Transcript Chapter 11
Injuries to the Shoulder Region PE 236 Amber Giacomazzi MS, ATC 1 Anatomy Shoulder bones: – Consist of shoulder girdle (clavicle & scapula) and humerus. Shoulder joints: – ______________ – ______________ – ______________ 2 Anatomy • Joints are held together with ____________ and ____________ that provide stability and allow for limited movement – Shoulder girdle and the GH joint can move in almost every direction • _________ joints are just under the skin and are vulnerable to injury, even in muscular athletes • Major nerves are from a group called the ________________ 3 4 Muscular Anatomy 5 Rotator Cuff •S.I.T.S. muscles ___________ ___________ ___________ ___________ 6 Prevention of Shoulder Injuries • Proper physical conditioning is key • Develop body and specific regions relative to sport • Strengthen through ___________ – Focus on _____________ in all ________ _________ – Be sure to incorporate _____________ muscles • Enhances base of function for glenohumeral joint 7 Throwing Mechanics Instruction in proper throwing mechanics is critical for injury prevention 8 • _______________ – First movement until ball leaves gloved hand – Lead leg strides forward while both shoulders ______, ______________ and _______________ • _______________ – When hands separate and ends at max ER of the humerus – Foot comes in contact with the ground • _______________ – Max _____________ until ball release (humerus adducts, horizontally adducts and internally rotates) – ___________________________________________ 9 • __________________ – Ball release until max shoulder ______________ – Eccentric contraction of ext. rotators to decelerate humerus while rhomboids decelerate scapula • __________________ – End of motion when athlete is in a balanced position 10 Fractured Clavicle Fractures of this bone are the most common fracture in this region – This injury usually results from ____ or direct blows – The adolescent form of this injury is known as a “___________” fracture ____________________________________ ______________ 11 12 Fractured Clavicle Signs and symptoms – – – – Swelling __________ Discoloration Broken bone ends may ________________ Treatment – Treat for shock – Apply __________________ – Apply ________________________ 13 14 AC Joint Injuries Typical mechanism is _____________ to the ______________ or fall _________ __________________ – Severity of injury is graded on the amount of damage to ligaments • 1st degree -- no significant ligament damage • 2nd degree -- partial tearing of ligaments Mild deformity • 3rd degree -- complete rupture gross deformity 15 16 AC Joint Injuries • Signs and symptoms – Mild swelling with point tenderness – __________________ __________________ ____________ – In 3rd degree sprain, a snap or pop may have been sensed along with a visible deformity • *_______________* 17 AC Joint Injuries Treatment – Treat for shock – Apply I.C.E – ____________________ – ____________________ 18 Glenohumeral Joint Injuries GH joint consists of _____________ and the ____________ of scapula – ____________ but inherently _____________ – Typical MOI is having the ___________, ____________, and extended stressing the anterior glenohumeral ligament – Most common type of dislocation is an _________ _________ that may be a subluxation or complete dislocation 19 Glenohumeral Joint Injuries Signs and symptoms – Shoulder joint deformity and down-sloping shoulder contour • “ _____________” – ___________________________ – Humeral head palpable within _______ – Athlete resists efforts to move GH joint In cases involving subluxation: – GH joint may appear normal – ______________________ – ______________________ 20 21 Glenohumeral Joint Injuries Treatment • Treat for shock • Application of ______________________________ _________________ • Apply sling & swathe bandage • Dislocations need to be re-located by ___________ • ______________________________ GH joint injuries tend to be ______ and _____. _______________ may be necessary. 22 Sternoclavicular Joint (SC) Injuries The sternoclavicular joint is formed by the union of the _____________ and the _________ of the ___________ – SC joint is supported by the several ligaments – Injuries are ____ compared to AC or GH joints – Sprains to the SC joint can range in severity Mechanism is external blow to the shoulder resulting in a _______________________; most commonly, the clavicle moving ________ and ___________ 23 24 Sternoclavicular Joint Injuries • Signs and Symptoms – – – – Grade 1-little pain & disability, point tender Grade 2-deformity, swelling inability to abduct shoulder Grade 3-gross displacement “Retro-sternal” dislocation- ______________________ __________________________ • Treatment – Treat for shock – Apply ice and compression – _____________________ 25 Rotator Cuff Strains • Any muscle of the shoulder can suffer a strain. Most common injury is rotator cuff strain • Rotator cuff muscles contribute to GH joint _________ and ______ • Errors in the ________ ________ or ______ can contribute to ______________ 26 27 Rotator Cuff Strains Signs and symptoms • Pain within the shoulder, especially during _______________________________ • Difficulty bringing arm up and back during cocking phase of throw. Pain and stiffness in shoulder region _________________________ ______________________ • Point tenderness around region of the humeral head that seems to be ___________________ 28 Rotator Cuff Strains Treatment – First aid is ______ practical due to chronic nature of condition – I.C.E. – _______________ 29 GH Joint-Related “Impingement” Syndrome Occurs when a _____ or ________ is squeezed between moving structures – The _____________ ________ is most commonly impinged – ____________ or __________________ __________________ 30 GH Joint-Related “Impingement” Syndrome 31 GH Joint-Related “Impingement” Syndrome – __________________ eventually leads to irritation and inflammation of these structures – Athletes in sports that emphasize overhead arm movements have a high risk of this injury • ______________________ ______________________ 32 GH Joint-Related “Impingement” Syndrome Signs and symptoms – Pain deep in shoulder and with abduction & external rotation – ________________ – Pain when arm is ____________________ – ___________________________________ – ________________ 33 GH Joint-Related “Impingement” Syndrome Treatment • • • • Rest ________________________ ________________ In extreme cases, surgery 34 Labral Tear • The labrum is the lip of ______________ located where the shoulder ligaments, which make up the ___________, connect to the edge of the _________ • The tendon of the ______ muscle attaches to the shoulder at the ________________ • How do Labral tears occur? – – – – ______________ A forced movement of our arm or shoulder Using arm to break a fall Repetitive, _________________ such as throwing a ball or serving in tennis – __________ 35 Labral Tear • Signs and Symptoms – Arm and shoulder _____ – Arm and shoulder _________ – Painful overhead movements – ________ or ______ sounds or sensations when moving shoulders • Diagnosis – ____________________ 36 37 Labral Tear • Treatment – Ice – NSAIDs – Shoulder rehabilitation exercises – _________ 38 Shoulder Subluxation/Dislocation • _______________ (___________) – Used for anterior glenohumeral instability – _________________ _________________ 39 Shoulder Subluxation/Dislocation • ________________ _____________ – Performed like the Apprehension Test however the examiners hand is placed over the athletes humeral head – ______________ and _____________ is a positive finding 40 Shoulder Impingement – _______________________________ test for impingement used to assess impingement of soft tissue structures – Positive test is indicated by ________________ 41 Supraspinatus Weakness / Tear • _______________ – 90 degrees of shoulder flexion, internal rotation and 30 degrees of horizontal abduction – Downward pressure is applied – _______________ _______________ _______________ 42 Bicipital Tendonitis • ________________ – Elbow flexed to 90 and stabilized to the thorax. Forearm is pronated – __________________ __________________ __________________ _____________ 43