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

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

3. 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 ________________

5. Muscular Anatomy

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

7. 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

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

9. _______________ 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)
___________________________________________

10. __________________ 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

11. 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
____________________________________ ______________

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

15. 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

17. 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
*_______________*

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

19. 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

20. 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
______________________

22. 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.

23. 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 ___________

25. 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
_____________________

26. 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 ______________

28. 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 ___________________

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

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

31. GH Joint-Related “Impingement” Syndrome

32. 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
______________________ ______________________

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

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

35. 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
__________

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

38. Labral Tear Treatment Ice NSAIDs Shoulder rehabilitation exercises
_________

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

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

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

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

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