Recognition of Shoulder Injuries

Treatment & Evaluation Standard 17

I WILL…describe the principles of common shoulder injuries, mechanism of injury, special test, and rehabilitation progression.

The mission of the Cane Ridge Academy of Health Management is to provide a solid academic foundation in a nurturing environment that prepares students with the professional skills necessary for post-secondary academics and healthcare related careers.

Boney Anatomy• Humerus

– Humeral head– Greater Tubercle– Lesser Tubercle– Bicipital groove

• Scapula– Acromion– Coracoid Process– Scapular Spine– Inferior Angle

Shoulder Stability/Instability

Glenoid Labrum & 4 Rotator Cuff Muscles give shoulder joint it’s stability

Boney Anatomy• Glenohumeral Joint

– Ball and Socket– Head articulates with

glenoid cavity– Cavity deepened by

Glenoid Labrum– Maintained by labrum,

ligaments, deltoid and RTC

Boney Anatomy• Acromioclavicular Joint

– Gliding articulation– Lateral end of clavicle with

acromion process– Weak Junction– Disc separates the two

articulating surfaces

Boney Anatomy• Sternoclavicular Joint

– Clavicle articulates with the manubrium of sternum

– Only direct connection between UE and Trunk

• Scapulothoracic Joint– Not a true joint,

articulation– Movement of Scapula on

wall of thoracic cage is critical

Soft Tissue Anatomy• Ligaments

– Attach bone to bone• Sternoclavicular joint ligaments

– Anterior: prevents upward displacement of clavicle

– Posterior: prevents upward displacement of clavicle

– Lateral: prevents lateral displacement of clavicle

Soft Tissue Anatomy

• Ligaments– Attach bone to bone

• Acromioclavicular joint ligament– Anterior, posterior, superior

and inferior– Coracoclavicular joint ligament

• Glenohumeral joint ligaments– Superior, middle and inferior– Coracohumeral ligament

Soft Tissue Anatomy• Muscles*

– Rotator Cuff RTC• Supraspinatus• Infraspinatus• Teres Minor• Subscapularis

– IR, ER and ABD

– Biceps Brachii– Deltoid– Pectoralis major– Teres major– Triceps Brachii– Latissimus dorsi

Anterior Anatomy

Posterior Anatomy

Soft Tissue Anatomy• Glenoid Labrum

– Cartilage

Muscle Grade StrainsGrade 1 • Over stretched• Micro tears possible• Mild pain• With or without

swelling• RICE• Rehab

Grade 2• Over stretched• More tears, but not

complete• Pain• Swelling• Point tender• Possible Ecchymosis• Possible decreased ROM• RICE• Refer• Rehab

Grade 3• Most of the fibers torn

if not complete rupture• Pain• Swelling• Point tender• Ecchymosis• Decreased ROM• Refer• Surgery in most cases• Rehab

RTC StrainMOI:• Usually a sudden powerful

movement– Falling on outstretched

hand– A sudden thrust– Following a pitch

• Lifting• Pulling• Repetitive stress

Signs & Symptoms• See previous slide

RTC TendonitisMOI Signs & Symptoms

• Pain can be present during activity and rest

• Pain can radiate down• Pain with lifting and

reaching movements• May lose strength and

motion• ADLs may become difficult

• Caused by overuse– Swim and throwing common

• Overload-walking a dog, dog keeps pulling

Acromioclavicular SprainMOI• Direct impact • Upward force

Signs & Symptoms• 6 grades• Point tender• Deformity possible• Possible ROM deformity• Instability of shoulder• Possible ecchymosis• Possible swelling

Acromioclavicular Sprain

Sternoclavicular Sprain

Concern – Breathing & Blood Flow compromise

Fractured Clavicle

ImpingementMOI• Compression of supraspinatus

tendon, subacromial bursa and long head of biceps tendon

• Overhead activities– Throwing– Swimming– Tennis serve– Spiking

Signs & Symptoms• Diffuse pain around acromion• Point tender over supraspinatus

or biceps tendon• Overhead Increases pain• Achy when done workout• ER weaker than IR

Glenoid Labrum TearMOI• Falling on outstretched arm• Direct blow to shoulder• Sudden pull (lift heavy object)• Throwing or weightlifters can tear

it with repetitive shoulder motion

Signs & Symptoms• Pain• Catching, clicking and/or popping• Night pain – trouble sleeping• Pain with activity• Instability• Decrease strength• Decrease ROM

Biceps TendonitisMOI• Repetitive overuse of biceps

tendon• Throw, swim or swing• Can be acute - fall

Signs & Symptoms• Pain over biceps tendon• Pain with overhead activity• May feel weak

Frozen Shoulder

MOI – shoulder pain that causes the patient to stop utilizing his/her shoulder due to pain.

• Decrease in shoulder ROM• Prominent in older females

• Can not perform overhead activates• Treatment - PT

Winging scapula

MOI – damage to the long thoracic nerve that innervates the serratus anterior muscle (SAM pulls scapula forward)

Prophylactic Bracing

ROM ExercisesTowel Slides- flexion/extensionCodman’s- circular motion- clock & counter clock Wall finger climb - flexionPulley – active/passiveWand assist – prone flexion

StrengtheningIsometric contraction

Theraband-flexion,extension, abduction, IR, ER, SS

Dumbbell

Manual

ProprioceptiveUnstable surface

Positional changes

Shoulder Injury Exit Ticket

1. What is the purpose of the glenoid labrum?2. List the 4 joints of the shoulder complex3. List the four muscles of the RTC4. MOI of Impingement? 5. Define Frozen Shoulder and it’s MOI?6. What 2 structures give the shoulder stability?

Shoulder Do Now…1. Frozen shoulder effects what demographic the most often?2. List 2 ROM exercises.3. List the 5 RTC strengthening movements?4. Define a winging scapula5. Common complaint for a glenoid labrum tear?6. List the three bones the glenoid joint.7. MOI for AC sprain