shoulder injuries

shoulder injuries

1. shoulder

   • is one of the largest and most complex joints in the body
   • The shoulder joint is formed where the humerus (upper arm bone) fits into the scapula, like a ball and socket
     • The humerus fits relatively loosely into the shoulder joint. This gives the shoulder a wide range of motion, but also makes it vulnerable to injury.
   • important bones in the shoulder include:
     • The acromion is a bony projection off the scapula.
     • The clavicle meets the acromion in the acromioclavicular joint.
     • The coracoid process is a bony projection from the scapula.
   • other important structures:
     • The rotator cuff
       • is a collection of muscles and tendons that surround the shoulder, giving it support and allowing a wide range of motion.
         • Subcapsularis-anteriorly / Supraspinatus-posteriorly / Infraspinatous-posteriorly / Teres Minor-posteriorly
     • The bursa is a small sac of fluid that cushions and protects the tendons of the rotator cuff.
     • A cuff of cartilage called the labrum forms a cup for the ball-like head of the humerus to fit into

2. joints and movements

3. common causes of shoulder pain

4. clinical presentation of shoulder injuries

   • rotator cuff tear
   • Impingement syndrome (swimmer’s shoulder)
   • Shoulder dislocation

5. Physical examination of the shoulder

   • inspection
     • From the front, side and above: scars/ shoulder alignment/ swelling/ muscle wasting
     • From behind: scars/ shoulder alignment/ scapula symmetry/ muscle wasting
   • palpation
     • Sternoclavicular joint to the acromioclavicular joint and acromion and coracoid process / Greater and lesser tuberosity / Glenohumeral joint / Bicep tendon / Spine and border of scapula
   • move
     • Always examine the cervical spine. Move both arms. Active then passive range of movement.
   • impingement test
     • diagnostic test in which local anesthetic is injected into the subacromial space of a patient with impingement signs

6. investigations

   • Projectional Radiography (X-rays)
     • X-rays are generated via interactions of the accelerated electrons with electrons of tungsten nuclei within the tube cathode. Used for detection of: Bone fractures. Infections (Pneumonia). Tumors.
   • Magnetic Resonance Imaging (MRI)
     • Uses strong magnets, magnetic fields, and radio waves that interact with the hydrogen atoms in the body
     • . A computer is used to construct an image from the signal received from the atoms. Used to image the structure and function of the brain, heart, soft tissue, and the inside of bones.
   • ultrasound
     • Uses high-frequency sound waves produced by a transducer that are reflected back to the transducer by internal body structures

7. Natural History of a Rotator Cuff Injury

   • Susceptibility: Increases with age, Athletes etc.
   • Types: Traumatic (Early treatment) and Degenerative.
   • Pathologic Changes: Location, Tear characteristics, muscle degeneration.

8. Complications of shoulder injury

   • Common complications
     • Associated muscle tearing / neck and upper back pain / Multidirectional instability
   • other complications
     • Bone and muscle damage / Nerve and blood vessel  damage / Rotator cuff injuries  (Bursitis, Tendinitis, shoulder impingement, wear or tear of a tendon or ligament)
   • shoulder impingement

9. Psychological effects of sport injuries

10. Methods to address poor compliance in patients

    • Be understanding. Educate. Document everything. Set boundaries and enforce them. Avoid ultimatums

11. sports medicine

    • It is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise .

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