Ayman the Swimmer

Ayman the Swimmer

1. Demography

   • Name: Ayman
     • presents with painful shoulder
       • possibilities
         • injury to
           • bones
             • clavicle
             • scapula
             • head of humerus
           • tendons
             • rotator cuff
               • infraspinatus
               • supraspinatus
                 • greater tuberosity of humerus head
               • teres minor
               • subscapular
                 • lesser tuberosity of humerus head
             • scapula
               • coracoid process
                 • pectoralis minor
                 • coracobrachealis
                 • short head of biceps
               • medial border
                 • serratus anterior
           • ligaments
             • coracoclavicular
               • trapezoid and conoid
             • interclavicular
             • acromioclavicular
             • capsularis
           • muscles
             • attached to
       • diagnosis
   • Age: 19 years
   • university student - swimmer- works as a volunteer

2. Anatomy

   • explains physiology
     • Movements of the shoulder
       • Adduction
         • Pectoralis major
         • teres major
         • latissmus dorsi
       • Lateral rotation
         • teres minor
         • supraspinatus
       • Medial rotation
         • teres major
         • subscapularis
         • pectoralis major
         • latissmus dorsi
       • Flexion
         • anterior deltoid
         • coracobrachealis
       • Extension
         • posterior deltoid
         • pectoralis major
           • from hyperflexed position
       • Abduction
         • pectoralis major (>90 degrees)
         • deltoid

3. Sports Injuries

   • Acute
     • sprains
     • strains
     • fractures
     • injuries from sudden traumas
     • dislocations
   • Chronic
     • caused by overuse
     • overtraining syndrome
     • degenerative disease
     • tendon injuries
       • tendinosis
       • tendinopathy
       • tendinitis
   • Managed by
     • Sports Medicine
       • team
         • sports physician
         • nutritionist
         • trainer
         • physiotherapist
         • psychotherapist
           • to solve
   • psychological effects
     • pain catastrophisation
     • doctor shopping
     • refusal of treatment
     • major depressive disorder
   • Complications
     • recurrence of
     • damage to the nerves
       • paralysis
     • damage to the blood vessels
       • ischemia

4. Diagnosis

   • injury to one of
   • reached by
     • investigations
       • X-ray
       • MRI
         • to check for soft tissue injury
     • Physical examinations
       • Inspection
         • swelling
         • discoloration
         • atrophy
         • asymmetry
         • deformity
       • Palpation
         • temperature
         • radial pulse
         • bones and muscles of the area
       • range of movement
         • active
           • the patient is asked to do specific movements
         • passive
           • the patient rests and the examiner does the movements
       • tests
         • Impingement
         • Apprehension
         • Apley's scratch
   • Management
     • physiotherapy
     • 6 phases
       • 1) RICE
         • Rest
         • Ice
         • compression
         • elevation
         • 2) regain range of movement
           • 3) restore scapular control
             • 4) restore shoulder function
               • 5) restore rotator cuff function
                 • 6) restore speed and power