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Chapter 10 Shoulder Injuries. Chapter Objectives Understand the basic anatomy of the shoulder.Understand the basic anatomy of the shoulder. Explain how.

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Presentation on theme: "Chapter 10 Shoulder Injuries. Chapter Objectives Understand the basic anatomy of the shoulder.Understand the basic anatomy of the shoulder. Explain how."— Presentation transcript:

1 Chapter 10 Shoulder Injuries

2 Chapter Objectives Understand the basic anatomy of the shoulder.Understand the basic anatomy of the shoulder. Explain how shoulder injuries occur.Explain how shoulder injuries occur. Describe the various types of injuries to the shoulder.Describe the various types of injuries to the shoulder. Explain treatment procedures fro common shoulder injuries.Explain treatment procedures fro common shoulder injuries.

3 Anatomy BonesBones HumerusHumerus ClavicleClavicle ScapulaScapula

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5 Humerus

6 Scapula

7 Clavicle

8 Anatomy LigamentsLigaments Coracoclavicular Ligaments Trapezoid Conoid Acromioclavicular ligament Corocoacromial

9 Muscles Rotator CuffRotator Cuff S ubscapularis S ubscapularis internal rotatorinternal rotator I nfraspinatus I nfraspinatus external rotatorexternal rotator T eres Minor T eres Minor external rotatorexternal rotator S upraspinatus S upraspinatus primarily an abductor of the armprimarily an abductor of the arm

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11 Muscles DeltoidDeltoid Attaches to acromion process and lateral humerus 3 portions Anterior, posterior, and medial Abducts, flexes, and extends the shoulder

12 Muscles Pectoralis minorPectoralis minor Pectoralis majorPectoralis major Primarily responsible for horizontal adduction and protractionPrimarily responsible for horizontal adduction and protraction

13 Muscles Biceps brachiiBiceps brachii 2 heads2 heads Originates at supraglenoid tubercle and corocoid processOriginates at supraglenoid tubercle and corocoid process Inserts at radiusInserts at radius Bicep tendon/bicipital grooveBicep tendon/bicipital groove Held in place by transverse ligamentHeld in place by transverse ligament Flexes elbow, abducts and supinates forearmFlexes elbow, abducts and supinates forearm

14 Muscles Triceps brachiiTriceps brachii 3 heads-long, lateral, and medial3 heads-long, lateral, and medial Originate posterior humerusOriginate posterior humerus Insert at ulnaInsert at ulna Extend elbow, humeral adductionExtend elbow, humeral adduction

15 Joints Acromioclavicular (AC) jointAcromioclavicular (AC) joint One of most common injured areas of shoulder Consists of acromion process and distal clavicle Held together by the ac ligament

16 Injured AC joint

17 Joints Glenohumeral jointGlenohumeral joint Articulation of the humerus and glenoid fossaArticulation of the humerus and glenoid fossa Very susceptible to injury due to fossa being shallowVery susceptible to injury due to fossa being shallow Humeral head covered with articular cartilageHumeral head covered with articular cartilage Capsular ligament surrounds the entire joint which aids in joint stabilityCapsular ligament surrounds the entire joint which aids in joint stability

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19 Injuries- prevention Shoulder injury causesShoulder injury causes Muscle weaknessMuscle weakness Postural problemsPostural problems Nature of the jointNature of the joint

20 Addressing muscular weakness Often weak in posterior (back) musclesOften weak in posterior (back) muscles Signs- rounded shoulders, tight pectoralis muscles, weak posterior shoulder musclesSigns- rounded shoulders, tight pectoralis muscles, weak posterior shoulder muscles All predispose athlete to injuryAll predispose athlete to injury Proper technique in throwing, swimming, etc. prevent injuryProper technique in throwing, swimming, etc. prevent injury Proper padding importantProper padding important

21 Common shoulder injuries Acromioclavicular ligament sprainAcromioclavicular ligament sprain Aka-separated shoulderAka-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

22 AC sprain (cont.) Mild (1 st degree)Mild (1 st degree) stretching or slight tearing of the ligament fibersstretching or slight tearing of the ligament fibers Mild joint tenderness, mild swelling, and little or no disability of the shoulderMild joint tenderness, mild swelling, and little or no disability of the shoulder Moderate (2 nd degree)Moderate (2 nd degree) partial disruption of the supporting ligamentspartial disruption of the supporting ligaments pain and tenderness directly over and around the joint, local swelling, and an increase in pain on forced motionpain and tenderness directly over and around the joint, local swelling, and an increase in pain on forced motion Severe (3 rd degree)Severe (3 rd degree) total disruption of one or more of the supporting ligamentstotal 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 jointvarying 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.often exhibit a piano key sign; that is, the clavicle can be pushed down but will spring back up when pressure is released.

23 AC sprain treatments PRICEPRICE Refer if 2 nd or 3 rd degree to r/o fractureRefer if 2 nd or 3 rd degree to r/o fracture 3 rd degree may require surgery or harness immobilization3 rd degree may require surgery or harness immobilization

24 Glenohumeral ligament sprain sprains of the shoulder joint seldom occur unless there is a subluxation or dislocationsprains of the shoulder joint seldom occur unless there is a subluxation or dislocation Vulnerable in abduction and external rotationVulnerable in abduction and external rotation Pain with any motionPain with any motion PRICE and refer to physicianPRICE and refer to physician

25 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 shoulderInjuries to rotator cuff muscles are difficult to detect and isolate because these muscles, which reinforce the joint capsule, lie deep in the shoulder MOI-MOI- ballistic arm activitiesballistic arm activities forceful concentric contraction of the muscles that accelerate and decelerate limb activitiesforceful concentric contraction of the muscles that accelerate and decelerate limb activities improper warm upsimproper warm ups muscle fatiguemuscle fatigue

26 Rotator cuff injuries (cont) Signs and symptomsSigns and symptoms anterior-lateral shoulder painanterior-lateral shoulder pain point tendernesspoint tenderness decreased range of motiondecreased range of motion loss of strength consistent with the severity of the injuryloss of strength consistent with the severity of the injury Pain may radiate down the lateral arm but usually stops at mid-humerusPain 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 sidePain is often increased at night while the individual is lying on the affected side

27 Rotator cuff injuries (cont) TreatmentTreatment PRICEPRICE Gentle strengthening and flexibility exercisesGentle strengthening and flexibility exercises See handout for examplesSee handout for examples

28 Impingement sydrome common injury involving the soft tissues of the shoulder comprising of the subacromial space (often involves the supraspinatus and biceps)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 movementUsually result of repetitive overhead types of movement TreatmentTreatment Modified activityModified activity Strengthening posterior shoulder musclesStrengthening posterior shoulder muscles Improving flexibility (especially in pecs)Improving flexibility (especially in pecs)

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30 Bicipital tendinitis Common with overhead activities (swimming, throwing, etc)Common with overhead activities (swimming, throwing, etc) Tendon becomes irritated in bicipital grooveTendon becomes irritated in bicipital groove May feel crepitis (grinding)May feel crepitis (grinding) Rest and immobilization may be requiredRest and immobilization may be required Treat with Ultrasound and N-SAIDSTreat with Ultrasound and N-SAIDS

31 Bicep tendon rupture Caused by direct blow or severe contracture forcesCaused by direct blow or severe contracture forces Athlete will have inability to flex the elbowAthlete will have inability to flex the elbow Noticeable deformity as bicep muscle will roll up under skinNoticeable deformity as bicep muscle will roll up under skin Treat- ice, immobilized, refer to physicianTreat- ice, immobilized, refer to physician Surgical repair necessarySurgical repair necessary

32 Clavicular fracture Most often fractures occur in distal 1/3 of boneMost often fractures occur in distal 1/3 of bone Usually caused by direct blow or falling on the tip of the shoulderUsually caused by direct blow or falling on the tip of the shoulder Restrict motion with sling and iceRestrict motion with sling and ice Refer for x-rayRefer for x-ray Most fractures take 6 weeks to healMost fractures take 6 weeks to heal

33 Humeral fracture Not difficult to find if fractured at midshaftNot difficult to find if fractured at midshaft Shoulder can sometimes hide humeral head fracturesShoulder can sometimes hide humeral head fractures Pain on all sides of bone when palpated (around circumference) is good indicator of fracturePain on all sides of bone when palpated (around circumference) is good indicator of fracture Splint and refer for immediate careSplint and refer for immediate care Check pulse before and after splinting to check circulationCheck pulse before and after splinting to check circulation

34 Epiphysis injury Can be caused byCan be caused by Blow to humeral headBlow to humeral head Falling on elbow and driving humerus into glenoid fossaFalling on elbow and driving humerus into glenoid fossa Signs/symptoms-same as humeral fxSigns/symptoms-same as humeral fx Treat with ice, splint, slingTreat with ice, splint, sling Refer, can cause growth impairmentRefer, can cause growth impairment Young pitchers prone to epiphyseal injury from excessive throwingYoung pitchers prone to epiphyseal injury from excessive throwing

35 Avulsion fracture Can accompany a glenohumeral or AC sprainCan accompany a glenohumeral or AC sprain Capsular ligament pulls away from scapula when humerous dislocates from glenoid fossaCapsular ligament pulls away from scapula when humerous dislocates from glenoid fossa Only revealed or ruled out by x-rayOnly revealed or ruled out by x-ray Treat with splint and iceTreat with splint and ice

36 Glenohumeral dislocations and subluxations Head of humerous is out of the socketHead of humerous is out of the socket Sublux- head was out, then back inSublux- head was out, then back in Cause-excessive abduction and external rotationCause-excessive abduction and external rotation

37 Glenohumeral dislocations and subluxations Dislocation can cause tear of the capsular ligamentDislocation can cause tear of the capsular ligament Anterior dislocation most commonAnterior dislocation most common Deformity usually seen at deltoid muscle (shoulder flat)Deformity usually seen at deltoid muscle (shoulder flat) X-ray needed to determine extent of injuryX-ray needed to determine extent of injury

38 Glenohumeral dislocations and subluxations Dislocations and subluxations need to strengthen adductors and internal rotatorsDislocations and subluxations need to strengthen adductors and internal rotators Can wear restrictive harnessCan wear restrictive harness Surgery sometimes required to repair capsular ligamentSurgery sometimes required to repair capsular ligament

39 Adhesive capsulitis frozen shoulderfrozen shoulder inflammation about the rotator cuff and capsular area that can result in dense adhesions and capsular contractures causing restriction of motion and pain 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 unknownexact cause remains unknown The main feature is a lack of passive range of motionThe main feature is a lack of passive range of motion

40 Brachial plexus injury normally involves the cervical spine, but the symptoms are exhibited in the shoulder and upper extremitynormally involves the cervical spine, but the symptoms are exhibited in the shoulder and upper extremity Usually caused by forced rotation or lateral flexionUsually caused by forced rotation or lateral flexion Is a stretching or pinching of brachial plexusIs a stretching or pinching of brachial plexus

41 Brachial plexus injury result in transitory paralysis of the armresult in transitory paralysis of the arm numbness or a burning sensations radiating down the arm and sometimes into the handnumbness 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 physicianWeakness or numbness lasting more than an hour should be referred to a physician

42 Thoracic Outlet Syndrome a group of symptoms resulting from compression of the thoracic neurovascular bundlea 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. 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 symptomsNarrowing of the outlet can cause a variety of symptoms

43 Thoracic Outlet Syndrome Possible causesPossible causes hypertrophy of one of the scalene muscleshypertrophy of one of the scalene muscles shape of the first ribshape of the first rib scar tissue formation around the nerve rootsscar tissue formation around the nerve roots cervical ribscervical ribs excess callus formation as a result of a fractured clavicleexcess callus formation as a result of a fractured clavicle hyperabduction or stretching of the brachial plexushyperabduction or stretching of the brachial plexus

44 Thoracic Outlet Syndrome SymptomsSymptoms aching pain across the shoulderaching pain across the shoulder pain in the side of the neck and down the armpain in the side of the neck and down the arm sensation of weakness, heaviness, and easily fatigability when using the armsensation 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 areaAthletes exhibiting TOS often have a history of trauma to the head, neck, or shoulder area

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