بنام خداوند جان وخرد

1. بنام خداوند جان وخرد

2. Injuries to the athletic shoulderضایعات شانه در ورزشکاران Dr.H.Saremi Orthopaedic surgeon, Hand & Shoulder fellowship Hamedan university of medical sciences Besat Hospital

3. Sport injuries • Sport specific injuries • Regional Injuries

4. Shoulder • 4joints • The least stable joint

9. 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

10. Instability • Unique anatomy for Mobility and Stability • Sports that stress the static and dynamic stabilizers beyond their physiological limit(repeatativeoverhead maneuvers)

11. Instability • Pain • Feeling that the shoulder is loose • Painfull giving way associated with dead arm syndrom • Dislocation

12. Instability • Post traumatic anterior SX or DX • Post traumatic posterior SX or DX • Atraumatic Anterior SX or DX • Atraumatic posterior SX or DX • Multidirectional SX or DX

13. Instability • Description of arm position when symptoms occur • Is it completely involuntary

14. Traumatic anterior DX • 98% of shoulder dislocations • Excessive abduction and Ex rotation • Direct blow from the behind • Pain ,decreased ROM ,guarding • An immediate reduction may be attempted on the playing field,if unsuccessful another attemp can be made in the locker room

15. Simple reduction manuvere

16. Traumatic anterior DX • Immobilization? • 6w(>40 y 7-10 days) • Internal or ex rotation? • Recurrency?

17. Traumatic anterior DX • The criteria for returning to sport are based on a FULL ROM and FULL strength

18. Traumatic anterior DX • If repeated or sustained instability symptoms and signs ARTHROSCOPIC REPAIR

19. LABRAL DETACHMENT

20. GLENOID DEFECT

22. Posterior traumatic sx or dx Less common Direct blow to the anterior shoulder Direct forces with the arm I flx, Add, int rot Axillary view is critical <40y ----4-6w immobilization,>40y---2-3w

23. Atramatic anterior shoulder instability Sign and symptoms of instability without significant initial trauma Repetitive over head activity Thrawers in acceleration phase Swimmers during the backsroke or turns Pain may be posterior

25. Atramatic anterior shoulder instability Sling and antiinflamatory medication Vigorous physical therapy Arthroscopic repair

26. Atraumatic posterior shoulder instability Unlike posterior dislocation ,is relatively common Athlete usually complain of pain rather than instability Follow through in pitching, pull through phase in swimming ,serving motions or backhand in tennis

27. PH.EX

28. Atraumatic posterior shoulder instability Sling and antiinflamatory Physiotherapy Arthroscopic repair

29. Multidirectional instability Instability occurring in more than one plan(anteroinferior,posteroinferior,or three directions May have generalized ligamentous laxity(beightonhypermobility score) Physical therapy

30. Multidirectional instability The athlete may return to activity at a low level during therapy as long as the specific activities that couse that symptoms are avoided Therapy should progress until the patient can return to activities without symptoms Arthroscopic repair and capsular shift

32. A

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

35. Rotator cuff

36. DEPRESSION effect

38. Impingement • Outlet impingement • Non outlet impingement • An unstable head that subluxesanteriorly 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 • Stabilize the shoulder

39. Impingement syndrom

40. ACROMIO Humeral distance

41. CUFF ARTHROPATHY

43. Impingement syndrom • Painful arc sign • Positive howkin’s sign and jobe test • Non operative treatment • Operative treatment(arthroscopic)

44. Internal Glenoid impingement

45. Rotator cuff tear • Repetitive microtrama ,occasionally single traumatic event • Progressive pain and weakness • Restriction of ROM • May be an aging process(30-50% cadavr) • Partial or fullthickness • Non operative treatment • operative treatment(arthroscopic) • Rotator cuff arthropathy

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

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