shoulder injuries sports medicine class john hardin instructor

Shoulder InjuriesShoulder Injuries

Sports medicine classSports medicine class

John HardinJohn Hardin

InstructorInstructor

AnatomyAnatomy

BonesBones

LigamentsLigaments

Joints Joints

MusclesMuscles

BonesBonesClavicleClavicle– Sternal end, distal endSternal end, distal end

ScapulaScapula– Glenoid fossa, acromion process, coracoid Glenoid fossa, acromion process, coracoid

process, spine, supraspinous fossa, process, spine, supraspinous fossa, infraspinous fossa, vertebral border, inferior infraspinous fossa, vertebral border, inferior angleangle

HumerusHumerus– Head, greater & lesser tuberosity, bicipital Head, greater & lesser tuberosity, bicipital

groovegroove

LigamentsLigaments

AcromioclavicularAcromioclavicular

CoracoclavicularCoracoclavicular

CoracoacromialCoracoacromial

GlenohumeralGlenohumeral– SuperiorSuperior– MiddleMiddle– InferiorInferior

Glenoid LabrumGlenoid Labrum

JointsJoints

Glenohumeral jointGlenohumeral joint

Acromioclavicular jointAcromioclavicular joint

Sternoclavicular jointSternoclavicular joint

Scapulothoracic jointScapulothoracic joint

MusclesMusclesProduce dynamic motion & establish Produce dynamic motion & establish stability to compensate for the stability to compensate for the greater mobilitygreater mobilityMotions at shoulder jointMotions at shoulder joint– flexion & extensionflexion & extension– Internal & external rotationInternal & external rotation– Abduction & AdductionAbduction & Adduction– Horizontal flexionHorizontal flexion– CircumductionCircumduction

Muscles attaching axial skeleton to Muscles attaching axial skeleton to humerushumerus

Latissimus dorsiLatissimus dorsi– Shoulder extension, adductionShoulder extension, adduction

Pectoralis majorPectoralis major– Shoulder adduction, horizontal flexionShoulder adduction, horizontal flexion

Muscles attaching scapula to Muscles attaching scapula to humerushumerus

DeltoidDeltoid– Abduction, flexion, extensionAbduction, flexion, extension

Teres majorTeres major– Internal rotationInternal rotation

CoracobrachialisCoracobrachialis– Shoulder flexionShoulder flexion

Rotator cuff musclesRotator cuff muscles– Supraspinatus-Supraspinatus- external rotation, initiates external rotation, initiates

abductionabduction– Infraspinatus-external rotationInfraspinatus-external rotation– Teres minor-external rotationTeres minor-external rotation– Subscapularis-internal rotationSubscapularis-internal rotation

Muscles attaching axial skeleton to Muscles attaching axial skeleton to scapulascapula

Levator scapulaLevator scapula– Shoulder elevationShoulder elevation

TrapeziusTrapezius– Shoulder elevation, retraction, depressionShoulder elevation, retraction, depression

Rhomboids (major & minor)Rhomboids (major & minor)– Shoulder retractionShoulder retraction

Serratus anteriorSerratus anterior– Shoulder protraction, holds scapula flat against Shoulder protraction, holds scapula flat against

thoracic cagethoracic cage

Other musclesOther muscles

Biceps brachii—long head & short Biceps brachii—long head & short headhead– Shoulder flexionShoulder flexion

Triceps brachii—long head, medial Triceps brachii—long head, medial head, lateral headhead, lateral head– Shoulder extensionShoulder extension

Preventing shoulder injuriesPreventing shoulder injuries

Maintain adequate strength & Maintain adequate strength & flexibility of all shoulder musclesflexibility of all shoulder muscles

Good postureGood posture

Proper techniquesProper techniques

Proper warmupProper warmup

Proper protective gearProper protective gear

Types of InjuriesTypes of Injuries

SprainsSprains

DislocationsDislocations

StrainsStrains

OveruseOveruse

FracturesFractures

AC SprainAC Sprain

Shoulder separationShoulder separation

MechanismMechanism

Impact to tip of shoulderImpact to tip of shoulder

Fall on outstretched armFall on outstretched arm

Signs and symptomsSigns and symptoms

Deformity at AC jointDeformity at AC joint– distal end of clavicle rides distal end of clavicle rides superiorlysuperiorly

Pain with movement and palpationPain with movement and palpation

““+” piano key sign+” piano key sign

Degrees of injuryDegrees of injury11stst degree: no deformity, pain w/ degree: no deformity, pain w/ palpation & motion, mild stretching of AC palpation & motion, mild stretching of AC ligamentligament

22ndnd degree: displacement of distal end of degree: displacement of distal end of clavicle, unable to abduct arm or bring it clavicle, unable to abduct arm or bring it across body, painacross body, pain

33rdrd degree: complete rupture of AC and degree: complete rupture of AC and CC ligaments, with dislocation of the CC ligaments, with dislocation of the distal end of clavicle, severe pain, LOM, distal end of clavicle, severe pain, LOM, instabilityinstability

TreatmentTreatment

RICERICE

Immobilization Immobilization

Physician referral if more than 1Physician referral if more than 1stst degreedegree

Possible surgeryPossible surgery

SC SprainSC Sprain

Relatively uncommon injuryRelatively uncommon injury

Mechanism of injuryMechanism of injury

Indirect force transmitted through Indirect force transmitted through the humerus, the shoulder joint and the humerus, the shoulder joint and the clavicle the clavicle

Direct impact to clavicleDirect impact to clavicle

Signs & symptomsSigns & symptoms

3 degrees3 degrees

May have deformity at sternal endMay have deformity at sternal end

SwellingSwelling

PainPain

POTPOT

Inability to abduct shoulder through Inability to abduct shoulder through full ROMfull ROM

TreatmentTreatment

RICERICE

ImmobilizationImmobilization

Physician referralPhysician referral

Glenohumeral dislocationGlenohumeral dislocation

Shoulder dislocationShoulder dislocation

Anterior—most commonAnterior—most common

PosteriorPosterior

InferiorInferior

MultidirectionalMultidirectional

Anterior shoulder dislocationAnterior shoulder dislocation

GH dislocationGH dislocation

MechanismMechanism

Arm forced into external rotation Arm forced into external rotation abduction and extensionabduction and extension

Posterior force driving the head of Posterior force driving the head of the humerus posteriorlythe humerus posteriorly

Signs & symptomsSigns & symptomsDeformity—step off (deltoid will look Deformity—step off (deltoid will look flattenedflattenedArm in slight abduction, external Arm in slight abduction, external rotationrotationWill not be able to move shoulder Will not be able to move shoulder jointjointUnable to touch opposite shoulder Unable to touch opposite shoulder with hand of affected sidewith hand of affected sidePain and POTPain and POT

TreatmentTreatment


ER to have shoulder reduced by a ER to have shoulder reduced by a physicianphysician

Immobilization for 1-2 weeksImmobilization for 1-2 weeks

No activity 4-6 weeksNo activity 4-6 weeks

Rehab-ROM and strengtheningRehab-ROM and strengthening

High incidence of recurrence after High incidence of recurrence after the first dislocationthe first dislocation

Shoulder reductionShoulder reduction

Immobilization of shoulder joint

Shoulder dislocation videoShoulder dislocation video

Watch shoulder dislocation on Google Video.htm

Shoulder subluxationShoulder subluxation

Partial dislocation/spontaneous Partial dislocation/spontaneous reductionreduction

MechanismMechanism

External rotation, abduction, External rotation, abduction, extensionextension


PainPain

Limited ROMLimited ROM

POTPOT

TreatmentTreatment

IceIce



Rehab—strengthening muscles Rehab—strengthening muscles around jointaround joint

Rotator Cuff StrainRotator Cuff Strain

3 degrees3 degrees

Most involve supraspinatusMost involve supraspinatus

Tears usually at insertion on Tears usually at insertion on humerushumerus

Rotator cuff strainRotator cuff strain

MechanismMechanism

Dynamic rotation of arm at high Dynamic rotation of arm at high velocity (overhead throwing)velocity (overhead throwing)

Usually involves individuals with a Usually involves individuals with a history of impingement or instabilityhistory of impingement or instability


Pain w/ muscle contractionPain w/ muscle contraction

POT over greater tuberosityPOT over greater tuberosity

Loss of strengthLoss of strength

Complete tear produces pain, loss of Complete tear produces pain, loss of function, swelling and POTfunction, swelling and POT

TreatmentTreatment

RICERICE

Decrease level of activity Decrease level of activity

Exercises to strengthen rotator cuffExercises to strengthen rotator cuff

Biceps tendon ruptureBiceps tendon rupture

Mechanism Mechanism

Direct blow Direct blow

Severe contraction of bicepsSevere contraction of biceps


Unable to flex elbowUnable to flex elbow

Deformity of biceps—balling up of Deformity of biceps—balling up of muscle bellymuscle belly

PainPain

POTPOT

Treatment Treatment

IceIce



Tendonitis Tendonitis

Rotator cuffRotator cuff

BicepsBiceps

Common among athletes performing Common among athletes performing overhead motions due to overuse or overhead motions due to overuse or muscle weaknessmuscle weakness

Mechanism Mechanism

Repetitive overhead motion causing Repetitive overhead motion causing inflammation of tendoninflammation of tendon


POTPOT

SwellingSwelling

CrepitusCrepitus

Pain with motionPain with motion

TreatmentTreatment

RestRest

IceIce

HeatHeat

NSAIDSNSAIDS

StretchingStretching

StrengtheningStrengthening

Impingement syndromeImpingement syndrome

Involves compression of Involves compression of supraspinatus tendon, subacromial supraspinatus tendon, subacromial bursa, long head of biceps tendon bursa, long head of biceps tendon (all are under the coracoacromial (all are under the coracoacromial arch)arch)

Impingement

Mechanism Mechanism

Repetitive overhead motionsRepetitive overhead motions


Diffuse pain around the acromion Diffuse pain around the acromion process when arm is in overhead process when arm is in overhead positionposition

External rotators are weakExternal rotators are weak

““+” impingement test+” impingement test

Empty can test may increase painEmpty can test may increase pain

Pinching sensationPinching sensation

Treatment Treatment

RICERICE

Restore normal biomechanics to Restore normal biomechanics to shouldershoulder

Strengthen RC muscles and muscles Strengthen RC muscles and muscles that produce movement of scapulathat produce movement of scapula

Stretch posterior and inferior joint Stretch posterior and inferior joint capsulecapsule

Clavicle FractureClavicle Fracture

Most common in distal thirdMost common in distal third

Clavicle FractureClavicle Fracture

Clavicle fractureClavicle fracture

Mechanism Mechanism

Fall on tip of shoulderFall on tip of shoulder

Direct blow to clavicleDirect blow to clavicle


PainPain

DeformityDeformity

Hold arm close to sideHold arm close to side

Hunch shouldersHunch shoulders

Treatment Treatment

IceIce


ER visitER visit

Clavicle fracture surgical repairClavicle fracture surgical repair

Humeral FractureHumeral Fracture

Mechanism Mechanism

Direct blowDirect blow

DislocationDislocation

Fall on outstretched armFall on outstretched arm


PainPain

Hear a crackHear a crack

Unable to move armUnable to move arm

Swelling, Swelling,

POTPOT

Possible deformityPossible deformity

Discoloration of superficial tissueDiscoloration of superficial tissue

Treatment Treatment

Splint/immobilizeSplint/immobilize

Treat for shockTreat for shock

ER visitER visit

Possible surgeryPossible surgery

2-6 months recovery2-6 months recovery

Epiphyseal FractureEpiphyseal Fracture

Fracture to growth plate in younger Fracture to growth plate in younger athleteathlete

Epiphyseal fracture

Epiphyseal Fracture

Mechanism Mechanism

Falling on elbow, driving head of Falling on elbow, driving head of humerus into the glenoid fossahumerus into the glenoid fossa

Blow to head of humerusBlow to head of humerus


Pain Pain

Inability or desire to move armInability or desire to move arm

Feeling a “pop”Feeling a “pop”

Treatment Treatment

IceIce



Possible surgery to hold head of Possible surgery to hold head of humerus to shaft to ensure proper humerus to shaft to ensure proper healing and growthhealing and growth

Shoulder PointerShoulder Pointer

Contusion to tip of shoulderContusion to tip of shoulder

MechanismMechanism

Direct blow to tip of shoulderDirect blow to tip of shoulder


POTPOT

PainPain

DiscolorationDiscoloration

SwellingSwelling

Decreased motionDecreased motion

Treatment Treatment

IceIce

Protective paddingProtective padding

Modify activityModify activity

shoulder injuries sports medicine class john hardin instructor

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