Transcript lecture 13 the shoulder

Lecture # 13
The Shoulder
Complex
The Shoulder Complex
the loose structure of the shoulder
complex allows extreme mobility but
provides little stability
 as a result the shoulder is prone to injury
and is involved in 8 t0 13 % of all sports
related injuries

shoulder injuries are a major concern in all
sports involving overhead activities , ie
basketball, volleyball, baseball etc.
 these activities place significant demands
on the shoulder and may lead to acute or
chronic injuries

Bony Structures and
Articulations
1) Acromiociavicular – acromion process
and distal end of clavicle – limited ROM
2) Sternociavicular – superior sternum and
proximal end of clavicle - rotation
3) Glenohumeral – glenoid fossa ( of
scapula) and the head of the humerous –
extensive ROM but poor stability
glenoid fossa is deepened by the glenoid
labrum – a narrow rim of fibrocartilage
around the edge of the fossa
 ligaments surround joint but are lax and
provide little stability
 SITS or rotator cuff muscles
 supraspinatus
 infraspinatus
 teres minor
 subscapularis

Range of Motion in the
Shoulder Complex
flexion, extension - abduction, adduction
 horizontal abduction , horizontal adduction
 plus elevation/depression , protraction/
retraction

Common Injuries to the
Shoulder
Shoulder
Dislocation/Subluxation
2nd to fingers for
dislocations
 90% anterior
dislocation
 70% develop
traumatic recurrent
dislocation

intense pain, tingling and numbness
may extend down the arm into the hand
 injured arm is often held in slight
abduction and external rotated and is
usually stabilized by the opposite arm
 a pulse should be taken to assess
circulation as well sensations should be
tested
 management – first time requires
reduction by a physician because this
may be associated with a fracture or
labrum tear and or nerve damage..

3-6 weeks immobilization
 recurrent dislocations – individual may be
able to reduce it their self or with aid of
therapist
 strengthening important factor – but
recurrent dislocations usually result in
surgical intervention

First Aid Care
Immediately apply ice, front and back of
gh joint
 If possible put arm in a sling , or support
gh joint with a wrap or shirt ( needs
support)
 Immediate referral to medical centre
 Treat for shock

AC Sprain
aka - shoulder separation
 the AC joint is weak and easily injured with
a direct blow or a fall on the point of the
shoulder and occasional from a fall on the
outstretched arm
 Very Common in sports
 swelling and loss of function are present
depending on the degree off injury

with a 2nd to 3rd degree there may be a
step deformity – in which the clavicle rides
above the scapula
 Localized pain at AC joint with tenderness
 pain with movement through most ranges
– but especially with horizontal adduction
 Rx – PIER – NSAIDS, immobilization if
necessary, ROM exercise and
strengthening

First Aid Care
Immediately apply ice on
top of AC joint
 Support with a sling (and
swath )
 Have athlete rest
 If needed refer to
physician or hospital for
xrays .

Stenoclavicular Sprain
extremely rare, but usually associated
with collision sport or falls directly on
point of shoulder
 point tenderness at the SC joint ,
swelling and pain with horizontal
adduction
 pain with lateral compression of the
shoulders
 Rx – PEIR – immobilization if necessary

Impingement of
Supraspinatus Tendon,
lnfraspinatus Tendon, Long
Head of Biceps Tendon,
and Subacromial Bursa
impingement syndrome is a chronic
condition caused by repetitive overhead
activity that damages tissues in the
shoulder complex
 initially there is pain with activity – usually
only in the impingement position
 as condition gets worse the individual
experiences pain at other times –
progressing to pain at night while
attempting to sleep
 there may be crepitus in certain ROM

Factors Contributing to an
Impingement Syndrome
 Excessive amount of overhead movement
 Limited subacromial space
 Thickness of supraspinatus and biceps
tendon
 Lack of flexibility and strength of
supraspinatus and biceps
 Weakness in post rotator cuff muscles

Hypermobility of the shoulder joint
 Imbalance of muscle strength, and or coordination of movement
 Shape of acromion
 Training devices ( ie hand paddles in
swimming)

Rotator Cuff Tendinitis/Strain
usually result of repetitive microtraumas
 may be from a acute trauma
 muscle balance between int/ext rotators
or tightness
 almost always results in impingement
 must know throwing mechanics motion
(especially when working with sports
involving throwing)

22-5
First Aid Care
Immediately apply ice, compression and
elevate
 Have athlete rest , use a sling if necessary
 If needed refer to medical personnel

Clavicular #'s
because of S shape it is highly susceptible
to compressive forces caused by a blow or
fall on the point of the shoulder
 80 % take place in midclaviclar region
 swelling , ecchymosis and deformity
 Rx involve a figure 8 brace to pull the
shoulder backward and upwards for 4 to 6
weeks

First Aid Care
Treat for shock
 apply ice
 Carefully put into support , a sling wrap or
shirt
 refer to physician or hospital for xrays .

Bicipital Tendon Injuries
common in overhead throwing , or
repetitive overuse during overhead
movements
 irritation of the tendon (esp. long head) as
it passes back and forth in the bicipital
groove of the humerous

the tendon may sublux as well from the
bicipital groove
 pain and tenderness over the bicipital
groove groove (especially with internal and
external rotation), crepitus and weakness
 Rx – PIER , NSAIDS – modalities ..
retraining , stretching and strengthening

Bursitis
usually associated with a rotator cuff
strain or an impingement syndrome
 usually injured is the subacromial bursa
 point tenderness and a painful arc will
exist between 70 and 120 degrees of
passive abduction difficulty sleeping on
effected side
 Rx- PIER – may need cortizone
injection

Burner or Zinger
not really a shoulder injury
 injury to brachial plexus
 usually a result of a stretch and the neck
being forced into hyperextension or
opposite side flexion and the shoulder
forced into horizontal abduction
