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Non shoulder causes of shoulder injury

Non shoulder causes of shoulder injury. LISTEN UP. W. Ben Kibler, MD. Medical director. THE KINETIC CHAIN. Wrist. F O R C E. Elbow. Shoulder. Trunk and Back. Legs. 0. TIME. Adapted From Groppel. Implications. Body works in coordinated patterns to produce function

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Non shoulder causes of shoulder injury

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  1. Non shoulder causes of shoulder injury LISTEN UP

  2. W. Ben Kibler, MD Medical director

  3. THE KINETIC CHAIN Wrist F O R C E Elbow Shoulder Trunk and Back Legs 0 TIME Adapted From Groppel

  4. Implications Body works in coordinated patterns to produce function Multiple DOF in kinetic chain- possible weak links in kinetic chain Body fails in patterns around the weak links- compensations

  5. “CATCH UP” Wrist Elbow F O R C E Normal Catch Up % Shoulder SHLDR VEL 3.3 4.43 34 Trunk and Back SHLDR MASS 9 16.25 80 Legs 20% DECREASE IN TRUNK K.E. 0 TIME Adapted From Groppel

  6. Results Small vs. Large Knee Flexion * Significant difference (p<0.05) ** Sign. diff., even when normalized Fleisig GS, et.al.

  7. Tennis injury/mechanics study 20 professional players- no injuries Biomechanical analysis of serves- kinetics, kinematics 2 year follow-up- injuries 9/ no injury, 11/ shoulder/arm injury Martin C, AJSM 2015

  8. Tennis injury/mechanics study Shoulder/arm injury players- later in: Pelvis rotation Trunk rotation Torso rotation Trunk flexion H-add/max ext rotation

  9. CASE- 32 y.o.pro tennis player • High ranking, grad onset shoulder pain • Posterior shoulder, from ball impact > follow through- “tight pull” • Decreased ball velocity, arm strength • Rest, modalities, rot cuff strength • MRA- SLAP, partial rotator cuff injury

  10. CASE- exam • (-) M-DLS, 30 deg GIRD, (-) load/shift • Normal flexion, abduction strength • Scapular dyskinesis, weak low row • (L) hip IR- 20 deg, (R) hip IR- 35 deg • Tight (L) ITB, lateral patellar tilt • 0 deg ankle d-flexion- pain

  11. CASE- imaging

  12. CASE- treatment • Ankle scope- debridement of bone spur • Quad/ITB flexibility, patellar mobilization • Hip/core stability, strength • Scapular retraction control • GH ROM, posterior muscle eccentric strength, endurance

  13. CASE- outcomes • 4 month rehabilitation, conditioning • RTP, competition 4- 5 months • 1 year > high ranking • High serve velocity, endurance • Finals of tournaments • No shoulder pain

  14. CASE- 18 y.o. college pitcher • High school senior- state title • Summer- work on tobacco farm • Fall- college, shoulder pain every throw, decreased velocity, movement • Pain- ball release, can’t get loose • Imaging- “possible labral injury”

  15. CASE- treatment • DL x 4 weeks, no throwing, may bat • Hip/core strength, stability • Scapular retraction control • GH joint- eccentric 7 shoulder strength • GH joint- ROM IR/ER • Throwing progressions

  16. CASE- outcomes • RTP fall ball- pitch count • Off season core stability • RTP spring- progression in pitch count • 6- 2, one no-hitter • Completed college play, no injury

  17. Conclusions Kinetic chain- mechanism by which coordination of the multiple segments for specific tasks is achieved Body works as a unit Kinetic chain framework

  18. Conclusions Body fails as a unit Patterns of failure- proximal, distal Catch up, compensations Victims and culprits Overview, screening, detailed exam Knowledge- sports mechanics

  19. THANK YOU www.shouldercenterofky.com

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