‫بنام خداوند جان وخرد‬
Injuries to the athletic shoulder
‫ضایعات شانه در ورزشکاران‬
Dr.H.Saremi
Orthopaedic surgeon, Hand & Shoulder fellowship
Hamedan university of medical sciences
Besat Hospital
Sport injuries
• Sport specific injuries
• Regional Injuries
Shoulder
• 4joints
• The least stable joint
Injuries to the athletic shoulder
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Instability
Impingement and rotator cuff problems
Biceps labral complex injuries
Ac joint injuries
S.c joint injuries
Fractures
Neurovascular injuries
Instability
• Unique anatomy for Mobility and Stability
• Sports that stress the static and dynamic
stabilizers beyond their physiological
limit(repeatative overhead maneuvers)
Instability
• Pain
• Feeling that the shoulder is loose
• Painfull giving way associated with dead arm
syndrom
• Dislocation
Instability
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Post traumatic anterior SX or DX
Post traumatic posterior SX or DX
Atraumatic Anterior SX or DX
Atraumatic posterior SX or DX
Multidirectional SX or DX
Instability
• Description of arm position when symptoms
occur
• Is it completely involuntary
Traumatic anterior DX
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98% of shoulder dislocations
Excessive abduction and Ex rotation
Direct blow from the behind
Pain ,decreased ROM ,guarding
An immediate reduction may be attempted on
the playing field,if unsuccessful another attemp
can be made in the locker room
Simple reduction manuvere
Traumatic anterior DX
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Immobilization?
6w(>40 y 7-10 days)
Internal or ex rotation?
Recurrency?
Traumatic anterior DX
• The criteria for returning to sport are
based on a FULL ROM and FULL
strength
Traumatic anterior DX
• If repeated or sustained instability
symptoms and signs ARTHROSCOPIC
REPAIR
LABRAL
DETACHMENT
GLENOID DEFECT
Posterior traumatic sx or dx
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Less common
Direct blow to the anterior shoulder
Direct forces with the arm I flx, Add, int rot
Axillary view is critical
<40y ----4-6w immobilization,>40y---2-3w
Atramatic anterior
shoulder instability
• Sign and symptoms of instability without
significant initial trauma
• Repetitive over head activity
• Thrawers in acceleration phase
• Swimmers during the backsroke or turns
• Pain may be posterior
Atramatic anterior
shoulder instability
• Sling and antiinflamatory medication
• Vigorous physical therapy
• Arthroscopic repair
Atraumatic posterior shoulder
instability
• Unlike posterior dislocation ,is relatively
common
• Athlete usually complain of pain rather than
instability
• Follow through in pitching, pull through
phase in swimming ,serving motions or
backhand in tennis
PH.EX
Atraumatic posterior shoulder
instability
• Sling and antiinflamatory
• Physiotherapy
• Arthroscopic repair
Multidirectional instability
• Instability occurring in more than one
plan(antero inferior,posteroinferior,or three
directions
• May have generalized ligamentous
laxity(beighton hypermobility score)
• Physical therapy
Multidirectional instability
• The athlete may return to activity at a low
level during therapy as long as the specific
activities that couse that symptoms are
avoided
• Therapy should progress until the patient
can return to activities without symptoms
• Arthroscopic repair and capsular shift
A
Impingement and rotator cuff
problems
• Subacromial impingement is one of the
most common couse s of shoulder pain in
athletes
Rotator cuff
DEPRESSION effect
Impingement
• Outlet impingement
• Non outlet impingement
• An unstable head that subluxes anteriorly
due ro capsular laxity may displace upward
against the acromion
• Stabilize the shoulder
• Secondary impingement is the most
common type of impingement in young
athletes
• Stabilize the shoulder
Impingement syndrom
ACROMIO Humeral distance
CUFF ARTHROPATHY
Impingement syndrom
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Painful arc sign
Positive howkin’s sign and jobe test
Non operative treatment
Operative treatment(arthroscopic)
Internal Glenoid impingement
Rotator cuff tear
• Repetitive microtrama ,occasionally single
traumatic event
• Progressive pain and weakness
• Restriction of ROM
• May be an aging process(30-50% cadavr)
• Partial or fullthickness
• Non operative treatment
• operative treatment(arthroscopic)
• Rotator cuff arthropathy
Non operative treatment
• Physio therapy
• NASAID
• Corticoid injection
Non operative Treatment
• STEP 1 :Avoid repeated injury
• Work
• Sport
Non operative treatment
• STEP 2: Restore normal flexibility
• Stretch out all the direction of
tightnessspecially posterior
• Most effective by the patient
• Gentle stretched five times a day by patient
• To the point of pull of tightness not to the
point of pain
• Each stretche for 1 min----30 min a day
• Obvious improvement---1 m may be 3 m
Non operative treatment
• STEP 3: Restore normal strenth
• When near normal passive flexibility of the
shoulder is restored
• Internal and external strenthening
excersiseswith the arm at the side
• By the patient
Non operative treatment
• Deltoid strengthing is added when it can be
performed comfortably
• Scapular motors
Non operative treatment
• STEP 4:Perform aerobic exercise
• To get back in shape and improve the sense
of well being
• 5 days a week,sweaty ex 30 min
Non operative treatment
• STEP5: Modify work or sport
• Reviewe the technique of sport
• Modifiy the job
Operative treatment
• Sub acromial decompression
• Rotator cuff repair (Arthroscopic)
Post opp Rehabilitation
Post opp Rehabilitation
Closed chain passive EX
• A hundred times every
day ,I remained myself
that my inner and
outer life are based on
the labors of other men
living and dead,and
that I must exert
myself in order to give
in the same measure as
I have received.
ALBERT EINSTEIN
Frozen shoulder(adhessive
capsulitis)
• Restricted active and passive motion
• Idiopathic(DM,IHD,cervical
discopathyimmmobilizationhyperthyroidism,stro
ke,Mi
• Secondary(trauma,shoulder surgery)
• Pain and restrictedROM(Int .R,Flex,ext.Rot)
• Pain,Stiffness,Thawing
• Non operative treatment
• Operative treatment(arthroscopic release)
Calcific tendinitis
• Site of diminished blood suply(1.5-2 cm to
insertion of supraspinatus)
• >30y/o
• W>M
• Precalcification stage
• Calcification stage
Phase of formation
Resting phase
Resorptive phase
• Post calcification phase
Calcific tendinitis
• Non operative treatment
• Operative treatment(arthroscopic)
Biceps tendinitis
Biceps tendinitis
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>30-40 years
Pain during flx and supination of elbow
Non operative treatment
Operative treatment
RUPTURE
Trauma to shoulder
Fx of the clavicle
Most common fx in children
mechanism
N.V damage
Open
Skin irritation
1/3 distal
>2cm over riding
Fliale shoulder
FX of clavicle
Complications
N.V damage
Non union
malunion
AC dislocation
• Mechanism
• Classification
• treatment
Ac dislocation
Sc dislocation
• Anterior
• posterior
Scapular fx
• Glenoid
• Body
Glenohumeral dislocation
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More than 90% anterior
Abd,ext.Rot
PH.ex
Complication
Treatment
Post opp
Posterior dislocation
• Not obvious in Ap view
• Abd,Int.rot
• Following seizure
Posterior dislocation
Fx arround the shoulder
• Greater tuberosity
• Surgical neck
• shaft
AP_LAT scapular view
Axillary view
Neer classification