Shoulder Injuries

Glenohumeral Subluxation/ dislocation Anterior

AKA subcoracoid dislocation, caused by force abduction and ER. The head of the humerus is forced past the labrum and downward to the rest under the coracoid process. S&S- intense pain but as recurrent less painful, tingling and numbness down arm, flattened deltoid, prominent humeral head in axilla, arm carried in slight abduction and external rotation. Once had one more prone to another.

Blocker's Exostosis

An overgrowth in a portion of the bone in the upper arm into the deltoid muscle (bone spur). Occurs from repeated direct blows to the shoulder and causes pain and tenderness at the area.

1st Degree SC joint sprain

Partial tare, no deformity, slight swelling, mild pain, mild discomfort with horizontal adduction, standard acute cause and immobilization with sling

Sternoclavicular joint sprain

Sprain that is the result of an indirect force or a blunt trauma. Posterior displacement may occur. Graded 1-3

Glenohumeral (GH) sprain

Sprain that occurs from forceful abduction, forceful abduction and external rotation, or a direct anterior blow. S&S include in a 1st degree limited ROM limited, anterior pain, in a 2nd degree joint laxity, swelling, ecchymosis, decreased ROM, pain and in 3rd a complete dislocation. Management includes standard acute care, sling

Static stabilizing structures

Stabilizing structures that don't contract: bony geometry, glenoid labrum, capsule-ligamentous complex, intra-articular pressure

Primary dynamic stabilizing structures of the shoulder

Suprasinatus, infraspinatus, teres minor, subscapularis

Rotator Cuff Muscles

Supraspinatus, Infraspinatus, Subscapularis, and Teres minor

Rotator Cuff Injury

A strain to 1 or more of the rotator cuff muscles, may be acute or chronic and can range from tendinitis to a tear

Thoracic Outlet Syndrome

Condition where nerves and blood vessels become compressed in the neck or axilla. This compression occurs due to decreased space between clavicle and first rib, scalene compression, compression by pectorals minor or the presence of an extra cervical rib.

Shoulder Pointer Contusion

Contusion to the bony prominence of shoulder on the lateral acromion process- no ligament injury. Occurs from a direct blow and S&S include pain and swelling

Glenohumeral subluxation/ dislocation posterior

Etiology- falling on and extended arm and IR of shoulder. S&S- severe pain and disability, arm carried in adduction and internal rotation, prominent accordion and coracoid process, limited external rotation and abduction, possible posterior bulgeG

Glenoid Labrum

Fibrous rim which depends the gleaned fossa and increases the total surface contact area and serves as a buttress in controlling GH translation

Scapula Fracture

Frature that is the result of a direct impact or force transmitted up through the humerus. Signs and symptoms include minimal displacement, localized pain and hemorrhage, and hesitance to move in adduction. Management includes sling/ice- refer to doctor.

3rd Degree SC joint sprain

Gross prominence of medial end of the clavicle, severe swelling and pain, limited movement with more severe pain. Treatment includes application of a figure-eight immobilizer and refer immediately to a physician. Check radial pulse, respiration, and ability to swallow.

Glenohumeral dislocation management

If the first time dislocation- immediate referral, immobilize in comfortable position, ice. Post reduction immobilization followed by rehabilitation.

Impingement Syndrome

Impingement of supraspinatus and subbacromial bursa against the coracoacromial ligament and acromion. Occurs as the result of repetitive overhead movements (common with swimmers, baseball/softball players) S&S- supraspinatus weakness, pain over lateral aspect of shoulder, pain during active and resistive abduction, "deep pain". Management- standard acute, NSAIDs, Gradual RTP- work on flexibility and strength

Subacromial Bursitis

Injury caused by repeated compression between acromion process and supraspinatus tendon and/or repeated overhead activity. S&S include localized inflammation, a partial tear, pain with overhead activity, and painful arc

Chronic Rotator Cuff Tear

Injury found in people in sports/occupations requiring excessive overhead activity. S&S- pain usually worse at night, worsening pain followed by gradual weakness, decrease in ability to move arm (esp. abduction)

Acute Rotator Cuff Tear

Injury that results from sudden powerful raising of the arm against resistance. S&S- tear may be felt and followed by severe pain shooting through the arm, motion is limited by pain and muscle spasm. Acute pain from bleeding and muscle spasm, point tenderness over the site or rupture and with large tears inability to raise arm out to the side.

Acromioclavicular (AC) joint sprains

Injury to the ligament at the AC joint- usually occurs from falling on an outstretched arm

Clavicle Fractures

Most occur in the middle 1/3 of the clavicle where the bone is the weakest, can be the result of a direct or indirect force. S&S include deformity, pain, swelling, and ecchymosis. Management includes immediately sling and refer to further care, figure 8 brace

Rotator Cuff Tendonitis

Occurs due to a repeated micro trauma such as compression or excessive tensile stress. Occurs most commonly in supraspinatus and may lead to tendon degeneration

Bicipital Tendinitis

Occurs from repetitive overhead activities involving excess elbow flexion and supination where the tendon passes back and forth in groove and occurs subsequent to impingement syndrome. S&S- pain with ER and IR rotation of shoulder, pain with passive stretch in shoulder extension. Management includes rest until pain free but most athletes would rather play through pain

Prevention of shoulder conditions

Protective equipment (shoulder pads), physical conditioning (increase flexibility and strength), proper skill technique (throwing motion and proper falling technique)

Biceps Brachii Rupture

Result of a powerful contraction and generally occurs near origin of muscle. S&S- athlete hears a resounding snap and feels a sudden and intense protruding bulge near middle of biceps. Weakness with elbow flexion and supination. Management includes ice, sling, & refer. Athletes require surgery but some older individuals can rely on other muscles

Thoracic Outlet Syndrome S&S

S&S include paresthesia in the back of the neck, shoulder, medial arm, and hand and grip is weak if the nerves are affected. If a vein is affected there is edema, hand stiffness, and cyanosis. If the artery is effected there may be feelings of coolness, diminished radial pulse and numbness. Management includes immediate referral, stretching/ strengthening, surgical treatment is sometimes needed

2nd Degree SC joint sprain

Slight prominence of medial end of the clavicle, moderate swelling and pain, inability to ABD the arm or horizontally ADD the arm without noticeable pain. Standard acute care and immobilization 3-4 weeks

Secondary dynamic stabilizing structures of the shoulder

Teres major, latissimus dorsi, pectoralis major, long head of biceps, deltoid

Humerus Fractures

These fractures may occur in the shaft, neck or the epiphyseal plate of the humerus. Usually occur from falling on an outstretched hand. S&S include pain, swelling, ecchymosis, decreased ROM, and an athlete probably is holding arm close to body. Management includes sling/ice and reduction/immobilization for 4 weeks

Joint Capsule

Thin, weak and relatively loose complex that increases mobility and decreases stability

Reduced dislocation

When the bone goes back in place after the dislocation

frontal kinematics

abduction and adduction

Adhesive Capsulitis

aka "frozen shoulder," contracted and thickened capsule tight around the humeral head, little synovial fluid, chronic inflammation and rotator cuff contracted and inelastic

Sagittal kinematics

flexion and extension

transverse kinematics

medial rotation and lateral rotation, horizontal abduction and adduction

Dynamic stabilizing structures

stabilizing structures that contract: musical-tendinous influences