M O I , S & S , A N D T R E AT M E N T

INJURIES TO THE SHOULDER

FRACTURE OF CLAVICLE

• MOI: direct blow or FOTOSA (falling on the outstretched arm)• S&S: step off

deformity, visible or palpable• Common in

athletes who are still maturing

TREATMENT OF FRACTURED CLAVICLE

• Immobilize in a sling until healing process is complete• Surgery with plates

and pins may be required if the two ends are to far apart to heal properly.

ACROMIOCLAVICULAR JOINT SPRAIN/DISLOCATION

• MOI: FOTOSA, fall on tip of shoulder, direct blow to acromion process• Tear of

acromioclavicular ligament and coracoclavicular ligament

AC JOINT DISLOCATION

• 1st degree acromioclavicular lig. Stretched/torn• 2nd degree – AC lig

torn and coracoclavicular lig stretched/partial torn• 3rd degree – AC and

CC ligaments torn

IMAGE OF FOTOSA

• Humeral head is forced superiorly into glenoid humeral joint

HUMERAL DISLOCATION

• MOI: blow to shoulder when humerus is abducted and externally rotated• Anterior/inferior

dislocation is most common; posterior is rare!

HUMERAL DISLOCATION

• S&S: visual deformity, drop off from deltoid• Tingling down the

arm

SHOULDER DISLOCATION

• The athlete many times will want the shoulder to “hang” in order to release the pain and numbing sensation.

REDUCTION OF DISLOCATION

• Many times the humeral head will self reduce but if not have a PROFESSIONAL reduce the shoulder so as not to impinge blood vessels and nerve routes to the arm!

POTENTIAL NERVE IMPINGEMENT

• Median nerve can be trapped under the humeral head upon reduction

TREATMENT OF SHOULDER DISLOCATIONS

• 9 out of 10 dislocations reoccur• Surgery required

for recurrent subluxations and dislocations

• Immobilize for 3-4 weeks• Rehabilitation to

strengthen the rotator cuff muscles

STERNOCLAVICULAR DISLOCATION

• Tear of sternoclavicular ligament• Treatment:

immobilization with sling

STERNOCLAVICULAR JOINT DISLOCATION

• MOI: direct blow or compression to the shoulder joint – humeral head• S&S: visual

deformity, instability

BICIPITAL TENDONITIS

• Swimmers shoulder• MOI: overuse injury

caused by repetitive movement, lifting or overload• Rest, ice, massage,

stretching• Pain flexion and

supination

IMPINGEMENT SYNDROME

• MOI: overuse injury to the rotator cuff.• supraspinatus

tendon becomes impinged under the acromion process

IMPINGEMENT RANGE OF MOTION

• Pain upon 60-120 degree abduction

TREATMENT OF IMPINGEMENT

• ICE• ULTRASOUND• NSAIDS and REST• CORTISONE

INJECTIONS FOR CHRONIC PAIN

• COMPLICATIONS: frozen shoulder due to scar tissue that forms due to using scapula instead of humerus to move the shoulder joint.

SLAP LESION

• S=superior• L=labral• A=anterior• L=lesion

• Tear of the labrum, cartilage that deepens the socket

SLAP LESION

• A SLAP lesion is a tear that occurs where the biceps tendon meets the labrum

MOI AND S&S OF SLAP LESIONS

• MOI:• FOTOSA• Direct blow• Sudden pull –

lifting overhead• Repetitive use –

throwing, pitching, lifting

• S&S:• Clicking/locking• Pain anterior

shoulder• Pain overhead

activities• Decrease ROM• Increase

subluxation/dislocation

FOUR TYPES OF SLAP LESIONS

• TYPE I – frayed labrum

• TYPE II – biceps tendon and labrum detached from glenoid fossa

• TYPE III – flap of the labrum hangs down into the joint, locking

• TYPE IV – labrum has a tear that extends into bicep tendon

SLAP LESION

• Frayed labrum

TREATMENT OF SLAP LESION

• REST, NSAIDS, PT• Surgery to clean

out debris or remove / stitch torn labrum• MRI with dye to

determine site and length of tear.

FORMER STUDENT INJURIES