Ayman the Swimmer

Ayman the Swimmer

1. Anatomy

   • Joints
     • where two bones meet together
       • Fibrous
         • Connected by strong fibrous tissue
           • No mobility
             • Sutures of the skull
               • ossifies with age
             • They don't ossify with age
               • Gomphosis
               • Sydnemosis
       • Cartilaginous
         • Connected by cartilage
           • Secondary
             • disc of dense white fibro cartilage
               • Limited movement
                 • midline of the body
                   • Symphysis pubis
                   • Intervertebral discs
                   • b/w pieces of sternum
           • Primary
             • Hyaline cartilage
               • No movement
                 • ossifies with age
                   • epiphyseal cartilage
                   • b/w the first costal cartilage and sternum
       • Synovial
         • Freely mobile
           • Plane
             • Acromioclavicular
           • Gliding
             • Acrmio-clavicular
             • Intercarpal
           • Hinge
             • Elbow
             • Ankle
           • Pivot
             • Atlanto-axial
             • radio-ulnar
           • Ellipsoid
             • Wrist
           • Saddle
             • Carpometacarpal joint of the thumb
           • Ball and socket
             • Hip and shoulder
           • Condyloid
             • Knee joint
       • Joint pain
         • Neurologic and pain syndromes
           • Peripheral Neuropathy and somatization
         • Congenital and Metabolic
           • Gout, vitamins deficiencies
         • Inflammatory and Reactive
           • Kawasaki Syndrome
         • Neoplastic
           • Cancers and tumors
         • Bone and cartilage
           • Trauma
         • Immunodefiencies
           • HIV
         • Infectious
           • Viral, Fungal, and bacterial
         • Rheumatologic
           • psoriatic arthritis
   • Muscles
     • Rotator Cuff
       • Supraspinatus
         • Origin:Supraspinous fossa of the scapula . Insertion:superior on the greater tuberosity of the humerus
           • Initiation of abduction to 20
       • Infraspinatus
         • Origin:infraspinatus fossa of the scapula. Insertion :inferior and posterior on greater tuberosity
           • External Rotation
             • • weakening and tearing of the tendons forming the rotator cuff under stress Decreases the range of motion in the shoulder
                 • Rotator cuff degeneration & tear
       • Teres Minor
         • Origin:lateral border of the scapula. Insertion:inferior to infraspinatus on the greater tuberosity
           • External Rotation of the Humerus
       • Subscapularis
         • Origin: subscapular fossa of the scapula. Insertion : lesser tuberosity of the humerus
           • Internal Rotation of the humerus
     • Shoulder muscles
       • Pectoralis Minor
         • Origin: ribs 3-5
           • Insertion :Coracoid process of the scapula
             • Actions :Protraction(forward) and retraction(backward) of the scapula.
       • Pectoralis Major
         • Origin :medial 1/2 of the clavicle, manubrium & body of sternum, costal cartilages of ribs 2-6.
           • Insertion :Lateral lip of bicipital groove (humerus)
             • Actions :1-Adduction of the arm. 2-medial rotation of the arm 3-Flexion of the arm.
       • Teres Major
         • Origin :Dorsal surface of the inferior angle of the scapula.
           • Insertion: The medial lip of the bicipital groove (intertubercular sulcus) of the humerus.
             • Action :Medial rotation & Adduction of humerus.
       • Deltoid
         • Origin :Anterior (clavicular) head: anterior surface of the lateral clavicle. b. Middle (acromial) head: acromion process and spine of the scapula. -
           • Insertion : Deltoid tuberosity of the humerus.
             • Action :Adduction from 20˚ to 90˚
       • Latissimus Dorsi
         • Origin :vertebral spines from T7 to the sacrum, posterior 1/3 of iliac crest. • Posterior layer of thoracolumbar fascia lower 3 or 4 ribs. • sometimes from the inf. angle of scapula.
           • Insertion :floor of the intertubercular groove
             • Action :rotates the arm medially • adducts arm • Extends the arm
       • Serratus Anterior
         • Origin:surface of the 1st to 8th ribs at the side of the chest
           • Insertion: along the entire anterior length of the medial border of the scapula.
             • Action: Laterally rotates and protracts scapula
   • Bones
     • Clavicle
       • surfaces
         • Inferior surface
           • Rough due to the attachments of ligaments
             • trapezoid line
             • Conoid tubercle
         • Superficial surface
           • Smooth
             • No ligaments attached
       • Ends
         • Acromial End
           • Flat
             • Articulates with
               • Acromoin process of the scapula
                 • Acromioclavicular joint
         • Sternal End
           • Rounded
             • Articulates with
               • sternum bone of the chest
                 • Sternoclavicular joint
       • Lateral 1/3 is convex backward +medial 2/3 is convex forward
       • Moving from anterior to posterior
         • A transition
           • the clavicle is more prone to injuries at that site
     • Scapula
       • 2 surfaces
         • Anterior
         • Posterior
       • 3 borders
         • Lateral
         • Medial
         • Superior
       • 3 angles
         • Superior
         • inferior
         • Lateral
       • 4 fossae
         • Glenoid fossae
           • Where a humerus articulates
             • Glenohumeral Joint
         • Supraspinous
           • Divided by the spine
         • Infraspinous
         • Subscapular
       • 2 processes
         • Acromion
           • Articulates with clavicle
             • Acrmoioclavicular Joint
         • Coracoid
           • Articulates with clavicle
             • coracocvicular joint
       • Shoulder Blade
     • Humerus
       • Head of humerus
       • Intertubuler groove
         • between lesser and greater tubercles
       • Surgical neck
       • Anatomical Neck
       • Shaft

2. Challenges Athletes face

   • Motivation
   • Media
   • Coaches
   • Training and Practice
   • Career Vision
   • Popularity
   • Priorities
   • Injuries
     • In sports, they most commonly occur in MSK structures
       • Results due to :
         • Not taking the proper safety precautions.illegal play. Wrong training technique. insufficient warm up. Not using sutiable protective techniques. Overuse. preexisting disorder
       • Types
         • contact injury
           • contusions (bruises) or lacerations(tears in skin)
         • ligament sprains
           • overstretching or tearing injury
         • sprained ankle
         • Muscle strains
           • overstretching or tearing
         • Dislocations
           • moving a bone out of its normal position
         • Sublaxation
           • pops out of its place and pops back on its own
         • fractures
           • a compressed or twisted bone
         • Nerve Injury
           • compression , stretch, severance, or friction
       • First actions (PRICE)
         • Protection Rest. Ice( cryotherapy) Compression Elevation

3. Swimmer's shoulder

   • Overuse of the shoulder muscles
     • gradual onset due to repetitive activity and can be classified as microtrauma
       • impaired posture
       • Impaired glenohumeral joint mobility.
         • Results in Rotator cuff tendinitis
           • irritation of these tendons and inflammation of the bursa (a normally smooth layer) lining these tendons.
       • Impaired neuromuscular control,
       • Impaired muscle performance
       • alterations in active ROM of the shoulder

4. Physical Examination

   • Inspection
     • Observing both shoulders together to look for any atrophy , asymmetry, swelling, and any venous distention
   • Feel
     • Palpating specific anatomical structures of the shoulder helps physicians to identify the affected areas
       • the sternoclavicular joint
       • the clavicle
       • the acromioclavicular joint
       • the coracoid process
       • the borders of the scapula
       • the greater and lesser tuberosities of the humerus.
   • Special Tests
     • Impingement Test
     • apprehension test
     • Apley’s scratch test
   • Range of motion
     • forward Flexion = 0-160 Extension = 0-50 Abduction =0-170 Adduction = 0-50 Internal Rotation = 90 degrees External Rotation = 65 degrees And Circumduction

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