Shoulder Injuries

Anatomy

Anatomy 4 rotator cuff muscles  Subscapularis - internal rotator Supraspinatus - abduction Infraspinatus - external rotator Teres minor - external rotator

Recognition and Management of Injuries Clavicle Fracture Cause: fall on outstretched arm, fall on tip of shoulder, direct impact S&S: supports arm; tilts head toward toward injured side; clavicle appears a little lower, swelling, point tenderness, mild deformity Care: sling and swath, xray, reduction followed by immobilization 6-8 wks; sling 3-4 wks with isometric and mobilization exercises

Humerus fracture Cause: direct blow, dislocation, impact received by falling on outstretched arm S&S: may be difficult to recognize, pain, inability to move arm, swelling point tenderness Care: splint with sling; prevent shock; referral to physician; 2-6 months out of competition

Acromioclavicular (AC) joint sprain (separated shoulder) Cause: fall on outstretched arm, direct impact on shoulder S&S: point tenderness, discomfort, Grade 1 = no deformity Grade 2 = definite displacement and prominence of lateral end of clavicle; ROM, Grade 3 = gross deformity and prominence of distal clavicle; severe pain, loss of movement Care: ice and pressure; immobilization 2-3 wks; referral ; aggressive rehab-joint mobilization, flexibility and strength exercises

Glenohumeral dislocations Cause: Subluxations: excessive translation of the humeral head without complete separation of the joint surfaces Anterior glenohumeral dislocation Forced abduction, external rotation, and extension Posterior glenohumeral dislocation Forced abduction and internal rotation of the shoulder or a fall on an extended and internally rotated arm

S&S: flattened deltoid contour; pain; obvious deformity Care: immobilization; reduction; xray; cold packs; muscle reconditioning ASAP; sling for 3wks; strengthening

Rotator cuff strains Cause: usually involves supraspinatus muscle; dynamic rotation of the arm at high velocity; long history of shoulder impingement or instability; tears at insertion of humerus S&S: diffuse pain around acromion; overhead activities increase pain; point tenderness; loss of strength due to pain; (+) impingement and empty can Care: RICE; Progressive Resistive Exercise’s; decrease activity

Shoulder bursitis Cause: trauma or overuse; direct impact S&S: pain with movement; tenderness to palpation in area just under acromion Care: ice; NSAIDs; maintaining full ROM

Biceps brachii ruptures Cause: performing a powerful concentric or eccentric contraction of the biceps muscle; most commonly occurs near the origin of the muscle S&S: a resounding snap and feels a sudden intense pain; protruding bulge may appear near the middle of the biceps; weakness with elbow flexion and supination of forearm Care: ice, sling; referral to MD; surgery

Bicipital tenosynovitis Cause: common in overhead activities; repeated stretching of the biceps in highly ballistic activities causing an irritation of the tendon and synovial sheath S&S: tenderness in anterior upper arm; swelling; warmth; crepitus; pain with overhead activities Care: rest for several days; ice; NSAIDs; gradual strengthening and stretching of the biceps muscle; rehab

 Shoulder impingement Cause: mechanical compression of supraspinatus tendon, the subacromial bursa, and long head of biceps tendon; most common in overhead activities S&S: diffuse pain around the acromion in overhead position; external rotators weaker than internal; tightness in posterior and inferior capsules; Care: restoring normal biomechanics; RICE; strengthening rotator cuff muscles and scapula muscles; modified activity