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Shoulder Injuries

Shoulder Injuries. Clavicle Fx. MOI: FOOSH, Fall on tip of shoulder, direct contact S&S: guarding, obvious deformity, swelling, point tenderness. Clavicle Fx. Plan: refer for x-rays, sling and swathe, treat for shock, possible surgery Follow up: immobilize 6-8 weeks.

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Shoulder Injuries

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  1. Shoulder Injuries

  2. Clavicle Fx • MOI: FOOSH, Fall on tip of shoulder, direct contact • S&S: guarding, obvious deformity, swelling, point tenderness

  3. Clavicle Fx • Plan: refer for x-rays, sling and swathe, treat for shock, possible surgery • Follow up: immobilize 6-8 weeks

  4. Acromioclavicular Sprain • MOI: direct contact to tip of shoulder or FOOSH

  5. Acromioclavicular Sprain • S&S: • Grade 1-point tenderness, discomfort during movement • Grade 2-partial displacement, acromial end of clavicle sticks up, ttp, unable to fully abduct, AC stress test positive

  6. Acromioclavicular Sprain • S&S: • Grade 3 – complete rupture of the AC and CC ligaments, displacement, limited abduction • Grade 4 – posterior dislocation of clavicle, point tenderness, limited ROM

  7. Acromioclavicular Sprain • S&S: • Grade 5 – Muscle and ligament ruptures, gross deformity, severe pain, loss of movement, shoulder instability • Grade 6 – clavicle displaced inferior to the coracoid, rare in sports

  8. Acromioclavicular Sprain • Plan: • 1. Cold and pressure • 2. Sling and Swathe • 3. Refer to doctor

  9. GH Dislocations • Anterior • Posterior

  10. GH Dislocations • Extensive damage to the shoulder complex occurs.

  11. Anterior Dislocation • MOI: • Direct contact to posterior shoulder • Forced abduction, external rotation, and extension

  12. Anterior Dislocations • S&S • 1. Flattened deltoid contour • 2. Guarding – slight abduction and external rotation • 3. Humeral head palpated in the axilla(armpit) • 4. Unable to touch opposite shoulder • 5. Moderate pain • 6. Disability

  13. Posterior GH Dislocation • MOI: • Forced adduction and internal rotation • Fall on extended and internally rotated arm

  14. Posterior GH Dislocations • S&S: • 1. Severe pain and disability • 2. Guarding – adduction and internal rotation • 3. Acromion and coracoid stick out • 4. Head of humerus visible posterior • 5. Limited external rotation and elevation

  15. GH Dislocation - Plan • Immobilization • Ice • X-ray if first dislocation • Reduce shoulder • Ice • Immobilization

  16. GH Dislocation - Plan • Rehab • Internal and External rotation are IMPORTANT • Start with isometrics then add resistance • Bracing for play

  17. Impingement Syndrome • MOI: repetitive overhead stress • Examples: • Swimming • Serving a tennis ball • Hitting volleyball (spike) • Throwing (baseball, track, football)

  18. Impingement Syndrome • S&S: • 1. Diffuse pain around acromion • 2. Pain with overhead activities • 3. E.R. weaker than I.R. • 4. Positive impingement tests • 5. Empty can and drop test increase pain.

  19. Impingement Syndrome • Plan: • 1. Restoring normal biomechanics • 2. Strengthen rotator cuff • 3. Strengthen core • 4. Joint Mobilizations • 5. RICE and e-stim • 6. Modify activity

  20. Severe Impingement • Plan: • Immobilization and complete rest. • Potentially need surgical intervention

  21. Thoracic Outlet – Basics • Compression of the brachial plexus, subclavian artery and vein

  22. Thoracic Outlet Syndrome • MOI: • 1. Narrowing between 1st rib and clavicle • 2. Anterior and middle scalene muscles • 3. Pectoralis minor compressing • 4. Presence of a cervical rib

  23. Thoracic Outlet Syndrome • S&S: • Paresthesia • Pain • Feeling cold • Muscle weakness • Muscle atrophy • Radial nerve palsy • Poor circulation in hand

  24. Thoracic Outlet Syndrome • Special Tests: • 1. Wright’s Test or Hyperabduction test • 2. Eden’s Test • 3. Roo’s Test • 4. Adson’s Test

  25. Thoracic Outlet Syndrome • Plan: Correcting the MOI with stretching & strengthening • 1. Stretching • Pectoralis minor • Scalenes

  26. TOS - Plan • Strengthening • Trapezius • Rhomboids • Serratus Anterior

  27. TOS - Plan • Strengthening • Trapezius • Rhomboids • Serratus Anterior

  28. Strengthening • Trapezius • Rhomboids • Serratus Anterior

  29. Brachial Plexus Neuropraxia • Also called a stinger or burner. • MOI: direct contact or hyper-horizontal abduction

  30. Brachial Plexus Neuroplaxia • S&S: • Numbness and tingling down through hand • Pain shooting to hand • Inability to move hand • Pain in shoulder

  31. Brachial Plexus Neuroplaxia • Plan: • Have athlete move their arm. • Give them about 15 minutes to recover. If they don’t recover, send to hospital.

  32. Biceps Brachii Ruptures • MOI: • Powerful eccentric or concentric contraction of • the muscle • Can rupture at long head or insertion • “Popeye” effect

  33. Biceps Brachii Rupture • S&S: • SNAP • Sudden, intense pain • Popeye effect • Weakness of the biceps

  34. Biceps Brachii Rupture • Plan: • Cold • Sling • Refer to physician • Usually surgery

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