1. By Taelar Shelton, MS, ATC, AT/L
Shoulder Injuries
By Taelar Shelton, MS, ATC, AT/L

2. Review Internal vs external rotation Abduction vs adduction MOI S&S Rx
FOOSH

3. Contusions MOI: Blows to the shoulder
S&S: discoloration, pain and restricted movement
Treatment: RICE, protection with padding

4. Shoulder Pointer MOI: Blow to the lateral shoulder
S&S: tender on lateral clavicle (bone bruise), similar to A/C sprain, severe discomfort, limited ROM
Rx: RICE, shoulder sling or ace wrap

5. Sternoclavicular (S/C) Sprains
MOI: twisting an elevated arm, indirect force, blow that hits poorly padded clavicle
S&S: usually a deformity from the dislocation, point tenderness, pain, swelling, discoloration, decreased ROM
Can be serious if dislocated inferiorly
Rx: reduced clavicle dislocation by physician, immobilize, gradual rehab program

6. Acromioclavicular (A/C) sprain
MOI: fall on tip of shoulder, blow to posterior shoulder or FOOSH
S&S: obvious deformity (depends on severity), point tenderness, pain, loss of movement, instability
Rx: ice, sling, referral
Grade 3 A/C sprain “sepparation” involves the A/C ligament and the coroclavicular ligaments

7. Glenohumeral joint sprain
MOI: (Anterior) arm forced upward and rotated
S&S: pain, decrease in ROM, tender to palpation, pain when MOI is reproduced
Rx: Rest, ice, compression and sling; rehab program

8. Subluxations and Dislocations
Head of the humerus is displaced and reduces on its own
Head of the humerus is displaced and doesn’t return to normal position without reduction

9. Dislocation Anterior- External rotation, forced abduction
Inferior- violent pull inferiorly
Posterior- FOOSH, internal roation

10. Anterior Dislocation (most common)
MOI: external rotation and forced abduction
S&S: flat deltoid appearance, pain, axillary pain and deformity, holding the involved arm, disability
Rx: first time dislocations can be associated with a fracture, refer and immobilize

11. Labral Tears
MOI: Compression of the head of the humerus from excessive rotation
S&S: click or pop sound when moving the shoulder, pain with internal and external roation
Rx: referral to physician, imaging, sling, surgery or conservative rehab

12. Chronic recurrent instabilities
Macrotraumatic- one or more traumatic situations
Atraumatic- volunatry displaces shouder joint
Microtraumatic-faulty biomechanics leading to tissue laxity (repeativite use)
Recurrent- continual stretching of ligaments, capsule and muscles

13. Rotator Cuff Impingement
MOI: over use or disuse, inflammation of the tendon takes up too much space
S&S: joint pain during and after activity
Rx: warm up before activity, rehab exercises, ice therapy, work on techniques; rest

14. Rotator Cuff Strains: “SITS” muscles
MOI: violent pull to the arm, abnormal or excessive rotation, FOOSH
S&S: Swelling, point tenderness, pain, loss of function
Rx: rehab (conservative approach), proper instruction on form, strengthening and ice; surgery

15. Clavicle Fx MOI: FOOSH or direct blow
S&S: usually the middle 1/3, deformity, tenderness and pain
Rx: sling, ice and x-ray

16. Humeral Fracture MOI: direct blow to arm or FOOSH
S&S: jagged edges of fractured bone can cause radial nerve damage
Rx: splint, treat for shock, referral to MD, usually takes 3-4 months to recover

17. Upper Humeral Fx MOI: direct blow, FOOSH or dislocation
S&S: pain, inability to move, point tenderness, discoloration
Rx: sling, referral to MD

18. Epiphyseal Fx
MOI: common in youth athletes (10 years or younger) from an indirect force

19. Bursitis MOI: trauma or overuse leads to inflmmation of the bursa
S&S: pain around the bursa, can lead to impingement
Rx: Rest, heat after the inflammatory response is over, range of motion exercises, ice after activity and during inflammatory response

20. Thoracic Outlet Syndrome
MOI: Compression over cervicle rib, muscle spasm, compression of major blood vessels and nerves between rib and clavicle, compression beneath corocoid process S&S: numbness, cold feeling, poor cirulation, muscle weakness, muscle atrophy, nerve palsy Rx: conservative approach in % of cases -sling -NSAID’s -Strengthening and postural correction

21. Myositis Ossificans MOI: contussion that did not get treated properly
S&S: swelling and irritation that lasts for 2-3 weeks
Rx: get an MRI or xray (tricpes to the right)

22. Bicipital Tenosynovitis
MOI: repetitive internal roation irritates the synovial sheath of the biceps, can sprain the transverse ligament
S&S: ache on the anterior aspect or the lateral side of the shoulder, tenderness on the biceps tendon, inflammation, “pop” of the tendon on the bone
Rx: rest and ice, gradual reconditioning program

23. Biceps Rupture MOI: Over stretching or a powerful movement
S&S: Snap, intense pain, prodruding bluge in the middle of the biceps, muscle weakness
Rx: sling and refer = surgical repair