ATHLETIC INJURIES

SHOULDER INJURIES
 SHOULDER INJURIES

• INTRODUCTION
– The shoulder is a multi-axial ball and socket
joint and has a great degree of movement.
– Sport activities, especially those which
involved overhead movement place a great
deal of stress of this joint.
– Shoulder injuries can involve many different
types of injuries including; tendonitis,
impingement syndrome, tears fractures
separations and dislocations.
 SHOULDER INJURIES
• RELEVANT ANATOMY
– Bone
– Ligament
– Muscle (Rotator Cuff)
– Joints
• -Sternoclavicular
• -Acromioclavicular
• -Glenohumeral
• -Scapulothoracic
 SHOULDER INJURIES
– Rotator Cuff Injuries
• Tendinitis, strain, Impingement Syndrome
– Bicipital Tendon
• Tear, tendonitis, subluxing long head
– Acromioclavicular Separations
– Glenohumeral Subluxations/Dislocations
– For each condition, the Mechanism, Signs
and Symptoms, Testing procedures and Care
will be discussed.
THE JOINTS OF THE SHOULDER
STERNOCLAVICULAR SEPATATIONS
STERNOCLAVICULAR SEPATATIONS
BONY LANDMARKS
(ANTERIOR VIEW)
BONY LANDMARKS
(POSTERIOR VIEW)
THE ACROMIOCLAVICULAR
JOINT
THE CORACOACROMIAL ARCH
LABRAL TEARS
 LABRAL TEARS

• Labral tears can be caused by overuse or trauma.

• Two common labral tears are SLAP lesions
(Superior Labrum Anterior-Posterior) or Bankart
lesions.
• SLAP Tears - A SLAP tear is a type of labral tear
most commonly seen in overhead throwing
athletes such as baseball players and tennis
players. The torn labrum seen in a SLAP tear is at
the top of the shoulder socket where the biceps
tendon attaches to the shoulder.
 TYPES OF LABRAL TEARS

• Bankart Lesions - A
Bankart lesion is a labral
tear that occurs when a
shoulder dislocates. When
the shoulder comes out of
joint, the labrum is torn,
and makes the shoulder
more susceptible to future
dislocations.
RANGE OF MOTION AND THE
ROTATOR CUFF MUSCLES
– The rotator cuff or S.I.T.S. muscles play an
important role in helping provide movement and
stability to the glenohumeral joint.
– Movements of the shoulder joint include; flexion,
extension, abduction, adduction, internal and
external rotation, horizintal abduction/and
adduction and circumduction.
– There are also combined movements of
abduction and external rotation and adduction
and internal rotation (both tested with the
Appley’s Scratch Tests).
RANGE OF MOTION
THE APPLEY’S SCRATCH TESTS
Abduction External Rotation Adduction/Internal Rotation
 RANGE OF MOTION
• Pain or limitation
during movement
testing may indicate a
variety of conditions
or injuries including:
– Tendonitis
– Acromioclavicaular
Problems
– A Frozen Shoulder
 RANGE OF MOTION
• In abduction, motion
occurs at the
glenohumeral and
scapulothoracic
articulation at a ratio of
2:1.
• Frozen Shoulder
(Adhesive Capsulitis)
occurs when there is little
glenohumeral movement,
only scapulothoracic.
THE ROTATOR CUFF MUSCLES
– The rotator cuff muscles are the
Supraspinatus, Infraspinatus, Subscapularis
and the Teres Minor.
– The key role of the supraspinatus is the initiation
of abduction, the infraspinatus and teres minor
are external rotators and the subscapularis is an
internal rotator muscle.
– These muscles may develop a tendonitis, a tear,
or in the case of the supraspinatus tendon, an
impingement.
THE ROTATOR CUFF MUSCLES
 THE ROTATOR CUFF MUSCLES
• There are a number of tests designed to test
and isolate the various rotator cuff muscles.
• These include:
– The Codman’s Drop Arm Test (General Test)
– The Empty Can Test (Supraspinatus)
– Tests for External Rotation (Infra/Teres)
– Hornblower’s sign/test (Teres Minor)
– Tests for Internal Rotation (Subscapularis)
– Lift Off Sign (Subscapularis)
TEARS IN THE ROTATOR CUFF
Drop-Arm (Codman’s) Test
THE EMPTY CAN TEST
(Supraspinatus)
THE SUBSCAPULARIS MUSCLE
(Resited Internal Rotation/Lift Off Sign)
EXTERNAL ROTATION
(Infraspinatus/Teres Minor)
HORNBLOWER’S TEST/SIGN
(Teres Minor)
MUSCLE IMBALANCE CONCEPT
 IMPINGEMENT SYNDROME
• Impingement syndrome is a common overuse
condition with overhead sporting activity.
• The etiology involves three structures, the
supraspinatus tendon, the long head of the
biceps and the subdeltoid/subacromial bursa
occupying a confined area under the coraco-
acromial arch.
• With repeated overhead activity, the greater
tuberosity of the humerus impinges and inflames
these structures leading to pain and
inflammation with any overhead activity.
IMPINGEMENT SYNDROME
 IMPINGEMENT SYNDROME
NEER’S TEST HAWKINS KENNEDY
TEST
 THE LONG HEAD OF THE
BICEPS
– The long head of the biceps along with the
rotator cuff function to provide
dynamicstability in the shoulder.
– Because it plays a key role in glenohumeral
stabilization, the bicipital tendon is frequently
involved in shoulder injuries.
– The long head of the biceps may be; develop
a tendonitis, TEAR, or tear the supporting
ligament and sublux out of the bicipital
groove.
LONG HEAD OF BICEPS
SPEED’S TEST FOR A LONG HEAD
BICEPS TENDONITIS
SUBLUXING LONG HEAD OF
BICEPS TENDON
DIFFERENT SHAPES OF THE
BICIPITAL GROOVE
YERGASON’S TEST FOR A
SUBLUXING LONG HEAD
 ACROMIOCLAVICULAR
SEPARATIONS/SPRAINS

– The Acromioclavicular or AC joint is located at the

distal clavicle and articulates with the acromion
process of the scapula.
– This is a weak joint, held together by ligaments and a
joint capsule.
– When there is damage to one or more of these
supporting ligaments the clavicle ‘separates’ or
dislocates, creating a step or piano key deformity.
– Graded as 1 – 3rd (based on number of ligaments torn)
4-6 degrees depending on the position of the clavicle
(Rockwood’s classification).
 ACROMIOCLAVICULAR
SEPARATIONS/SPRAINS
• There is also a fibrocartligeous disk present
which separates the two bones of the acromion
and clavicle.
• The two main supporting ligaments are the
acromioclavicular (AC Ligament) and the
coraco-clavicular ligament, which is made up of
the conoid and trapezoid ligaments.
THE ACROMIOCLAVICULAR
JOINT
ACROMIOCLAVICULAR
SEPARATION
 ACROMIOCLAVICULAR
SEPARATIONS/SPRAINS
• Specific tests for this injury involve
opening or ‘gapping’ the AC joint.
• Orthopaedic tests for this injury
include:
– The Traction test
– The Crossbody, Crossover, Horizontal
Abduction test
– The Shear test
A.C. LIGAMENT TESTS
(Traction Test)
 A.C. LIGAMENT TESTS
(Cross Over, Cross Body, Horizontal Abduction
Test)
THE SHEAR TEST
SHOULDER DISLOCATIONS
– Shoulder dislocations account for up to 50%
of all the dislocations in the body.
– Due to the fact that the shoulder has a great
degree of movement and that it relies on the
surrounding musculature for support, shoulder
dislocations are a common shoulder injury.
– The most common type of dislocation is an
Anterior dislocation.
ANTERIOR GLENOHUMERAL
DISLOCATION
SHOULDER DISLOCATIONS

– An anterior-inferior dislocation may result from

direct impact or a forced abduction and
external rotation.
– With this type of dislocation, the head of the
humerus is forced out of the glenoid fossa
anteriorly and inferiorly.
– There is a high risk of fracture and possible
neurovascular injury.
SULCUS SIGN FROM SHOULDER
INSTABILITY
DISLOCATIONS OF THE
SHOULDER