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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