Shoulder Injuries

Clavicle FxMOI: FOOSH, Fall on tip of

shoulder, direct contact

S&S: guarding, obvious deformity, swelling, point tenderness

Clavicle FxPlan: refer for x-rays, sling

and swathe, treat for shock, possible surgery

Follow up: immobilize 6-8 weeks

Acromioclavicular SprainMOI: direct contact to tip

of shoulder or FOOSH

Acromioclavicular SprainS&S: Grade 1-point tenderness,

discomfort during movement

Grade 2-partial displacement, acromial end of clavicle sticks up, ttp, unable to fully abduct, AC stress test positive

Acromioclavicular SprainS&S: Grade 3 – complete rupture

of the AC and CC ligaments, displacement, limited abduction

Grade 4 – posterior dislocation of clavicle, point tenderness, limited ROM

Acromioclavicular SprainS&S: Grade 5 – Muscle and

ligament ruptures, gross deformity, severe pain, loss of movement, shoulder instability

Grade 6 – clavicle displaced inferior to the coracoid, rare in sports

Acromioclavicular SprainPlan: 1. Cold and pressure2. Sling and Swathe3. Refer to doctor

GH DislocationsAnterior

Posterior

GH DislocationsExtensive damage to the

shoulder complex occurs.

Anterior DislocationMOI:

• Direct contact to posterior shoulder

• Forced abduction, external rotation, and extension

Anterior DislocationsS&S1. Flattened deltoid contour2. Guarding – slight abduction and external rotation3. Humeral head palpated in the axilla(armpit)4. Unable to touch opposite shoulder5. Moderate pain6. Disability

Posterior GH DislocationMOI:

• Forced adduction and internal rotation

• Fall on extended and internally rotated arm

Posterior GH DislocationsS&S:1. Severe pain and disability2. Guarding – adduction and internal rotation3. Acromion and coracoid stick out4. Head of humerus visible posterior5. Limited external rotation and elevation

GH Dislocation - PlanImmobilizationIceX-ray if first dislocationReduce shoulderIceImmobilization

GH Dislocation - PlanRehab

• Internal and External rotation are IMPORTANT

• Start with isometrics then add resistance

Bracing for play

Impingement SyndromeMOI: repetitive overhead

stressExamples:

• Swimming

• Serving a tennis ball

• Hitting volleyball (spike)

• Throwing (baseball, track, football)

Impingement SyndromeS&S:1. Diffuse pain around acromion2. Pain with overhead activities3. E.R. weaker than I.R.4. Positive impingement tests5. Empty can and drop test increase pain.

Impingement SyndromePlan:1. Restoring normal biomechanics2. Strengthen rotator cuff3. Strengthen core4. Joint Mobilizations5. RICE and e-stim6. Modify activity

Severe ImpingementPlan:Immobilization and

complete rest.Potentially need surgical

intervention

Thoracic Outlet – BasicsCompression of the

brachial plexus, subclavian artery and vein

Thoracic Outlet SyndromeMOI:1. Narrowing between 1st rib and clavicle2. Anterior and middle scalene muscles3. Pectoralis minor compressing4. Presence of a cervical rib

Thoracic Outlet SyndromeS&S:

• Paresthesia

• Pain

• Feeling cold

• Muscle weakness

• Muscle atrophy

• Radial nerve palsy

• Poor circulation in hand

Thoracic Outlet SyndromeSpecial Tests:1. Wright’s Test or Hyperabduction test2. Eden’s Test3. Roo’s Test4. Adson’s Test

Thoracic Outlet SyndromePlan: Correcting the MOI

with stretching & strengthening

1. Stretching• Pectoralis minor

• Scalenes

TOS - Plan

Strengthening• Trapezius

• Rhomboids

• Serratus Anterior

TOS - Plan

Strengthening• Trapezius

• Rhomboids

• Serratus Anterior

Strengthening• Trapezius

• Rhomboids

• Serratus Anterior

Brachial Plexus Neuropraxia

Also called a stinger or burner.

MOI: direct contact or hyper-horizontal abduction

Brachial Plexus Neuroplaxia

S&S:

• Numbness and tingling down through hand

• Pain shooting to hand

• Inability to move hand

• Pain in shoulder

Plan:Have athlete move their

arm.Give them about 15

minutes to recover. If they don’t recover, send to hospital.

Brachial Plexus Neuroplaxia

Biceps Brachii RupturesMOI:Powerful eccentric or

concentric contraction of the muscle

Can rupture at long head or insertion

“Popeye” effect

Biceps Brachii RuptureS&S:

• SNAP

• Sudden, intense pain

• Popeye effect

• Weakness of the biceps

Biceps Brachii RupturePlan:

• Cold

• Sling

• Refer to physician

• Usually surgery