Shoulder Injuries

1. Shoulder Injuries Sports medicine class John Hardin Instructor

2. Anatomy • Bones • Ligaments • Joints • Muscles

3. Bones • Clavicle • Sternal end, distal end • Scapula • Glenoid fossa, acromion process, coracoid process, spine, supraspinous fossa, infraspinous fossa, vertebral border, inferior angle • Humerus • Head, greater & lesser tuberosity, bicipital groove

4. Ligaments • Acromioclavicular • Coracoclavicular • Coracoacromial • Glenohumeral • Superior • Middle • Inferior • Glenoid Labrum

5. Joints • Glenohumeral joint • Acromioclavicular joint • Sternoclavicular joint • Scapulothoracic joint

6. Muscles • Produce dynamic motion & establish stability to compensate for the greater mobility • Motions at shoulder joint • flexion & extension • Internal & external rotation • Abduction & Adduction • Horizontal flexion • Circumduction

7. Muscles attaching axial skeleton to humerus • Latissimus dorsi • Shoulder extension, adduction • Pectoralis major • Shoulder adduction, horizontal flexion

8. Muscles attaching scapula to humerus • Deltoid • Abduction, flexion, extension • Teres major • Internal rotation • Coracobrachialis • Shoulder flexion • Rotator cuff muscles • Supraspinatus- external rotation, initiates abduction • Infraspinatus-external rotation • Teres minor-external rotation • Subscapularis-internal rotation

9. Muscles attaching axial skeleton to scapula • Levator scapula • Shoulder elevation • Trapezius • Shoulder elevation, retraction, depression • Rhomboids (major & minor) • Shoulder retraction • Serratus anterior • Shoulder protraction, holds scapula flat against thoracic cage

10. Other muscles • Biceps brachii—long head & short head • Shoulder flexion • Triceps brachii—long head, medial head, lateral head • Shoulder extension

11. Preventing shoulder injuries • Maintain adequate strength & flexibility of all shoulder muscles • Good posture • Proper techniques • Proper warmup • Proper protective gear

12. Types of Injuries • Sprains • Dislocations • Strains • Overuse • Fractures

13. AC Sprain Shoulder separation

14. Mechanism • Impact to tip of shoulder • Fall on outstretched arm

15. Signs and symptoms • Deformity at AC joint • distal end of clavicle rides superiorly • Pain with movement and palpation • “+” piano key sign

16. Degrees of injury • 1st degree: no deformity, pain w/ palpation & motion, mild stretching of AC ligament • 2nd degree: displacement of distal end of clavicle, unable to abduct arm or bring it across body, pain • 3rd degree: complete rupture of AC and CC ligaments, with dislocation of the distal end of clavicle, severe pain, LOM, instability

17. Treatment • RICE • Immobilization • Physician referral if more than 1st degree • Possible surgery

18. SC Sprain • Relatively uncommon injury

19. Mechanism of injury • Indirect force transmitted through the humerus, the shoulder joint and the clavicle • Direct impact to clavicle

20. Signs & symptoms • 3 degrees • May have deformity at sternal end • Swelling • Pain • POT • Inability to abduct shoulder through full ROM

21. Treatment • RICE • Immobilization • Physician referral

22. Glenohumeral dislocation • Shoulder dislocation • Anterior—most common • Posterior • Inferior • Multidirectional

23. Anterior shoulder dislocation

24. Anterior shoulder dislocation

25. GH dislocation

26. GH dislocation

27. Mechanism • Arm forced into external rotation abduction and extension • Posterior force driving the head of the humerus posteriorly

28. Signs & symptoms • Deformity—step off (deltoid will look flattened • Arm in slight abduction, external rotation • Will not be able to move shoulder joint • Unable to touch opposite shoulder with hand of affected side • Pain and POT

29. Treatment • Immobilization • ER to have shoulder reduced by a physician • Immobilization for 1-2 weeks • No activity 4-6 weeks • Rehab-ROM and strengthening • High incidence of recurrence after the first dislocation

30. Shoulder reduction

31. Immobilization of shoulder joint

32. Shoulder dislocation video • Watch shoulder dislocation on Google Video.htm

33. Shoulder subluxation • Partial dislocation/spontaneous reduction

34. Mechanism • External rotation, abduction, extension

35. Signs & symptoms • Pain • Limited ROM • POT

36. Treatment • Ice • Immobilization • Physician referral • Rehab—strengthening muscles around joint

37. Rotator Cuff Strain • 3 degrees • Most involve supraspinatus • Tears usually at insertion on humerus

38. Rotator cuff strain

39. Mechanism • Dynamic rotation of arm at high velocity (overhead throwing) • Usually involves individuals with a history of impingement or instability

40. Signs & symptoms • Pain w/ muscle contraction • POT over greater tuberosity • Loss of strength • Complete tear produces pain, loss of function, swelling and POT

41. Treatment • RICE • Decrease level of activity • Exercises to strengthen rotator cuff

42. Biceps tendon rupture

43. Mechanism • Direct blow • Severe contraction of biceps

44. Signs & symptoms • Unable to flex elbow • Deformity of biceps—balling up of muscle belly • Pain • POT

45. Treatment • Ice • Immobilization • Physician referral

46. Tendonitis • Rotator cuff • Biceps • Common among athletes performing overhead motions due to overuse or muscle weakness

47. Mechanism • Repetitive overhead motion causing inflammation of tendon

48. Signs & symptoms • POT • Swelling • Crepitus • Pain with motion

49. Treatment • Rest • Ice • Heat • NSAIDS • Stretching • Strengthening

50. Impingement syndrome • Involves compression of supraspinatus tendon, subacromial bursa, long head of biceps tendon (all are under the coracoacromial arch)