Shoulder Injuries Chapter 16

Anatomy of the Shoulder Bones Humerus (upper arm bone) Clavicle (collar bone) Scapula (shoulder blade) The head of the humerus articulates with the glenoid fossa. The clavicle articulates with the acromion process.

Muscles Rotator Cuff (SITS)=internal and external rotation. Subscapularis m. Infraspinatus m. Teres minor m. Supraspinatus m. Deltoid m.=abduction, flexion, extension Pectoralis major and minor m. = horizontal adduction and protraction Biceps m.=shoulder flexion Triceps m.=shoulder extension Latissimus dorsi m.=adduction Trapezius m.=elevation Rhomboid m.=retraction

Joints Acromioclavicular Joint (AC Joint) Acromioclavicular lig. Glenohumeral Joint (GH Joint) Held in place by the capsular lig. The glenoid fossa is covered by the labrum

Preventing Shoulder Injuries Make sure athletes train more than their “mirror muscles”. Strengthen antagonist muscles (ones opposite of the repetitive movement). Work on posture. Stretching. Use protective padding Ice Hockey Football Men’s Lacrosse

Treating Shoulder Injuries AC Ligament Sprain (shoulder separation) = impact to the top of the arm or falling on an outstretched hand (FOOSH). Grade 1 = PRICE Grade 2 or 3 = PRICE, refer to an orthopedist for an X-ray, may need surgery Glenohumeral lig. Sprain = excessive abduction and external rotation Grade 3 = subluxation or dislocation

Muscle and Tendon Injuries Rotator Cuff Strain – due to overuse. Grade 3 may need surgery. Can lead to impingement and crepitus. PRICE, Strengthen, Stretch Impingement – usually from overhead movements (swimmers, throwers, etc.) Subacromial space narrows putting pressure on biceps and rotator cuff tendons. Modify activity

Bicipital Tendinitis Common in athletes who do overhead movements (ex. tennis) This irritates the bicipital tendon in the bicipital groove Tendon will feel fat and wormy and ATC may feel crepitus Immobilize, PRICE, and maybe ultrasound and an anti-inflammatory med

Bicep Tendon Rupture From a direct blow or a severe contractional force Unable to flex the elbow Obvious deformity (muscle rolled up under the skin) Ice, immobilize, refer to a physician Surgical repair is necessary

Bone Injuries Clavicle fracture – usually happens in the distal one third, from a direct blow or a fall on the tip of the shoulder There may be a step off or Piano Key sign Immobilize shoulder and refer, takes 6 weeks to heal Humeral fracture – may feel a pop when falling, pain on all sides indicate a fracture, splint and refer Epiphysis injury – occurs in young athletes at the growth plate, from a direct blow or falling on an outstretched arm, may need surgery

Bone Injuries Cont. Avulsion Fractures – can occur with a GH or AC Sprain, X-rays are necessary Glenohumeral Dislocations and Subluxations From excessive abduction and external rotation Refer a dislocation or call EMS Refer a 1 st time subluxation for evaluation