Sick Scapula

Walch et al first described the internal impingement as an intraarticular impingement of the rotator cuff in the abducted and externally rotated shoulder. With 90 degrees of both abduction and external rotation, the articular surface of the posterior superior rotator cuff becomes pinched between the labrum and the greater tuberosity.5 The authors separated the labral lesions from SLAP lesions which extended anteriorly to the biceps anchor at the supraglenoid tubercle, concluding that internal impingement may be responsible for a subset of patients with isolated posterior SLAP tears.5

Russell Carrington is a 25 year old right handed relief pitcher for the MLB team the Baltimore Orioles. Carrington has been playing baseball since he was seven years old and this was his third season in the Major Leagues. Carrington was at the mound and in the motion of throwing a fastball, when he felt a “pop” in his overhand motion. He dropped to his knees and clinched his right shoulder in pain. Athletic trainers came onto the field an upon examination Carrington stated his arm felt like it was “dead” and felt like it was “catching”. Carrington was seen by the team physician. She performed ROM exercises, strength, and stability tests on his shoulder and examined his neck and head to ensure pain wasn’t coming from a pinched nerve. She concluded that further testing and imaging was necessary. Carrington had an X-ray and MRI done on his shoulder and he was diagnosed with a type II SLAP (Superior Labrum Anterior and Posterior) lesion. He didn’t want surgery done because he would miss the remainder of the season and possibly the next, so doctors prescribed non-steroid anti-inflammatory medication and five months physical therapy to strengthen the shoulder capsule. After completion of physical therapy, the pain didn’t improve and arthroscopy surgery was recommended.

Aside from the common training and exercises above, proper warm-up of shoulders is crucial before you get started with any of your baseball routines. Without proper warm-up, the rotator cuff is subject to wearing out.

In Drew Marcos presentation, were first introduced to one athlete, in particular, Tommy John, an American professional baseball (left-handed) pitcher, who permanently damaged his ulnar collateral ligament in his pitching arm, leading to a revolutionary surgical operation. known as Tommy John surgery. It replaced the ligament in the elbow of his pitching arm with a tendon from his right forearm. The surgery was performed by Dr. Frank Jobe in 1974. After the surgery, the odds were against John, since there was a 1 in 100 success rate for that operation. But, he took a season off to recover and worked with a kinesiologist, who taught him a completely different way to pitching, eliminating the chance of him hurting his knee and arm. Before his surgery he won 124 games after his surgery 164 games won, John continued to play for 14 more years, retiring in 1989. Marcos, went on to discuss scapular strength and positional impairments such as scapular dyskinesia, insufficient posterior tilt, excessive abduction and prominent inferior medial border, which are all factors that play a part in the inverted “W” pitching position; that Marcos believes, is one of the driving forces behind the some pitcher’s injuries and the Tommy

Thus obtaining on proposed rehabilitation program in accordance with the scientific foundations in order to achieve the desired benefit which represents in enhancing the functional efficiency of athletes after ACL surgery for return to their preinjury state and participate in their sports activities.

This paper is going to be over rotator cuff injuries and what to do if this occurs to an athlete. The rotator cuff consists of four muscles which are the Subscapularis, infraspinatus, teres minor, and the supraspinatus and their associated tendons that insert into the Humerus. These groups of muscles are responsible for rotating the arm internally and externally as well as abducting the shoulder. The acronym for the four muscles of the rotator cuff is known as SITS. The best treatment for symptomatic, nontraumatic rotator cuff tears is unknown. The purpose of this trial was to compare the effectiveness of physiotherapy, acromioplasty, and rotator cuff repair for this injury. The way this trial worked was that 180 shoulders with the symptomatic,

Inspection of the right shoulder joint reveals atrophy. Movements are restricted with flexion to 90 degrees limited by pain and abduction to 75 degrees limited by pain. Hawkin’s test, Neer’s test, Shoulder crossover test, Empty Cans test, Lift-off test, and Apprehension test is positive. On palpation, tenderness is noted in the acromioclavicular joint and subdeltoid

The introductory section of this research emphasizes common types of injuries a collegiate baseball player may experience. Since it mainly focuses on the function of overhead-throwing motion, the emphasis on concentric internal rotator strength was utilized to crease the upper extremity plyometric program. Additionally, it is stated in the introduction that if the shoulders external rotator musculature is not strong enough, the athlete is more susceptible to shoulder injury.

Komblatt, the patient underwent extensive chiropractic treatment with 87 sessions from 10/07/11 through 07/11/12. It was opined that it does appear that the IW ha s undergone excessive passive-chiropractic treatment referable to both lumbar spine and right shoulder. It was further opined that the IW has reached MMI regarding the lumbosacral strain and contusion of the right shoulder within approximately 6-8 weeks post injury. Appropriate treatment would have consisted of aggressive right shoulder and low back rehabilitation to include aerobic conditioning, strengthening exercises involving the right upper extremity, lumbar spine and core, and resumption of normal recreational and work activities within 6-8

The patient notes that the injury happen when he was lifting some metal trash trays into a trash bin when he felt a sharp pain in his shoulders. Treatment history notes that the treatment to date has consisted of medications. Of note, the MRI done showed a large full thickness tear with retraction of the tendon. Physical examination of the left shoulder revealed that the range of motion has forward flexion of 0-175 degrees, external rotation of 0-40 degrees, and internal rotation to T12. There is positive Hawkins’ and Neer’s sign for impingement. There is weakness with abduction testing. Treatment plan notes recommendation, surgical intervention in the form of a left shoulder, subacromial decompression, rotator cuff repair surgery as necessary. A follow up of 2 to 3 weeks if surgery is authorized. As per medical summary and work status dated 6/14/16, it was noted that the patient has not improved significantly and would be needing surgery. The patient’s return to work date is 6/14/16 with no lifting over 10 pounds and no overhead reach. Follow up to clinic date is on

The overall objectives that were taken under consideration included nearly all aspects in regards to functionality of the knee (14). Many studies have placed patients recovering from ACL reconstruction on rehab regimens with the hope to improve various aspects concerned with how well and at what levels the knee can function. Treatment programs, accelerated or non-accelerated commonly encompass similar exercises and physical activity such as stretching, strength training, and activation of muscles through electrical stimulation. The intensity and general progression of therapy is where the two significantly contrast. With the use of weight bearing exercises, or strength training within the accelerated regimen, it has been proven to limit muscle weakness as a consequence of immobilization after surgery. Shelbourne carried out this method of intervention every week, 2-3 times per week, while progressively increasing weight and the degrees to which the knee was stretched. The results were assessed using The Cybex Isokinetic Device, a

^8,5 ASI occurs when the arm is in adduction with the shoulder internally rotated. The biceps complex pulley, also known as a capsuloligamentous complex, adjoins the anterior glenoid causing injury when in extreme motions. With the PSI, the pulley is put into risk with abduction and external rotation on the posterosuperior glenoid. ^8 PSI is also associated with partial-thickness tears on the deep side of the articular surface of the rotator cuff. ^5 This can be a common cause for a peel-back mechanism associated with a SLAP lesion. ^8 Peel-back mechanisms can be produced many different ways, but are mostly seen with a SLAP lesion or internal impingement. These can occur when the shoulder is placed into abduction and extreme external rotation with a torsional force added to the labro-bicipital complex that is at the base of the biceps on the posterior superior labrum. ^1,5 This causes fatigue and failure of the humeral head that rotates medially over the upper rim of the glenoid fossa creating a shearing force. ^1,5 Increased superior labral strain in overhead athletes occurs during the late-cocking phase of throwing when arm is externally rotated. ^1

*insert article *attachedBesides being able to see the inside of a shoulder, doctors use different physical tests to evaluate the shoulder in order to determine what type of injury and how severe an injury may be. One such test was recently developed by Dr. Carl J. Basamania at the Womack Army Medical center in Fort Bragg, N.C. The test was developed to evaluate shoulder instability in a patient. During the test the Dr. or examiner stands next to the patient who is to lay flat on his/her back. The hand of the examined should is held firmly by the examiner. The examiner then pushes against the clavicle to stabilize th scapula, while they also gently hold the pectoral muscle with their thumb in order to be able to assess relaxation. The examiner then rotates the arm form neutral to full external rotation. If the patient has AIGHL incompetence there is a lack of tightening as the arm reaches full external rotation. The test has appeared to be highly accurate and may be of value to Dr.'s and surgeons alike. After doctors have determined what type and what degree of injury a patient has sustained using various tests it is on to the next step, rehabilitation.

Please allow me to make some correction to the rating of Dr. Miner’s report. It appears Dr. Miner used the range of motion measurement from the right shoulder [uninvolved joint] as a baseline to determine the impairment to the left shoulder as a result of a

As mentioned by Wilk and Leonard4 it has been found most shoulder lesions can be rehabilitated conservative without requiring operation.4 Furthermore, it can be speculated that rehabilitation after a required surgery is critical to return the patients to their functional goals. Additionally, a concrete designed rehabilitation program to increase the range of motion, strength, endurance while increasing the stability of the shoulder is a determinant factor as seen in athletes.4