Shoulder Injuries
Biceps Brachii Tendinitis/Ruptures
This injury is common in overhead activities and prevalent in pitchers, tennis players, volleyball players, and javelin throwers. Repetitive stretching of the biceps causes irritation and inflammation of the tendon. The signs and symptoms of biceps tendonitis are tenderness, swelling, and increased warmth over the tendon with increased pain with overhead activities. The treatment for this condition is rest and cold application to decrease inflammation. Once inflammation has been controlled, strengthening and stretching of the muscle and tendon can begin. Ruptures occur with athletes performing powerful contractions of the muscle. Signs and symptoms include a snap and sudden intense pain at the point of injury, a protruding buldge in the middle of the biceps, and weakness with elbow flexion. Treatment for a rupture is immobilization, cold application, and referral to a physician.
Clavicle (Collarbone) Fracture
The clavicle is one of the most frequently fractured bones in sports. A clavicle fracture usually results from a fall on an outstretched arm, a fall on the tip of the shoulder, or by direct impact. Signs and symptoms of a clavicle fracture include swelling, point tenderness, mild deformity, and pain. The immediate treatment for a clavicle fracture is to immobilize the affected side in a sling, cold application, and immediate referral to a physician.
Impingement Syndrome
Impingement syndrome involves a mechanical compression of tendons and bursa under the coracoacromial arch decreasing the space under the arch. Repetitive compression eventually leads to irritation and inflammation. This condition is common in repetitive overhead activities such as throwing, serving a tennis ball, spiking a volleyball, and swimming. Impingement syndrome is closely related to shoulder instability. Failure of the rotator cuff muscles to maintain the position of the head of the humerus leads to repetitive stress on theses structures. The prolonged inflammation causes decrease muscular efficiency, and a progressively worsening cycle is created. This cycle can lead to a rupture of the one of the rotator cuff muscles or the biceps tendon. The sign and symptoms of impingement syndrome include diffuse pain around the top of the shoulder and an achy feeling at the end of activity. Overhead activities increase the pain. Management of impingement syndrome is established by restoring normal biomechanics, which should be done without pain. Start by controlling the pain and inflammation with the use of cold application and other therapeutic modalities. Then therapy can begin to rehabilitate and strengthen the rotator cuff and scapulothoracic muscles.
Rotator Cuff Tears
Rotator cuff tears can be full-thickness or partial-thickness tears, with partial thickness tears being the most common. Most are relatively uncommon under the age of 40. The primary mechanism of injury involves either acute trauma or impingement. The most commonly involved muscle is the supraspinatus muscle. The signs and symptoms of a rotator cuff tear are diffuse pain around the top of the shoulder, increased pain with overhead activities. Management of this condition is the same as impingement syndrome. With a full-thickness tear or more sever partial-thickness tear surgery may be required.
Separated Shoulder (AC Sprain)
The AC joint is extremely vulnerable to sprains in collision sports. This condition is usually caused by direct impact to the tip of the shoulder. The signs and symptoms of a separated shoulder are point tenderness and discomfort during movement or a decreased range of motion and possible deformity depending on the severity of the injury (degree of the sprain). Management of an AC sprain is to immobilize the affected side in a sling, cold application, and immediate referral to a physician.
Shoulder Subluxation and/or Dislocation
A shoulder subluxations an excessive translation of the humeral head without a complete separation of the joint surfaces. It is a brief, transient occurrence that returns to the normal position. In a dislocation, the humeral head is forced out of its articular capsule. A dislocation may result from direct impact to the back of the shoulder, but most commonly happens when the shoulder is forced up, out, and back (a very vulnerable position). The signs and symptoms of a dislocation are hearing a “pop” in the shoulder, feeling a tearing sensation with intense pain, and deformity. The immediate treatment for a shoulder dislocation is to immobilize the affected arm, cold application, and refer for immediate treatment by a physician.
