Injuries to the Shoulder Region PE 236 Amber Giacomazzi MS, ATC

Anatomy Shoulder bones: Shoulder joints: Consist of shoulder girdle (clavicle & scapula) and humerus. Shoulder joints: ______________

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 ________________

Muscular Anatomy

Rotator Cuff S.I.T.S. muscles ___________ ___________ ___________ ___________

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

Throwing Mechanics Instruction in proper throwing mechanics is critical for injury prevention

_______________ 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) ___________________________________________

__________________ 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

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 ____________________________________ ______________

Fractured Clavicle Signs and symptoms Treatment Swelling __________ Discoloration Broken bone ends may ________________ Treatment Treat for shock Apply __________________ Apply ________________________

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

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 *_______________*

AC Joint Injuries Treatment Treat for shock Apply I.C.E ____________________

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

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 ______________________

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.

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 ___________

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 _____________________

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 ______________

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 ___________________

Rotator Cuff Strains Treatment First aid is ______ practical due to chronic nature of condition I.C.E. _______________

GH Joint-Related “Impingement” Syndrome Occurs when a _____ or ________ is squeezed between moving structures The _____________ ________ is most commonly impinged ____________ or __________________ __________________

GH Joint-Related “Impingement” Syndrome

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 ______________________ ______________________

GH Joint-Related “Impingement” Syndrome Signs and symptoms Pain deep in shoulder and with abduction & external rotation ________________ Pain when arm is ____________________ ___________________________________

GH Joint-Related “Impingement” Syndrome Treatment Rest ________________________ ________________ In extreme cases, surgery

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 __________

Labral Tear Signs and Symptoms Diagnosis Arm and shoulder _____ Painful overhead movements ________ or ______ sounds or sensations when moving shoulders Diagnosis ____________________

Labral Tear Treatment Ice NSAIDs Shoulder rehabilitation exercises _________

Shoulder Subluxation/Dislocation _______________ (___________) Used for anterior glenohumeral instability _________________ _________________

Shoulder Subluxation/Dislocation ________________ _____________ Performed like the Apprehension Test however the examiners hand is placed over the athletes humeral head ______________ and _____________ is a positive finding

Shoulder Impingement _______________________________ test for impingement used to assess impingement of soft tissue structures Positive test is indicated by ________________

Supraspinatus Weakness / Tear _______________ 90 degrees of shoulder flexion, internal rotation and 30 degrees of horizontal abduction Downward pressure is applied _______________ _______________ _______________

Bicipital Tendonitis ________________ Elbow flexed to 90 and stabilized to the thorax. Forearm is pronated __________________ __________________ __________________ _____________