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بنام خداوند جان وخرد. Injuries to the athletic shoulder. (impingement syndrom ) Dr.H.Saremi Orthopaedic surgeon, Hand & Shoulder fellowship Hamedan university of medical sciences Hamedan,IRAN www.shoulderclinic.ir. Sport injuries. Sport specific injuries Regional Injuries.

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Injuries to the athletic shoulder

Injuries to the athletic shoulder

(impingement syndrom)

Dr.H.Saremi

Orthopaedic surgeon, Hand & Shoulder fellowship

Hamedan university of medical sciences

Hamedan,IRAN

www.shoulderclinic.ir


Sport injuries

Sport injuries

  • Sport specific injuries

  • Regional Injuries


Injuries to the athletic shoulder1

Injuries to the athletic shoulder

  • Instability

  • Impingement and rotator cuff problems

  • Biceps labral complex injuries

  • Ac joint injuries

  • S.c joint injuries

  • Fractures

  • Neurovascular injuries


Impingement syndrom

Impingement syndrom

The term impingement syndrome was fi rst used byNeerin 1972 to describe a condition of shoulder

pain associated with chronic bursitis and partial

tearing of the rotator cuff. Impingement comes fromaLatin root impingo, which means to strike

against.


Impingement and rotator cuff problems

Impingement and rotator cuff problems

Subacromial impingement is one of the most common couse s of shoulder pain in athletes


Rotator cuff

Rotator cuff


Impingement

Impingement

  • Outlet impingement

  • Non outlet impingement

  • An unstable head that subluxes anteriorly due ro capsular laxity may displace upward against the acromion

  • Stabilize the shoulder

  • Secondary impingement is the most common type of impingement in young athletes


Bigliani classification

Bigliani classification


Sign symtoms

Sign &symtoms

Pain with overhead activities,and internal rotation

Partial cuff tear symptoms


Painful arc sign positive howkin s sign and neer sign

Painful arc signPositive howkins sign and neer sign


Impingement syndrom1

Impingement syndrom


Cuff arthropathy

Cuff arthropathy


Impingement syndrom2

Impingement syndrom

  • Non operative treatment

  • Operative treatment(arthroscopic)


Non operative treatment

Non operative treatment

  • Physio therapy

  • NASAID

  • Corticoid injection


Non operative treatment1

Non operative Treatment

  • STEP 1 :Avoid repeated injury

  • Work

  • Sport


Non operative treatment2

Non operative treatment

  • STEP 2: Restore normal flexibility

  • Stretch out all the direction of tightnessspecially posterior

  • Most effective by the patient

  • Gentle stretched five times a day by patient

  • To the point of pull of tightness not to the point of pain

  • Each stretche for 1 min----30 min a day

  • Obvious improvement---1 m may be 3 m full recovery


Non operative treatment3

Non operative treatment

  • STEP 3: Restore normal strenth

  • When near normal passive flexibility of the shoulder is restored

  • Internal and external strentheningexcersiseswith the arm at the side

  • By the patient


Non operative treatment4

Non operative treatment

  • Deltoid strengthing is added when it can be performed comfortably


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  • Scapular motors


Non operative treatment5

Non operative treatment

  • STEP 4:Perform aerobic exercise

  • To get back in shape and improve the sense of well being

  • 5 days a week,sweaty ex 30 min


Non operative treatment6

Non operative treatment

  • STEP5: Modify work or sport

  • Reviewe the technique of sport

  • Modifiy the job


Operative treatment

Operative treatment

  • Sub acromial decompression

  • Rotator cuff repair


Internal glenoid impingement

Internal Glenoid impingement


Subcoracoid impingement

Subcoracoid impingement


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longitudinal tear and fraying of subscapularis tendon due to subcoracoid impingement


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