Shoulder Injuries

Shoulder Injuries
By Taelar Shelton, MS, ATC, AT/L
Internal vs external rotation
Abduction vs adduction
• MOI: Blows to the shoulder
• S&S: discoloration, pain and
restricted movement
• Treatment: RICE, protection
with padding
Shoulder Pointer
• MOI: Blow to the lateral
• S&S: tender on lateral clavicle
(bone bruise), similar to A/C
sprain, severe discomfort,
limited ROM
• Rx: RICE, shoulder sling or
ace wrap
Sternoclavicular (S/C) Sprains
• MOI: twisting an elevated arm,
indirect force, blow that hits
poorly padded clavicle
• S&S: usually a deformity from
the dislocation, point
tenderness, pain, swelling,
discoloration, decreased ROM
• Can be serious if dislocated
• Rx: reduced clavicle
dislocation by physician,
immobilize, gradual rehab
Acromioclavicular (A/C) sprain
• MOI: fall on tip of shoulder,
blow to posterior shoulder or
• S&S: obvious deformity
(depends on severity), point
tenderness, pain, loss of
movement, instability
• Rx: ice, sling, referral
• Grade 3 A/C sprain
“sepparation” involves the A/C
ligament and the
coroclavicular ligaments
Glenohumeral joint sprain
• MOI: (Anterior) arm forced
upward and rotated
• S&S: pain, decrease in ROM,
tender to palpation, pain when
MOI is reproduced
• Rx: Rest, ice, compression and
sling; rehab program
Subluxations and Dislocations
• Head of the humerus is
displaced and reduces on its
• Head of the humerus is
displaced and doesn’t return to
normal position without
• Anterior- External rotation,
forced abduction
• Inferior- violent pull inferiorly
• Posterior- FOOSH, internal
Anterior Dislocation
• MOI: external rotation and
forced abduction
• S&S: flat deltoid appearance,
pain, axillary pain and
deformity, holding the
involved arm, disability
• Rx: first time dislocations can
be associated with a fracture,
refer and immobilize
(most common)
Labral Tears
• MOI: Compression of the head
of the humerus from excessive
• S&S: click or pop sound when
moving the shoulder, pain
with internal and external
• Rx: referral to physician,
imaging, sling, surgery or
conservative rehab
Chronic recurrent instabilities
• Macrotraumatic- one or more traumatic
• Atraumatic- volunatry displaces shouder joint
• Microtraumatic-faulty biomechanics leading to
tissue laxity (repeativite use)
• Recurrent- continual stretching of ligaments,
capsule and muscles
Rotator Cuff Impingement
• MOI: over use or disuse,
inflammation of the tendon
takes up too much space
• S&S: joint pain during and
after activity
• Rx: warm up before activity,
rehab exercises, ice therapy,
work on techniques; rest
Rotator Cuff Strains: “SITS” muscles
• MOI: violent pull to the arm,
abnormal or excessive
rotation, FOOSH
• S&S: Swelling, point
tenderness, pain, loss of
• Rx: rehab (conservative
approach), proper instruction
on form, strengthening and
ice; surgery
Clavicle Fx
• MOI: FOOSH or direct blow
• S&S: usually the middle 1/3,
deformity, tenderness and
• Rx: sling, ice and x-ray
Humeral Fracture
• MOI: direct blow to arm or
• S&S: jagged edges of fractured
bone can cause radial nerve
• Rx: splint, treat for shock,
referral to MD, usually takes
3-4 months to recover
Upper Humeral Fx
• MOI: direct blow, FOOSH or
• S&S: pain, inability to move,
point tenderness, discoloration
• Rx: sling, referral to MD
Epiphyseal Fx
• MOI: common in youth
athletes (10 years or younger)
from an indirect force
• MOI: trauma or overuse leads
to inflmmation of the bursa
• S&S: pain around the bursa,
can lead to impingement
• Rx: Rest, heat after the
inflammatory response is over,
range of motion exercises, ice
after activity and during
inflammatory response
Thoracic Outlet Syndrome
MOI: Compression over cervicle
rib, muscle spasm, compression
of major blood vessels and
nerves between rib and clavicle,
compression beneath corocoid
S&S: numbness, cold feeling, poor
cirulation, muscle weakness,
muscle atrophy, nerve palsy
Rx: conservative approach in 5080% of cases
-Strengthening and postural
Myositis Ossificans
• MOI: contussion that did not
get treated properly
• S&S: swelling and irritation
that lasts for 2-3 weeks
• Rx: get an MRI or xray (tricpes
to the right)
Bicipital Tenosynovitis
• MOI: repetitive internal
roation irritates the synovial
sheath of the biceps, can
sprain the transverse ligament
• S&S: ache on the anterior
aspect or the lateral side of the
shoulder, tenderness on the
biceps tendon, inflammation,
“pop” of the tendon on the
• Rx: rest and ice, gradual
reconditioning program
Biceps Rupture
• MOI: Over stretching or a
powerful movement
• S&S: Snap, intense pain,
prodruding bluge in the
middle of the biceps, muscle
• Rx: sling and refer = surgical

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