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Chapter 10 Shoulder Injuries

Chapter 10 Shoulder Injuries. Chapter Objectives. Understand the basic anatomy of the shoulder. Explain how shoulder injuries occur. Describe the various types of injuries to the shoulder. Explain treatment procedures fro common shoulder injuries. Anatomy. Bones Humerus Clavicle Scapula.

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Chapter 10 Shoulder Injuries

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  1. Chapter 10Shoulder Injuries

  2. Chapter Objectives • Understand the basic anatomy of the shoulder. • Explain how shoulder injuries occur. • Describe the various types of injuries to the shoulder. • Explain treatment procedures fro common shoulder injuries.

  3. Anatomy • Bones • Humerus • Clavicle • Scapula

  4. Humerus

  5. Scapula

  6. Clavicle

  7. Anatomy • Ligaments • Coracoclavicular Ligaments • Trapezoid • Conoid • Acromioclavicular ligament • Corocoacromial

  8. Muscles • Rotator Cuff • Subscapularis • internal rotator • Infraspinatus • external rotator • Teres Minor • external rotator • Supraspinatus • primarily an abductor of the arm

  9. Muscles • Deltoid • Attaches to acromion process and lateral humerus • 3 portions • Anterior, posterior, and medial • Abducts, flexes, and extends the shoulder

  10. Muscles • Pectoralis minor • Pectoralis major • Primarily responsible for horizontal adduction and protraction

  11. Muscles • Biceps brachii • 2 heads • Originates at supraglenoid tubercle and corocoid process • Inserts at radius • Bicep tendon/bicipital groove • Held in place by transverse ligament • Flexes elbow, abducts and supinates forearm

  12. Muscles • Triceps brachii • 3 heads-long, lateral, and medial • Originate posterior humerus • Insert at ulna • Extend elbow, humeral adduction

  13. Joints • Acromioclavicular (AC) joint • One of most common injured areas of shoulder • Consists of acromion process and distal clavicle • Held together by the ac ligament

  14. Injured AC joint

  15. Joints • Glenohumeral joint • Articulation of the humerus and glenoid fossa • Very susceptible to injury due to fossa being shallow • Humeral head covered with articular cartilage • Capsular ligament surrounds the entire joint which aids in joint stability

  16. Injuries- prevention • Shoulder injury causes • Muscle weakness • Postural problems • Nature of the joint

  17. Addressing muscular weakness • Often weak in posterior (back) muscles • Signs- rounded shoulders, tight pectoralis muscles, weak posterior shoulder muscles • All predispose athlete to injury • Proper technique in throwing, swimming, etc. prevent injury • Proper padding important

  18. Common shoulder injuries • Acromioclavicular ligament sprain • Aka-separated shoulder • most common mechanism of injury occurs when the athlete falls onto the point of the shoulder or receives a direct blow to the tip of the shoulder or falls on an outstretched arm • graded according to the degrees  of severity

  19. AC sprain (cont.) • Mild (1st degree) • stretching or slight tearing of the ligament fibers • Mild joint tenderness, mild swelling, and little or no disability of the shoulder • Moderate (2nd degree) • partial disruption of the supporting ligaments • pain and tenderness directly over and around the joint, local swelling, and an increase in pain on forced motion • Severe (3rd degree) • total disruption of one or more of the supporting ligaments • varying degrees of tenderness, swelling, instability, and an increase in pain with any effort to stress the joint • often exhibit a piano key sign; that is, the clavicle can be pushed down but will spring back up when pressure is released. 

  20. AC sprain treatments • PRICE • Refer if 2nd or 3rd degree to r/o fracture • 3rd degree may require surgery or harness immobilization

  21. Glenohumeral ligament sprain • sprains of the shoulder joint seldom occur unless there is a subluxation or dislocation • Vulnerable in abduction and external rotation • Pain with any motion • PRICE and refer to physician

  22. Rotator cuff strain • Injuries to rotator cuff muscles are difficult to detect and isolate because these muscles, which reinforce the joint capsule, lie deep in the shoulder • MOI- • ballistic arm activities • forceful concentric contraction of the muscles that accelerate and decelerate limb activities • improper warm ups • muscle fatigue

  23. Rotator cuff injuries (cont) • Signs and symptoms • anterior-lateral shoulder pain • point tenderness • decreased range of motion • loss of strength consistent with the severity of the injury • Pain may radiate down the lateral arm but usually stops at mid-humerus • Pain is often increased at night while the individual is lying on the affected side

  24. Rotator cuff injuries (cont) • Treatment • PRICE • Gentle strengthening and flexibility exercises • See handout for examples

  25. Impingement sydrome • common injury involving the soft tissues of the shoulder comprising of the subacromial space (often involves the supraspinatus and biceps) • Usually result of repetitive overhead types of movement • Treatment • Modified activity • Strengthening posterior shoulder muscles • Improving flexibility (especially in pecs)

  26. Bicipital tendinitis • Common with overhead activities (swimming, throwing, etc) • Tendon becomes irritated in bicipital groove • May feel crepitis (grinding) • Rest and immobilization may be required • Treat with Ultrasound and N-SAIDS

  27. Bicep tendon rupture • Caused by direct blow or severe contracture forces • Athlete will have inability to flex the elbow • Noticeable deformity as bicep muscle will roll up under skin • Treat- ice, immobilized, refer to physician • Surgical repair necessary

  28. Clavicular fracture • Most often fractures occur in distal 1/3 of bone • Usually caused by direct blow or falling on the tip of the shoulder • Restrict motion with sling and ice • Refer for x-ray • Most fractures take 6 weeks to heal

  29. Humeral fracture • Not difficult to find if fractured at midshaft • Shoulder can sometimes hide humeral head fractures • Pain on all sides of bone when palpated (around circumference) is good indicator of fracture • Splint and refer for immediate care • Check pulse before and after splinting to check circulation

  30. Epiphysis injury • Can be caused by • Blow to humeral head • Falling on elbow and driving humerus into glenoid fossa • Signs/symptoms-same as humeral fx • Treat with ice, splint, sling • Refer, can cause growth impairment • Young pitchers prone to epiphyseal injury from excessive throwing

  31. Avulsion fracture • Can accompany a glenohumeral or AC sprain • Capsular ligament pulls away from scapula when humerous dislocates from glenoid fossa • Only revealed or ruled out by x-ray • Treat with splint and ice

  32. Glenohumeral dislocations and subluxations • Head of humerous is out of the socket • Sublux- head was out, then back in • Cause-excessive abduction and external rotation

  33. Glenohumeral dislocations and subluxations • Dislocation can cause tear of the capsular ligament • Anterior dislocation most common • Deformity usually seen at deltoid muscle (shoulder flat) • X-ray needed to determine extent of injury

  34. Glenohumeral dislocations and subluxations • Dislocations and subluxations need to strengthen adductors and internal rotators • Can wear restrictive harness • Surgery sometimes required to repair capsular ligament

  35. Adhesive capsulitis • frozen shoulder • inflammation about the rotator cuff and capsular area that can result in dense adhesions and capsular contractures causing restriction of motion and pain • exact cause remains unknown • The main feature is a lack of passive range of motion

  36. Brachial plexus injury • normally involves the cervical spine, but the symptoms are exhibited in the shoulder and upper extremity • Usually caused by forced rotation or lateral flexion • Is a stretching or pinching of brachial plexus

  37. Brachial plexus injury • result in transitory paralysis of the arm • numbness or a burning sensations radiating down the arm and sometimes into the hand • Weakness or numbness lasting more than an hour should be referred to a physician

  38. Thoracic Outlet Syndrome • a group of symptoms resulting from compression of the thoracic neurovascular bundle • .  This neurovascular bundle emerges from the thorax though an outlet or triangle formed by the scalene muscles and the first rib • Narrowing of the outlet can cause a variety of symptoms

  39. Thoracic Outlet Syndrome • Possible causes • hypertrophy of one of the scalene muscles • shape of the first rib • scar tissue formation around the nerve roots • cervical ribs • excess callus formation as a result of a fractured clavicle • hyperabduction or stretching of the brachial plexus

  40. Thoracic Outlet Syndrome • Symptoms • aching pain across the shoulder • pain in the side of the neck and down the arm • sensation of weakness, heaviness, and easily fatigability when using the arm • Athletes exhibiting TOS often have a history of trauma to the head, neck, or shoulder area

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