Shoulder Injuries

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Shoulder Injuries

• Sports medicine class
• John Hardin
• Instructor

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Anatomy

• Bones
• Ligaments
• Joints
• Muscles

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Bones

• Clavicle
• Sternal end, distal end
• Scapula
• Glenoid fossa, acromion process, coracoid
  process, spine, supraspinous fossa, infraspinous
  fossa, vertebral border, inferior angle
• Humerus
• Head, greater lesser tuberosity, bicipital
  groove

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Ligaments

• Acromioclavicular
• Coracoclavicular
• Coracoacromial
• Glenohumeral
• Superior
• Middle
• Inferior
• Glenoid Labrum

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Joints

• Glenohumeral joint
• Acromioclavicular joint
• Sternoclavicular joint
• Scapulothoracic joint

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Muscles

• Produce dynamic motion establish stability to
  compensate for the greater mobility
• Motions at shoulder joint
• flexion extension
• Internal external rotation
• Abduction Adduction
• Horizontal flexion
• Circumduction

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Muscles attaching axial skeleton to humerus

• Latissimus dorsi
• Shoulder extension, adduction
• Pectoralis major
• Shoulder adduction, horizontal flexion

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Muscles attaching scapula to humerus

• Deltoid
• Abduction, flexion, extension
• Teres major
• Internal rotation
• Coracobrachialis
• Shoulder flexion
• Rotator cuff muscles
• Supraspinatus- external rotation, initiates
  abduction
• Infraspinatus-external rotation
• Teres minor-external rotation
• Subscapularis-internal rotation

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Muscles attaching axial skeleton to scapula

• Levator scapula
• Shoulder elevation
• Trapezius
• Shoulder elevation, retraction, depression
• Rhomboids (major minor)
• Shoulder retraction
• Serratus anterior
• Shoulder protraction, holds scapula flat against
  thoracic cage

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Other muscles

• Biceps brachiilong head short head
• Shoulder flexion
• Triceps brachiilong head, medial head, lateral
  head
• Shoulder extension

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Preventing shoulder injuries

• Maintain adequate strength flexibility of all
  shoulder muscles
• Good posture
• Proper techniques
• Proper warmup
• Proper protective gear

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Types of Injuries

• Sprains
• Dislocations
• Strains
• Overuse
• Fractures

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AC Sprain

• Shoulder separation

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Mechanism

• Impact to tip of shoulder
• Fall on outstretched arm

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Signs and symptoms

• Deformity at AC joint
• distal end of clavicle rides superiorly
• Pain with movement and palpation
• piano key sign

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Degrees of injury

• 1st degree no deformity, pain w/ palpation
  motion, mild stretching of AC ligament
• 2nd degree displacement of distal end of
  clavicle, unable to abduct arm or bring it across
  body, pain
• 3rd degree complete rupture of AC and CC
  ligaments, with dislocation of the distal end of
  clavicle, severe pain, LOM, instability

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Treatment

• RICE
• Immobilization
• Physician referral if more than 1st degree
• Possible surgery

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SC Sprain

• Relatively uncommon injury

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Mechanism of injury

• Indirect force transmitted through the humerus,
  the shoulder joint and the clavicle
• Direct impact to clavicle

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Signs symptoms

• 3 degrees
• May have deformity at sternal end
• Swelling
• Pain
• POT
• Inability to abduct shoulder through full ROM

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Treatment

• RICE
• Immobilization
• Physician referral

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Glenohumeral dislocation

• Shoulder dislocation
• Anteriormost common
• Posterior
• Inferior
• Multidirectional

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Anterior shoulder dislocation
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Anterior shoulder dislocation
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GH dislocation
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GH dislocation
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Mechanism

• Arm forced into external rotation abduction and
  extension
• Posterior force driving the head of the humerus
  posteriorly

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Signs symptoms

• Deformitystep off (deltoid will look flattened
• Arm in slight abduction, external rotation
• Will not be able to move shoulder joint
• Unable to touch opposite shoulder with hand of
  affected side
• Pain and POT

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Treatment

• Immobilization
• ER to have shoulder reduced by a physician
• Immobilization for 1-2 weeks
• No activity 4-6 weeks
• Rehab-ROM and strengthening
• High incidence of recurrence after the first
  dislocation

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Shoulder reduction
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Immobilization of shoulder joint
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Shoulder dislocation video

• Watch shoulder dislocation on Google Video.htm

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Shoulder subluxation

• Partial dislocation/spontaneous reduction

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Mechanism

• External rotation, abduction, extension

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Signs symptoms

• Pain
• Limited ROM
• POT

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Treatment

• Ice
• Immobilization
• Physician referral
• Rehabstrengthening muscles around joint

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Rotator Cuff Strain

• 3 degrees
• Most involve supraspinatus
• Tears usually at insertion on humerus

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Rotator cuff strain
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Mechanism

• Dynamic rotation of arm at high velocity
  (overhead throwing)
• Usually involves individuals with a history of
  impingement or instability

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Signs symptoms

• Pain w/ muscle contraction
• POT over greater tuberosity
• Loss of strength
• Complete tear produces pain, loss of function,
  swelling and POT

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Treatment

• RICE
• Decrease level of activity
• Exercises to strengthen rotator cuff

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Biceps tendon rupture
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Mechanism

• Direct blow
• Severe contraction of biceps

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Signs symptoms

• Unable to flex elbow
• Deformity of bicepsballing up of muscle belly
• Pain
• POT

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Treatment

• Ice
• Immobilization
• Physician referral

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Tendonitis

• Rotator cuff
• Biceps
• Common among athletes performing overhead motions
  due to overuse or muscle weakness

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Mechanism

• Repetitive overhead motion causing inflammation
  of tendon

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Signs symptoms

• POT
• Swelling
• Crepitus
• Pain with motion

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Treatment

• Rest
• Ice
• Heat
• NSAIDS
• Stretching
• Strengthening

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Impingement syndrome

• Involves compression of supraspinatus tendon,
  subacromial bursa, long head of biceps tendon
  (all are under the coracoacromial arch)

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Impingement
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Impingement
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Mechanism

• Repetitive overhead motions

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Signs symptoms

• Diffuse pain around the acromion process when arm
  is in overhead position
• External rotators are weak
• impingement test
• Empty can test may increase pain
• Pinching sensation

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Treatment

• RICE
• Restore normal biomechanics to shoulder
• Strengthen RC muscles and muscles that produce
  movement of scapula
• Stretch posterior and inferior joint capsule

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Clavicle Fracture

• Most common in distal third

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Clavicle Fracture
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Clavicle Fracture
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Clavicle Fracture
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Clavicle Fracture
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Clavicle Fracture
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Clavicle fracture
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Mechanism

• Fall on tip of shoulder
• Direct blow to clavicle

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Signs symptoms

• Pain
• Deformity
• Hold arm close to side
• Hunch shoulders

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Treatment

• Ice
• Immobilization
• ER visit

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Clavicle fracture surgical repair
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Humeral Fracture
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Mechanism

• Direct blow
• Dislocation
• Fall on outstretched arm

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Signs symptoms

• Pain
• Hear a crack
• Unable to move arm
• Swelling,
• POT
• Possible deformity
• Discoloration of superficial tissue

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Treatment

• Splint/immobilize
• Treat for shock
• ER visit
• Possible surgery
• 2-6 months recovery

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Epiphyseal Fracture

• Fracture to growth plate in younger athlete

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Epiphyseal fracture
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Epiphyseal fracture
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Epiphyseal Fracture
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Mechanism

• Falling on elbow, driving head of humerus into
  the glenoid fossa
• Blow to head of humerus

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Signs symptoms

• Pain
• Inability or desire to move arm
• Feeling a pop

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Treatment

• Ice
• Immobilization
• Physician referral
• Possible surgery to hold head of humerus to shaft
  to ensure proper healing and growth

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Shoulder Pointer

• Contusion to tip of shoulder

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Mechanism

• Direct blow to tip of shoulder

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Signs symptoms

• POT
• Pain
• Discoloration
• Swelling
• Decreased motion

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Treatment

• Ice
• Protective padding
• Modify activity