Ayman the Swimmer

Anatomy
1. Joints
  1. where two bones meet together
    1. Fibrous
      1. Connected by strong fibrous tissue
        No mobility
        Sutures of the skull
        ossifies with age
        They don't ossify with age
        Gomphosis
        Sydnemosis
    2. Cartilaginous
      1. 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
    3. Synovial
      1. 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
    4. Joint pain
      1. Neurologic and pain syndromes
        Peripheral Neuropathy and somatization
      2. Congenital and Metabolic
        Gout, vitamins deficiencies
      3. Inflammatory and Reactive
        Kawasaki Syndrome
      4. Neoplastic
        Cancers and tumors
      5. Bone and cartilage
        Trauma
      6. Immunodefiencies
        HIV
      7. Infectious
        Viral, Fungal, and bacterial
      8. Rheumatologic
        psoriatic arthritis
2. Muscles
  1. Rotator Cuff
    1. Supraspinatus
      1. Origin:Supraspinous fossa of the scapula . Insertion:superior on the greater tuberosity of the humerus
        Initiation of abduction to 20
    2. Infraspinatus
      1. 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
    3. Teres Minor
      1. Origin:lateral border of the scapula. Insertion:inferior to infraspinatus on the greater tuberosity
        External Rotation of the Humerus
    4. Subscapularis
      1. Origin: subscapular fossa of the scapula. Insertion : lesser tuberosity of the humerus
        Internal Rotation of the humerus
  2. Shoulder muscles
    1. Pectoralis Minor
      1. Origin: ribs 3-5
        Insertion :Coracoid process of the scapula
        Actions :Protraction(forward) and retraction(backward) of the scapula.
    2. Pectoralis Major
      1. 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.
    3. Teres Major
      1. 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.
    4. Deltoid
      1. 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˚
    5. Latissimus Dorsi
      1. 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
    6. Serratus Anterior
      1. 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
3. Bones
  1. Clavicle
    1. surfaces
      1. Inferior surface
        Rough due to the attachments of ligaments
        trapezoid line
        Conoid tubercle
      2. Superficial surface
        Smooth
        No ligaments attached
    2. Ends
      1. Acromial End
        Flat
        Articulates with
        Acromoin process of the scapula
        Acromioclavicular joint
      2. Sternal End
        Rounded
        Articulates with
        sternum bone of the chest
        Sternoclavicular joint
    3. Lateral 1/3 is convex backward +medial 2/3 is convex forward
    4. Moving from anterior to posterior
      1. A transition
        the clavicle is more prone to injuries at that site
  2. Scapula
    1. 2 surfaces
      1. Anterior
      2. Posterior
    2. 3 borders
      1. Lateral
      2. Medial
      3. Superior
    3. 3 angles
      1. Superior
      2. inferior
      3. Lateral
    4. 4 fossae
      1. Glenoid fossae
        Where a humerus articulates
        Glenohumeral Joint
      2. Supraspinous
        Divided by the spine
      3. Infraspinous
      4. Subscapular
    5. 2 processes
      1. Acromion
        Articulates with clavicle
        Acrmoioclavicular Joint
      2. Coracoid
        Articulates with clavicle
        coracocvicular joint
    6. Shoulder Blade
  3. Humerus
    1. Head of humerus
    2. Intertubuler groove
      1. between lesser and greater tubercles
    3. Surgical neck
    4. Anatomical Neck
    5. Shaft
Challenges Athletes face
1. Motivation
2. Media
3. Coaches
4. Training and Practice
5. Career Vision
6. Popularity
7. Priorities
8. Injuries
  1. In sports, they most commonly occur in MSK structures
    1. Results due to :
      1. Not taking the proper safety precautions.illegal play. Wrong training technique. insufficient warm up. Not using sutiable protective techniques. Overuse. preexisting disorder
    2. Types
      1. contact injury
        contusions (bruises) or lacerations(tears in skin)
      2. ligament sprains
        overstretching or tearing injury
      3. sprained ankle
      4. Muscle strains
        overstretching or tearing
      5. Dislocations
        moving a bone out of its normal position
      6. Sublaxation
        pops out of its place and pops back on its own
      7. fractures
        a compressed or twisted bone
      8. Nerve Injury
        compression , stretch, severance, or friction
    3. First actions (PRICE)
      1. Protection Rest. Ice( cryotherapy) Compression Elevation
Swimmer's shoulder
1. Overuse of the shoulder muscles
  1. gradual onset due to repetitive activity and can be classified as microtrauma
    1. impaired posture
    2. Impaired glenohumeral joint mobility.
      1. Results in Rotator cuff tendinitis
        irritation of these tendons and inflammation of the bursa (a normally smooth layer) lining these tendons.
    3. Impaired neuromuscular control,
    4. Impaired muscle performance
    5. alterations in active ROM of the shoulder
Physical Examination
1. Inspection
  1. Observing both shoulders together to look for any atrophy , asymmetry, swelling, and any venous distention
2. Feel
  1. Palpating specific anatomical structures of the shoulder helps physicians to identify the affected areas
    1. the sternoclavicular joint
    2. the clavicle
    3. the acromioclavicular joint
    4. the coracoid process
    5. the borders of the scapula
    6. the greater and lesser tuberosities of the humerus.
3. Special Tests
  1. Impingement Test
  2. apprehension test
  3. Apley’s scratch test
4. Range of motion
  1. 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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Ayman the Swimmer

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	Created by Fatma Shwaylia about 7 years ago