1. Shoulder Injuries

2. Anatomy

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

4. 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

5. 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

6. 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

7. 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

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

9. 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

10. 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

11. 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

12. 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

13.  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