Injuries to the Shoulder Region

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• Injuries to the Shoulder Region

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Movements of the Shoulder

• Flexion
• Extension
• Abduction
• Adduction
• Internal Rotation
• External Rotation
• Horizontal Abduction

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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 Review

• Injuries 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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Ligaments
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Muscles of the Shoulder
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Posterior Muscles
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Major Arteries of the Arm
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Brachial 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 Plexus
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Fractured 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 Clavicle

• Signs/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 Scapula

• Uncommon 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 Injuries

• AC joint is located on the lateral/superior
  shoulder, just under the skin.
• AC ligaments CC ligaments

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Acromioclavicular 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 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 Injury

• First Aid
• Treat for shock
• I.C.E.
• Sling swathe bandage
• Refer to MD

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Glenohumeral 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 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 Injury

• 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 Injury

• First Aid
• Treat for shock
• Place rolled towel into the armpit
• I.C.E.
• Sling swathe bandage
• 85-90 of injuries tend to recur

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Sternoclavicular 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 Sternoclavicular Joint Injuries

• First Aid
• Treat for shock
• I.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 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 Cuff 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 Syndrome

• Occurs when a bursae/ tendon is squeezed between
  moving structures
• supraspinatus is commonly impinged

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Impingement Syndrome

• Sports that emphasize overhead arm movements
  showed a relative high incidence of these
  injuries.

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Signs/Symptoms of 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 Syndrome

• First Aid
• Rest
• Anti-inflammatory drugs
• Physical therapy
• In extreme cases, surgery

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Biceps Tendon Problems

• Anatomic relationships between LH biceps tendon
  and the GHJ capsule, transverse humeral ligament
  and subacromial space

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Biceps 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 Tendon 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 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 Region

• 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 Region

• First Aid
• Immediate application of ICE
• Sling swathe bandage
• Medical referral

• Signs/symptoms --
• history of recent blow
• decreased ROM
• muscle spasm
• discoloration swelling