Injuries to the Shoulder Region PE 236 Amber Giacomazzi MS, ATC

1. Injuries to the Shoulder RegionPE 236Amber Giacomazzi MS, ATC

2. Anatomy Shoulder bones: • Consist of shoulder girdle (clavicle & scapula) and humerus. Shoulder joints: • ______________ • ______________ • ______________

3. Anatomy • Joints are held together with ____________ and ____________ that provide stability and allow for limited movement • Shoulder girdle and the GH joint can move in almost every direction • _________ joints are just under the skin and are vulnerable to injury, even in muscular athletes • Major nerves are from a group called the ________________

5. Muscular Anatomy

6. Rotator Cuff • S.I.T.S. muscles____________________________________________

7. Prevention of Shoulder Injuries • Proper physical conditioning is key • Develop body and specific regions relative to sport • Strengthen through ___________ • Focus on _____________ in all ________ _________ • Be sure to incorporate _____________ muscles • Enhances base of function for glenohumeral joint

8. Throwing Mechanics Instruction in proper throwing mechanics is critical for injury prevention

9. _______________ • First movement until ball leaves gloved hand • Lead leg strides forward while both shoulders ______, ______________ and _______________ • _______________ • When hands separate and ends at max ER of the humerus • Foot comes in contact with the ground • _______________ • Max _____________ until ball release (humerus adducts, horizontally adducts and internally rotates) • ___________________________________________

10. __________________ • Ball release until max shoulder ______________ • Eccentric contraction of ext. rotators to decelerate humerus while rhomboids decelerate scapula • __________________ • End of motion when athlete is in a balanced position

11. Fractured Clavicle Fractures of this bone are the most common fracture in this region • This injury usually results from ____ or direct blows • The adolescent form of this injury is known as a “___________” fracture ____________________________________ ______________

13. Signs and symptoms Swelling __________ Discoloration Broken bone ends may ________________ Treatment Treat for shock Apply __________________ Apply ________________________ Fractured Clavicle

15. AC Joint Injuries Typical mechanism is _____________ to the ______________ or fall _________ __________________ • Severity of injury is graded on the amount of damage to ligaments • 1st degree -- no significant ligament damage • 2nd degree -- partial tearing of ligaments Mild deformity • 3rd degree -- complete rupture gross deformity

17. Signs and symptoms Mild swelling with point tenderness __________________ __________________ ____________ In 3rd degree sprain, a snap or pop may have been sensed along with a visible deformity *_______________* AC Joint Injuries

18. AC Joint Injuries Treatment • Treat for shock • Apply I.C.E • ____________________ • ____________________

19. Glenohumeral Joint Injuries GH joint consists of _____________ and the ____________ of scapula • ____________ but inherently _____________ • Typical MOI is having the ___________, ____________, and extended stressing the anterior glenohumeral ligament • Most common type of dislocation is an _________ _________ that may be a subluxation or complete dislocation

20. Signs and symptoms Shoulder joint deformity and down-sloping shoulder contour “ _____________” ___________________________ Humeral head palpable within _______ Athlete resists efforts to move GH joint In cases involving subluxation: GH joint may appear normal ______________________ ______________________ Glenohumeral Joint Injuries

22. Glenohumeral Joint Injuries Treatment • Treat for shock • Application of ______________________________ _________________ • Apply sling & swathe bandage • Dislocations need to be re-located by ___________ • ______________________________ GH joint injuries tend to be ______ and _____. _______________ may be necessary.

23. Sternoclavicular Joint (SC) Injuries The sternoclavicular joint is formed by the union of the _____________ and the _________ of the ___________ • SC joint is supported by the several ligaments • Injuries are ____ compared to AC or GH joints • Sprains to the SC joint can range in severity Mechanism is external blow to the shoulder resulting in a _______________________; most commonly, the clavicle moving ________ and ___________

25. Signs and Symptoms Grade 1-little pain & disability, point tender Grade 2-deformity, swelling inability to abduct shoulder Grade 3-gross displacement “Retro-sternal” dislocation- ______________________ __________________________ Treatment Treat for shock Apply ice and compression _____________________ Sternoclavicular Joint Injuries

26. Rotator Cuff Strains • Any muscle of the shoulder can suffer a strain. Most common injury is rotator cuff strain • Rotator cuff muscles contribute to GH joint _________ and ______ • Errors in the ________ ________ or ______ can contribute to ______________

28. Rotator Cuff Strains Signs and symptoms • Pain within the shoulder, especially during _______________________________ • Difficulty bringing arm up and back during cocking phase of throw. Pain and stiffness in shoulder region _________________________ ______________________ • Point tenderness around region of the humeral head that seems to be ___________________

29. Rotator Cuff Strains Treatment • First aid is ______ practical due to chronic nature of condition • I.C.E. • _______________

30. GH Joint-Related “Impingement” Syndrome Occurs when a _____ or ________ is squeezed between moving structures • The _____________ ________ is most commonly impinged • ____________ or __________________ __________________

31. GH Joint-Related “Impingement” Syndrome

32. GH Joint-Related “Impingement” Syndrome • __________________ eventually leads to irritation and inflammation of these structures • Athletes in sports that emphasize overhead arm movements have a high risk of this injury • ______________________ ______________________

33. Signs and symptoms Pain deep in shoulder and with abduction & external rotation ________________ Pain when arm is ____________________ ___________________________________ ________________ GH Joint-Related “Impingement” Syndrome

34. GH Joint-Related “Impingement” Syndrome Treatment • Rest • ________________________ • ________________ • In extreme cases, surgery

35. Labral Tear • The labrum is the lip of ______________ located where the shoulder ligaments, which make up the ___________, connect to the edge of the _________ • The tendon of the ______ muscle attaches to the shoulder at the ________________ • How do Labral tears occur? • ______________ • A forced movement of our arm or shoulder • Using arm to break a fall • Repetitive, _________________ such as throwing a ball or serving in tennis • __________

36. Labral Tear • Signs and Symptoms • Arm and shoulder _____ • Arm and shoulder _________ • Painful overhead movements • ________ or ______ sounds or sensations when moving shoulders • Diagnosis • ____________________

38. Labral Tear • Treatment • Ice • NSAIDs • Shoulder rehabilitation exercises • _________

39. Shoulder Subluxation/Dislocation • _______________ (___________) • Used for anterior glenohumeral instability • _________________ _________________

40. Shoulder Subluxation/Dislocation • ________________ _____________ • Performed like the Apprehension Test however the examiners hand is placed over the athletes humeral head • ______________ and _____________ is a positive finding

41. Shoulder Impingement • _______________________________ test for impingement used to assess impingement of soft tissue structures • Positive test is indicated by ________________

42. Supraspinatus Weakness / Tear • _______________ • 90 degrees of shoulder flexion, internal rotation and 30 degrees of horizontal abduction • Downward pressure is applied • _______________ _______________ _______________

43. Bicipital Tendonitis • ________________ • Elbow flexed to 90 and stabilized to the thorax. Forearm is pronated • __________________ __________________ __________________ _____________