Slap Tear

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.

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

Millions of people across the United States suffer from either Bursitis or a rotator cuff injury every year. Although sometimes the two can be misconceived, they are very different in all actuality. Bursitis is the inflammation or irritation of the bursa. A bursa is a fluid-filled sac used as a bumper near the joints to reduce friction. There are many bursae located in your body, some of which being in the hip, shoulder, wrist, and elbow. However, a rotator cuff injury only affects the shoulder area of the body. The “rotator cuff” is composed of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles. There is only one main way to be diagnosed with Bursitis and it happens when you overuse a joint in sports or on the job. You can put the bursa under pressure for a long time, thus causing the bursa to become inflamed.

Instability Impingement. This occurs in younger patients, typically 15-30 years old. The rotator cuff is irritated because the shoulder is loose in the socket. This often happens in baseball pitchers, swimmers, and other throwing athletes. Shoulder instability can be classified into two different types, dislocations and subluxations. Dislocations happen when the head of the humerus completely pops out of the socket. The first few times this happens, it is usually with significant trauma although some people can have these without any injury at all. After that, it can get easier and easier for the joint to dislocate. Most shoulder dislocations are anterior - this means that the ball pops out the front of the socket. Subluxations are the feeling that the shoulder slips slightly out of socket, then immediately comes back in place. This often happens without any major trauma. Sometimes it happens in people who are very "loose-jointed". Sometimes these happen in just one direction like out the front, "anterior", and other times they happen out multiple directions like the front and back,

DOI: 5/8/2016. Patient is a 48-year old male maintenance operator who sustained a strained shoulder when he was throwing waste metal into a bin.The patient was subsequently diagnosed with left shoulder impingement syndrome with massive tear of the supraspinatus and infraspinatus tendons. MRI report dated 5/28/16 revealed suboptimal examination; massive full-thickness rotator cuff tear involving the entire supraspinatus and infraspinatus tendons with severe medial retraction beyond the level of the glenoid measuring approximately 6.2 cm. Severe fatty atrophy and loss of muscle bulk in the supraspinatus and infraspinatus muscles; large glenohumeral joint effusion with fluid in the subacromial/subdeltoid bursa and subcoracoid bursa; mild to moderate degenerative changes of the glenohumeral joint; severe acromioclavicular joint arthritis with

Acute tears of the anterior bundle of the UCL can be seen on high quality MR images. Edema, abnormal laxity, and discontinuity of the ligament are all signs of UCL disruption. Partial tears can be diagnosed with edema and focal areas of discontinuity with residual intact fibers. However, according to Awh (2010), “with complete tears, laxity is more apparent and edema and/or disorganized soft tissue extend across the width of the anterior bundle. With proper inspection, one can identify both the site and severity of UCL injury.”

Labral injuries can occur in the superior and posterior labrum from impingement during the cocking phases. Pain will be present deep in the shoulder joint. Capsular injuries will present a slipping shoulder feeling, loss of control and velocity. Scapular dyskinesis appear with anterior lateral cuff impingement pain. The pain can radiate through the posterior and medial portions of the scapula. Ulnar collateral ligament sprains can present with various forms of pain and locations. All of these injuries can be treated with physical therapy and surgery if need be (Madden, 2010). It is also a good idea to have a rehabilitation throwing program in place to assist with training the body correct movements of throwing mechanics. This can prevent injuries from reoccurring or other injuries from taking place (Donatelli,

^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

Athletes that throw claim that the pain mainly occurs in the acceleration part of the throwing motion. A UCL tear is often an obvious injury as it usually occurs in the throwing motion when the elbow is already sore and there is often a distinct ‘pop’ that happens when performing the injury causing throw ( ). An elbow with a UCL tear will also become slightly inflamed and there will often be numbness in the Digitus Minimus Manus (Pinky Finger) of the injured arm as the Ulnar Nerve, a nerve that runs down the medial part of the arm to the pinky finger, will usually also be slightly affected in the elbow injury (

The patient was a 41-year-old male who failed conservative treatment of a SLAP tear and full thickness glenoid and humeral head articular

Because there are numerous variations of SLAP lesion, doctors classified SLAP lesions into 10 categories. Type I SLAP lesion, typically degenerative in nature, is classified as isolated fraying of the superior labrum. The labrum, however, is still attached to the glenoid. Type II SLAP lesion is described as the detachment of the superior labrum and origin of tendon of the long head of the biceps brachii from the glenoid. This kind of SLAP lesion results in the instability of the biceps-labral anchor. A patient has type III SLAP lesion when there is a bucket-handle tear of the labrum with the bicep insertions still attached. Type IV SLAP lesion is described as a bucket-handle tear of the labrum that extends into the biceps tendon. Similar to

In a case-control study performed by Oh et al.,2 the main objective was to evaluate the sensitivity, specificity, and predictive values of 10 different physical examination tests for the diagnosis of type II SLAP lesions. Sixty-eight individuals with an

Sub-acromial pinching syndrome is mainly seen among athletes that perform throwing motions while participating in the sports activity. There are two types of pinching syndrome, primary sub-acromial pinching caused by the impact of the rotary cuff between the greater tuberosity and the coracoacromial arch or acromioclavivular joint. (Silva, 2010) The second type of pinching is called sub-acromial pinching and it is seen commonly in younger athletes. This pinching is characterized by minor condition of

The cause is unknown but it is believed that thickening and contraction of the glenohumeral joint capsule and the consequent formation of adhesions cause pain and loss of movement. It can occur spontaneously or following an injury to the shoulder (rotator cuff injury) or a period of immobilisation. Diagnosis is made upon history and examination, and the main diagnostic test is the patient’s inability to externally rotate the shoulder, other movements such as abduction and internal