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 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 3wks;
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
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