Lecture # 13
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Transcript of Lecture # 13
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 Articulations1) 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 co-
ordination 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