Download Chapter 10 Shoulder Injuries

Chapter 10
Shoulder Injuries
Chapter Objectives
• Understand the basic anatomy of the
shoulder.
• Explain how shoulder injuries occur.
• Describe the various types of injuries to
the shoulder.
• Explain treatment procedures fro
common shoulder injuries.
Anatomy
• Bones
• Humerus
• Clavicle
• Scapula
Humerus
Scapula
Clavicle
Anatomy
• Ligaments
• Coracoclavicular
Ligaments
• Trapezoid
• Conoid
• Acromioclavicular
ligament
• Corocoacromial
Muscles
• Rotator Cuff
• Subscapularis
• internal rotator
• Infraspinatus
• external rotator
• Teres Minor
• external rotator
• Supraspinatus
• primarily an abductor
of the arm
Muscles
• Deltoid
• Attaches to acromion
process and lateral
humerus
• 3 portions
• Anterior, posterior,
and medial
• Abducts, flexes, and
extends the shoulder
Muscles
• Pectoralis minor
• Pectoralis major
• Primarily
responsible for
horizontal adduction
and protraction
• Biceps brachii
•
•
•
•
•
•
Muscles
2 heads
Originates at supraglenoid tubercle and corocoid process
Inserts at radius
Bicep tendon/bicipital groove
Held in place by transverse ligament
Flexes elbow, abducts and supinates forearm
Muscles
• Triceps brachii
•
•
•
•
3 heads-long, lateral, and medial
Originate posterior humerus
Insert at ulna
Extend elbow, humeral adduction
Joints
• Acromioclavicular
(AC) joint
• One of most common
injured areas of
shoulder
• Consists of acromion
process and distal
clavicle
• Held together by the ac
ligament
Injured AC joint
Joints
• Glenohumeral joint
• Articulation of the humerus and glenoid
fossa
• Very susceptible to injury due to fossa
being shallow
• Humeral head covered with articular
cartilage
• Capsular ligament surrounds the entire
joint which aids in joint stability
Injuries- prevention
• Shoulder injury
causes
• Muscle weakness
• Postural problems
• Nature of the joint
Addressing muscular weakness
• Often weak in posterior (back) muscles
• Signs- rounded shoulders, tight
pectoralis muscles, weak posterior
shoulder muscles
• All predispose athlete to injury
• Proper technique in throwing,
swimming, etc. prevent injury
• Proper padding important
Common shoulder injuries
• Acromioclavicular
ligament sprain
• Aka-separated shoulder
• most common mechanism of
injury occurs when the
athlete falls onto the point of
the shoulder or receives a
direct blow to the tip of the
shoulder or falls on an
outstretched arm
• graded according to the
degrees of severity
AC sprain (cont.)
• Mild (1st degree)
• stretching or slight tearing of the ligament fibers
• Mild joint tenderness, mild swelling, and little or no
disability of the shoulder
• Moderate (2nd degree)
• partial disruption of the supporting ligaments
• pain and tenderness directly over and around the joint, local
swelling, and an increase in pain on forced motion
• Severe (3rd degree)
• total disruption of one or more of the supporting ligaments
• varying degrees of tenderness, swelling, instability, and an
increase in pain with any effort to stress the joint
• often exhibit a piano key sign; that is, the clavicle can be
pushed down but will spring back up when pressure is
released.
AC sprain treatments
• PRICE
• Refer if 2nd or 3rd degree to r/o fracture
• 3rd degree may require surgery or harness
immobilization
Glenohumeral ligament sprain
• sprains of the shoulder joint seldom
occur unless there is a subluxation or
dislocation
• Vulnerable in abduction and external
rotation
• Pain with any motion
• PRICE and refer to physician
Rotator
cuff
strain
• Injuries to rotator cuff
muscles are difficult to
detect and isolate
because these muscles,
which reinforce the
joint capsule, lie deep in
the shoulder
• MOI• ballistic arm activities
• forceful concentric
contraction of the
muscles that accelerate
and decelerate limb
activities
• improper warm ups
• muscle fatigue
Rotator cuff injuries (cont)
• Signs and symptoms
• anterior-lateral shoulder pain
• point tenderness
• decreased range of motion
• loss of strength consistent with the severity
of the injury
• Pain may radiate down the lateral arm but
usually stops at mid-humerus
• Pain is often increased at night while the
individual is lying on the affected side
Rotator cuff injuries (cont)
• Treatment
• PRICE
• Gentle strengthening and flexibility
exercises
• See handout for examples
Impingement sydrome
• common injury involving the soft
tissues of the shoulder comprising of
the subacromial space (often involves
the supraspinatus and biceps)
• Usually result of repetitive overhead
types of movement
• Treatment
• Modified activity
• Strengthening posterior shoulder muscles
• Improving flexibility (especially in pecs)
Bicipital tendinitis
• Common with
overhead activities
(swimming, throwing,
etc)
• Tendon becomes
irritated in bicipital
groove
• May feel crepitis
(grinding)
• Rest and
immobilization may be
required
• Treat with Ultrasound
and N-SAIDS
Bicep tendon rupture
• Caused by direct blow or severe
contracture forces
• Athlete will have inability to flex the
elbow
• Noticeable deformity as bicep muscle
will roll up under skin
• Treat- ice, immobilized, refer to
physician
• Surgical repair necessary
Clavicular fracture
• Most often fractures
occur in distal 1/3 of
bone
• Usually caused by
direct blow or
falling on the tip of
the shoulder
• Restrict motion with
sling and ice
• Refer for x-ray
• Most fractures take
6 weeks to heal
Humeral fracture
• Not difficult to find if fractured at midshaft
• Shoulder can sometimes hide humeral head
fractures
• Pain on all sides of bone when palpated
(around circumference) is good indicator of
fracture
• Splint and refer for immediate care
• Check pulse before and after splinting to
check circulation
Epiphysis injury
• Can be caused by
• Blow to humeral head
• Falling on elbow and driving humerus into
glenoid fossa
• Signs/symptoms-same as humeral fx
• Treat with ice, splint, sling
• Refer, can cause growth impairment
• Young pitchers prone to epiphyseal
injury from excessive throwing
Avulsion fracture
• Can accompany a glenohumeral or AC
sprain
• Capsular ligament pulls away from
scapula when humerous dislocates
from glenoid fossa
• Only revealed or ruled out by x-ray
• Treat with splint and ice
Glenohumeral dislocations and
subluxations
• Head of humerous
is out of the socket
• Sublux- head was
out, then back in
• Cause-excessive
abduction and
external rotation
Glenohumeral dislocations and
subluxations
• Dislocation can cause tear of the
capsular ligament
• Anterior dislocation most common
• Deformity usually seen at deltoid
muscle (shoulder flat)
• X-ray needed to determine extent of
injury
Glenohumeral dislocations and
subluxations
• Dislocations and subluxations need to
strengthen adductors and internal
rotators
• Can wear restrictive harness
• Surgery sometimes required to repair
capsular ligament
Adhesive capsulitis
• frozen shoulder
• inflammation about the
rotator cuff and
capsular area that can
result in dense
adhesions and capsular
contractures causing
restriction of motion
and pain
• exact cause remains
unknown
• The main feature is a
lack of passive range of
motion
Brachial plexus injury
• normally involves
the cervical spine,
but the symptoms
are exhibited in the
shoulder and upper
extremity
• Usually caused by
forced rotation or
lateral flexion
• Is a stretching or
pinching of brachial
plexus
Brachial plexus injury
• result in transitory
paralysis of the arm
• numbness or a
burning sensations
radiating down the
arm and sometimes
into the hand
• Weakness or
numbness lasting
more than an hour
should be referred
to a physician
Thoracic Outlet Syndrome
• a group of symptoms resulting from
compression of the thoracic
neurovascular bundle
• . This neurovascular bundle emerges
from the thorax though an outlet or
triangle formed by the scalene muscles
and the first rib
• Narrowing of the outlet can cause a
variety of symptoms
Thoracic Outlet Syndrome
• Possible causes
• hypertrophy of one of the scalene muscles
• shape of the first rib
• scar tissue formation around the nerve
roots
• cervical ribs
• excess callus formation as a result of a
fractured clavicle
• hyperabduction or stretching of the
brachial plexus
Thoracic Outlet Syndrome
• Symptoms
• aching pain across the shoulder
• pain in the side of the neck and down the
arm
• sensation of weakness, heaviness, and
easily fatigability when using the arm
• Athletes exhibiting TOS often have a
history of trauma to the head, neck, or
shoulder area