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Shoulder Injuries

Shoulder Injuries. Sports medicine class John Hardin Instructor. Anatomy. Bones Ligaments Joints Muscles. Bones. Clavicle Sternal end, distal end Scapula Glenoid fossa, acromion process, coracoid process, spine, supraspinous fossa, infraspinous fossa, vertebral border, inferior angle

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Shoulder Injuries

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  1. Shoulder Injuries Sports medicine class John Hardin Instructor

  2. Anatomy • Bones • Ligaments • Joints • Muscles

  3. Bones • Clavicle • Sternal end, distal end • Scapula • Glenoid fossa, acromion process, coracoid process, spine, supraspinous fossa, infraspinous fossa, vertebral border, inferior angle • Humerus • Head, greater & lesser tuberosity, bicipital groove

  4. Ligaments • Acromioclavicular • Coracoclavicular • Coracoacromial • Glenohumeral • Superior • Middle • Inferior • Glenoid Labrum

  5. Joints • Glenohumeral joint • Acromioclavicular joint • Sternoclavicular joint • Scapulothoracic joint

  6. Muscles • Produce dynamic motion & establish stability to compensate for the greater mobility • Motions at shoulder joint • flexion & extension • Internal & external rotation • Abduction & Adduction • Horizontal flexion • Circumduction

  7. Muscles attaching axial skeleton to humerus • Latissimus dorsi • Shoulder extension, adduction • Pectoralis major • Shoulder adduction, horizontal flexion

  8. Muscles attaching scapula to humerus • Deltoid • Abduction, flexion, extension • Teres major • Internal rotation • Coracobrachialis • Shoulder flexion • Rotator cuff muscles • Supraspinatus- external rotation, initiates abduction • Infraspinatus-external rotation • Teres minor-external rotation • Subscapularis-internal rotation

  9. Muscles attaching axial skeleton to scapula • Levator scapula • Shoulder elevation • Trapezius • Shoulder elevation, retraction, depression • Rhomboids (major & minor) • Shoulder retraction • Serratus anterior • Shoulder protraction, holds scapula flat against thoracic cage

  10. Other muscles • Biceps brachii—long head & short head • Shoulder flexion • Triceps brachii—long head, medial head, lateral head • Shoulder extension

  11. Preventing shoulder injuries • Maintain adequate strength & flexibility of all shoulder muscles • Good posture • Proper techniques • Proper warmup • Proper protective gear

  12. Types of Injuries • Sprains • Dislocations • Strains • Overuse • Fractures

  13. AC Sprain Shoulder separation

  14. Mechanism • Impact to tip of shoulder • Fall on outstretched arm

  15. Signs and symptoms • Deformity at AC joint • distal end of clavicle rides superiorly • Pain with movement and palpation • “+” piano key sign

  16. Degrees of injury • 1st degree: no deformity, pain w/ palpation & motion, mild stretching of AC ligament • 2nd degree: displacement of distal end of clavicle, unable to abduct arm or bring it across body, pain • 3rd degree: complete rupture of AC and CC ligaments, with dislocation of the distal end of clavicle, severe pain, LOM, instability

  17. Treatment • RICE • Immobilization • Physician referral if more than 1st degree • Possible surgery

  18. SC Sprain • Relatively uncommon injury

  19. Mechanism of injury • Indirect force transmitted through the humerus, the shoulder joint and the clavicle • Direct impact to clavicle

  20. Signs & symptoms • 3 degrees • May have deformity at sternal end • Swelling • Pain • POT • Inability to abduct shoulder through full ROM

  21. Treatment • RICE • Immobilization • Physician referral

  22. Glenohumeral dislocation • Shoulder dislocation • Anterior—most common • Posterior • Inferior • Multidirectional

  23. Anterior shoulder dislocation

  24. Anterior shoulder dislocation

  25. GH dislocation

  26. GH dislocation

  27. Mechanism • Arm forced into external rotation abduction and extension • Posterior force driving the head of the humerus posteriorly

  28. Signs & symptoms • Deformity—step off (deltoid will look flattened • Arm in slight abduction, external rotation • Will not be able to move shoulder joint • Unable to touch opposite shoulder with hand of affected side • Pain and POT

  29. Treatment • Immobilization • ER to have shoulder reduced by a physician • Immobilization for 1-2 weeks • No activity 4-6 weeks • Rehab-ROM and strengthening • High incidence of recurrence after the first dislocation

  30. Shoulder reduction

  31. Immobilization of shoulder joint

  32. Shoulder dislocation video • Watch shoulder dislocation on Google Video.htm

  33. Shoulder subluxation • Partial dislocation/spontaneous reduction

  34. Mechanism • External rotation, abduction, extension

  35. Signs & symptoms • Pain • Limited ROM • POT

  36. Treatment • Ice • Immobilization • Physician referral • Rehab—strengthening muscles around joint

  37. Rotator Cuff Strain • 3 degrees • Most involve supraspinatus • Tears usually at insertion on humerus

  38. Rotator cuff strain

  39. Mechanism • Dynamic rotation of arm at high velocity (overhead throwing) • Usually involves individuals with a history of impingement or instability

  40. Signs & symptoms • Pain w/ muscle contraction • POT over greater tuberosity • Loss of strength • Complete tear produces pain, loss of function, swelling and POT

  41. Treatment • RICE • Decrease level of activity • Exercises to strengthen rotator cuff

  42. Biceps tendon rupture

  43. Mechanism • Direct blow • Severe contraction of biceps

  44. Signs & symptoms • Unable to flex elbow • Deformity of biceps—balling up of muscle belly • Pain • POT

  45. Treatment • Ice • Immobilization • Physician referral

  46. Tendonitis • Rotator cuff • Biceps • Common among athletes performing overhead motions due to overuse or muscle weakness

  47. Mechanism • Repetitive overhead motion causing inflammation of tendon

  48. Signs & symptoms • POT • Swelling • Crepitus • Pain with motion

  49. Treatment • Rest • Ice • Heat • NSAIDS • Stretching • Strengthening

  50. Impingement syndrome • Involves compression of supraspinatus tendon, subacromial bursa, long head of biceps tendon (all are under the coracoacromial arch)

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