KIN 257 Prevention and Care of Athletic Injuries
- Slides: 41
KIN 257 – Prevention and Care of Athletic Injuries Shoulder Anatomy, Evaluation and Injuries
Anatomy
Bony Anatomy n Sternum n n Clavicle n n n Sternal (proximal) and acromial (distal) ends Characteristic “s-shape” Humerus n n Manubrium, body, xiphoid process Head, neck, greater/lesser tuberosity, bicipital (intertubercular) groove, deltoid tuberosity Scapula n Vertebral (medial)/axillary (lateral)/superior borders, inferior/superior angles, coracoid/acromion processes, spine, glenoid/supraspinous/infraspinous/subscapular fossas
Bony Anatomy
Bony Anatomy
Articulations n Sternoclavicular (SC) joint n n n Acromioclavicular (AC) joint n n n Distal clavicle and acromion process Superior/inferior AC ligaments, coracoclavicular ligaments Glenohumeral (GH) joint n n Proximal clavicle and sternum Anterior/posterior SC ligaments Head of humerus and glenoid fossa of scapula Joint capsule is primary ligamentous restraint Reinforced by glenoid labrum Scapulothoracic joint n Not a “true” joint, but significant for shoulder ROM
Articulations
Articulations
Muscular Anatomy n Muscles acting on the scapula Rhomboid major/minor n Levator scapulae n Serratus anterior n Pectoralis major/minor n Trapezius n Latissimus dorsi n
Muscular Anatomy n Muscles acting on the humerus n Rotator cuff (SITS) n n n n Supraspinatus, infraspinatus, teres minor, subscapularis Deltoid Pectoralis major Latissimus dorsi Teres major Long head of triceps brachii Biceps brachii (short/long heads) Coracobrachialis
Neurological Anatomy n Brachial plexus from cervical spine n n Nerve roots Associated peripheral nerves
Vascular Anatomy n Subclavian artery becomes axillary artery becomes brachial artery
Evaluation
History n Mechanism of injury (etiology) n n n Direct trauma – contusion, fracture, dislocation Abduction/external rotation – anterior GH dislocation Fall on outstretched arm – dislocations, fracture Fall on tip of shoulder – AC sprain, clavicle fracture, SC sprain Repetitive overhead movements – tendonitis, impingement syndromes, bursitis
History n Location of pain n n Localized to shoulder – general shoulder pathology Radiating pain – neurological involvement n Unusual sounds/sensations n History of previous injury n n Residual weakness from neck/shoulder injury Biomechanical changes from prior injury can result in increased risk of overuse injuries
History n Change in activity n n Acute/gradual onset of symptoms n n Macrotraumatic vs. microtruamatic Characterize pain n n Intensity, duration, frequency, surface change, equipment change Location (point with 1 finger) Dull, sharp, burning, throbbing, etc. Rate on scale (1 -10) What increases or decreases? Treatment, medication, evaluation to date
Inspection/Observation n General posture n n Anterior n n Level of shoulders, clavicle contour, deltoid contour, biceps brachii contour Lateral n n Head position, arm splinted to side, “dead arm”, deformity with dislocations Deltoid, acromion process, humerus position Posterior n Vertebral alignment (scoliosis), level of scapulae, muscle tone
Palpation – Anterior Structures n n n n SC joint Clavicle Acromion AC joint Coracoid process Humeral head Greater tuberosity n n n n Lesser tuberosity Bicipital groove Humeral shaft Pectoralis major Coracobrachialis Deltoid Biceps brachii
Palpation – Posterior Structures n n Spine of scapula Superior angle Inferior angle Rotator cuff n n Subscapularis Supraspinatus Infraspinatus Teres minor n n n n Teres major Rhomboids Levator scapulae Trapezius Latissimus dorsi Posterior deltoid Triceps brachii
Special Tests n ROM n n n Active – patient/athlete moves joint Passive – clinician moves joint, evaluates end feel Resistive – proximal stabilization and distal application of resistance (“break” test vs. resistance through ROM) n Neurovascular n Stress tests
Range of Motion n Flexion (~180 degrees) n n Extension (~60 degrees) n n Posterior deltoid, latissimus dorsi, teres major, triceps brachii (long head) Abduction (~180 degrees) n n Biceps brachii, coracobrachialis, anterior and middle deltoid, pectoralis major (clavicular head) Deltoid, supraspinatus, biceps brachii Adduction (~45 degrees) n Pectoralis major, latissimus dorsi, teres major, coracobrachialis, triceps brachii
Range of Motion n Internal rotation (~70 -80 degrees at 90/90) n n External rotation (~80 -90 degrees at 90/90) n n Infraspinatus, teres minor, supraspinatus, posterior deltoid Horizontal abduction (~45 degrees at 90) n n Subscapularis, pectoralis major, latissimus dorsi, teres major, anterior deltoid Posterior deltoid, infraspinatus, teres minor Horizontal adduction (~120 degrees at 90) n Pectoralis major, anterior deltoid
Range of Motion n Scapular protraction n n Scapular retraction n n Lower trapezius, pectoralis minor, subclavius Scapular downward rotation n n Upper trapezius, levator scapulae, rhomboids Scapular depression n n Trapezius, rhomboids, levator scapulae Scapular elevation n n Serratus anterior, pectoralis minor Rhomboids, pectoralis minor Scapular upward rotation n Trapezius, serratus anterior
Neurovascular n Neurological evalation n n Nerve root level and peripheral nerve sensory and motor distributions Vascular evaluation n n Skin temperature/color Capillary refill Radial pulse Brachial pulse Axillary pulse
Stress Tests n Anterior/posterior translation – SC joint n “Piano key” test – AC joint n Apprehension test – GH joint (anterior) n Relocation test – GH joint (anterior) n Anterior/posterior glide tests – GH joint n Sulcus test – GH joint (inferior)
Stress Tests n Neer test – rotator cuff impingement n Hawkins-Kennedy test – rotator cuff impingement n Yergason’s test – biceps tendon instability n Speed’s test – biceps tendon irritation n Empty can test – supraspinatus impingement n Drop arm test – rotator cuff tear
Injuries
Injuries n SC joint injuries n AC joint injuries n GH joint injuries n Rotator cuff injuries n Biceps tendon injuries n Fractures
SC Joint Injuries n n Most common direction of displacement is anterior Significant potential concerns if posterior
SC Joint Injuries
AC Joint Injuries n n n Horizontal stability from superior/inferior AC ligaments Vertical stability from coracoclavicular ligaments If “step-off” is present, indicates complete tear of AC ligaments and at least partial tear of coracoclavicular ligaments
AC Joint Injuries
GH Joint Injuries n n n Anterior much more common than posterior If occurs before age 30, >90% chance of recurrence – surgery If after age 30 – choose between surgery/rehab
Rotator Cuff Injuries n Impingement syndromes n n Tendinopathy n n “Pinching” of tendons under acromion process Poor blood supply, “wrung out” with rotation Rotator cuff tears n Usually from cumulative effects
Rotator Cuff Tendinopathy
Rotator Cuff Tear
Biceps Tendon Injuries n Tendinopathy n n Secondary to biomechanical issues and/or repetitive overuse movements Biceps tendon rupture n n Can occur to long head from glenoid rim, short head from coracoid process or distal tendon from radius at elbow Typically has resultant deformity
Biceps Tendon Rupture
Fractures n Scapula n n n Clavicle n n Rarely suffers bony injury If so, processes most common site Commonly fractured in middle 1/3 Humerus n n Head often injured with GH dislocations Shaft rarely injured unless severe forces
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