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The Young Athlete

The Young Athlete. Kevin Latz, MD Center for Sports Medicine. Topics To Be Discussed. Shoulder anatomy Physical examination Common injuries encountered in sports Return to play guidelines. Shoulder Anatomy. Glenohumeral joint Acromioclavicular joint (AC) Sternoclavicular joint

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The Young Athlete

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  1. The Young Athlete Kevin Latz, MD Center for Sports Medicine

  2. Topics To Be Discussed • Shoulder anatomy • Physical examination • Common injuries encountered in sports • Return to play guidelines

  3. Shoulder Anatomy • Glenohumeral joint • Acromioclavicular joint (AC) • Sternoclavicular joint • Scapulothoracic joint

  4. Glenohumeral Bony Anatomy • Humerus • 19 degrees retroversion • Blood supply anterolateral branch of anterior circumflex artery • Head is 6 mm above greater tuberosity • Glenoid • Pear shaped • 2 degrees retroversion

  5. Glenohumeral Joint - Bones

  6. Glenohumeral Joint -Stabilizers Dynamic (Rotator cuff) Static (ligamentous) Superior Middle INFERIOR (anterior/posterior) Infraspinatus Supraspinatus Subscapularis Teres Minor

  7. Rotator Cuff

  8. Glenohumeral Ligaments

  9. Physical Examination • Inspection • Palpation • Strength testing • Provocative Testing

  10. Inspection

  11. Palpation

  12. Provocative Testing – Atraumatic /Multidirectional

  13. Provocative Testing • Apprehension/Crank • Shift/Load

  14. Common Injuries Encountered • Glenohumeral instability • Acromioclavicular injuries (separation) • Sternoclavicular injuries (dislocation) • Clavicle fractures

  15. Glenohumeral Instability • Traumatic/atraumatic • Dislocation/subluxation • Direction • Acute/recurrent • TUBS/AMBRI

  16. Traumatic Instability • Anterior (95+%) • Risk of recurrence • Bankart lesion (ALPSA) • Hill-Sachs lesion • Humeral sided capsule tear (HAGL) • Axillary nerve injury 15%

  17. Traumatic Instability Controversies • Surgical management of first time dislocators • Open/Arthroscopic • Position of immobilization • Necessity of identification of bone defect not controversial

  18. Traumatic Instability • Management of in season athlete

  19. A-C Separation • Fibrocarilaginous disc • Ligaments • AC joint capsule • Coroclavicular ligaments (conoid,trapazoid)

  20. A-C Separation Classification • Rockwood based on degree/direction of displacement

  21. Management of AC Separations • Non operative mgmt of types 1 and 2 • Operative mgmt of types 4-6 • Lack of consensus for mgmt of type 3 (dominant arm overhead throwing athlete) • Scapular dyskinesia

  22. Surgical Management of AC Joint Injuries

  23. AC Joint Injuries • Management of the in season athlete • Full range of motion • Full strength • +/- Pain free • 3-6 weeks

  24. Sternoclavicular Injuries • Unusual injury • Classified by direction • Physeal fx/dislocation • Atypical anatomy –ossifies 18, fuses 20-25 • Posterior capsule provides instability

  25. Sternoclavicular Injuries - Anterior • Most common • Associated with sports • Recurrence • Non operative mgmt • Bae et al JPO

  26. Sternoclavicular Injuries -Posterior • Associated with dysphagia/dysphonia • Compromise of vascular structures • Closed reduction (acute) • Surgical mgmt with CTS

  27. Surgical Management of S-C Dislocation

  28. Sternoclavicular Injuries • Management of the in season athlete • Anterior – full painless range of motion • Posterior – no guidelines

  29. Clavicle Fractures • Common Injuries • Classified by 1/3s • Middle third injuries most common • Lateral fractures confused with AC joint injuries • Operative mgmt is controversial

  30. Clavicle Fractures – Operative Mgmt • Dominant arm, overhead throwing athlete • 1.5 cm shortening

  31. Clavicle Fractures • Management of the in season athlete • Operative mgmt – benign incision, full painless range of motion • Non operative mgmt – full painless range of motion, callous on radiographs

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