بنام خداوند جان وخرد

1. بنام خداوند جان وخرد

2. Injuries to the athletic shoulder (impingement syndrom) Dr.H.Saremi Orthopaedic surgeon, Hand & Shoulder fellowship Hamedan university of medical sciences Hamedan,IRAN www.shoulderclinic.ir

3. Sport injuries • Sport specific injuries • Regional Injuries

4. Injuries to the athletic shoulder • Instability • Impingement and rotator cuff problems • Biceps labral complex injuries • Ac joint injuries • S.c joint injuries • Fractures • Neurovascular injuries

5. Impingement syndrom The term impingement syndrome was fi rst used byNeerin 1972 to describe a condition of shoulder pain associated with chronic bursitis and partial tearing of the rotator cuff. Impingement comes fromaLatin root impingo, which means “to strike against.

8. Impingement and rotator cuff problems Subacromial impingement is one of the most common couse s of shoulder pain in athletes

9. Rotator cuff

12. Impingement • Outlet impingement • Non outlet impingement • An unstable head that subluxes anteriorly due ro capsular laxity may displace upward against the acromion • Stabilize the shoulder • Secondary impingement is the most common type of impingement in young athletes

13. Bigliani classification

14. Sign &symtoms Pain with overhead activities,and internal rotation Partial cuff tear symptoms

15. Painful arc signPositive howkin’s sign and neer sign

17. Impingement syndrom

19. Cuff arthropathy

21. Impingement syndrom • Non operative treatment • Operative treatment(arthroscopic)

22. Non operative treatment • Physio therapy • NASAID • Corticoid injection

23. Non operative Treatment • STEP 1 :Avoid repeated injury • Work • Sport

24. Non operative treatment • STEP 2: Restore normal flexibility • Stretch out all the direction of tightnessspecially posterior • Most effective by the patient • Gentle stretched five times a day by patient • To the point of pull of tightness not to the point of pain • Each stretche for 1 min----30 min a day • Obvious improvement---1 m may be 3 m full recovery

29. Non operative treatment • STEP 3: Restore normal strenth • When near normal passive flexibility of the shoulder is restored • Internal and external strentheningexcersiseswith the arm at the side • By the patient

31. Non operative treatment • Deltoid strengthing is added when it can be performed comfortably

32. Scapular motors

33. Non operative treatment • STEP 4:Perform aerobic exercise • To get back in shape and improve the sense of well being • 5 days a week,sweaty ex 30 min

34. Non operative treatment • STEP5: Modify work or sport • Reviewe the technique of sport • Modifiy the job

35. Operative treatment • Sub acromial decompression • Rotator cuff repair

36. Internal Glenoid impingement

41. Subcoracoid impingement

42. ریش ریش شدن و پارگی طولی درساب اسکاپولاریس به دلیل گیر کردن به کوراکوئید longitudinal tear and fraying of subscapularis tendon due to subcoracoid impingement