Download Chapter 11

Injuries to the Shoulder
Region
PE 236
Amber Giacomazzi MS, ATC
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Anatomy
Shoulder bones:
– Consist of shoulder girdle
(clavicle & scapula) and
humerus.
Shoulder joints:
– ______________
– ______________
– ______________
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Anatomy
• Joints are held together with ____________
and ____________ that provide stability and
allow for limited movement
– Shoulder girdle and the GH joint can move in almost
every direction
• _________ joints are just under the skin and
are vulnerable to injury, even in muscular
athletes
• Major nerves are from a group called the
________________
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Muscular Anatomy
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Rotator Cuff
•S.I.T.S. muscles
___________
___________
___________
___________
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Prevention of Shoulder
Injuries
• Proper physical conditioning is key
• Develop body and specific regions
relative to sport
• Strengthen through ___________
– Focus on _____________ in all ________
_________
– Be sure to incorporate _____________
muscles
• Enhances base of function for glenohumeral
joint
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Throwing Mechanics
Instruction in proper throwing mechanics is
critical for injury prevention
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• _______________
– First movement until ball leaves gloved hand
– Lead leg strides forward while both shoulders ______,
______________ and _______________
• _______________
– When hands separate and ends at max ER of the humerus
– Foot comes in contact with the ground
• _______________
– Max _____________ until ball release (humerus adducts,
horizontally adducts and internally rotates)
– ___________________________________________
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• __________________
– Ball release until max shoulder ______________
– Eccentric contraction of ext. rotators to decelerate
humerus while rhomboids decelerate scapula
• __________________
– End of motion when athlete is in a balanced
position
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Fractured Clavicle
Fractures of this bone are the most common
fracture in this region
– This injury usually results from ____ or direct
blows
– The adolescent form of this injury is known as a
“___________” fracture
____________________________________
______________
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Fractured Clavicle
Signs and symptoms
–
–
–
–
Swelling
__________
Discoloration
Broken bone ends may ________________
Treatment
– Treat for shock
– Apply __________________
– Apply ________________________
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AC Joint Injuries
Typical mechanism is _____________ to
the ______________ or fall _________
__________________
– Severity of injury is graded on the amount
of damage to ligaments
• 1st degree -- no significant ligament damage
• 2nd degree -- partial tearing of ligaments Mild
deformity
• 3rd degree -- complete rupture gross deformity
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AC Joint Injuries
• Signs and symptoms
– Mild swelling with point
tenderness
– __________________
__________________
____________
– In 3rd degree sprain, a
snap or pop may have
been sensed along with a
visible deformity
• *_______________*
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AC Joint Injuries
Treatment
– Treat for shock
– Apply I.C.E
– ____________________
– ____________________
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Glenohumeral Joint
Injuries
GH joint consists of _____________ and the
____________ of scapula
– ____________ but inherently _____________
– Typical MOI is having the ___________,
____________, and extended stressing the
anterior glenohumeral ligament
– Most common type of dislocation is an _________
_________ that may be a subluxation or complete
dislocation
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Glenohumeral Joint Injuries
Signs and symptoms
– Shoulder joint deformity and down-sloping shoulder contour
• “ _____________”
– ___________________________
– Humeral head palpable within _______
– Athlete resists efforts to move GH joint
In cases involving subluxation:
– GH joint may appear normal
– ______________________
– ______________________
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Glenohumeral Joint Injuries
Treatment
• Treat for shock
• Application of ______________________________
_________________
• Apply sling & swathe bandage
• Dislocations need to be re-located by ___________
• ______________________________
GH joint injuries tend to be ______ and _____.
_______________ may be necessary.
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Sternoclavicular Joint (SC)
Injuries
The sternoclavicular joint is formed by the union
of the _____________ and the _________ of
the ___________
– SC joint is supported by the several ligaments
– Injuries are ____ compared to AC or GH joints
– Sprains to the SC joint can range in severity
Mechanism is external blow to the shoulder
resulting in a _______________________;
most commonly, the clavicle moving
________ and ___________
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Sternoclavicular Joint Injuries
• Signs and Symptoms
–
–
–
–
Grade 1-little pain & disability, point tender
Grade 2-deformity, swelling inability to abduct shoulder
Grade 3-gross displacement
“Retro-sternal” dislocation- ______________________
__________________________
• Treatment
– Treat for shock
– Apply ice and compression
– _____________________
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Rotator Cuff Strains
• Any muscle of the
shoulder can suffer a
strain. Most common
injury is rotator cuff
strain
• Rotator cuff muscles
contribute to GH joint
_________ and ______
• Errors in the ________
________ or ______ can
contribute to
______________
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Rotator Cuff Strains
Signs and symptoms
• Pain within the shoulder, especially during
_______________________________
• Difficulty bringing arm up and back during cocking
phase of throw. Pain and stiffness in shoulder region
_________________________
______________________
• Point tenderness around region of the humeral head
that seems to be ___________________
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Rotator Cuff Strains
Treatment
– First aid is ______ practical due to chronic
nature of condition
– I.C.E.
– _______________
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GH Joint-Related
“Impingement” Syndrome
Occurs when a _____ or
________ is squeezed
between moving
structures
– The _____________
________ is most
commonly impinged
– ____________ or
__________________
__________________
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GH Joint-Related “Impingement”
Syndrome
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GH Joint-Related “Impingement”
Syndrome
– __________________
eventually leads to irritation and
inflammation of these structures
– Athletes in sports that
emphasize overhead arm
movements have a high risk of
this injury
• ______________________
______________________
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GH Joint-Related “Impingement”
Syndrome
Signs and symptoms
– Pain deep in shoulder and with abduction &
external rotation
– ________________
– Pain when arm is ____________________
– ___________________________________
– ________________
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GH Joint-Related “Impingement”
Syndrome
Treatment
•
•
•
•
Rest
________________________
________________
In extreme cases, surgery
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Labral Tear
• The labrum is the lip of ______________
located where the shoulder ligaments, which
make up the ___________, connect to the edge
of the _________
• The tendon of the ______ muscle attaches to
the shoulder at the ________________
• How do Labral tears occur?
–
–
–
–
______________
A forced movement of our arm or shoulder
Using arm to break a fall
Repetitive, _________________ such as throwing a
ball or serving in tennis
– __________
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Labral Tear
• Signs and Symptoms
– Arm and shoulder _____
– Arm and shoulder _________
– Painful overhead movements
– ________ or ______ sounds or sensations
when moving shoulders
• Diagnosis
– ____________________
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Labral Tear
• Treatment
– Ice
– NSAIDs
– Shoulder rehabilitation exercises
– _________
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Shoulder
Subluxation/Dislocation
• _______________
(___________)
– Used for anterior
glenohumeral
instability
– _________________
_________________
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Shoulder
Subluxation/Dislocation
• ________________
_____________
– Performed like the
Apprehension Test
however the
examiners hand is
placed over the
athletes humeral head
– ______________ and
_____________ is a
positive finding
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Shoulder Impingement
– _______________________________ test for
impingement used to assess impingement of soft
tissue structures
– Positive test is indicated by ________________
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Supraspinatus Weakness / Tear
• _______________
– 90 degrees of
shoulder flexion,
internal rotation and
30 degrees of
horizontal abduction
– Downward pressure
is applied
– _______________
_______________
_______________
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Bicipital Tendonitis
• ________________
– Elbow flexed to 90 and
stabilized to the
thorax. Forearm is
pronated
– __________________
__________________
__________________
_____________
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