Post on 16-Dec-2015
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Injuries to the Shoulder Region
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Movements of the ShoulderMovements of the Shoulder
– Flexion– Extension– Abduction– Adduction– Internal Rotation– External Rotation– Horizontal Abduction
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Anatomy Review Anatomy Review Skeleton of the
shoulder– shoulder girdle
(clavicle & scapula)– glenohumeral joint– acromioclavicular &
sternoclavicular joints
Shoulder girdle and GH joint must move together
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Anatomy ReviewAnatomy ReviewInjuries are common….– AC and SC joint injuries are common in
wrestling.– Throwing and racquet/club sports can
result in injuries of the GH joint such as the rotator cuff.
– Cycling and skating sports -- fractures of the clavicle are common
– Injuries can be either chronic or acute.
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LigamentsLigaments
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Muscles of the ShoulderMuscles of the Shoulder
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Posterior MusclesPosterior Muscles
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Major Arteries of the ArmMajor Arteries of the Arm
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Brachial PlexusBrachial Plexus Shown here are the
major components of the brachial plexus..
Note the relative position of the plexus relative to the axillary artery and pectoralis minor.
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Brachial PlexusBrachial Plexus
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Fractured ClavicleFractured Clavicle Fractures of this bone are
the most common fracture in this region.– This injury usually results
from falls or direct blows. The adolescent form of
this injury is known as a “greenstick” fracture.
All clavicular fractures are potentially dangerous.
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Fractured ClavicleFractured ClavicleSigns/symptoms
– swelling, – deformity,– discoloration, – broken bone ends
protruding, etc.First Aid:
– Treat for shock– Sling & swathe bandage– Sterile dressings on
wounds
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Fractured ScapulaFractured ScapulaUncommon injury
-- normally the result of a direct blow
Signs and symptoms are less clear than are those for a fractured clavicle.
Symptoms include:– history of severe blow– pain and functional
loss
An athlete with such a history and symptoms should be referred to a medical doctor.
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Acromioclavicular InjuriesAcromioclavicular Injuries
AC joint is located on the lateral/superior shoulder, just under the skin.– AC ligaments &
CC ligaments
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Acromioclavicular InjuriesAcromioclavicular Injuries
Mechanism -- downward blow to the lateral shoulder or fall on an outstretched arm
Severity of injury is determined by the specific injuries damaged.– 1st deg. -- no significant damage– 2nd deg - partial tearing of ligs.– 3rd deg - complete rupture
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Signs/Symptoms of AC InjurySigns/Symptoms of AC Injury
Any movement of the SG or GHJ will be painful.
• Mild swelling associated with point tenderness
In 3rd degree injuries, a snap or pop may have been felt along with visible deformity. “Piano key sign”
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Treatment for a AC InjuryTreatment for a AC Injury
First Aid:Treat for shockI.C.E.Sling & swathe bandageRefer to MD
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Glenohumeral Joint InjuriesGlenohumeral Joint Injuries
GHJ formed of humeral head and the glenoid fossa – extremely mobile but
inherently unstable– major soft tissue structures
include: articular cartilage, coracohumeral, glenohumeral and transverse humeral ligs.
– glenoid labrum
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Glenohumeral Joint InjuriesGlenohumeral Joint Injuries
Mechanism -- abduction and external rotation– stresses the anterior
glenohumeral ligament– most common form is
known as an “anterior” dislocation
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Signs/Symptoms of GHJ Signs/Symptoms of GHJ InjuryInjury
Subluxation --– movement will be
painful– in absence of signs
Signs/symptoms -- – shoulder joint
deformity – abnormally long
arm – humeral head in
axillae– pain & dysfunction
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Treatment of a GHJ InjuryTreatment of a GHJ Injury
First Aid:Treat for shockPlace rolled towel into the armpitI.C.E.Sling & swathe bandage85%-90% of injuries tend to recur
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Sternoclavicular Joint InjuriesSternoclavicular Joint Injuries The sternoclavicular joint is
formed by the proximal end of the clavicle and the manubrium of the sternum.– supported by the SC ligaments– injuries are rare compared to
the AC or GH joints
Mechanism -- external blow (laterally placed) along the long axis of the clavicle, clavicle moves anteriorly/superiorly
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Signs/Symptoms of Signs/Symptoms of Sternoclavicular Joint InjuriesSternoclavicular Joint Injuries
First Aid:Treat for shockI.C.E.Sling & swathe
bandage
Signs/symptoms include:– gross deformity
(2nd & 3rd)– swelling & painful
movement– snapping sound
related to the injury
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Rotator Cuff StrainsRotator Cuff Strains Muscles of the cuff -
GHJ --- abduction, internal and external rotation
dynamic stabilizers (“cuff”)
SITS– Supraspinatus– Infraspinatus– Teres Minor– Subscapularis
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Signs/Symptoms of Rotator Signs/Symptoms of Rotator Cuff StrainsCuff Strains
pain within the shoulder -- especially during follow through phase
pain/stiffness 12-24 hours after throwing/swinging
point tenderness around the region of the humeral head
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GHJ Related “Impingement” GHJ Related “Impingement” SyndromeSyndrome
Occurs when a bursae/ tendon is squeezed between moving structures– supraspinatus is
commonly impinged
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Impingement SyndromeImpingement Syndrome
Sports that emphasize overhead arm movements showed a relative high incidence of these injuries.
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Signs/Symptoms of Signs/Symptoms of “Impingement Syndrome”“Impingement Syndrome”
pain on abduction & external rotation
strength loss
– pain when arm is abducted beyond 80-90 degrees
– nocturnal pain
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Impingement SyndromeImpingement Syndrome
First Aid:RestAnti-inflammatory drugsPhysical therapyIn extreme cases, surgery
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Biceps Tendon ProblemsBiceps Tendon Problems
Anatomic relationships between LH biceps tendon and the GHJ capsule, transverse humeral ligament and subacromial space
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Biceps Tendon ProblemsBiceps Tendon Problems
– LH tendon can be compressed within the subacromial space
– LH tendon may develop tendinitis and result in subluxation
– Violent force may sublux the LH tendon from the bicipital groove.
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Signs/symptoms of Biceps Signs/symptoms of Biceps Tendon ProblemsTendon Problems
Signs/symptoms --– painful abduction of
the shoulder joint– pain during resisted
supination
– resisted flexion/supination yields a snapping and/or popping sensation
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Biceps Tendon ProblemBiceps Tendon Problem
First Aid: This qualifies as an “overuse” type of injury -- no
first aid procedures. Emphasis should be on prevention through skill
development, rest, and strength training. Traumatic subluxations should be treated with ICE
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Contusions of the Shoulder Contusions of the Shoulder RegionRegion
External blows are common to this region.
The GHJ is well protected by muscles while the AC joint is exposed.
Contusions to this region can result in a
“shoulder pointer.”
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Contusions of the Shoulder Contusions of the Shoulder RegionRegion
First Aid:Immediate
application of ICESling & swathe
bandageMedical referral
Signs/symptoms --– history of recent
blow– decreased ROM– muscle spasm– discoloration &
swelling