THOUGHTS ON SHOULDER

INJURIES

John M. Cissik

Human Performance Services, LLC

Injuries and Modifications AC Joint Injuries Impingement

AC Joint Injuries

Dislocation Distal clavicle fractures Osteoarthritis

AC Separation

From Johnson,R.J. (2001). Usually caused by falling on the adducted shoulder Type 1 & 2 can be treated by exercise Type 3 treated by immobilization Type 4, 5, 6 treated by surgery

Treating AC Separation with Exercise

From Johnson, R.J. (2001b).

Distal Clavicle Fractures

10-20% of all clavicle fractures (Johnson, R.J. 2001)

Usually caused by lateral force directed against shoulder

Types of Distal Clavicular Fractures

Type 1: fracture is lateral to the coraclavicular ligaments. Treatment is use of a sling then rotator cuff and scapular exercises.

Type 2a: Occur medially to the coraclavicular ligaments. Displacement.

Type 2b: Occurs between the conoid and trapezoid ligaments, displacement.

Surgery for type 2 fractures.

Osteoarthritis

Caused by age, repetitive upper body exercises, previous injuries, etc.

Lateral shoulder pain, pain aggravated by horizontal adduction, worse at night

Treated with physical therapy, NSAIDs, corticosteroids, and surgery (removal of distal clavicle)

Rotator Cuff Injuries

Causes Types

Primary ImpingementSecondary ImpingementInternal or posterior superior glenoid

impingement

Predisposition to Rotator Cuff Injuries?

From Wolin & Tarbet (1997). Shape of acromion may predispose to injury. Type II & III correlated with full tears Type II tears correlated with partial tears

Primary Impingement

Repetitive overhead activity leads to impingement of supraspinatus against the inferior acromion and/or coracromial ligament

Shoulder Secondary Impingement, Scapulothoracic Causes

Excessive anterior tilt of the scapula

Fatigue of muscles stabilizing scapula (trapezius, serratus anterior)

From DePalma & Johnson (2003).

Diagnosing Scapulothoracic Rhythm Deficiencies

Medial “winging” Indicates

weaknesses or difficulties with the serratus anterior

From DePalma & Johnson (2003).

Diagnosing Scapulothoracic Rhythm Deficiencies

Lateral “winging” Indicates trapezius

weakness

From DePalma & Johnson (2003).

Rehabbing Scapulothoracic Rhythm

Isometric Stabilization Exercises

“Simple” Closed Chain

“Complex” Closed Chain

Rotator Cuff Exercises

Scapulothoracic Isometric Exercises Protraction Retraction Elevation Depression

“Simple” Closed Chain Exercises On all fours, elbows extended:

ElevationDepressionProtractionRetraction

“Complex” Closed Chain Exercises From retraction:

RowingPush-UpsPress-Ups

Internal/Posterior Superior Glenoid Impingement

Overhead activities where arm abducted to 90 degrees and maximally externally rotated.

Supraspinatus caught between humerus and glenoid labrum.

From Wolin & Tarbet (1997).

Rotator Cuff Injury Therapy

ROM Exercises

Very light weight, isotonic exercises

Weight-bearing, closed chain exercises

Rotator Cuff Rehab Guidelines

Initially performed with light weights or elastic bands

Performed with arm below shoulder level or at the side

Exercises that isolate specific cuff muscles should not be done at greater than 90 degrees of abduction

Modifying Exercises for RC Injuries Bench Press Dumbbell Press Seated Row Lat Pulldown

Bench Press

Towel Bench Press Floor Press Close Grip Bench Press

Dumbbell Press

Using a neutral grip Elbows at side

Seated Row 1

Higher Seat (arm less than 90 degrees of flexion)

From Lantz & McNamara (2003a).

Seated Row 2

Initiate movement with retraction

From Lantz & McNamara (2003a).

Seated Row 3

Arms travel to side of body only

From Lantz & McNamara (2003a).

Lat Pulldown 1

Depress and retract the scapula at beginning.

Maintain this position

From Lantz & McNamara (2003b).

Lat Pulldown 2

Don’t let elbows travel past the body.

From Lantz & McNamara (2003b).