Lesson 1 SHOULDER INJURIES Anatomy of the Shoulder

  • Slides: 32
Download presentation
Lesson #1 SHOULDER INJURIES Anatomy of the Shoulder Ball-and-Socket joint, but much shallower than

Lesson #1 SHOULDER INJURIES Anatomy of the Shoulder Ball-and-Socket joint, but much shallower than the hip. Relies on muscular strength for stability Involves several bones thus has movement across a wide range of motion. Often referred to as the shoulder girdle. 3 major components, bones, muscles, and joints.

ANATOMY OF THE SHOULDER 1. Bones: 3 basic bones, humerus, clavicle, and scapula, which

ANATOMY OF THE SHOULDER 1. Bones: 3 basic bones, humerus, clavicle, and scapula, which are all held together by ligaments. - Head of the humerus fits into the glenoid fossa of the scapula. - The bicipital groove (on top of humerus) is where the bicep tendon moves up and down during flexion and extension. - Clavicle (collarbone) articulates at the top of the shoulder and at the sternum. - Scapula (shoulder blade) has two forward projections located on the anterior aspect, acromion process and the coracoid process. Rotator cuff muscles attach to the scapula.

ANATOMY OF THE SHOULDER 2. Muscles: Rotator cuff consists of 4 muscles - SITS

ANATOMY OF THE SHOULDER 2. Muscles: Rotator cuff consists of 4 muscles - SITS (subscapularis, infraspinatus, teresminor, and the supraspinatus. (pg. 102) - Responsible for rotating the arm internally and externally, and abducting the shoulder. - Deltoid muscles lies over head of humerus. Attaches to acromion process and abducts, flexes and extends the shoulder. - Pectoralis muscles attach at the sternum and humerus. - Bicep muscle flexes the elbow and attaches to humerus and coracoid process. Bicep tendon runs through the bibipital groove. - Tricep muscle oppose the biceps. Attaches to the humerus and scapula.

ANATOMY OF THE SHOULDER 3. Joints: Several joints involved, but the most commonly injured

ANATOMY OF THE SHOULDER 3. Joints: Several joints involved, but the most commonly injured include the acromioclavicular and glenohumeral. - ACROMIOCLAVICULAR JOINT: includes the acromion process of the scapula and distal end of the clavicle. Held together by the acromioclavicular ligament. - GLENOHUMERAL JOINT: is the articulation of the head of the humerus and scapula. Very shallow, making it easy to injure. - A capsular ligament surrounds the glenohumeral joint giving it stability. Very easy to injure.

SHOULDER INJURIES Preventing Shoulder Injuries Shoulder injuries are often caused by: - muscular weakness

SHOULDER INJURIES Preventing Shoulder Injuries Shoulder injuries are often caused by: - muscular weakness - postural problems - the sport itself

SHOULDER INJURIES Preventing Shoulder Injuries ADDRESSING MUSCULAR WEAKNESS - Out of Sight , Out

SHOULDER INJURIES Preventing Shoulder Injuries ADDRESSING MUSCULAR WEAKNESS - Out of Sight , Out of Mind: refers to weight training that athletes do everyday. Often they only work the muscles they can see in the mirror, or can flex easily because of their size and proportion. As a result, the athlete can develop poor muscle symmetry leading to injury. (pg. 103) - Bench press and rounded shoulders. Leg Squats and weak hamstrings. Bicep curls and poor stability in the triceps. Anterior shoulder press and poor posterior strength.

TREATING SHOULDER INJURIES Ligament Injuries: – Acromioclavicular Ligament Sprain – Referred to as a

TREATING SHOULDER INJURIES Ligament Injuries: – Acromioclavicular Ligament Sprain – Referred to as a shoulder separation. Can be injured by impact to the top of the shoulder or by falling on an outstretched arm. Falling on the elbow forces the humerus up and into the acromioclavicular joint. Pain with movement, in a 3 rd degree sprain there will be a large abnormal bump caused by excessive displacement of the clavicle. Use the PRICE method to treat. Refer to a Doctor will use surgery or a harness. – Glenohumeral Ligament Sprain Vulnerable to sprains when the joint is placed in abduction and external rotation. Have pain and discomfort. Treat with PRICE.

3 rd Degree Shoulder Separation

3 rd Degree Shoulder Separation

TREATING SHOULDER INJURIES Muscle and Tendon Injuries: – Rotator Cuff Strain – Always 1

TREATING SHOULDER INJURIES Muscle and Tendon Injuries: – Rotator Cuff Strain – Always 1 st, 2 nd, or 3 rd degree strains. Occur from excessive motion beyond the normal range. Most often injury occurs to the supraspinatus. Pain in motion and when the shoulder is not moving. Pain generally occurs during abduction, if unable to abduct it means a complete tear is suspected. Repetitive movement. A complete tear must be surgically repaired. PRICE. – Impingement Syndrome – Developed from repetitive overhead types of movement. Tennis, throwers, ect. The supraspinatus and biceps muscles run through a space beneath the acromion process, if the space narrows from swelling, the two muscles become impinged. Treat with modified activity, strengthening.

TREATING SHOULDER INJURIES Muscle and Tendon Injuries: – Bicipital Tendinitis Repetitive movement causes an

TREATING SHOULDER INJURIES Muscle and Tendon Injuries: – Bicipital Tendinitis Repetitive movement causes an irritation of the tendon in the bicipital groove. AT will be able to palpate and feel crepitus. Pain is common. Immobilization is sometimes necessary, ultrasound or anti-inflammatory medications. – Biceps Tendon Rupture – Two instances, a direct blow or severe contractional forces. When the tendon ruptures, the athlete will not be able to flex the elbow. You will notice a change in the muscle as the tendon rolls up the arm, looking like a golf ball under the skin. Surgery is needed to repair.

TREATING SHOULDER INJURIES Bone Injuries: – Clavicular Fractures Most often fractured at it’s weakest

TREATING SHOULDER INJURIES Bone Injuries: – Clavicular Fractures Most often fractured at it’s weakest point, the distal third. Occurs from falls or direct blows. Arm must be restricted. Use PRICE. Takes generally 6 weeks to heal. – Humeral Fractures – Shoulder musculature sometimes hides a fracture. Athlete will be unable to move the arm, report hearing a pop. Palpate the circumference of the bone, if there is pain on all sides, it is fractured. Always placed in a splint, sometimes surgery. 6 weeks to heal.

TREATING SHOULDER INJURIES Bone Injuries: – Epiphysis Injury Growth plate in the shoulder is

TREATING SHOULDER INJURIES Bone Injuries: – Epiphysis Injury Growth plate in the shoulder is easily injured with direct blows. Falling on the elbow can cause this. Pain, inability to use the arm, feeling a pop. Use PRICE, immobilize, sometimes surgery. – Avulsion Fracture – Occurs when the ligament or tendon pulls away a small portion of the bone. Almost impossible for the AT to diagnose, send to a physician. PRICE. – Glenohumeral Dislocations & Subluxations – Head of the humerus is out of it’s socket, then went back in. Excessive abduction and external rotation. Can cause permanent damage to nerves and muscles. Pg. 107

Lesson 5 ELBOW INJURIES ANATOMY OF THE ELBOW - The elbow is a hinge

Lesson 5 ELBOW INJURIES ANATOMY OF THE ELBOW - The elbow is a hinge joint involving 3 major bones: humerus, radius, and ulna. - Radius and ulna are bones between the wrist and elbow - Distal end if the humerus becomes wider and forms the medial and lateral epicondyles. - Ulna is hooked to the end of the humerus and forms a tight joint. - Radius is the bone on the thumb side. - Radius allows the forearm to rotate.

ELBOW INJURIES ANATOMY OF THE ELBOW 1. Ligaments: joint capsule surrounds the elbow. Gives

ELBOW INJURIES ANATOMY OF THE ELBOW 1. Ligaments: joint capsule surrounds the elbow. Gives the elbow stability and protection. Ulnar Collateral, radial collateral, and annular ligament also give stability. Ulnar Collateral – stabilizes the inside and medial aspect of the elbow. Radial Collateral – stabilizes the outside and lateral aspect. These ligaments often referred to as the medial and lateral collateral ligaments. Annular ligament holds the radius and ulna together near the elbow joint.

ELBOW INJURIES ANATOMY OF THE ELBOW 2. Muscles: As previously stated. Several nerves and

ELBOW INJURIES ANATOMY OF THE ELBOW 2. Muscles: As previously stated. Several nerves and blood vessels pass through small grooves around the elbow en route to the lower arm. Any injury to the elbow must be assessed for nerve and blood vessel damage. Check for a pulse. Numb hands. Funny Bone – actually a direct blow to the Olecranon process. Nerves are damaged.

PREVENTING ELBOW INJURIES Not a frequently injured joint. Most injuries are caused by overuse

PREVENTING ELBOW INJURIES Not a frequently injured joint. Most injuries are caused by overuse and not direct blows. Breakdown of tissue causing inflammation and pain. ( Bursitis “itis” injuries) Work with coaches to detect training aspects: 1. Equipment problems (small grips on racquets) 2. Technique Problems (throwing and arm swings) 3. Develop proper Conditioning programs.

Lesson 7 1. TREATING ELBOW INJURIES Ligament Injuries: Sprains are classified as 1 st,

Lesson 7 1. TREATING ELBOW INJURIES Ligament Injuries: Sprains are classified as 1 st, 2 nd, or 3 rd. Any ligament can be sprained. A. Ulnar Collateral Ligament Sprain – More prone to sprains because of the amount of stress placed on the inner elbow during throwing and swinging. Repetitive trauma causes injury to occur. A direct blow may cause a sprain (wrestling) B. Valgus Stress – medial part of the joint separates apart as the forearm moves laterally. Characterized by swelling and elbow pain. Joint laxity may also be present. Treat a sprain using PRICE. C. Radial Collateral Ligament Sprain – very rare. Same as the ulna collateral except pain is on the lateral aspect.

TREATING ELBOW INJURIES 2. Muscle and Tendon Injuries: Strains are classified as 1 st,

TREATING ELBOW INJURIES 2. Muscle and Tendon Injuries: Strains are classified as 1 st, 2 nd, or 3 rd. Caused by excessive force or overuse. A. Elbow Flexor Strain: often caused by a loaded movement that includes the elbow and the shoulder. Two-joint muscles are prone to strains. Will have small amounts of swelling and be weaker. B. Elbow Extensor Strain: caused by excessive resistance to the triceps muscle such as trying to break a fall with an outstretched arm. More pain than flexor strains. Treat with PRICE.

TREATING ELBOW INJURIES C. Wrist Flexor Strains: caused by excessive resistance during wrist flexion

TREATING ELBOW INJURIES C. Wrist Flexor Strains: caused by excessive resistance during wrist flexion movements and overuse. Treat with PRICE and stretching. D. Wrist Extensor Strains: caused by excessive resistance during wrist extension movements and overuse. Treat with PRICE and stretching.

TREATING ELBOW INJURIES E. Medial and Lateral Epicondylitis: Chronic inflammation which occurs at the

TREATING ELBOW INJURIES E. Medial and Lateral Epicondylitis: Chronic inflammation which occurs at the medial and lateral epicondyles. Wrist extensors become inflamed. Also called Tennis Elbow. Lateral epicondylitis is most common. Characterized by pain over the lateral epicondyle. Treat with PRICE. Medial epicondylitis is also called Little League Elbow is also suggested to be a separation of the epiphysis at the medial aspect of the humerus. (ages 9 -12)

TREATING ELBOW INJURIES 3. Bone Injuries: Fractures to the distal end of the humerus

TREATING ELBOW INJURIES 3. Bone Injuries: Fractures to the distal end of the humerus are not common in athletics. Must be a very powerful mechanism for injury to occur. If direct impact is the mechanism and there is pain located at the medial aspect of the elbow two inches above the joint, suspect a fracture. If an ATC suspects this it is an absolute emergency because these fractures can damage arteries and nerves.

TREATING ELBOW INJURIES Epiphyseal and Avulsion Fractures – more common on the medial epicondyle

TREATING ELBOW INJURIES Epiphyseal and Avulsion Fractures – more common on the medial epicondyle or olecranon aspect of the elbow. Epiphyseal injury must be suspected when an athlete presents swelling and loss of movement. Ulna Dislocation – The elbow is one of the most commonly dislocated joints in the body. Very tight joint, therefore it takes a violent trauma to dislocate it. A violent hyperextension or severe blow to the lateral aspect will dislodge the ulna from the humerus. Sling immediately, then see a physician.

TREATING ELBOW INJURIES OTHER COMMON INJURIES – ATHLETES will often fall on an outstretched

TREATING ELBOW INJURIES OTHER COMMON INJURIES – ATHLETES will often fall on an outstretched arm or receive a blow that causes the elbow to be hyper-extended. This can result in one of three problems: sprain the ligament at the anterior aspect of the elbow, strain the musculature at the anterior aspect of the elbow, receive a painful bony compression if the olecranon process impacts the humerus. Initially they are ALL treated with PRICE, then for more severe you refer to a physician. 1. 2. 3. Olecranon Bursitis – when there is bruising on the olecranon bursa causing it to become irritated and build up fluid at the tip. If the fluid does not dissipate, it must be drained by a physician.

Lesson 8 WRIST AND HAND INJURIES ANATOMY OF WRIST AND HAND - The wrist

Lesson 8 WRIST AND HAND INJURIES ANATOMY OF WRIST AND HAND - The wrist and hand contain many blood vessels, bones, muscles, ligaments, and nerves all necessary for total functioning of the hand. - If one part is injured, it will decrease an athletes functional ability. - It is the most active body part.

WRIST AND HAND INJURIES 1. Bones and Joints - Wrist is the joint between

WRIST AND HAND INJURIES 1. Bones and Joints - Wrist is the joint between the arm and the hand. It is made up of 7 irregularly shaped carpal bones that articulate between the radius and the ulna of the arm and the metacarpals of the hand to allow movement. - Scaphoid bone is very important because it has a blood supply on one end, and therefore has difficulty healing when fractured. - When the fingers are spread, the Scaphoid sits at the depression in the wrist. - Referred to as “Anatomical Snuff Box”

WRIST AND HAND INJURIES 2. Muscles - Wrist and hand movements are controlled by

WRIST AND HAND INJURIES 2. Muscles - Wrist and hand movements are controlled by many muscles. - Extensor group ( posterior aspect of the forearm) - Flexor group (anterior aspect of the forearm) 3. Ligaments - Quite intricate because of the many bones that must be connected. A. Ulna Collateral and Radial Collateral - Also called medial and lateral collateral, stabilize the wrist. B. Flexor Retinaculum (Transverse carpal Ligament) - stabilizes carpal bones, but also provides a protective covering over flexor tendons and median nerve that pass beneath it. THUMB Ligaments

WRIST AND HAND INJURIES Preventing Injuries: Commonly used protective equipment include braces, tape, gloves,

WRIST AND HAND INJURIES Preventing Injuries: Commonly used protective equipment include braces, tape, gloves, and padding.

Lesson 9 TREATING WRIST AND HAND INJURIES With one hand, one can manipulate objects

Lesson 9 TREATING WRIST AND HAND INJURIES With one hand, one can manipulate objects and perform feats of astounding complexity. The slightest injury can effect this process. 1. Ligament Injuries - Sprains are not serious and can be treated with PRICE. - Sprains are injured ligaments, pulling on them only causes more injury. A. Wrist Sprains – occur from overuse, falls, and forceful twisting motions. Which ligament is injured depends on the stress. Injury occurs on the opposite side. Excessive Ulnar deviation will cause an injury on the radial side do too stretching. Pain will occur, decreased range of motion, swelling, and loss of grip strength. Use PRICE, and taping when back at their sport.

TREATING WRIST AND HAND INJURIES B. Dislocation of the Lunate – caused by falling

TREATING WRIST AND HAND INJURIES B. Dislocation of the Lunate – caused by falling on the hand with flexion or extension. Causes deformity, pain, swelling, and decreased ROM. Should be splinted. C. Ganglion Cyst – A pocket of fluid within the sheath. Use ice. D. Gamekeeper’s Thumb – An injury to the medial collateral ligament of the thumb. Term is used to describe the farmer who injured his ligament when breaking the necks of birds. Occurs when the thumb is forcefully abducted. (catching a basketball) Treatment involves splinting, ice, and generally an x-ray. E. Finger Sprains and Finger Disclocations – Use ice, always have the team physician relocate dislocated fingers so to prevent further nerve and blood vessel damage.

TREATING WRIST AND HAND INJURIES 2. Muscle and Tendon Injuries - Repetitive stress and

TREATING WRIST AND HAND INJURIES 2. Muscle and Tendon Injuries - Repetitive stress and stretching will cause the muscles to strain. Pain, swelling, weakness, and inability to move are common signs and symptoms. - ATC should use a ROM test to determine which muscles are injured. Analysis of the Athlete’s movements can determine if the injury is from repetitive stress. - Use PRICE and conditioning exercises. A. Tendinitis – inflammation of the tendon. Cause can be overuse, stretching, or impact. ATCs goal is to condition the athlete so this does not occur. De Quervain’s Tendinitis affects the abductor pollicis longus and extensor pollicis brevis of the thumb. Athlete will have difficulty with abduction of the thumb. Treat with PRICE.

TREATING WRIST AND HAND INJURIES B. Mallet Finger – is the result of the

TREATING WRIST AND HAND INJURIES B. Mallet Finger – is the result of the fingertip receiving an impact. The impact causes the extensor tendon to be torn from the bone. (pg. 123) Fingertip will be in flexion and the athlete can not straighten it because the tendon is no longer attached. Splint it and refer to a physician were it will be surgically repaired, or splinted for a period of time. C. Jersey Finger – very similar to Mallet finger but it is the flexor tendon tears from the fingertip. Athlete will not be able to flex the DIP joint. Injury occurs when an athlete grabs an opponents jersey with a fist and the finger is forced to extend tearing the tendon. Same treatment. D. Boutonniere Deformity – occurs at the proximal interphalangeal joint of the finger. (pg. 124) A hard impact over the PIP joint causes a tear in the joint capsule which leads to the extensor tendons falling laterally. Same Treatment with PRICE and physician.

TREATING WRIST AND HAND INJURIES 3. Bone Injuries - Any bone within the wrist

TREATING WRIST AND HAND INJURIES 3. Bone Injuries - Any bone within the wrist and hand can fracture. Swelling, pain, and deformity are all signs and symptoms. - Two complications are nonunion (fracture that does not heal and remains two pieces of bone) and Avascular Necrosis (death due to lack of blood flow) - Scaphoid bone is the most common bone associated with this. - All fractures should be cared for by a physician. FYI – Volar (refers to the palm side of the hand) - Dorsal (refers to the back or posterior portion of the body)