1. Sports medicine class John Hardin Instructor
Shoulder Injuries
Sports medicine class
John Hardin
Instructor

2. Anatomy
Bones
Ligaments
Joints
Muscles

3. Bones Clavicle Scapula Humerus Sternal end, distal end
Glenoid fossa, acromion process, coracoid process, spine, supraspinous fossa, infraspinous fossa, vertebral border, inferior angle
Humerus
Head, greater & lesser tuberosity, bicipital groove

4. Ligaments Acromioclavicular Coracoclavicular Coracoacromial
Glenohumeral
Superior
Middle
Inferior
Glenoid Labrum

5. Joints Glenohumeral joint Acromioclavicular joint
Sternoclavicular joint
Scapulothoracic joint

6. Muscles
Produce dynamic motion & establish stability to compensate for the greater mobility
Motions at shoulder joint
flexion & extension
Internal & external rotation
Abduction & Adduction
Horizontal flexion
Circumduction

7. Muscles attaching axial skeleton to humerus
Latissimus dorsi
Shoulder extension, adduction
Pectoralis major
Shoulder adduction, horizontal flexion

8. Muscles attaching scapula to humerus
Deltoid
Abduction, flexion, extension
Teres major
Internal rotation
Coracobrachialis
Shoulder flexion
Rotator cuff muscles
Supraspinatus- external rotation, initiates abduction
Infraspinatus-external rotation
Teres minor-external rotation
Subscapularis-internal rotation

9. Muscles attaching axial skeleton to scapula
Levator scapula
Shoulder elevation
Trapezius
Shoulder elevation, retraction, depression
Rhomboids (major & minor)
Shoulder retraction
Serratus anterior
Shoulder protraction, holds scapula flat against thoracic cage

10. Other muscles Biceps brachii—long head & short head
Shoulder flexion
Triceps brachii—long head, medial head, lateral head
Shoulder extension

11. Preventing shoulder injuries
Maintain adequate strength & flexibility of all shoulder muscles
Good posture
Proper techniques
Proper warmup
Proper protective gear

12. Types of Injuries
Sprains
Dislocations
Strains
Overuse
Fractures

13. AC Sprain
Shoulder separation

14. Mechanism
Impact to tip of shoulder
Fall on outstretched arm

15. Signs and symptoms Deformity at AC joint
distal end of clavicle rides superiorly
Pain with movement and palpation
“+” piano key sign

16. Degrees of injury
1st degree: no deformity, pain w/ palpation & motion, mild stretching of AC ligament
2nd degree: displacement of distal end of clavicle, unable to abduct arm or bring it across body, pain
3rd degree: complete rupture of AC and CC ligaments, with dislocation of the distal end of clavicle, severe pain, LOM, instability

17. Treatment RICE Immobilization
Physician referral if more than 1st degree
Possible surgery

18. SC Sprain
Relatively uncommon injury

19. Mechanism of injury
Indirect force transmitted through the humerus, the shoulder joint and the clavicle
Direct impact to clavicle

20. Signs & symptoms 3 degrees May have deformity at sternal end Swelling
Pain
POT
Inability to abduct shoulder through full ROM

21. Treatment
RICE
Immobilization
Physician referral

22. Glenohumeral dislocation
Shoulder dislocation
Anterior—most common
Posterior
Inferior
Multidirectional

23. Anterior shoulder dislocation

24. Anterior shoulder dislocation

25. GH dislocation

26. GH dislocation

27. Mechanism Arm forced into external rotation abduction and extension
Posterior force driving the head of the humerus posteriorly

28. Signs & symptoms Deformity—step off (deltoid will look flattened
Arm in slight abduction, external rotation
Will not be able to move shoulder joint
Unable to touch opposite shoulder with hand of affected side
Pain and POT

29. Treatment Immobilization ER to have shoulder reduced by a physician
Immobilization for 1-2 weeks
No activity 4-6 weeks
Rehab-ROM and strengthening
High incidence of recurrence after the first dislocation

30. Shoulder reduction

31. Immobilization of shoulder joint

32. Shoulder dislocation video
Watch shoulder dislocation on Google Video.htm

33. Shoulder subluxation
Partial dislocation/spontaneous reduction

34. Mechanism
External rotation, abduction, extension

35. Signs & symptoms
Pain
Limited ROM
POT

36. Treatment Ice Immobilization Physician referral
Rehab—strengthening muscles around joint

37. Rotator Cuff Strain 3 degrees Most involve supraspinatus
Tears usually at insertion on humerus

38. Rotator cuff strain

39. Mechanism Dynamic rotation of arm at high velocity (overhead throwing)
Usually involves individuals with a history of impingement or instability

40. Signs & symptoms Pain w/ muscle contraction
POT over greater tuberosity
Loss of strength
Complete tear produces pain, loss of function, swelling and POT

41. Treatment RICE Decrease level of activity
Exercises to strengthen rotator cuff

42. Biceps tendon rupture

43. Mechanism
Direct blow
Severe contraction of biceps

44. Signs & symptoms Unable to flex elbow
Deformity of biceps—balling up of muscle belly
Pain
POT

45. Treatment
Ice
Immobilization
Physician referral

46. Tendonitis Rotator cuff Biceps
Common among athletes performing overhead motions due to overuse or muscle weakness

47. Mechanism
Repetitive overhead motion causing inflammation of tendon

48. Signs & symptoms
POT
Swelling
Crepitus
Pain with motion

49. Treatment
Rest
Ice
Heat
NSAIDS
Stretching
Strengthening

50. Impingement syndrome
Involves compression of supraspinatus tendon, subacromial bursa, long head of biceps tendon (all are under the coracoacromial arch)

51. Impingement

52. Impingement

53. Mechanism
Repetitive overhead motions

54. Signs & symptoms
Diffuse pain around the acromion process when arm is in overhead position
External rotators are weak
“+” impingement test
Empty can test may increase pain
Pinching sensation

55. Treatment RICE Restore normal biomechanics to shoulder
Strengthen RC muscles and muscles that produce movement of scapula
Stretch posterior and inferior joint capsule

56. Clavicle Fracture
Most common in distal third

57. Clavicle Fracture

58. Clavicle Fracture

59. Clavicle Fracture

60. Clavicle Fracture

61. Clavicle Fracture

62. Clavicle fracture

63. Mechanism
Fall on tip of shoulder
Direct blow to clavicle

64. Signs & symptoms
Pain
Deformity
Hold arm close to side
Hunch shoulders

65. Treatment
Ice
Immobilization
ER visit

66. Clavicle fracture surgical repair

67. Humeral Fracture

68. Mechanism
Direct blow
Dislocation
Fall on outstretched arm

69. Signs & symptoms Pain Hear a crack Unable to move arm Swelling, POT
Possible deformity
Discoloration of superficial tissue

70. Treatment Splint/immobilize Treat for shock ER visit Possible surgery
2-6 months recovery

71. Epiphyseal Fracture
Fracture to growth plate in younger athlete

72. Epiphyseal fracture

73. Epiphyseal fracture

74. Epiphyseal Fracture

75. Mechanism
Falling on elbow, driving head of humerus into the glenoid fossa
Blow to head of humerus

76. Signs & symptoms
Pain
Inability or desire to move arm
Feeling a “pop”

77. Treatment Ice Immobilization Physician referral
Possible surgery to hold head of humerus to shaft to ensure proper healing and growth

78. Shoulder Pointer
Contusion to tip of shoulder

79. Mechanism
Direct blow to tip of shoulder

80. Signs & symptoms
POT
Pain
Discoloration
Swelling
Decreased motion

81. Treatment
Ice
Protective padding
Modify activity