Shoulder Injuries Anatomy Anatomy 4 rotator cuff muscles

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 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 3 wks; 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