Download Shoulder Injuries

SHOULDER INJURIES
ANATOMY OF THE SHOULDER
Ball-and-socket joint
 Relies on muscular strength for stability
 Several bones link up at the shoulder
 Entire bony linkage of the shoulder referred to
as the shoulder girdle

BONES

3 basic bony components
 Humerus
 Clavicle
(aka collarbone)
 Scapula (aka shoulder blade)
MUSCLES

Rotator Cuff
 Consists
of 4 muscles (SITS)
 Subscapularis
 Infraspinatus
 Teres
Minor
 Supraspinatus
 Responsible
for rotating the arm internally and
externally as well as abduction
MUSCLES (CONT’D)

Deltoid-lies over the head of the humerus.
 Abducts,
flexes, and extends shoulder
Anterior portion of shoulder-pectoralis major
and pectoralis minor
 Biceps-flexes the elbow
 Triceps-extends the forearm and shoulder.

JOINTS
Shoulder girdle composed of several joints
 Most commonly injured joints of the shoulder
are:

 acromioclavicular
joint (Acromion process of
scapula and the distal end of clavicle
 glenohumeral joint (articulation of the head of the
humerus and the glenoid fossa)
**articulation-point of contact
**glenoid fossa-saucerlike portion of scapula
WHAT CAUSES MOST SHOULDER INJURIES?
Muscle weaknesses
 Postural problems
 Nature of the game

ADDRESSING MUSCLE WEAKNESS

“Out of sight, out of mind”-weight training
 Athletes
often lift weights only for the muscles they
can see in the mirror which leads to weaknesses in
opposing muscles

Athletes with rounded shoulders, tight pecs, or
weak posterior shoulder muscles may be
predisposed to injuries.

Supraspinatus muscle, nerve, and blood vessel run through a very
narrow space and narrowing that space can cause those tissues to
become pinched
MUSCLE WEAKNESS (CONT’D)

Using arm continually in one direction
 Ex.
Freestyle swimming or throwing
 Need to strengthen the muscles opposing the
motion in order to prevent injuries.
 Otherwise, it creates a muscle imbalance.
 Ex. A swimmer who swims 300 strokes freestyle
must swim 300 strokes backstroke to balance the
strength of the muscles.
ACROMIOCLAVICULAR LIGAMENT SPRAIN
Referred to as a shoulder separation
 Can be injured by impact to the top of the
shoulder or by falling on an outstreched arm
 Athlete will indicate pain with movement
 More serious sprains cause the clavicle to
move superiorly

ACROMIOCLAVICULAR LIGAMENT SPRAIN
(CONT’D)

3rd degree separation-large abnormal bump
caused by excessive upward desplacement of
clavicle.
 Unable
body

to move arm and will hold it tight against
Treatment
 1st degree-PRICE
 2nd & 3rd –PRICE initially
orthopedist.
and then referred to an
ACROMIOCLAVICULAR LIGAMENT SPRAIN
(CONT’D)

2 courses of action to treat 3rd degree tear:
 Surgery-joint
wired or screwed together
 Harness-straps the clavicle downward in an attempt
to hold the joint together long enough to allow the
ligament to heal.
GLENOHUMERAL LIGAMENT SPRAIN
Especially vulnerable when in abduction and
external rotation.
 If a 3rd degree sprain, subluxation or
dislocation is likely
 Will have pain with motion
 Treated by PRICE and referred to a physician

MUSCLE AND TENDON INJURIES
Most muscle and tendon injuries are caused by
overuse
 Athletes who throw, shoot, or repeat a swim
stroke prone to overuse injuries
 Require rest, ice application, immobilization,
and physician referrals

ROTATOR CUFF STRAIN
Occur from excessive motion beyond the
normal range
 Supraspinatus is most often injured
 Pain with motion and sometimes when
shoulder is not moving.
 Pain generally occurs with abduction
 If unable to abduct, complete tear or 3rd degree
strain is suspected

IMPINGEMENT SYNDROME




Develops from repetitive overhead types of movement
Supraspinatus and biceps muscles run together through a
space beneath acromion process
 If space narrows due to swelling, tendinitis, weak
posterior muscle strength, or poor posture, the muscles
become impinged in the space
Creates pain and discomfort with overhead movements.
Treatment-modified activity, strengthening posterior
muscles, improving flexibility of tight pectoralis muscles.
BICIPITAL TENDINITIS
Common in athletes who are constantly raising
their arms above their heads
 Repetitive nature of the movement causes
irritation of the tendon in bicipital groove
 Immobilization in a sling will make athlete more
comfortable
 Physician may prescribe ultrasound therapy
and anti-inflammatory medication.

BICEPS TENDON RUPTURE
Can rupture from a direct blow or severe
contractional forces
 Unable to flex elbow
 Noticeable change in appearance of muscle
(look like a golf ball under the skin)
 Arm must be iced and immobilized
 Referred to physician
 Tendon must be surgically repaired

CLAVICULAR FRACTURES


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



Most often fractured at its weakest point (distal 3rd)
Caused by a direct blow or fall on the tip of shoulder
Experience pain and will hold arm close to body to
prevent movement
Ice used to decrease swelling and pain
Sling restricts arm movement
Physician can set the clavicle in place using a harness
Fracture takes 6 weeks to heal
HUMERAL FRACTURE
Midshaft fractures easy to locate
 Humeral head fractures sometimes hard to find
if hidden behind shoulder musculature
 Shoulder sprain can mimic a fracture so its
important to ensure proper assessment.
 Unable to move arm and will experience pain
 May report feeling or hearing a pop
 Will hold arm against body

HUMERAL FRACTURE (CONT’D)
Easiest way to determine a fracture: palpate
circumference of bone
 Painful on all sides, most likely a fracture
 Physician referral
 Severity determines treatment-could just be a
sling or surgery with long arm cast
 Takes at least 6 weeks to heal

EPIPHYSIS INJURY
Growth plate susceptible to direct and indirect
blows
 Same signs and symptoms as humeral fractures
 Can cause permanent growth impairment
 Ice, splinting, and a sling-what an ATC should do
 Physician will determine severity of injury and
treatment.

EPIPHYSIS INJURY (CONT’D)
Some injuries require surgery to hold the head
of humerus to the shaft of humerus
 Teenage pitchers prone to epiphyseal injury
from excessive throwing.

 Limited
in number of games allowed to play as well
as number of pitches thrown
AVULSION FRACTURES





May accompany a glenoumeral or acromioclavicular
sprain
Ligament or tendon pulls away a small portion of bone
When humerus is dislocating from glenoid fossa,
capsular ligament can pull on scapula
Athlete will experience pain associated with the
dislocation and avulsion fracture
Impossible to know if avulsion fracture exists: ATC
must assume until X-ray reveals otherwise
GLENOHUMERAL DISLOCATIONS AND
SUBLUXATIONS
Glenohumeral dislocation means that head of
humerus is out of its socket
 Subluxation means that head of humerus came
out of socket and then went back in
 Cause for both is the same: excessive abduction
and external rotation.
 Results are completely different
 Both require attention by ATC and team physician

GLENOHUMERAL DISLOCATIONS AND
SUBLUXATIONS (CONT’D)
Dislocation sometimes causes the humerus head
to tear the capsular ligament anteriorly
 Instability of capsular ligament allows the humerus
head to shift forward (most common type of
shoulder dislocation)
 Experience pain and inability to use shoulder
 ATC will see a deformity at deltoid muscle
 Shoulder will be flat, not round
 Physician needs to reduce a dislocation

GLENOHUMERAL DISLOCATIONS AND
SUBLUXATIONS (CONT’D)
For a subluxation, athlete may feel his shoulder
“pop out and then pop back in”
 X-ray necessary to determine extent of the
dislocation or subluxation
 Athlete needs to strengthen the muscles of
adduction and internal rotation
 If athlete experiences recurrent subluxations or
dislocations will require surgery to repair
capsular ligaments.
