Athletic injuries Shoulder/ Upper Arm

Epiphyseal Plate Injury (proximal humerus)

MOI: A growth plate fracture is usually caused by a fall or impact on the arm or shoulder, although it can occur in parts of the body through overuse. Long bones such as the this one grow from the ends. At each end there is a growth plate which is the last part of the bone to harden from cartilage. For this reason, it is the most susceptible area to injury. Growth plate fractures occur in children and adolescents. This area is rarely injured in adults as the ligaments and other soft tissues surrounding the joint are stronger in a child than the soft bone is. This results in the bone being the first casualty! In adults, the soft tissue is more likely to be injured. Signs and Symptoms: Sudden pain in the upper arm and shoulder at the time of injury with rapid swelling in the shoulder. Attempting to move the arm will be painful and it is possible the shoulder joint may appear deformed.

Subacromial Bursitis

MOI: An chronic overuse injury that results in inflammation of the fluid filled sac in the subacromial space of the shoulder. Inflammation may develop from direct impact, a fall on the tip of the shoulder, or shoulder impingement. Signs and Symptoms: The patient has pain when trying to move the shoulder especially in abduction, adduction, flexion, and internal rotation. Impingement test will be positive.

Ulna Fracture

MOI: Breaks in the forearm usually involve both bone instead of just one. However, when a blow to the forearm happens breaks happen on the shaft of the this bone. Signs and Symptoms: the patient experiences an audible pop or crack followed by moderate to severe pain, swelling, and disability. There is localized tenderness, edema and ecchymosis with possible crepitus.

Radial Fracture

MOI: Breaks in the forearm usually involve both bone instead of just one. However, when a blow to the forearm happens breaks happen on the shaft of the ulna. Colle's breaks usually involve the lower end of this bone. It is caused by a fall on a outstretched hand, forcing the radius backward and upward (hyperextension). Smith's fracture is more common then Colle's fracture. It is a transverse break, of the distal radial metaphysis with anterior displacement of the distal fragments. If the break is intraarticular, it is called a Barton fracture. Signs and Symptoms: pain, visual deformity of the wrist, bleeding, and swelling.

Long Thoracic Nerve

MOI: Injury to the long thoracic nerve occurs acutely from a blow to the shoulder, or with activities that involve chronic repetitive traction on the nerve. Signs and Symptoms: diffuse shoulder or neck pain that worsens with overhead activities. Examination reveals scapular winging and weakness with forward elevation of the arm.

Radial nerve injury

MOI: Injury to this nerve usually causes symptoms in the back of the hand, near the thumb, and in the pointer and middle fingers. Injury to this nerve can occur in a number of different ways. These include fracturing the humerus (upper arm bone), pressure from leaning the arm over the back of a chair (called "Saturday night palsy" when caused by consuming too much alcohol and falling asleep in this position), using crutches, falling on or receiving a blow to the arm, motor vehicle accident, long-term constricting of the wrist (for example, by wearing a tight bracelet or watch strap). Signs and Symptoms: sharp or burning pain,numbness or tingling trouble straightening the arm, trouble moving the wrist and fingers "drooping" of the wrist and fingers (not being able to extend or straighten the wrist or fingers), also called "wrist drop" weakness in a hand grip.

Rotator Cuff Strain

MOI: This area in the shoulder is injured due to over head activities. Other times they can occur due to fall on outstretched hand or a direct blow to the shoulder. Signs and Symptoms: acute onset of pain and painful movement of the shoulder. Pain is worst when you use your arm for activities above your shoulder level. This means that the pain can affect your ability to lift your arm up - for example, to comb your hair or dress yourself. Swimming, basketball and painting can be painful but writing and typing can produce little in the way of pain. Pain may also affect sleep.

Glenohumeral Dislocation/Subluxation

MOI: This area of the shoulder can come out or back in anteriorly, posteriorly, and inferiorly (rare). The shoulder head coming in and out has excessive translation of the humeral head without complete separation of the joint surfaces. It is brief, transient occurrence in which the humeral head quickly returns to its normal joint surfaces relative to the glenoid. It can occur anteriorly, posteriroly, and inferiorly. Anterior displacement of the shoulder may result from direct impact to the posteiror or posterolateral aspect of the shoulder. The most common mechanism is forced abduction, external rotation, and extension that forces the humeral head out of the glenoid cavity. Signs and Symptoms: patient will have pain over the bicepital groove along with bicep function loss. Most likely the rotator cuff muscles will have been damaged.

Subdeltoid Bursitis

MOI: This bursa is located between the joint capsule and the deep surface of the deltoid muscle in the shoulder joint. A bursa is a fluid-filled sac, lined with synovial membranes, that occurs near the joint. This condition is what happens when the fluid filled sac becomes inflamed and swollen. Inflammation may develop from direct impact, a fall on the tip of the shoulder, or shoulder impingement. Signs and Symptoms: The patient has pain in shoulder movement especially with abduction, flexion, adduction, and internal rotation. Impingement test will be positive.

Sternoclavicular sprain

MOI: This injury is a relatively uncommon occurrence, but occasionally this may be caused by trauma to the shoulder. It is caused by indirect force through the humerus of the shoulder joint such as a blow that strikes the poorly padded clavicle or by twisting or torsion of the posteriorly extended arm. Signs and Symptoms: pain from mild to severe, disability, point tender, maybe visible deformity, inability for abduction and horizontal adduction, swelling, and possibly displacement of the clavicle.

Long head of the Biceps Tenosynovitis

MOI: This injury is common among people engaged in overhead activities. The repeated stretching of the biceps in highly ballistic activities may eventually cause an irritation of both the tendon and its synovial sheath as it passes under the transverse humeral ligament in the bicipital groove. Complete rupture of the transverse ligament, which holds the biceps in its groove, may take place, or a constant inflammation may result in degenerative scarring or a subluxated tendon. Signs and Symptoms: There will be tenderness in the anterior upper arm over the bicipital groove. There may also be some swelling, increased warmth, and crepitus because of the inflammation. The patient may complain of pain when performing dynamic overhead throwing-type activities.

Rupture of the long head of the bicep

MOI: This injury often occurs after a sudden contraction of the biceps with resistance to flexion and supination of the forearm. Also intrinsic degeneration of the tendon release and frictional wear of the tendon belly may have an impact.This intrinsic degeneration is caused by improper training or fatigue, inordinate stresses can be placed on the biceps as it attempts to compensate for other muscles. This can lead to attrition and failure, either within the tendon substance or at its origin. This ligament has several functions like dynamic stabilizer of the glenohumeral joint and a depressor of the humeral head. Signs and Symptoms: Some patients hear a pop at the time of the trauma, others feel a sharp pain in the anterior shoulder. This acute pain can be accompanied by snapping sensation. Some patients have a nondescriptive pain while performing overhead activities. Other patients have a nondescriptive anterior shoulder pain that may get worse at night. Most LHB pathologies were associated with Rotator Cuff tears of a duration longer then 3 months and an area of 5 cm2. Also shoulder problems like tendonitis or schoulder impingement can cause a rupture of the Long head biceps. The subscapularis tendon is mostly involved with LHB pathologies. If there is a rupture of the distal biceps tendon, a Popeye deformity can be seen.

Acromioclavicular Sprain

MOI: This joint is very vulnerable to sprains among active sports participants, especially in collision sports. The mechanism of this sprain is most often induced by direct impact to the tip of the shoulder that forces the area downward, backward, and inward while the clavicle is pushed down against the rib cage. Injury may also occur when an upward force is exerted against the long axis of the humerus by a fall on an outstretched arm. The position of the arm during indirect injury is one of adduction and partial flexion. Depending on the ligamentous involvement determines how bad the sprain is. Direct impact injuries usually cause more severe injury. Signs and Symptoms: It can have point tenderness and discomfort during movement at the junction between the ligament with assoicated stretching of the corcoclavicular ligament. Could have a tear or rupture and maybe partial displacement of the lateral end of the clavicle. Unable to fully abduct through range of motion to bring the arm fully across the chest. Maybe even posterior separation of the clavicle. Maybe the deltoid and traps will tear, moderate to severe pain, loss of movement, and instability of the shoulder.

Humerus Fracture

MOI: This long bone can break in three places. The shaft, proximal portion, and the growth plate. The shaft breaks happen occasionally, usually as the result of a direct blow or a fall on the arm. The type of break is usually comminuted or transverse, and a deformity is often produced because the bone fragments override each other as a result of strong muscular pull. There may be a chance of the radial nerve to be severed by jagged bone pieces, resulting in radial nerve paralysis and causing wrist drop and inability to perform forearm supination. The proximal portion pose considerable danger to nerves and vessels of that area. Breaks of this long bone can result from a direct blow, a dislocation, or the impact received by falling onto the outstretched arm. Sometimes this injury is mistaken for a separated shoulder. Growth plate breaks of the head of the long bone is much more common in the young patient than is a bone break. Usually seen in athletes ten years and younger. Caused by an direct or indirect blow to the shoulder that travels along the length of the axis of the long bone. Causes arm swelling, pain, disability, and arm shortening. Signs and Symptoms: pain, inability to move the arm, swelling, point tenderness, and discoloration of the superficial tissue.

Ulnar nerve Injury

MOI: This nerve injuries may be the result of pressure, trauma or illness. The most common cause of injury to this nerve is entrapment, in which this nerve is compressed. This may result from bone damage, such as an elbow fracture or dislocation, swelling of soft tissue, or external pressure from certain activities or positions. In some cases, this nerve injuries may arise without a known cause. Signs and Symptoms: sharp or burning pain,numbness or tingling trouble straightening the arm, trouble moving the wrist and fingers. This is felt on the inner third finger to the 5th finger and down the arm.

Dislocation of the Long Head of the Biceps

MOI: This tendon is usually located inferiorly in the bicipital groove and is held there by the transverse humeral ligament. As it moves superiorly it arches through the rotator cuff interval where it is held by a sling formed by the superior glenohumeral ligament and the coracohumeral ligament. When this ligament is deficient the tendon is free to dislocate medially. If the tendon of the subscapularis is intact then the tendon is seen lying anterior to it. If, as is common, the subscapularis tendon is also deficient then the tendon of the long head of biceps can prolapse into the glenohumeral joint. This injury is caused by tear of the subscapularis or supraspinatus tendons or both. Signs and Symptoms: The shoulder has pain over the bicepital groove, shoulder function is hindered, and the rotator cuff muscles are injured as well.

Axillary nerve injury

MOI: Trauma to the this nerve from either a compressive force or traction injury following anterior dislocation of the shoulder.This nerve injury is also called neuropathy of the this nerve. It describes a loss of movement or lack of sensation in the shoulder area of the body. Stress or damage to this nerve, which serves the deltoid muscles and skin of the shoulder, causes this dysfunction. Since this is a problem with just one nerve, it is a type of Peripheral neuropathy called mononeuropathy. Of all brachial plexus injuries, this nerve palsy represents only .3% to 6% of them Signs and Symptoms: pain, weakness in the shoulder, numbness, and loss of function.

Blocker's Exostosis

MOI: This injury is an overgrowth in a portion of the bone in the humerus. This condition occurs at the site of repeated injury, usually direct blows. It is a benign bony reaction to repeated injury. Signs and Symptoms: Occasionally there are no symptoms. However, the symptoms that can happen are pain and tenderness that increases with pressure on the area, physical changes in the arm noticed by sight or touch, if it breaks off (rare) the piece can be felt, and bruising and swelling with repeated injury.

Glenohumeral Sprain

MOI: This injury is similar to that which produces dislocations and strains. Anterior capsular sprains occur when the arm is forced into abduction. It can aslo occur from external rotation of the arm. A direct blow to the shoulder could also result in a sprain. A sprain to this joint often involves the rotator cuff muscles. The posterior capsule can be sprained by a forceful movement of the humerus posteriorly when the arm is flexed. Signs and Symptoms: The patient complains of pain during arm movement, especially when the sprain mechanism is reproduced. There may be decreased range of motion and pain during palpation.