Shoulder Injuries By Taelar Shelton, MS, ATC, AT/L

Review •Internal vs external rotation•Abduction vs adduction •MOI•S&S•Rx•FOOSH

Contusions • MOI: Blows to the

shoulder• S&S: discoloration, pain

and restricted movement• Treatment: RICE,

protection with padding

Shoulder Pointer• MOI: Blow to the lateral

shoulder• S&S: tender on lateral

clavicle (bone bruise), similar to A/C sprain, severe discomfort, limited ROM

• Rx: RICE, shoulder sling or ace wrap

Sternoclavicular (S/C) Sprains • MOI: twisting an elevated

arm, indirect force, blow that hits poorly padded clavicle

• S&S: usually a deformity from the dislocation, point tenderness, pain, swelling, discoloration, decreased ROM

• Can be serious if dislocated inferiorly

• Rx: reduced clavicle dislocation by physician, immobilize, gradual rehab program

Acromioclavicular (A/C) sprain • MOI: fall on tip of shoulder,

blow to posterior shoulder or FOOSH

• S&S: obvious deformity (depends on severity), point tenderness, pain, loss of movement, instability

• Rx: ice, sling, referral

• Grade 3 A/C sprain “sepparation” involves the A/C ligament and the coroclavicular ligaments

Glenohumeral joint sprain • MOI: (Anterior) arm

forced upward and rotated • S&S: pain, decrease in

ROM, tender to palpation, pain when MOI is reproduced

• Rx: Rest, ice, compression and sling; rehab program

Subluxations and Dislocations Subluxation Dislocation • Head of the humerus is

displaced and reduces on its own

• Head of the humerus is displaced and doesn’t return to normal position without reduction

Dislocation • Anterior- External

rotation, forced abduction • Inferior- violent pull

inferiorly • Posterior- FOOSH,

internal roation

Anterior Dislocation (most common)• MOI: external rotation and

forced abduction • S&S: flat deltoid

appearance, pain, axillary pain and deformity, holding the involved arm, disability

• Rx: first time dislocations can be associated with a fracture, refer and immobilize

Labral Tears • MOI: Compression of the

head of the humerus from excessive rotation

• S&S: click or pop sound when moving the shoulder, pain with internal and external roation

• Rx: referral to physician, imaging, sling, surgery or conservative rehab

Chronic recurrent instabilities •Macrotraumatic- one or more traumatic

situations •Atraumatic- volunatry displaces shouder

joint•Microtraumatic-faulty biomechanics

leading to tissue laxity (repeativite use)•Recurrent- continual stretching of

ligaments, capsule and muscles

Rotator Cuff Impingement • MOI: over use or disuse,

inflammation of the tendon takes up too much space

• S&S: joint pain during and after activity

• Rx: warm up before activity, rehab exercises, ice therapy, work on techniques; rest

Rotator Cuff Strains: “SITS” muscles• MOI: violent pull to the

arm, abnormal or excessive rotation, FOOSH

• S&S: Swelling, point tenderness, pain, loss of function

• Rx: rehab (conservative approach), proper instruction on form, strengthening and ice; surgery

Clavicle Fx• MOI: FOOSH or direct

blow• S&S: usually the middle

1/3, deformity, tenderness and pain

• Rx: sling, ice and x-ray

Humeral Fracture• MOI: direct blow to arm or

FOOSH• S&S: jagged edges of

fractured bone can cause radial nerve damage

• Rx: splint, treat for shock, referral to MD, usually takes 3-4 months to recover

Upper Humeral Fx• MOI: direct blow, FOOSH

or dislocation• S&S: pain, inability to

move, point tenderness, discoloration

• Rx: sling, referral to MD

Epiphyseal Fx• MOI: common in youth

athletes (10 years or younger) from an indirect force

Bursitis • MOI: trauma or overuse

leads to inflmmation of the bursa

• S&S: pain around the bursa, can lead to impingement

• Rx: Rest, heat after the inflammatory response is over, range of motion exercises, ice after activity and during inflammatory response

Thoracic Outlet SyndromeMOI: Compression over cervicle

rib, muscle spasm, compression of major blood vessels and nerves between rib and clavicle, compression beneath corocoid process

S&S: numbness, cold feeling, poor cirulation, muscle weakness, muscle atrophy, nerve palsy

Rx: conservative approach in 50-80% of cases

-sling-NSAID’s-Strengthening and postural

correction

Myositis Ossificans • MOI: contussion that did

not get treated properly• S&S: swelling and

irritation that lasts for 2-3 weeks

• Rx: get an MRI or xray (tricpes to the right)

Bicipital Tenosynovitis • MOI: repetitive internal

roation irritates the synovial sheath of the biceps, can sprain the transverse ligament

• S&S: ache on the anterior aspect or the lateral side of the shoulder, tenderness on the biceps tendon, inflammation, “pop” of the tendon on the bone

• Rx: rest and ice, gradual reconditioning program

Biceps Rupture • MOI: Over stretching or a

powerful movement• S&S: Snap, intense pain,

prodruding bluge in the middle of the biceps, muscle weakness

• Rx: sling and refer = surgical repair