Shoulder Injuries. Anatomy 4 rotator cuff muscles Subscapularis - internal rotator Supraspinatus -...

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Shoulder Injuries

Transcript of Shoulder Injuries. Anatomy 4 rotator cuff muscles Subscapularis - internal rotator Supraspinatus -...

Shoulder Injuries

Anatomy

Anatomy

4 rotator cuff muscles

• Subscapularis - internal rotator• Supraspinatus - abduction• Infraspinatus - external rotator• Teres minor - external rotator

Recognition and Management of Injuries

• Clavicle Fracture

Cause: fall on outstretched arm, fall on tip of shoulder, direct impact

S&S: supports arm; tilts head toward toward injured side; clavicle appears a little lower, swelling, point tenderness, mild deformity

Care: sling and swath, xray, reduction followed by immobilization 6-8 wks; sling 3-4 wks with

isometric and mobilization exercises

• Humerus fracture

Cause: direct blow, dislocation, impact received by falling on outstretched arm

S&S: may be difficult to recognize, pain, inability to move arm, swelling point tenderness

Care: splint with sling; prevent shock; referral to physician; 2-6 months out of competition

• Acromioclavicular (AC) joint sprain (separated shoulder)

Cause: fall on outstretched arm, direct impact on shoulder

S&S: point tenderness, discomfort, • Grade 1 = no deformity• Grade 2 = definite displacement and prominence of lateral end of

clavicle; ROM,• Grade 3 = gross deformity and prominence of distal clavicle; severe

pain, loss of movement

Care: ice and pressure; immobilization 2-3 wks; referral ; aggressive rehab-joint mobilization,

flexibility and strength exercises

• Glenohumeral dislocations

Cause: • Subluxations:

– excessive translation of the humeral head without complete separation of the joint surfaces

• Anterior glenohumeral dislocation– Forced abduction, external rotation, and extension

• Posterior glenohumeral dislocation– Forced abduction and internal rotation of the

shoulder or a fall on an extended and internally rotated arm

S&S: flattened deltoid contour; pain; obvious deformity

Care: immobilization; reduction; xray; cold packs; muscle reconditioning ASAP; sling for 3wks;

strengthening

• Rotator cuff strains

Cause: usually involves supraspinatus muscle; dynamic rotation of the arm at high velocity; long history of shoulder impingement or instability; tears at insertion of humerus

S&S: diffuse pain around acromion; overhead activities increase pain; point tenderness; loss of strength due to pain; (+) impingement and empty can

Care: RICE;

Progressive Resistive Exercise’s;

decrease activity

• Shoulder bursitis

Cause: trauma or overuse; direct impact

S&S: pain with movement; tenderness to palpation in area just under acromion

Care: ice; NSAIDs; maintaining full ROM

• Biceps brachii ruptures

Cause: performing a powerful concentric or eccentric contraction of the biceps muscle; most commonly occurs near the origin of the muscle

S&S: a resounding snap and feels a sudden intense pain; protruding bulge may appear near the middle of the biceps; weakness with elbow flexion and supination of forearm

Care: ice, sling; referral to MD; surgery

• Bicipital tenosynovitis

Cause: common in overhead activities; repeated stretching of the biceps in highly ballistic activities causing an irritation of the tendon and synovial sheath

S&S: tenderness in anterior upper arm; swelling; warmth; crepitus; pain with overhead activities

Care: rest for several days; ice; NSAIDs; gradual strengthening and stretching of the biceps muscle; rehab

• Shoulder impingement

Cause: mechanical compression of supraspinatus tendon, the subacromial bursa, and long head of biceps tendon; most common in overhead activities

S&S: diffuse pain around the acromion in overhead position; external rotators weaker than internal; tightness in posterior and inferior capsules;

Care: restoring normal biomechanics; RICE;

strengthening rotator cuff muscles and

scapula muscles; modified activity