Chapter 11- Athletic Training:Sal Monty

Fractured scapula:

Less common. Occurs in pro-football

Acromioclavicular joint injuries

Located just under the skin on the lateral superior surface of the shoulder is the AC joint

First aid care of sternoclavicular joint injuries:

1. Apply ice and compression, which is best accomplished using a plastic bag filled with crushed ice that is secured with an elastic wrap tied in a figure-eight configuration. Take care not to put pressure over the airway when wrapping the pressure over the airway when wrapping the shoulder for compression of the SC joint. 2. Place the arm of the affected shoulder in a standard sling-and-swathe bandage as described by the National Safety Council (1991). 3. In cases of severe soft-tissue damage, treat the athlete for shock. Treatment of majority of SC joint sprains 2 to 3 weeks of support with a sling-and-swathe bandage and rehab

Glenohumeral Joint Injuries: Signs and symptoms:

1. Deformity of the shoulder joint: The normal contour of the shoulder is lost, and it appears to slope down abnormally. 2. The arm of the affected side will appear longer than normal. 3. The head of the humerus will be palpable with the axilla. 4. The athlete will be supporting the arm on the affected side with the opposite arm; the affected arm will be slightly abducted at the shoulder and flexed at the elbow 5. The athlete will resist all efforts passively or actively to move the GH joint. 6. Special Note: In cases of subluxations of the GH, the shoulder may appear normal. However, it will be extremely painful for the athlete to attempt any movement. In addition, the joint may be point tender.

Two mechanisms of injuries:

1. Downward blow to the outer end of the clavicle 2. Falling forward on an outstretched arm.

First aid care for strains of the shoulder region:

1. Overuse injuries are difficult to treat effectively without a thorough medical evaluation. When symptoms occur, the application of ice and compression may prove helpful in reducing the pain and loss of function associated with the injury. 2. In the majority of cases, the athlete will report repeated episodes of symptoms spanning many weeks or even months. Therefore, medical referral for a complete evaluation is essential.

Signs and symptoms of Glenohumeral joint-related impingement syndrome:

1. Pain when the GH joint is abducted and externally rotated in conjunction with loss of strength. 2. Pain whenever the arm is abducted beyond 80 to 90 degrees. 3. Nocturnal pain. 4. Pain felt deep within the shoulder.

Sings and symptoms of strains of the shoulder region:

1. Pain within the shoulder, especially during the follow-through phase of a throw or swing. 2. Difficulty in bringing the arm up and back during the cocking phase of a throw or swing. 3. Pain and stiffness within the shoulder region 12 to 24 hours after a practice or competition that involved throwing or swinging. 4. Point tenderness around the region of the humeral head that appears to be deep within the deltoid muscle. (It should be noted that rotator cuff injuries can mimic others common to the shoulder region, including bursitis and tendonitis).

Signs and symptoms of biceps tendon problems:

1. Painful abduction of the shoulder joint similar to that seen in impingement problems. 2. Pain in the shoulder joint when the athlete supinates the forearm against any resistance. 3. When actively flexing and supinating the forarm against resistance, the athlete may note a popping or snapping sensation as the tendon of the long head of the biceps brachii subluxates.

Second degree injury:

1. Relatively Severe damage (tearing) of the ligaments. There will be no abnormal movement, and the clavicle will be in the normal position.

Signs and symptoms of fractured clavicle:

1. Swelling and/or deformity of the clavicle. 2. Discoloration at the site of the fracture 3. Possible broken bone end projecting through the skin. 4. Athlete reporting that a snap or pop was felt or heard. 5. Athlete holding the arm on the affected side in order to relieve pressure on shoulder girdle.

First aid care for clavicle fracture:

1. Treat for possible shock 2. Carefully apply a sling-and-swathe bandage 3. Apply sterile dressings to any related wounds. 4. Arrange for transport to a medical facility

Signs and symptoms of soft tissue injuries:

1. With first- and second- degree sprains there will be mild and discoloration around the AC joint. 2. Any movement of the shoulder region will elicit pain. 3. With a third-degree sprain there will be significant deformity in the region of the AC ligament. In the case of ruptures of both the AC and CC ligaments, there will be total displacement of the clavicle. 4. The athlete may report having felt a snap or heard a pop.

Large number of fractures of the clavicle brought about by falls

Cycling and skating

Adolescent athlete another type of clavicular fracture called?

Greenstick fracture

Signs and symptoms of a fractured scapula:

Immediate pain and loss of function. Can only be identified by X-ray. Athlete will be removed from sport participation for 6 weeks.

Two types of bicep tendon problems are:

Impingement and tendinitis

What are the muscles of the rotator cuff?

Infraspinatus, Supraspinatus, Teres minor, Subscapularis

First degree injury:

No significant damage, all ligaments intact

Majority of clavicular fractures occur about mid-haft; the remainder involve either the ?

Proximal or distal end of the bone

Mechanism of fractured scapula:

Result from a direct blow to the shoulder region.

Strains of the shoulder region: Rotator cuff:

Rotator cuff serve a variety of purposes, including stabilization of the humeral head in the glenoid fossa as well as abduction and internal and external rotation of the GH joint. *Mechanism---of rotator cuff is overhand throw and/or swing. *Throwing has been described as a five-phase process involving windup, cocking, acceleration, release, and, follow-through. *The vast majority of strains to the rotator cuff occur during the follow-through phase. *Strains to the rotator cuff are normally the result of overuse.

Soft tissue injuries

The GH and AC joints are the most commonly injured in the shoulder region in sports

Biceps tendon problems:

The anatomy of the GH joint includes the tendon of the long head of the biceps brachii muscle tendon of the long head of the biceps brachii muscle. Mechanism: over head movements of the arms.

The most common fracture of the shoulder region is a fracture of ?

The clavicle

Overused to the muscles of the rotator cuff

Throwing Injuries

Injuries of the shoulder region can be classified as either acute (of sudden onset) or chronic (resulting from overuse)

True

Injuries to Glenohumeral Joint is common in?

Wrestling

Third degree:

a. Complete rupture of the AC ligaments with an intact CC ligament. b. Complete rupture of the AC and CC ligaments.

Mechanisms are direct blow or force transmitted through the ?

arm or shoulder

First aid care of Glenohumeral joint-related impingement syndrome:

*As symptoms develop the athlete should be referred for complete medical evaluation. *Treatment will consist of rest, anti-inflammatory drugs, and physical therapy. If treatment fails surgery to correct the problem may be treated by Arthroscophy

First aid care of biceps tendon problems

*Generally develop over time and fall into the category of a chronic injury. *If the athlete should subluxate the biceps tendon from the bicipital groove, the initial episode of this injury can require first aid. *Immediate care Ice and compression *Long-term care Rest, anti-inflammatories, and gradually progressive exercise rehabilitation. *If symptoms persist and tendon continues to subluxate from the bicepital groove, then surgery may be required to stabilized the tendon.

Sternoclavicular joint injuries:

*The SC joint is formed by the union of the proximal end of the clavicle and the manubrium of the sternum. This synoviated articulation is strengthened by several ligaments *Mechanism ---for SC joint involves an external blow to the shoulder region that results in a dislocation of the proximal clavicle, most commonly with the bone moving anteriorly and superiorly.

Glenohumeral Joint-Related Impingement Syndrome:

*To impinge means to be forced "upon or against some-thing." *Impingement syndrome of the shoulder occurs when a soft-tissue structure such as a bursa or tendon is squeezed between moving joint structures, resulting in irritation and pain. *Most cases GH joint, the most common impingement occurs to the tendon of the supraspinatus muscle as it passes across the top of the joint en route to its insertion. *Mechanism---The most common causes of GH joint-related impingement syndromes are "anatomic variations in the coracoacrominal arch" that cause damage to the structures found within the subacromial space.

Contusions of the shoulder region:

-External blows around the shoulder region are a common occurrence in a variety of sports. -GH joint protected by muscles -AC joint is exposed and quite vulnerable to external blows. -If the athlete should sustained a contusion to this joint, the result can be an extremely painful condition known as a shoulder pointer.

Signs and symptoms of contusions of the shoulder:

1. History of a blow to the shoulder, with resulting pain and decreased range of motion. 2. Spasm if muscle tissue is involved. 3. Discoloration and swelling, especially over bony regions such as the AC joint.

First aid care of contusions of the shoulder region:

1. Immediately apply ice and compression directly over the area(s) involved. This is best accomplished with a bag of crushed ice and an elastic wrap. 2. In Cases of severe pain apply an arm sling to relieve stress on the shoulder region. 3. If significant swelling persists for more than 72 hours in the region of the AC joint, refer the athlete to a physician. In some cases the AC ligament may have sustained a sprain.

First aid care of Glenohumeral Joint Injuries:

1. Immediately apply ice and compression. Put a rolled towel in the axilla. Place a bag of crushed ice on the front and back of the shoulder joint and secure with an elastic wrap tied in a figure-eight configuration. 2. Once the ice and compression are in place apply a standard sling-and-swathe bandage as described by the National Safety Council (1991). 3. Immediately refer the athlete to a medical facility for further evaluation. 4. Because soft-tissue injury may be extensive, treat for shock.

First aid care of soft tissue injuries:

1. Immediately apply ice compression and over AC Joint. 2. Apply a sling and swathe bandage. 3. Immediately refer the athlete to medical facility for further evaluation.

Signs and symptoms of sternoclavicular joint injuries:

1. In most cases (second- and third-degree sprains) there will be gross deformity present at the SC joint. 2. In all but the least severe cases, swelling will be immediate. 3. Movement of the entire shoulder girdle will be limited owing to pain within the SC joint. 4. The athlete will typically report having heard a snapping sound or may have experienced a tearing sensation at the SC joint. 5. Note the body position of the athlete, because in this injury the arm may be held close to the body and the head/neck may be tilted/flexed toward the injured shoulder (Wroble, 1995).