1. Injuries of the Shoulder Mechanism, Evaluation and Treatment

2. Rotator Cuff Strain Mechanism Typically from a violent pull of arm, an abnormal rotation force, or a fall on outstretched arm (foosh). Sometimes from repetitive motion (throwing, tennis, swimming)

3. Rotator Cuff Strain Signs & Symptoms Loss of function Pain and tenderness Lack of normal shoulder flexibility and strength Special Tests Drop Arm Test – Supraspinatus – abduct as far as possible then return to 90 and try to hold – if drop then torn Empty Can Test – checks supraspinatus – check strength in empty can motion at approx 45 degrees Apley’s Scratch Test – checks all muscle motions

4. Drop Arm Test

5. Empty Can Test

6. Rotator Cuff Strain Management Rest if necessary and Ice Rehabilitation emphasizing stretching & strengthening Surgery on a rare occasion

7. Acromioclavicular Sprain or Separated Shoulder Mechanism Direct blow to tip of shoulder or foosh driving arm against the acromion Damages the ligaments and acromion and clavicle may separate. May be classified as first, second, or third degree sprains.

8. Acromioclavicular Sprain or Separated Shoulder Signs and Symptoms Pain and tenderness at end of the collar bone Deformity caused by upward displacement of collar bone Loss of function Special Tests Distraction (Piano Key)

9. Acromioclavicular Sprain or Separated Shoulder Management Ice to control bleeding and swelling Immobilization with sling and swathe Rehab to restore normal strength & flexibility Protective taping and padding Out how long???? Depends on degree of separation and amount of pain can tolerate

10. Anterior Dislocation Mechanism – when arm is forcefully abducted and externally rotated (ex. Abnormal force to an arm that is executing a throw or and arm tackle) A fall on an arm Humeral head slips forward out of the glenoid fossa. Often causes a labral tear.

12. Anterior Dislocation Signs and Symptoms Pain and Tenderness Deformity – flattened shoulder contour – stair step defect Loss of function – arm will just hang Special Tests Apprehension – abduct arm to 90 degrees then force arm into external rotation Relocation test – do apprehension test but hold glenohumeral head in place

13. Shoulder Dislocation

14. Apprehension Test

15. Relocation Test

16. Anterior Dislocation Management Cold Application Immobilization AS IS – DO NOT RELOCATE ON OWN. Rehabilization Restore normal strength and flexibility Brace Sully Brace – Limit ROM – esp. Abduction/External Rotation Surgery

17. Glenoid Labrum Tear (Labral Tear) Mechanism Anterior Dislocation/Subluxation of glenohumeral joint Repetitive shoulder motion Acute trauma

18. Glenoid Labrum Tear (Labral Tear) Signs & Symptoms Pain changes smooth motion of shoulder Feels or hears pop with forced external rotation Pain with external rotation at 90 degrees of abduction – apprehension test Weakness of rotator cuff Possible positive clunk test Pain with forced horizontal adduction

22. Clunk Test

23. Long Thoracic Nerve Contusion Mechanism Indirect trauma to shoulder or thoracic wall, overuse or prolonged traction (as in cycling) Signs & Symptoms Pain, dull ache in shoulder Protruding/winging scapula due to weak serratus anterior muscle due to damage to nerve

24. Long Thoracic Nerve Contusion Special Test Wall push up

25. Clavicle Fracture Broken Collar Bone Mechanism Foosh fall or hit on tip of shoulder Signs & Symptoms Holding up arm Head toward injured side Possible deformity & crepitus

26. Clavicle Fracture Treatment X-ray Surgery

27. Bicep Tendinitis Mechanism Irritation of the Bicep Tendon Signs & Symptoms Pain, feel like bicep is moving Special Tests Speed’s Test – resist shoulder flexion Yergason Test – athlete tries to keep arm from externally rotating and extending the elbow – checks for bicep stability

28. Bicep Rupture Mechanism Violent contraction Signs and symptoms Hears/feels a sensation of rolling up of the arm Protruding bulge in the bicep – divet in arm Loss of function/strength Treatment Refer to orthopedic surgeon

29. Bicep Rupture

30. Rotator Cuff Impingement Mechanism Caused due to swelling in AC joint. No where for swelling to go. Rotator cuff is impinged in the joint. Special Tests Impingement Tests Force arm into horizontal adduction Empty Can Test Resisted as empty can motion at 45 degree angle

31. Rotator Cuff Impingement

32. Impingement Test

33. Other Typical Injuries Bursitis Contusion Fracture

34. Prevention of Shoulder Injuries Overall Conditioning Strengthen in Full ROM Warm Up properly before explosive arm movements Instruct in proper falling techniques Protective equipment Teach proper mechanics Avoid overuse Sport Specific Training

35. Videos Shoulder Injuries (9:58) http://www.bing.com/videos/watch/video/shoulder- injuries/a31bc6c1eb13284489f0a31bc6c1eb13284489f0- 289506132305?q=shoulder%20injury%20videos http://www.bing.com/videos/watch/video/shoulder- injuries/a31bc6c1eb13284489f0a31bc6c1eb13284489f0- 289506132305?q=shoulder%20injury%20videos Shoulder Injuries (Part 1) (15:03) http://www.youtube.com/watch?v=yVoFmYJLx74 Shoulder Injuries (Part 2) (11:38) http://www.youtube.com/watch?v=Q4fFV07ITNE&feature=chann el http://www.youtube.com/watch?v=Q4fFV07ITNE&feature=chann el Shoulder Dislocation (X-ray) (1:00) http://www.youtube.com/watch?v=8_tQJDR7ORc&feature=relat ed http://www.youtube.com/watch?v=8_tQJDR7ORc&feature=relat ed

36. Videos Understanding Shoulder Pain (Sports Injuries #3) (2:59) http://www.youtube.com/watch?v=HULJU_ROdCI&feature=rec- LGOUT-exp_fresh+div-HM http://www.youtube.com/watch?v=HULJU_ROdCI&feature=rec- LGOUT-exp_fresh+div-HM Shoulder Dislocation Dwyane Wade (3:00) http://www.bing.com/videos/watch/video/dwyane-wade- shoulder- injury/27b33922cf2f85a7e6cf27b33922cf2f85a7e6cf- 302259110559?q=shoulder%20injury%20videos http://www.bing.com/videos/watch/video/dwyane-wade- shoulder- injury/27b33922cf2f85a7e6cf27b33922cf2f85a7e6cf- 302259110559?q=shoulder%20injury%20videos Shoulder Injury Campbell (Raiders) (1:13) http://www.nfl.com/videos/nfl-game- highlights/09000d5d81a17e3b/Campbell-injury http://www.nfl.com/videos/nfl-game- highlights/09000d5d81a17e3b/Campbell-injury Shoulder dislocation wrestling (0:19) http://www.youtube.com/watch?v=-Hv8FM78I7I