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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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