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Injuries to the Shoulder Region

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Injuries to the Shoulder Region Movements of the Shoulder Flexion Extension Abduction Adduction Internal Rotation External Rotation Horizontal Abduction Anatomy ... – PowerPoint PPT presentation

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Title: Injuries to the Shoulder Region


1
  • Injuries to the Shoulder Region

2
Movements of the Shoulder
  • Flexion
  • Extension
  • Abduction
  • Adduction
  • Internal Rotation
  • External Rotation
  • Horizontal Abduction

3
(No Transcript)
4
Anatomy Review
  • Skeleton of the shoulder
  • shoulder girdle (clavicle scapula)
  • glenohumeral joint
  • acromioclavicular sternoclavicular joints
  • Shoulder girdle and GH joint must move together

5
Anatomy Review
  • Injuries are common.
  • AC and SC joint injuries are common in
    wrestling.
  • Throwing and racquet/club sports can result in
    injuries of the GH joint such as the rotator
    cuff.
  • Cycling and skating sports -- fractures of the
    clavicle are common
  • Injuries can be either chronic or acute.

6
Ligaments
7
Muscles of the Shoulder
8
Posterior Muscles
9
Major Arteries of the Arm
10
Brachial Plexus
  • Shown here are the major components of the
    brachial plexus..
  • Note the relative position of the plexus relative
    to the axillary artery and pectoralis minor.

11
Brachial Plexus
12
Fractured Clavicle
  • Fractures of this bone are the most common
    fracture in this region.
  • This injury usually results from falls or direct
    blows.
  • The adolescent form of this injury is known as a
    greenstick fracture.
  • All clavicular fractures are potentially
    dangerous.

13
Fractured Clavicle
  • Signs/symptoms
  • swelling,
  • deformity,
  • discoloration,
  • broken bone ends protruding, etc.
  • First Aid
  • Treat for shock
  • Sling swathe bandage
  • Sterile dressings on wounds

14
Fractured Scapula
  • Uncommon injury -- normally the result of a
    direct blow
  • Signs and symptoms are less clear than are those
    for a fractured clavicle.
  • Symptoms include
  • history of severe blow
  • pain and functional loss
  • An athlete with such a history and symptoms
    should be referred to a medical doctor.

15
Acromioclavicular Injuries
  • AC joint is located on the lateral/superior
    shoulder, just under the skin.
  • AC ligaments CC ligaments

16
Acromioclavicular Injuries
  • Mechanism -- downward blow to the lateral
    shoulder or fall on an outstretched arm
  • Severity of injury is determined by the specific
    injuries damaged.
  • 1st deg. -- no significant damage
  • 2nd deg - partial tearing of ligs.
  • 3rd deg - complete rupture

17
Signs/Symptoms of AC Injury
  • Any movement of the SG or GHJ will be painful.
  • Mild swelling associated with point
    tenderness
  • In 3rd degree injuries, a snap or pop may have
    been felt along with visible deformity. Piano
    key sign

18
Treatment for a AC Injury
  • First Aid
  • Treat for shock
  • I.C.E.
  • Sling swathe bandage
  • Refer to MD

19
Glenohumeral Joint Injuries
  • GHJ formed of humeral head and the glenoid fossa
  • extremely mobile but inherently unstable
  • major soft tissue structures include articular
    cartilage, coracohumeral, glenohumeral and
    transverse humeral ligs.
  • glenoid labrum

20
Glenohumeral Joint Injuries
  • Mechanism -- abduction and external rotation
  • stresses the anterior glenohumeral ligament
  • most common form is known as an anterior
    dislocation

21
Signs/Symptoms of GHJ Injury
  • Subluxation --
  • movement will be painful
  • in absence of signs
  • Signs/symptoms --
  • shoulder joint deformity
  • abnormally long arm
  • humeral head in axillae
  • pain dysfunction

22
Treatment of a GHJ Injury
  • First Aid
  • Treat for shock
  • Place rolled towel into the armpit
  • I.C.E.
  • Sling swathe bandage
  • 85-90 of injuries tend to recur

23
Sternoclavicular Joint Injuries
  • The sternoclavicular joint is formed by the
    proximal end of the clavicle and the manubrium of
    the sternum.
  • supported by the SC ligaments
  • injuries are rare compared to the AC or GH
    joints
  • Mechanism -- external blow (laterally placed)
    along the long axis of the clavicle, clavicle
    moves anteriorly/superiorly

24
Signs/Symptoms of Sternoclavicular Joint Injuries
  • First Aid
  • Treat for shock
  • I.C.E.
  • Sling swathe bandage
  • Signs/symptoms include
  • gross deformity (2nd 3rd)
  • swelling painful movement
  • snapping sound related to the injury

25
Rotator Cuff Strains
  • Muscles of the cuff - GHJ --- abduction, internal
    and external rotation
  • dynamic stabilizers (cuff)
  • SITS
  • Supraspinatus
  • Infraspinatus
  • Teres Minor
  • Subscapularis

26
Signs/Symptoms of Rotator Cuff Strains
  • pain within the shoulder -- especially during
    follow through phase
  • pain/stiffness 12-24 hours after
    throwing/swinging
  • point tenderness around the region of the humeral
    head

27
GHJ Related Impingement Syndrome
  • Occurs when a bursae/ tendon is squeezed between
    moving structures
  • supraspinatus is commonly impinged

28
Impingement Syndrome
  • Sports that emphasize overhead arm movements
    showed a relative high incidence of these
    injuries.

29
Signs/Symptoms of Impingement Syndrome
  • pain on abduction external rotation
  • strength loss
  • pain when arm is abducted beyond 80-90 degrees
  • nocturnal pain

30
Impingement Syndrome
  • First Aid
  • Rest
  • Anti-inflammatory drugs
  • Physical therapy
  • In extreme cases, surgery

31
Biceps Tendon Problems
  • Anatomic relationships between LH biceps tendon
    and the GHJ capsule, transverse humeral ligament
    and subacromial space

32
Biceps Tendon Problems
  • LH tendon can be compressed within the
    subacromial space
  • LH tendon may develop tendinitis and result in
    subluxation
  • Violent force may sublux the LH tendon from the
    bicipital groove.

33
Signs/symptoms of Biceps Tendon Problems
  • Signs/symptoms --
  • painful abduction of the shoulder joint
  • pain during resisted supination
  • resisted flexion/supination yields a snapping
    and/or popping sensation

34
Biceps Tendon Problem
  • First Aid
  • This qualifies as an overuse type of injury --
    no first aid procedures.
  • Emphasis should be on prevention through skill
    development, rest, and strength training.
  • Traumatic subluxations should be treated with ICE

35
Contusions of the Shoulder Region
  • External blows are common to this region.
  • The GHJ is well protected by muscles while the AC
    joint is exposed.
  • Contusions to this region can result in a
    shoulder pointer.

36
Contusions of the Shoulder Region
  • First Aid
  • Immediate application of ICE
  • Sling swathe bandage
  • Medical referral
  • Signs/symptoms --
  • history of recent blow
  • decreased ROM
  • muscle spasm
  • discoloration swelling
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