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Ch. 21 Shoulder Injuries
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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
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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
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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
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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
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Biceps TendonitisIrritation of the
tendon in the bicipital groove
Caused by repetitive overhead motion
Treatment: NSAIDs, rest, ice, ultrasound
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Biceps Tendon RuptureUsually occurs
with a ‘pop’ during vigorous activity
S/S: bruising, Popeye muscle
Treat conservatively or surgical
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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
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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
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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
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Glenoid Labrum InjuriesS/S: pain,
catching, popping, decrease ROM
Treatment conservatively with rotator cuff strengthening
Surgery to trim off flap
Special Test◦ Clunk Test
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Multidirectional InstabilityShoulder slips out
of socket easilyUsually bilateralStrengthening
program should solve problem
Special Test◦ Sulcus Sign◦ Anterior
Apprehension◦ Feagin’s
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Acromioclavicular SeparationAC sprain occurs
when athlete falls on tip of shoulder
S/S: pain, decreased ROM, elevation of clavicle
Treat with immobilization, ROM exercises
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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
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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