KINE 4403 - Chapter 11 - Shoulder Injuries

Biceps Tendon Problems Mechanism

LH tendon compressed within subacromial space. LH tendon may develop tendinitis and result in subluxation. Violent force may sublux the LH tendon from the bicipital groove.

Winging Scapula

A winged scapula is caused by damage or contusion to the long thoracic nerve of the shoulder and/or weakness in the serratus anterior muscle. Damage to the nerve can be caused by a contusion or blunt trauma of the shoulder, traction of the neck, and can (sometimes) follow a viral illness.

Acromioclavicular Joint Injuries

AC Joint is located on the lateral/superior shoulder just under the skin. AC/CC ligaments. Mechanism - Downward blow to the lateral shoulder or fall on an outstretched arm. Severity of injury is determined by the specific injuries damaged: 1st degree - No significant damage. 2nd degree - Partial tearing of ligaments 3rd degree - Complete rupture S/S - Any movement of the SG and GHJ will be painful, mild swelling associated with point tenderness, and, in 3rd degree injuries, a snap or pop may have been felt, along with visible deformity. "Piano key sign." TX - Treat for shock, I.C.E., sling, swath bandage, and reference to MD.

Biceps Tendon Problems

Anatomic relationship between the LH biceps tendon and the GHJ capsule/transverse humeral ligament and subacromial space. 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. S/S - Painful abduction of the shoulder joint, pain during resisted supination, and resisted flexion/supination yields a snapping and/or popping sensation. TX - Overuse injury, so no first aid procedures. Prevention through skill development, rest, and strength training. Traumatic subluxations should be treated with I.C.E.

Acromioclavicular Joint Injury Signs and Symptoms

Any movement of the SG or GHJ will be painful, mild swelling associated with point tenderness, and, in 3rd degree injuries, a popping or snapping along with visible deformity. "Piano key sign."

Glenohumeral Joint Injuries

Common in throwing and racquet/club sports. Often a rotator cuff injury.

Acromioclavicular/Sternoclavicular Injuires

Common in wrestlers

Acromioclavicular Joint Injury Mechanism

Downward blow to the lateral shoulder or fall on an outstretched arm. Severity is determined by specific injury's damage: 1st Degree - No significant damage 2nd Degree - Partial tearing of ligaments 3rd Degree - Complete rupture

Shoulder Loading

Ergonomists recommend workers seated at desk use arm position with 20 degrees or less of abduction and 25 degrees or less of flexion

Sternoclavicular Joint Injury Mechanisms

External blow (laterally placed) along the long axis of the clavicle. Clavicle moves anteriorly/superiorly.

Contusions of the Shoulder Region Mechanism

External blow. AKA shoulder pointer.

Contusions of the Shoulder Region

External blows are common to this region GHJ is well protected by muscles, but AC joint is exposed. Contusions to this region can result in a "shoulder pointer." S/S - History of recent blow, decreased ROM, muscle spasm, discoloration, and swelling. TX - Immediate application of I.C.E., sling, swathe bandage, and medical referral.

Extreme External Rotation in Overarm Pitching

External rotation is terminated by these forces: Anterior Joint Capsule and Ligaments Subscapularis Pectoralis Major Triceps Brachii Teres Major Latissimus Dorsi

Fractured Clavicle Mechanism

Falls or direct blows.

Swimmer's Shoulder (Impingement Syndrome)

Hand Entry - Shoulder forced to perform extreme abduction, flexion, and internal rotation. Allows proximal head of humerus to rub across the supraspinatus tendon. Can "impinge" the supraspinatus tendon between humerus and coracohumeral ligament. Increased internal rotation when elbow is held in place and arm pushes back. Head of humerus is thrust forward and is close to ligamentous structure of shoulder joint where contact can occur. This increases likelihood of impingement. Completion of Arm Pull - Shoulder adducted such that the supraspinatus tendon is stretched over the head of the humerus. Cuts off blood supply to the tendon.

Rotator Cuff Impingement/Impingement Syndrome

Impingement of supraspinatus tendon 2 theories: Genetic - Too narrow of a space b/w acromion process and humeral head Overuse - Repeated stretching of the supraspinatus tendon weakens its ability to stabilize the humeral head, so deltoid compensates, pulls humerus up, and impinges the tissue. S/S - Pain on abduction and external rotation, strength loss, pain when arm is abducted beyond 80-90º, and nocturnal pain. TX - Rest, anti-inflammatory drugs, PT, and, in extreme cases, surgery.

Rotator Cuff Impingement Mechanism

Impingement of supraspinatus tendon. Genetic - Too narrow of a space between humeral head and acromion. Overuse - Repeated stretching of supraspinatus tendon weakens its ability to stabilize the humerus, leading to deltoid pulling the humerus up and impinging tissues.

Fractured Clavicle

Most common fracture for shoulder region. Results from falls or direct blows. Adolescent form of this injury is known as a "greenstick" fracture. All clavicle fractures are potentially dangerous. S/S - Pain, swelling, deformity, discoloration, and broken bone ends protruding. TX - Treat for shock, sling, swathe bandage, and sterile dressings on wounds.

Rotator Cuff Impingement Signs and Symptoms

Pain on abduction and external rotation, strength loss, pain when arm is abducted beyond 80-90º, and nocturnal pain.

Biceps Tendon Problems Signs and Symptoms

Painful abduction of the shoulder joint, pain during resisted supination, and resisted flexion/supination yields a snapping and/or popping sensation.

Swimmer's Shoulder

Recovery - Near maximum tension in serratus anterior during recovery to rotate scapula and facilitate overhead arm movements. Fatigued serratus will not rotate scapula, so rotator cuff muscles are impinged.

Sternoclavicular Joint Injuries

SC Joint is formed by the proximal end of the clavicle and the manubrium of the sternum. These injuries are rare compared to acromioclavicular and glenohumeral joint injuries. Mechanism - External blow (laterally placed) along the long axis of the clavicle. The clavicle moves anteriorly/superiorly. S/S - Gross deformity (in 2nd and 3rd degrees), swelling, painful movement, and snapping sound related to injury. TX - Treat for shock, I.C.E., sling, and swathe bandage.

Glenohumeral Joint Injury Signs and Symptoms

Shoulder joint deformity, abnormally long arm, humeral head in axillae, pain, dysfunction, and subluxation.

"SLAP" Lesion

Superior labrum anterior-posterior tear. Injury to superior aspect of labrum. Begins from posterior towards anterior. Affect attachment of long head of biceps to the superior labrum.

Fractured Clavicle Signs and Symptoms

Swelling, deformity, discoloration, and broken bone ends protruding.

Glenohumeral Joint Injury Mechanism

Abduction and external rotation. Stresses anterior glenohumeral ligament. Most common form is known as an "anterior" dislocation.

Fractures of Clavicle

Common in cycling and skating sports

Winging Scapula Mechanism

Damage to nerve caused by contusion or blunt trauma of the shoulder, traction of neck, and (sometimes) can follow a viral illness.

Rotator Cuff Impingement Treatment

Rest, anti-inflammatory drugs, PT, and, in extreme cases, surgery.

Sternoclavicular Joint Injury Treatment

Treat for shock, I.C.E., sling, and swathe bandage.

Glenohumeral Joint Injuries

GHJ formed from humeral head and glenoid fossa. Extremely mobile, but very unstable. Soft tissues include: articular cartilage, coracohumeral, glenohumeral, and transverse humeral joints. Mechanism - Abduction and external rotation. Stresses the anterior glenohumeral ligament. Most commonly known as an "anterior" dislocation. S/S - Shoulder joint deformity, abnormally long arm, humeral head in axillae, pain, dysfunction, and subluxation - movement will be painful, in absence of signs TX - Treat for shock, place rolled towel into the armpit, I.C.E., sling, swathe bandage, and 85-90% of the injuries tend to recur.

Sternoclavicular Joint Injury Signs and Symptoms

Gross deformity (in 2nd and 3rd degrees), swelling, painful movement, and snapping sound related to injury.

Contusions of the Shoulder Region Signs and Symptoms

History of recent blow, decreased ROM, muscle spasm, discoloration, and swelling.

Contusions of the Shoulder Region Treatment

Immediate application of I.C.E., sling, swathe bandage, and medical referral.

Soft Tissue Injuries

Often associated with overarm motions, such as throwing. Preparatory Phase - Anterior capsule and subscapularis are susceptible to strain or tendinitis at the insertion on the lesser tubercle. Acceleration (Explosive) Phase - Posterior capsule and labrum are susceptible to injury as the anterior shoulder is tightened, driving the humeral head backwards. Follow-Through Phase - Rotator cuff works to decelerate the shoulder's internal rotation. Infraspinatus and Teres Minor very susceptible to muscle strain or tendinitis.

Biceps Tendon Problems Treatment

Overuse injury, so no first aid procedures. Prevention through skill development, rest, and strength training. Traumatic subluxations should be treated with I.C.E.

Acromioclavicular Joint Injury Treatment

Treat for shock, I.C.E., sling, swathe bandage, and reference to MD.

Glenohumeral Joint Injury Treatment

Treat for shock, place rolled towel into armpit, I.C.E., sling, swathe bandage, and 85-90% of injuries tend to recur.

Fractured Clavicle Treatment

Treat for shock, sling, swathe bandage, and sterile dressings on wounds.

Detecting a Torn Rotator Cuff Tendon

Use an Arthrogram Inject dye into the joint and see if it leaks out where the rotator cuff tendon is supposed to be.