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Sports Injuries

The sports physical examination. The successful treatment of a dysfunctional shoulder relies on an accurate and correct diagnosis.

Chief complaint. What are they seeing you for. The age of the athlete and the sport and position should be determined. The age and when I workup a shoulder, I go through a series of things. You will start off with the initial impression when the athlete or when the patient walks into your office or when the injury happens on the court or on the field. Inspection, palpation, range of motion and strength testing.

What I do want to talk about is going into the stability assessment and some of the special tests. So we’re going to start off by going into some of the stability things and I will start off by mentioning the load in shift test. The load in shift test is one of the most useful tests that I’ve found in evaluating an athlete or any patient’s shoulder.

Biceps tendinitis. Biceps resistance test. That is spelled out in the handouts. I don't find these tests very useful. It is important to know how to do them. If you suspect something, it should be part of the workup but it is not something that you will use every day.

Shoulder instability. When we deal with anterior instability, it is usually what we’re calling TUBS – traumatic unidirectional instability – associated with a Bankhart lesion and usually requires some type of surgery. This is an anatomic picture of the shoulder. Glenoid socket is right in here. Biceps tendon coming up here. Anterior is to your left, posterior is to the right.

Anterior glenohumeral instability. We’ve talked about the apprehension sign. This is a great picture because this is a truly positive apprehension test. This is what that patient looks like and feels like when that shoulder is going to come out. So this is what you want to see when you say somebody has got a positive apprehension test.

Associated injuries. What else can happen with some type of anterior instability. Greater tuberosity fracture is common. You can see axillary nerve, even some musculocutaneous nerve injuries. Or in your older patients, and not necessarily even older, but even in their mid 40s, they can have associated rotator cuff tearing. So if you have a patient who has had a dislocation, who may be in their 40s and they have pretty significant weakness when you are examining them after the shoulder has been reduced.

Acromioclavicular joint injuries, one of the most common things that you will see, especially this time of year, are falls on the point of a shoulder. They come in and either they have obvious deformity or they will have tenderness to palpation over the AC joint.

Treatment, Grades I, II and III AC separation, your PRICEs. Protection, rest, ice, compression. Working through the standard treatment protocol with that. Sling if they are initially tender. Some anti-inflammatory medicines.

Sternoclavicular sprains we will just mention this briefly. The sternoclavicular joint can be injured in a couple of ways. It is typically seen in a football player who is at the bottom of a pile and happens to be on his side and the pile comes down on top.

Glenoid labrum and, again, the labrum is the cartilage around the socket and we as orthopods aren’t smart enough to remember a lot of big words so we make up abbreviations for these things and so we call them SLAP lesions.

Rotator cuff impingment. Outlet impingement. Again, we’ve talked a little bit about impingement but the outlet is between the acromion – your coracoacromial ligament – and your rotator cuff in this area. So this is what we call the supraspinatus outlet.

Rotator cuff tear. The tear can be caused by trauma, a fall on an outstretched arm. It can be the repetitive microtrauma in your thrower or a dislocation in your 40-45 year old patient.

Evaluation of a rotator cuff tear is pretty straightforward. You are going to do your physical examination of their shoulder. They are going to have some impingement. They will have a painful arc which is usually between 70 and about 120º of abduction.

Biceps tendon subluxation. A diagnosis that people use. It is not something, however, that is very common. It is very rare to see this as an isolated event. It is usually associated with tearing of the anterior rotator cuff, the subscapularis and a portion of the coracohumeral ligament. So if you think that someone is dislocating their biceps tendon up at their shoulder, they’ve probably got 

Biceps tendon rupture. Here is a guy who came into the office. He had some type of forceful injury. He was lifting weights and felt a pop and comes in with a lot bruising and swelling. Probably some types of biceps rupture although possibly even a pectorals major rupture in this weight lifter here. The biceps tendon can tear proximally or distally. We see probably the proximal long head of the

Clavicle fractures are pretty common, probably the most common bone that you will see fractured. The middle third is the most common area. Why do they get deformed? Well, there are a lot of muscle forces that are deforming that. The weight of the shoulder pulling down on the distal clavicle and the scapula and the muscles pulling up on the medial will cause some deforming forces.

Treatment is pretty simple. Figure-of-eight brace or a sling. 98% of these go on to heal without problems. It is very rare that we have to operate on these. 2% may go on to non-union. Some people may have enough displacement that that bony fragment is tenting the skin

Scapular fractures. Not a common thing and luckily we don’t see a lot of them in athletes. These are usually associated with high

Proximal humerus fractures. Surgical neck fractures common in your elderly population. You may see this in some of the young

Adhesive capsulitis or frozen shoulder. A pretty common thing that is often mistaken for a rotator cuff tear or impingement. The hallmark is just capsular tightness and lack of motion. Usually they will lose internal rotation first and then eventually they will lose

Ankle and leg injuries. We’ll move down a little bit and go on to some of these things. We will talk a little bit about physical examination. Again, these are spelled out in your handout. Everyone knows the basics of the physical examination. Inspection,

Occult fractures. Occult fractures associated with ankle injuries. Transchondral talar dome injuries, posterior process of the talus, dorsal avulsion of the talus or the anterior process of the calcaneus can happen. So keep that in mind when you evaluate an ankle

Stress fractures. Tibia is one of the most common areas that we will see in runners and being track season we’ve seen a lot of these

Ankle sprains. Again, a common thing that everybody deals with. We won’t get into the basics. Important to know your anatomy. Anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament. Palpate these areas and see where they are

Syndesmosis ankle sprain or the high ankle sprain. We see a lot in wrestlers in a soft surface where the foot sinks in and they have some type of twisting. This is the classic mechanism. Some type of forced plantar flexion with an external rotation of the ankle and