ball-and-socket joint relies on muscular strength for stability several bones link up at the...
TRANSCRIPT
Ball-and-socket joint Relies on muscular strength for stability Several bones link up at the shoulder Entire bony linkage of the shoulder
referred to as the shoulder girdle
3 basic bony components Humerus Clavicle (aka collarbone) Scapula (aka shoulder blade)
Rotator Cuff Consists of 4 muscles (SITS)
Subscapularis Infraspinatus Teres Minor Supraspinatus
Responsible for rotating the arm internally and externally as well as abduction
Deltoid-lies over the head of the humerus. Abducts, flexes, and extends shoulder
Anterior portion of shoulder-pectoralis major and pectoralis minor
Biceps-flexes the elbow Triceps-extends the forearm and
shoulder.
Shoulder girdle composed of several joints
Most commonly injured joints of the shoulder are: acromioclavicular joint (Acromion process
of scapula and the distal end of clavicle glenohumeral joint (articulation of the head
of the humerus and the glenoid fossa)**articulation-point of contact**glenoid fossa-saucerlike portion of scapula
Muscle weaknesses Postural problems Nature of the game
“Out of sight, out of mind”-weight training Athletes often lift weights only for the muscles
they can see in the mirror which leads to weaknesses in opposing muscles
Athletes with rounded shoulders, tight pecs, or weak posterior shoulder muscles may be predisposed to injuries. Supraspinatus muscle, nerve, and blood vessel run through a
very narrow space and narrowing that space can cause those tissues to become pinched
Using arm continually in one direction Ex. Freestyle swimming or throwing Need to strengthen the muscles opposing
the motion in order to prevent injuries. Otherwise, it creates a muscle imbalance. Ex. A swimmer who swims 300 strokes
freestyle must swim 300 strokes backstroke to balance the strength of the muscles.
Referred to as a shoulder separation Can be injured by impact to the top of
the shoulder or by falling on an outstreched arm
Athlete will indicate pain with movement
More serious sprains cause the clavicle to move superiorly
3rd degree separation-large abnormal bump caused by excessive upward desplacement of clavicle. Unable to move arm and will hold it tight
against body Treatment
1st degree-PRICE 2nd & 3rd –PRICE initially and then referred
to an orthopedist.
2 courses of action to treat 3rd degree tear: Surgery-joint wired or screwed together Harness-straps the clavicle downward in an
attempt to hold the joint together long enough to allow the ligament to heal.
Especially vulnerable when in abduction and external rotation.
If a 3rd degree sprain, subluxation or dislocation is likely
Will have pain with motion Treated by PRICE and referred to a
physician
Most muscle and tendon injuries are caused by overuse
Athletes who throw, shoot, or repeat a swim stroke prone to overuse injuries
Require rest, ice application, immobilization, and physician referrals
Occur from excessive motion beyond the normal range
Supraspinatus is most often injured Pain with motion and sometimes when
shoulder is not moving. Pain generally occurs with abduction If unable to abduct, complete tear or 3rd
degree strain is suspected
Develops from repetitive overhead types of movement Supraspinatus and biceps muscles run together
through a space beneath acromion process If space narrows due to swelling, tendinitis, weak
posterior muscle strength, or poor posture, the muscles become impinged in the space
Creates pain and discomfort with overhead movements.
Treatment-modified activity, strengthening posterior muscles, improving flexibility of tight pectoralis muscles.
Common in athletes who are constantly raising their arms above their heads
Repetitive nature of the movement causes irritation of the tendon in bicipital groove
Immobilization in a sling will make athlete more comfortable
Physician may prescribe ultrasound therapy and anti-inflammatory medication.
Can rupture from a direct blow or severe contractional forces
Unable to flex elbow Noticeable change in appearance of
muscle (look like a golf ball under the skin)
Arm must be iced and immobilized Referred to physician Tendon must be surgically repaired
Most often fractured at its weakest point (distal 3rd) Caused by a direct blow or fall on the tip of
shoulder Experience pain and will hold arm close to body to
prevent movement Ice used to decrease swelling and pain Sling restricts arm movement Physician can set the clavicle in place using a
harness Fracture takes 6 weeks to heal
Midshaft fractures easy to locate Humeral head fractures sometimes hard to
find if hidden behind shoulder musculature Shoulder sprain can mimic a fracture so its
important to ensure proper assessment. Unable to move arm and will experience
pain May report feeling or hearing a pop Will hold arm against body
Easiest way to determine a fracture: palpate circumference of bone
Painful on all sides, most likely a fracture Physician referral Severity determines treatment-could just
be a sling or surgery with long arm cast Takes at least 6 weeks to heal
Growth plate susceptible to direct and indirect blows
Same signs and symptoms as humeral fractures
Can cause permanent growth impairment Ice, splinting, and a sling-what an ATC
should do Physician will determine severity of injury
and treatment.
Some injuries require surgery to hold the head of humerus to the shaft of humerus
Teenage pitchers prone to epiphyseal injury from excessive throwing. Limited in number of games allowed to
play as well as number of pitches thrown
May accompany a glenoumeral or acromioclavicular sprain
Ligament or tendon pulls away a small portion of bone
When humerus is dislocating from glenoid fossa, capsular ligament can pull on scapula
Athlete will experience pain associated with the dislocation and avulsion fracture
Impossible to know if avulsion fracture exists: ATC must assume until X-ray reveals otherwise
Glenohumeral dislocation means that head of humerus is out of its socket
Subluxation means that head of humerus came out of socket and then went back in
Cause for both is the same: excessive abduction and external rotation.
Results are completely different Both require attention by ATC and team
physician
Dislocation sometimes causes the humerus head to tear the capsular ligament anteriorly
Instability of capsular ligament allows the humerus head to shift forward (most common type of shoulder dislocation)
Experience pain and inability to use shoulder ATC will see a deformity at deltoid muscle Shoulder will be flat, not round Physician needs to reduce a dislocation
For a subluxation, athlete may feel his shoulder “pop out and then pop back in”
X-ray necessary to determine extent of the dislocation or subluxation
Athlete needs to strengthen the muscles of adduction and internal rotation
If athlete experiences recurrent subluxations or dislocations will require surgery to repair capsular ligaments.