U NDERSTANDING A THLETIC - R ELATED I NJURIES TO THE U PPER E XTREMITY Shoulder Injuries David Smith

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Transcript of U NDERSTANDING A THLETIC - R ELATED I NJURIES TO THE U PPER E XTREMITY Shoulder Injuries David Smith

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  • U NDERSTANDING A THLETIC - R ELATED I NJURIES TO THE U PPER E XTREMITY Shoulder Injuries David Smith
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  • A NATOMY OF THE S HOULDER Ball and Socket Joint Great degree of mobility, therefore it is highly susceptible to injury Many sports activities, in particular those that involve repetitive overhead movements place a great deal of stress on the supporting structures Throwers, swimmers, football, serving in tennis or volleyball
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  • M AJOR BONES OF SHOULDER JOINT Humerus Scapula Clavicle Sternum
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  • HUMERUS Head of the humerus articulates with the scapulas shallow glenoid fossa Bicipital groove for biceps tendon. It fits between the greater and lesser tuberosity
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  • SCAPULA Glenoid Cavity Situated laterally on the scapula inferior to the acromion and is relatively shallow The glenoid labrum increases the depth of the articulation
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  • SCAPULA Three prominent projections Spine Divides the posterior scapula unequally Supraspinatus fossa and Infraspinatus fossa Acromion Sits at the lateral tip of the spine of the scapula. Tip of the shoulder Coracoid Process Hooklike Projection arises anteriorly from the scapula. Curves upward, forward, and outward in front of the glenoid fossa
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  • CLAVICLE S- shaped bone Supports the anterior portion of the shoulder Articulates at tip of shoulder with the acromion and at the sternum near throat
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  • CLAVICLE Medial 2/3 bends convexly forward, and the lateral 1/3 is concave The point at which the clavicle changes shape and contour presents a structural weakness Fractures occur at this point (The Middle 1/3)
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  • A NATOMY OF THE S HOULDER CONT Scapula Serves mainly as an articulating surface for the head of the humerus Glenoid Cavity Situated laterally on the scapula inferior to the acromion and is relatively shallow The glenoid labrum increases the depth of the articulation Serves as the site for many muscle attachements
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  • A.Bony Components 1.Clavicle: Collarbone 2.Scapula: Shoulder blade 3.Humerus: Upper arm
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  • A NATOMY OF THE S HOULDER CONT Articulations Sternum and Clavicle Acromion and Clavicle Glenoid cavity and Humerus Scapula and Thoracic cage
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  • A NATOMY OF THE S HOULDER CONT Joints Acromioclavicular Joint (AC) Acromion Process of Scapula and distal end of Clavicle Weak junction
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  • A NATOMY OF THE S HOULDER CONT Glenohumeral Joint (GH Joint) Head of humerus and glenoid fossa Ball and socket, very mobile Very shallow, very susceptible to injury Deepend by the glenoid labrum
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  • A NATOMY OF THE S HOULDER CONT Sternoclavicular Joint (SC Joint) Clavicle articulates with the manubrium of the sterum Allows the clavicle to move up and down, forward and backward, in combination, and in rotation
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  • A NATOMY OF THE S HOULDER CONT Scapulothoracic Joint Not a true joint- movement of the scapula on the wall of thoracic cage is critical to shoulder joint motion Scapular muscles attach the scapula to the axial skeleton is critical to stabilizing the scaupla
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  • F. Major Joints of the Shoulder Region Sternoclavicular joint (SC): Sternum articulates with the clavicle Acromioclavicular joint (AC): Scapulas acromion process and clavicle articulate. Very weak joint
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  • 3. Coracoclavicular Joint (CC): Clavicle and the scapulas coracoid process articulate 4. Glenohumeral joint: ball and socket joint, humerus articulates with the scapulas glenoid cavity. Glenoid labrum deepens the joint so the humerus can move. The joint is surrounded by synovial capsule
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  • Other Anatomy
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  • A NATOMY OF THE S HOULDER CONT Muscles Acting on the Glenohumeral Joint Originating on the scapula and attaching to the humerus Rotator Cuff (Decelerator Muscles) S upraspinatus I nfraspinatus T eres Minor S ubscapularis All responsible for internally and externally rotating the arm, as well as abduction
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  • B. Muscles: see handout for location of rotator cuff muscles Four muscles of the rotator cuff: SITS Supraspinatus: abduction of the arm Infraspinatus: external rotation of the arm Teres Minor: external rotation of the arm Subscapularis: internal rotation of the arm
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  • A NATOMY OF THE S HOULDER CONT Deltoid Abducts, flexes, and extends the shoulder Pectoralis Major and Minor Biceps and Triceps
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  • M AJOR M OVEMENTS OF THE S HOULDER Flexion Extension IR ER Abduction Adduction
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  • P REVENTING S HOULDER I NJURIES Most often caused by: Weakness Postural problems Nature of game (overhead movements)
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  • M USCULAR W EAKNESS AND P OSTURAL P ROBLEMS CAN CAUSE INJURIES Out of sight, out of mind Weakness on posterior side Rotator Cuff (Decelerators)!! Rounded shoulders Tight pectorals and weak posterior muscles Constant use of one muscle Swim, baseball, volleyballetc Balancing out the use Proper techniques
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  • L IGAMENT I NJURIES Sternoclavicular Ligament Sprain (SC) Separation of SC Joint Injured by falling on lateral side of shoulder Hit in sternum with violent force Acromioclavicular Ligament Sprain (AC) Shoulder separation, 1-3 sprain Injured by impact to the top of shoulder or by falling on an outstretched arm Glenohumeral Ligament Sprain (GH) Vulnerable when in abduction and external rotation Dislocation and subluxation
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  • Sprains to Joint-can occur in 3 major joints Sternoclavicular Sprain: Uncommon injury, occurs when the Medial end of clavicle is displaced. A 3rd degree is life threatening due to pressure placed on blood vessels, esophagus, or trachea
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  • G RADES OF AN SC SPRAIN
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  • 2. Acromioclavicular Sprain (separated shoulder): AC joint is extremely vulnerable to sprains. Caused by a direct blow to tip of the shoulder or landing on an outstretched arm or elbow, may also occur with a blow from behind the shoulder
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  • 1 st degree: Minor stretching and tearing, AC has point tenderness
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  • 2 nd degree: Partial tearing, cannot fully abduct arm
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  • 3 rd degree: complete rupture of ligament, dislocation.
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  • A CROMIOCLAVICULAR S EPERATION
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  • AC J OINT S EPARATION
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  • C LINICAL APPEARANCE OF AC S EPARATION
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  • M USCLE AND T ENDON I NJURIES Most caused by overuse Throwing, shooting, or repeating a swim stroke
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  • M USCLE AND T ENDON I NJURIES Rotator Cuff Strain 1- pain with no loss of ROM or stability 2- pain with some loss of ROM and stability 3- pain with partial or complete loss of ROM and stability
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  • M USCLE AND T ENDON I NJURIES CONT Rotator Cuff Strain Occur because of excessive motion beyond the normal range Most often, Supraspinatus Repetitive motions -> result in crepitus and impingement syndrome Rehab- RICE and gentle strengthening and flexibility exercises
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  • M USCLE AND T ENDON I NJURIES CONT Impingement Syndrome Repetitive overhead types of movement freestyle swimmers, throwers, and tennis players Supraspinatus and biceps run through space beneath acromion process Rehab- strengthening posterior muscles, modifying activity, and improving flexibility of pectorals
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  • I MPINGEMENT S YNDROME
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  • Rotator Cuff Impingement Syndrome: Impression of supraspinatus tendon between head of the humerus and the acromion process. Symptoms: Aching and pain when abducting the arm above 90 degrees.
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  • M USCLE AND T ENDON I NJURIES CONT Bicipital Tendonitis Very common Repetitive nature causes irritation of tendon in bicipital groove Rehab- stop repetitive action, immobilization, heat, anti- inflammatory medications
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  • 7. Bicipital Tendonitis: Irritation of the long head of the biceps tendon in the bicipital groove
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  • M USCLE AND T ENDON I NJURIES CONT Biceps tendon rupture Direct blow or severe contractile forces Unable to flex elbow Looks like a golf ball under skin Rehab- ice and immobilization, refer to physician for surgical repair
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  • B ONE I NJURIES Clavicle Fracture At weakest pt- middle 1/3 Immobilization and Ice, physician will set clavicle in place using a harness May need surgery if displaced
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  • Clavicle Fracture: Nearly 80% of all clavicle fractures occur in the middle 1/3 of cl