Injuries of the Shoulder

Mechanism, Evaluation and Treatment

Rotator Cuff StrainMechanism

Typically from a violent pull of arm, an abnormal rotation force, or a fall on outstretched arm (foosh).

Sometimes from repetitive motion (throwing, tennis, swimming)

Rotator Cuff StrainSigns & Symptoms

Loss of functionPain and tendernessLack of normal shoulder flexibility and strength

Special TestsDrop Arm Test – Supraspinatus – abduct as far as

possible then return to 90 and try to hold – if drop then torn

Empty Can Test – checks supraspinatus – check strength in empty can motion at approx 45 degrees

Apley’s Scratch Test – checks all muscle motions

Drop Arm Test

Empty Can Test

Rotator Cuff StrainManagement

Rest if necessary and IceRehabilitation emphasizing stretching &

strengtheningSurgery on a rare occasion

Acromioclavicular Sprain or Separated Shoulder

MechanismDirect blow to tip of shoulder or foosh driving arm

against the acromionDamages the ligaments and acromion and clavicle

may separate.May be classified as first, second, or third degree

sprains.

Acromioclavicular Sprain or Separated Shoulder

Signs and SymptomsPain and tenderness at end of the collar boneDeformity caused by upward displacement of

collar boneLoss of function

Special TestsDistraction (Piano Key)

Acromioclavicular Sprain or Separated Shoulder

Management Ice to control bleeding and swelling Immobilization with sling and swatheRehab to restore normal strength & flexibilityProtective taping and paddingOut how long???? Depends on degree of

separation and amount of pain can tolerate

Anterior DislocationMechanism –

when arm is forcefully abducted and externally rotated (ex. Abnormal force to an arm that is executing a throw or and arm tackle)

A fall on an armHumeral head slips forward out of the glenoid

fossa.Often causes a labral tear.

Anterior DislocationSigns and Symptoms

Pain and TendernessDeformity – flattened shoulder contour – stair

step defectLoss of function – arm will just hang

Special TestsApprehension – abduct arm to 90 degrees

then force arm into external rotation Relocation test – do apprehension test but

hold glenohumeral head in place

Shoulder Dislocation

Apprehension Test

Relocation Test

Anterior DislocationManagement

Cold Application Immobilization

AS IS – DO NOT RELOCATE ON OWN.Rehabilization

Restore normal strength and flexibilityBrace

Sully Brace – Limit ROM – esp. Abduction/External Rotation

Surgery

Glenoid Labrum Tear (Labral Tear)

MechanismAnterior Dislocation/Subluxation of glenohumeral

jointRepetitive shoulder motionAcute trauma

Glenoid Labrum Tear (Labral Tear)

Signs & SymptomsPain changes smooth motion of shoulderFeels or hears pop with forced external rotationPain with external rotation at 90 degrees of

abduction – apprehension testWeakness of rotator cuffPossible positive clunk testPain with forced horizontal adduction

Clunk Test

Long Thoracic Nerve Contusion

Mechanism Indirect trauma to shoulder or thoracic wall, overuse

or prolonged traction (as in cycling)

Signs & SymptomsPain, dull ache in shoulderProtruding/winging scapula due to weak serratus

anterior muscle due to damage to nerve

Long Thoracic Nerve Contusion

Special TestWall push up

Clavicle FractureBroken Collar Bone

MechanismFooshfall or hit on tip of shoulder

Signs & SymptomsHolding up armHead toward injured sidePossible deformity & crepitus

Clavicle FractureTreatment

X-raySurgery

Bicep TendinitisMechanism

Irritation of the Bicep Tendon

Signs & SymptomsPain, feel like bicep is moving

Special TestsSpeed’s Test – resist shoulder flexionYergason Test – athlete tries to keep arm from

externally rotating and extending the elbow – checks for bicep stability

Bicep RuptureMechanism

Violent contraction

Signs and symptomsHears/feels a sensation of rolling up of the armProtruding bulge in the bicep – divet in armLoss of function/strength

TreatmentRefer to orthopedic surgeon

Bicep Rupture

Rotator Cuff ImpingementMechanism

Caused due to swelling in AC joint. No where for swelling to go. Rotator cuff is impinged in the joint.

Special Tests Impingement Tests

Force arm into horizontal adductionEmpty Can Test

Resisted as empty can motion at 45 degree angle

Rotator Cuff Impingement

Impingement Test

Other Typical InjuriesBursitis

Contusion

Fracture

Prevention of Shoulder Injuries

Overall Conditioning

Strengthen in Full ROM

Warm Up properly before explosive arm movements

Instruct in proper falling techniques

Protective equipment

Teach proper mechanics

Avoid overuse

Sport Specific Training

VideosShoulder Injuries (9:58)http://www.bing.com/videos/watch/video/shoulder-injuries/a31bc6c1eb13284489f0a31bc6c1eb13284489f0-289506132305?q=shoulder%20injury%20videosShoulder Injuries (Part 1) (15:03)http://www.youtube.com/watch?v=yVoFmYJLx74Shoulder Injuries (Part 2) (11:38)http://www.youtube.com/watch?v=Q4fFV07ITNE&feature=channelShoulder Dislocation (X-ray) (1:00)http://www.youtube.com/watch?v=8_tQJDR7ORc&feature=related

VideosUnderstanding Shoulder Pain (Sports Injuries #3)

(2:59) http://www.youtube.com/watch?

v=HULJU_ROdCI&feature=rec-LGOUT-exp_fresh+div-HM

Shoulder Dislocation Dwyane Wade (3:00)http://www.bing.com/videos/watch/video/dwyane-

wade-shoulder-injury/27b33922cf2f85a7e6cf27b33922cf2f85a7e6cf-302259110559?q=shoulder%20injury%20videos

Shoulder Injury Campbell (Raiders) (1:13)http://www.nfl.com/videos/nfl-game-highlights/

09000d5d81a17e3b/Campbell-injuryShoulder dislocation wrestling (0:19)

http://www.youtube.com/watch?v=-Hv8FM78I7I