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Injuries to the Shoulder Region
PE 236Amber Giacomazzi MS, ATC
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Anatomy
Shoulder bones:– Consist of shoulder girdle
(clavicle & scapula) and humerus.
Shoulder joints:– ______________– ______________– ______________
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Anatomy• Joints are held together with ____________
and ____________ that provide stability and allow for limited movement– Shoulder girdle and the GH joint can move in almost
every direction
• _________ joints are just under the skin and are vulnerable to injury, even in muscular athletes
• Major nerves are from a group called the ________________
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Muscular Anatomy
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Rotator Cuff
• S.I.T.S. muscles____________________________________________
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Prevention of Shoulder Injuries
• Proper physical conditioning is key• Develop body and specific regions
relative to sport• Strengthen through ___________
– Focus on _____________ in all ________ _________
– Be sure to incorporate _____________ muscles• Enhances base of function for glenohumeral
joint
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Throwing Mechanics
Instruction in proper throwing mechanics is critical for injury prevention
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• _______________– First movement until ball leaves gloved hand– Lead leg strides forward while both shoulders ______,
______________ and _______________
• _______________– When hands separate and ends at max ER of the humerus– Foot comes in contact with the ground
• _______________– Max _____________ until ball release (humerus adducts,
horizontally adducts and internally rotates)– ___________________________________________
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• __________________– Ball release until max shoulder ______________– Eccentric contraction of ext. rotators to decelerate
humerus while rhomboids decelerate scapula
• __________________– End of motion when athlete is in a balanced
position
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Fractured Clavicle
Fractures of this bone are the most common fracture in this region– This injury usually results from ____ or direct
blows– The adolescent form of this injury is known as a
“___________” fracture
____________________________________ ______________
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Fractured Clavicle
Signs and symptoms– Swelling– __________– Discoloration– Broken bone ends may ________________
Treatment
– Treat for shock– Apply __________________– Apply ________________________
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AC Joint Injuries
Typical mechanism is _____________ to the ______________ or fall _________ __________________– Severity of injury is graded on the amount
of damage to ligaments• 1st degree -- no significant ligament damage • 2nd degree -- partial tearing of ligaments Mild
deformity• 3rd degree -- complete rupture gross deformity
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AC Joint Injuries
• Signs and symptoms– Mild swelling with point
tenderness– __________________
__________________ ____________
– In 3rd degree sprain, a snap or pop may have been sensed along with a visible deformity • *_______________*
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AC Joint Injuries
Treatment– Treat for shock– Apply I.C.E– ____________________– ____________________
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Glenohumeral Joint Injuries
GH joint consists of _____________ and the ____________ of scapula– ____________ but inherently _____________– Typical MOI is having the ___________,
____________, and extended stressing the anterior glenohumeral ligament
– Most common type of dislocation is an _________ _________ that may be a subluxation or complete dislocation
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Glenohumeral Joint Injuries
Signs and symptoms – Shoulder joint deformity and down-sloping shoulder contour
• “ _____________”– ___________________________– Humeral head palpable within _______– Athlete resists efforts to move GH joint
In cases involving subluxation:– GH joint may appear normal– ______________________– ______________________
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Glenohumeral Joint Injuries
Treatment• Treat for shock• Application of ______________________________
_________________• Apply sling & swathe bandage• Dislocations need to be re-located by ___________• ______________________________
GH joint injuries tend to be ______ and _____. _______________ may be necessary.
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Sternoclavicular Joint (SC) Injuries
The sternoclavicular joint is formed by the union of the _____________ and the _________ of the ___________– SC joint is supported by the several ligaments– Injuries are ____ compared to AC or GH joints– Sprains to the SC joint can range in severity
Mechanism is external blow to the shoulder resulting in a _______________________; most commonly, the clavicle moving ________ and ___________
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Sternoclavicular Joint Injuries
• Signs and Symptoms– Grade 1-little pain & disability, point tender– Grade 2-deformity, swelling inability to abduct shoulder– Grade 3-gross displacement– “Retro-sternal” dislocation- ______________________
__________________________
• Treatment – Treat for shock– Apply ice and compression– _____________________
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Rotator Cuff Strains
• Any muscle of the shoulder can suffer a strain. Most common injury is rotator cuff strain
• Rotator cuff muscles contribute to GH joint _________ and ______
• Errors in the ________ ________ or ______ can contribute to ______________
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Rotator Cuff Strains
Signs and symptoms
• Pain within the shoulder, especially during _______________________________
• Difficulty bringing arm up and back during cocking phase of throw. Pain and stiffness in shoulder region _________________________ ______________________
• Point tenderness around region of the humeral head that seems to be ___________________
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Rotator Cuff Strains
Treatment
– First aid is ______ practical due to chronic nature of condition
– I.C.E.– _______________
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GH Joint-Related “Impingement”
SyndromeOccurs when a _____ or
________ is squeezed between moving structures– The _____________
________ is most commonly impinged
– ____________ or __________________ __________________
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GH Joint-Related “Impingement” Syndrome
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GH Joint-Related “Impingement” Syndrome
– __________________ eventually leads to irritation and inflammation of these structures
– Athletes in sports that emphasize overhead arm movements have a high risk of this injury• ______________________
______________________
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GH Joint-Related “Impingement” Syndrome
Signs and symptoms
– Pain deep in shoulder and with abduction & external rotation
– ________________– Pain when arm is ____________________– ___________________________________– ________________
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GH Joint-Related “Impingement” Syndrome
Treatment
• Rest• ________________________• ________________• In extreme cases, surgery
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Labral Tear• The labrum is the lip of ______________
located where the shoulder ligaments, which make up the ___________, connect to the edge of the _________
• The tendon of the ______ muscle attaches to the shoulder at the ________________
• How do Labral tears occur?– ______________– A forced movement of our arm or shoulder– Using arm to break a fall– Repetitive, _________________ such as throwing a
ball or serving in tennis– __________
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Labral Tear
• Signs and Symptoms– Arm and shoulder _____– Arm and shoulder _________– Painful overhead movements– ________ or ______ sounds or sensations
when moving shoulders
• Diagnosis– ____________________
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Labral Tear
• Treatment– Ice– NSAIDs– Shoulder rehabilitation exercises– _________
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Shoulder Subluxation/Dislocation
• _______________ (___________)– Used for anterior
glenohumeral instability
– _________________ _________________
Shoulder Subluxation/Dislocation
• ________________ _____________– Performed like the
Apprehension Test however the examiners hand is placed over the athletes humeral head
– ______________ and _____________ is a positive finding
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Shoulder Impingement
– _______________________________ test for impingement used to assess impingement of soft tissue structures
– Positive test is indicated by ________________
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Supraspinatus Weakness / Tear
• _______________– 90 degrees of
shoulder flexion, internal rotation and 30 degrees of horizontal abduction
– Downward pressure is applied
– _______________ _______________ _______________
Bicipital Tendonitis
• ________________– Elbow flexed to 90 and
stabilized to the thorax. Forearm is pronated
– __________________ __________________ __________________ _____________
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