1 Injuries to the Shoulder Region

2 Movements of the Shoulder – Flexion – Extension – Abduction – Adduction – Internal Rotation – External Rotation – Horizontal Abduction

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4 Anatomy Review Skeleton of the shoulder – shoulder girdle (clavicle & scapula) – glenohumeral joint – acromioclavicular & sternoclavicular joints Shoulder girdle and GH joint must move together

5 Anatomy Review Injuries are common…. – AC and SC joint injuries are common in wrestling. – Throwing and racquet/club sports can result in injuries of the GH joint such as the rotator cuff. – Cycling and skating sports -- fractures of the clavicle are common – Injuries can be either chronic or acute.

6 Ligaments

7 Muscles of the Shoulder

8 Posterior Muscles

9 Major Arteries of the Arm

10 Brachial Plexus Shown here are the major components of the brachial plexus.. Note the relative position of the plexus relative to the axillary artery and pectoralis minor.

11 Brachial Plexus

12 Fractured Clavicle Fractures of this bone are the most common fracture in this region. – This injury usually results from falls or direct blows. The adolescent form of this injury is known as a “greenstick” fracture. All clavicular fractures are potentially dangerous.

13 Fractured Clavicle Signs/symptoms – swelling, – deformity, – discoloration, – broken bone ends protruding, etc. First Aid: – Treat for shock – Sling & swathe bandage – Sterile dressings on wounds

14 Fractured Scapula Uncommon injury - - normally the result of a direct blow Signs and symptoms are less clear than are those for a fractured clavicle. Symptoms include : – history of severe blow – pain and functional loss An athlete with such a history and symptoms should be referred to a medical doctor.

15 Acromioclavicular Injuries AC joint is located on the lateral/superior shoulder, just under the skin. – AC ligaments & CC ligaments

16 Acromioclavicular Injuries Mechanism -- downward blow to the lateral shoulder or fall on an outstretched arm Severity of injury is determined by the specific injuries damaged. – 1st deg. -- no significant damage – 2nd deg - partial tearing of ligs. – 3rd deg - complete rupture

17 Signs/Symptoms of AC Injury Any movement of the SG or GHJ will be painful. Mild swelling associated with point tenderness In 3rd degree injuries, a snap or pop may have been felt along with visible deformity. “Piano key sign”

18 Treatment for a AC Injury First Aid: Treat for shock I.C.E. Sling & swathe bandage Refer to MD

19 Glenohumeral Joint Injuries GHJ formed of humeral head and the glenoid fossa – extremely mobile but inherently unstable – major soft tissue structures include: articular cartilage, coracohumeral, glenohumeral and transverse humeral ligs. – glenoid labrum

20 Glenohumeral Joint Injuries Mechanism -- abduction and external rotation – stresses the anterior glenohumeral ligament – most common form is known as an “anterior” dislocation

21 Signs/Symptoms of GHJ Injury Subluxation -- – movement will be painful – in absence of signs Signs/symptoms -- – shoulder joint deformity – abnormally long arm – humeral head in axillae – pain & dysfunction

22 Treatment of a GHJ Injury First Aid: Treat for shock Place rolled towel into the armpit I.C.E. Sling & swathe bandage 85%-90% of injuries tend to recur

23 Sternoclavicular Joint Injuries The sternoclavicular joint is formed by the proximal end of the clavicle and the manubrium of the sternum. – supported by the SC ligaments – injuries are rare compared to the AC or GH joints Mechanism -- external blow (laterally placed) along the long axis of the clavicle, clavicle moves anteriorly/superiorly

24 Signs/Symptoms of Sternoclavicular Joint Injuries First Aid: Treat for shock I.C.E. Sling & swathe bandage Signs/symptoms include: – gross deformity (2nd & 3rd) – swelling & painful movement – snapping sound related to the injury

25 Rotator Cuff Strains Muscles of the cuff - GHJ --- abduction, internal and external rotation dynamic stabilizers (“cuff”) SITS – Supraspinatus – Infraspinatus – Teres Minor – Subscapularis

26 Signs/Symptoms of Rotator Cuff Strains pain within the shoulder -- especially during follow through phase pain/stiffness hours after throwing/swinging point tenderness around the region of the humeral head

27 GHJ Related “Impingement” Syndrome Occurs when a bursae/ tendon is squeezed between moving structures – supraspinatus is commonly impinged

28 Impingement Syndrome Sports that emphasize overhead arm movements showed a relative high incidence of these injuries.

29 Signs/Symptoms of “Impingement Syndrome” pain on abduction & external rotation strength loss – pain when arm is abducted beyond degrees – nocturnal pain

30 Impingement Syndrome First Aid: Rest Anti-inflammatory drugs Physical therapy In extreme cases, surgery

31 Biceps Tendon Problems Anatomic relationships between LH biceps tendon and the GHJ capsule, transverse humeral ligament and subacromial space

32 Biceps Tendon Problems – LH tendon can be compressed within the subacromial space – LH tendon may develop tendinitis and result in subluxation – Violent force may sublux the LH tendon from the bicipital groove.

33 Signs/symptoms of Biceps Tendon Problems Signs/symptoms -- – painful abduction of the shoulder joint – pain during resisted supination – resisted flexion/supination yields a snapping and/or popping sensation

34 Biceps Tendon Problem First Aid: This qualifies as an “overuse” type of injury -- no first aid procedures. Emphasis should be on prevention through skill development, rest, and strength training. Traumatic subluxations should be treated with ICE

35 Contusions of the Shoulder Region External blows are common to this region. The GHJ is well protected by muscles while the AC joint is exposed. Contusions to this region can result in a “shoulder pointer.”

36 Contusions of the Shoulder Region First Aid: Immediate application of ICE Sling & swathe bandage Medical referral Signs/symptoms -- – history of recent blow – decreased ROM – muscle spasm – discoloration & swelling