Title: Injuries to the Shoulder Region
1- Injuries to the Shoulder Region
2Movements of the Shoulder
- Flexion
- Extension
- Abduction
- Adduction
- Internal Rotation
- External Rotation
- Horizontal Abduction
3(No Transcript)
4Anatomy Review
- Skeleton of the shoulder
- shoulder girdle (clavicle scapula)
- glenohumeral joint
- acromioclavicular sternoclavicular joints
- Shoulder girdle and GH joint must move together
5Anatomy 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.
6Ligaments
7Muscles of the Shoulder
8Posterior Muscles
9Major Arteries of the Arm
10Brachial 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.
11Brachial Plexus
12Fractured 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.
13Fractured Clavicle
- Signs/symptoms
- swelling,
- deformity,
- discoloration,
- broken bone ends protruding, etc.
- First Aid
- Treat for shock
- Sling swathe bandage
- Sterile dressings on wounds
14Fractured 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.
15Acromioclavicular Injuries
- AC joint is located on the lateral/superior
shoulder, just under the skin. - AC ligaments CC ligaments
16Acromioclavicular 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
17Signs/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
18Treatment for a AC Injury
- First Aid
- Treat for shock
- I.C.E.
- Sling swathe bandage
- Refer to MD
19Glenohumeral 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
20Glenohumeral Joint Injuries
- Mechanism -- abduction and external rotation
- stresses the anterior glenohumeral ligament
- most common form is known as an anterior
dislocation
21Signs/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
22Treatment 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
23Sternoclavicular 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
24Signs/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
25Rotator Cuff Strains
- Muscles of the cuff - GHJ --- abduction, internal
and external rotation - dynamic stabilizers (cuff)
- SITS
- Supraspinatus
- Infraspinatus
- Teres Minor
- Subscapularis
26Signs/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
27GHJ Related Impingement Syndrome
- Occurs when a bursae/ tendon is squeezed between
moving structures - supraspinatus is commonly impinged
28Impingement Syndrome
-
- Sports that emphasize overhead arm movements
showed a relative high incidence of these
injuries.
29Signs/Symptoms of Impingement Syndrome
- pain on abduction external rotation
- strength loss
- pain when arm is abducted beyond 80-90 degrees
- nocturnal pain
30Impingement Syndrome
- First Aid
- Rest
- Anti-inflammatory drugs
- Physical therapy
- In extreme cases, surgery
31Biceps Tendon Problems
- Anatomic relationships between LH biceps tendon
and the GHJ capsule, transverse humeral ligament
and subacromial space
32Biceps 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.
33Signs/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
34Biceps 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
35Contusions 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.
36Contusions 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