Ch. 21 Shoulder Injuries

Impingement SyndromeSpace between

humeral head below and acromion above becomes narrowed

The structures that live in that space becomes impinged ◦ Joint capsule◦ Tendons of rotator

cuff◦ bursa

Impingement SyndromeMost common in

overhead athletesS/S: pain over GH

area, weakness with abduction, decreased IR

Treatment: fix technique, strengthen rotator cuff, taping

Special Tests◦ Hawkins-Kennedy◦ Neer’s

Rotator Cuff TearCan occur in

young and old people

Usually a traumatic injury in young

Partial thickness vs full thickness tears

Common overuse injury in overhead athletes

Rotator Cuff TearPartial tears will

have pain with normal ROM

Complete tears will usually be unable to move the arm normally

Diagnosis with MRISpecial Tests

◦ Drop Arm◦ Empty Can

Biceps TendonitisIrritation of the

tendon in the bicipital groove

Caused by repetitive overhead motion

Treatment: NSAIDs, rest, ice, ultrasound

Biceps Tendon RuptureUsually occurs

with a ‘pop’ during vigorous activity

S/S: bruising, Popeye muscle

Treat conservatively or surgical

Clavicular FractureMost common at

the distal thirdUsually from

contact with equipment, player, or ground

Usually an obvious deformity present

Treatment includes sling, clavicle harness, ice, NSAIDs

Shoulder DislocationMost common is

anteriorOccurs when arm is

abducted and a force causes external rotation

Will notice a flat deltoid

Place in sling and refer to doctor

Usually treated conservatively

Glenoid Labrum InjuriesGlenoid labrum

holds the humeral head in place on the glenoid fossa

Tear occurs with trauma or repetitive stress

Baseball pitchers are susceptible to labral changes

Glenoid Labrum InjuriesS/S: pain,

catching, popping, decrease ROM

Treatment conservatively with rotator cuff strengthening

Surgery to trim off flap

Special Test◦ Clunk Test

Multidirectional InstabilityShoulder slips out

of socket easilyUsually bilateralStrengthening

program should solve problem

Special Test◦ Sulcus Sign◦ Anterior

Apprehension◦ Feagin’s

Acromioclavicular SeparationAC sprain occurs

when athlete falls on tip of shoulder

S/S: pain, decreased ROM, elevation of clavicle

Treat with immobilization, ROM exercises

Brachial Plexus InjuryKnown as a stinger

or burnerBrachial plexus is a

group of nerves that innervate the arm

MOI is head and neck forced to one side therefore stretching the brachial plexus on the other side

Brachial Plexus InjuryS/S: pain from

neck down to the arm, pins and needles sensation, weakness in arm

Can last for several minutes to several hours

Symptoms must resolve before return to play