Download Shoulder

Injuries to the Shoulder Region
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Movements of the Shoulder
– Flexion
– Extension
– Abduction
– Adduction
– Internal Rotation
– External Rotation
– Horizontal Abduction
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Anatomy Review

Skeleton of the
shoulder
– shoulder girdle
(clavicle & scapula)
– glenohumeral joint
– acromioclavicular &
sternoclavicular joints

Shoulder girdle and
GH joint must
move together
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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.
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Ligaments
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Muscles of the Shoulder
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Posterior Muscles
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Major Arteries of the Arm
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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.
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Brachial Plexus
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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.
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Fractured Clavicle

Signs/symptoms
–
–
–
–

swelling,
deformity,
discoloration,
broken bone ends
protruding, etc.
First Aid:
– Treat for shock
– Sling & swathe bandage
– Sterile dressings on
wounds
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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.
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Acromioclavicular Injuries

AC joint is located
on the
lateral/superior
shoulder, just under
the skin.
– AC ligaments &
CC ligaments
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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
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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”
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Treatment for a AC Injury
First Aid:
Treat for shock
I.C.E.
Sling & swathe bandage
Refer to MD
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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
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Glenohumeral Joint Injuries

Mechanism -abduction and external
rotation
– stresses the anterior
glenohumeral ligament
– most common form is
known as an “anterior”
dislocation
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Signs/Symptoms of GHJ
Injury
Signs/symptoms -– shoulder joint
deformity
– abnormally long
arm
– humeral head in
axillae
– pain & dysfunction

Subluxation -– movement will be
painful
– in absence of signs
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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
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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
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Signs/Symptoms of
Sternoclavicular Joint Injuries

Signs/symptoms
include:
– gross deformity
(2nd & 3rd)
– swelling & painful
movement
– snapping sound
related to the injury
First Aid:
 Treat for shock
 I.C.E.
 Sling & swathe
bandage
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Rotator Cuff Strains

Muscles of the cuff GHJ --- abduction,
internal and external
rotation
 dynamic stabilizers
(“cuff”)
 SITS
– Supraspinatus
– Infraspinatus
– Teres Minor
– Subscapularis
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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
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GHJ Related “Impingement”
Syndrome

Occurs when a
bursae/ tendon is
squeezed between
moving structures
– supraspinatus is
commonly impinged
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Impingement Syndrome

Sports that emphasize
overhead arm
movements showed a
relative high incidence
of these injuries.
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Signs/Symptoms of
“Impingement Syndrome”

pain on abduction
& external rotation
 strength loss
– pain when arm is
abducted beyond
80-90 degrees
– nocturnal pain
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Impingement Syndrome
First Aid:
 Rest
 Anti-inflammatory drugs
 Physical therapy
 In extreme cases, surgery
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Biceps Tendon Problems

Anatomic
relationships
between LH biceps
tendon and the GHJ
capsule, transverse
humeral ligament
and subacromial
space
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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.
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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
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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
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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.”
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Contusions of the Shoulder
Region

Signs/symptoms -– history of recent
blow
– decreased ROM
– muscle spasm
– discoloration &
swelling
First Aid:
 Immediate
application of ICE
 Sling & swathe
bandage
 Medical referral
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