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Injuries to the Shoulder Region

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Movements of the ShoulderMovements of the Shoulder

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

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Anatomy Review 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 ReviewAnatomy ReviewInjuries 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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LigamentsLigaments

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Muscles of the ShoulderMuscles of the Shoulder

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Posterior MusclesPosterior Muscles

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Major Arteries of the ArmMajor Arteries of the Arm

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Brachial PlexusBrachial 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 PlexusBrachial Plexus

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Fractured ClavicleFractured 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 ClavicleFractured ClavicleSigns/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 ScapulaFractured ScapulaUncommon 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 InjuriesAcromioclavicular Injuries

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

CC ligaments

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Acromioclavicular InjuriesAcromioclavicular 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 InjurySigns/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 InjuryTreatment for a AC Injury

First Aid:Treat for shockI.C.E.Sling & swathe bandageRefer to MD

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Glenohumeral Joint InjuriesGlenohumeral 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 InjuriesGlenohumeral 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 Signs/Symptoms of GHJ InjuryInjury

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 InjuryTreatment of a GHJ Injury

First Aid:Treat for shockPlace rolled towel into the armpitI.C.E.Sling & swathe bandage85%-90% of injuries tend to recur

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Sternoclavicular Joint InjuriesSternoclavicular 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 Signs/Symptoms of Sternoclavicular Joint InjuriesSternoclavicular Joint Injuries

First Aid:Treat for shockI.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 StrainsRotator 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 Signs/Symptoms of Rotator Cuff StrainsCuff 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” GHJ Related “Impingement” SyndromeSyndrome

Occurs when a bursae/ tendon is squeezed between moving structures– supraspinatus is

commonly impinged

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Impingement SyndromeImpingement Syndrome

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

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Signs/Symptoms of Signs/Symptoms of “Impingement Syndrome”“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 SyndromeImpingement Syndrome

First Aid:RestAnti-inflammatory drugsPhysical therapyIn extreme cases, surgery

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Biceps Tendon ProblemsBiceps Tendon Problems

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

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Biceps Tendon ProblemsBiceps 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 Signs/symptoms of Biceps Tendon ProblemsTendon 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 ProblemBiceps 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 Contusions of the Shoulder RegionRegion

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 Contusions of the Shoulder RegionRegion

First Aid:Immediate

application of ICESling & swathe

bandageMedical referral

Signs/symptoms --– history of recent

blow– decreased ROM– muscle spasm– discoloration &

swelling