the collarbone can “separate” or injure these ligaments. You can see it as a bump on the top of the shoulder. This can be very painful injury because the entire weight of the arm and shoulder passes through this joint. The degree of separation is defined by how many ligaments are damaged and this determines how long the injury takes to heal. The good news is that these injuries rarely require surgery and often will heal.   A minor amount of separation is called a grade one injury and a severe separation is called a grade 3 injury.  In general terms these injuries can take from 10 days to six weeks to recover.

Shoulder dislocation involves the ball and socket joint of the shoulder. It is a much bigger injury than a shoulder separation. Ligaments rip, cartilage (labrum) tears, and the shoulder can end up being so loose that it will dislocate on its own. In hockey players, these injuries are typically surgically repaired immediately because this method has the best chance of preventing recurrence of dislocation.
Stingers occur when the nerves that come out of the neck and go down the arm are pinched or stretched by injury. A strong downward force on the collarbone or a forceful bending of the head to the same side or the opposite side can compress or stretch nerves. In the large majority of cases this injury is transient and the symptoms resolve almost immediately. In some cases the players are left with weakness which takes anywhere from days to weeks to fully recover. In rare cases strength does not fully recover for months.

Fractures can occur around the shoulder and usually require significant time missed or surgical intervention. Each fracture location and type requires different treatment with its own time frame for recovery.

he next time you hear a player is out with an upper body injury, keep in mind that it could be anything from a simple grade 1 AC joint injury to a dislocation or fracture which may require surgery and could be season ending.  We will find out in the next few days what Couturier’s actual injury is and what his potential return will be.