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Injuries to the Shoulder

Injuries to the Shoulder. Anatomy of the Shoulder. Bones of shoulder complex: clavicle (collar bone) scapula (shoulder blade) humerus Provide points of connection between upper extremities and axial skeleton. Articulations of the Shoulder. Sternoclavicular (SC) joint

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Injuries to the Shoulder

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  1. Injuries to the Shoulder

  2. Anatomy of the Shoulder • Bones of shoulder complex: • clavicle (collar bone) • scapula (shoulder blade) • humerus Provide points of connection between upper extremities and axial skeleton

  3. Articulations of the Shoulder • Sternoclavicular (SC) joint • Articulation between the sternum and clavicle • Acromioclavicular (AC) joint • Articulation between clavicle and acromium process • Glenohumeral joint • Articulation between head of humerus and scapula (ball and socket joint)

  4. Flexion Extension Abduction Adduction External rotation Internal rotation Horizontal abduction Horizontal adduction Circumduction ROM of Shoulder Joint

  5. Muscles of the Shoulder Joint • Deltoid • Teres Major • Rotator Cuffs • Supraspinatus • Infraspinatus • Teres minor • Subscapularis

  6. Rotator Cuff Tear

  7. Biceps brachii Brachialis Triceps brachii Attaches humerus to shoulder girdle Trapezius Rhomboids Serratus anterior Pectoralis Major Attaches shoulder girdle to trunk of body Main Muscles of Upper Arm

  8. Arteries Subclavian Axillary Brachial Radial & Ulnar Veins Radial & Ulnar Brachial Axillary Subclavian Major Arteries and Veins of Arm

  9. Major Nerves of the Arm • Brachial Plexus • Axillary • Musculocutaneous • Radial - extensors • Medial - flexors • Ulnar – flexors Nerve damage results in numbness, pain, and/or tingling

  10. Injuries to the Shoulder • Fractures • Usually clavicle or head of humerus Mechanism of Injury 1. direct blow 2. falling on outstretched hand 3. landing on acromiom process Symptoms • pain, swelling, deformity • hanging arm to side • and unable to lift arm

  11. Fractures Special Tests • Percussion Test • Lightly tap distal aspect of involved arm • Compression Test • Compress area above and below injured site • Be careful not to place hands on injured area

  12. Immediate Treatment • Place in sling or splint • Ice only if will not increase pain • Send to physician or call EMS

  13. Injuries to the Shoulder • Dislocation / Subluxations • Dislocation = head of humerus displaced • Subluxation = partial dislocation Mechanism of Injury 1. Falling on outstretched arm (Anterior) 2. Arm in 90° flexion forced back (Posterior) Symptoms • Pain • Loss of strength & ROM • “dead arm” • Slipping sensation

  14. Immediate Treatment • Place in comfortable position • Check for loss of circulation • Immobilize the joint & apply ice • Send to physician ** if loss of circulation is present, call EMS

  15. Injuries to the Shoulder • Contusions Mechanism of Injury • Direct blow Symptoms 1. point tenderness 2. loss of ROM 3. discoloration Immediate Treatment • Ice • Protect

  16. Injuries to the Shoulder • Sprains • Stretching or tearing of ligaments around AC joint, SC joint, and glenohumeral joint capsule Mechanism of Injury • Outstretched arm • Direct blow Symptoms 1. Point tenderness 3. Swelling 2. Weakness 4. Decreased ROM

  17. Special Tests for Glenohumeral Joint Instability • Sulcus • Downward distraction of the humerus to assess multidirectional instability of GH joint • Apprehension • Standing behind the athlete with their arm abducted 90°, grab their wrist and externally rotate the arm. At the sign of apprehension, stop. • Assesses instability of anterior GH joint capsule

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