• movement when taking off shirt
• visually inspect for swelling/effusion, deformity, and discoloration, compare bilaterally
• note posture

• shoulder alignment
• rounding
• unequal hight
• it is normal to have the dominate side slightly lower than the non-dominant side
• forward carriage of the head
• spinal curvatures
• kyphosis- thoracic curvature
• lordosis- lumbar curvature
• scoliosis- lateral curvature
• hip level
• scapula height
• alignment of the medial border to the spinal column
• bilateral muscle development
• trapezius
• deltoid
• bicep
• latissimus dorsi

ask athlete to demonstrate active ROM, note pain and restricted ROM, then facilitate passive, and resistive range of motion, then note pain and restricted ROM

• arms over head
• shoulder elevation and depression
• shoulder protraction & retraction
• removal of shirt
• flexion/extension
• horizontal abduction/adduction
• depression/elevation
• internal/external rotation
• abduction/adduction
• circumduction

• cross opposite shouler for internal rotation & adduction

[image]

[image]

• grape vine for external rotation & abduction

[image]

• below & behind for internal rotation & adduction

• biceps/triceps
• internal/external rotation
• ab/adduction
• shoulder elevation
• pronation/supination
• finger "O"

• may or may not see displacement, often can palpate fracture
• will have difficulty raising arm above the head
• athlete wil hold arm to support the shoulder

• treat for shock
• apply sling
• shoulder & elbow and 90 degrees, straight wrist, carried to the front of the body

[image]

• send to ER

• sternoclavicular joint
• posterior dislocation is a medical emergency
• unstable joint due to lack of surface area between the sternum & clavicle

[image]

includes falling on outstretched hand or on tip of shoulder, acromion moves superior or inferior to clavicle

(chronic or acute)

[image]

• 1st degree, pain over the AC joint, no laxity
• 2nd degree, pain over the AC joint and corocoid process, some movement
• 3rd degree, deformity of the AC joint (step off)

• treat for shock
• apply RICE
• apply sling
• better pain releif with support under the elbow, reduces trapezius spasm
• refer athlete to a physician

depression of the shoulder and lateral head flexion

[image]

• burning pain
• tingling sensation down the arm
• muscle weakness
• usually leaves field carrying arm

capsular ligament and the coracohumeral ligament

[image]

the humerus dislocates anteriorly that may be subluxation or complete dislocation

[image]

• shoulder joint deformity and down sloping shoulder contour
• abnormally long arm on affected side
• humeral head palpable within axilla
• athlete supports arm on affected side
• athlete resists any efforts to move glenohumeral joint

• GH joint may appear normal
• movement will be painful
• joint may be point tender
• complaints of laxity

• rotate the greater tuberosity on the humerus into under side of the acromion process to pinch an irritated bursa (abduction)

• GH joint stability,
• abduction, and
• rotation

• palpate rotator cuff with arm in extension
• rotator cuff rupture will not allow abduction
• since the supraspinatus initiates abduction, look for weakness and inflammation
• pain within the shoulder, particularly during the follow through phase of throwing motion

• gentle flexibility (esp. anterior shoulder)
• strength to 90 degrees of GH motion

any condition that decrease the size of the subacromial space

(sports that emphasize overhead arm movements)

overuse and weak muscles

(shape of acromion may predispose)

• palpate the bicep tendon (long head) with arm moving in internal and external rotation
• will have pain with resisted arm flexion

• strength loss
• pain with abduction & internal rotation
• pain when arm is abducted beyond 90 degrees
• nocturnal pain
• pain felt deep within shoulder

• control pain & swelling
• initial care, sling, movement under 90 degrees of glenohumeral joint
• ROM in all planes
• strength development
• glenohumeral stability (rotator cuff), posterior shoulder (middle/lower trap)
• functional throwing progression
• sport specific activities

1. acromioclavicular ligament
2. sternoclavicular ligament
3. coracoclavicular ligaments

• external rotators
• supraspinatus
• infraspinatus
• teres minor
• internal rotators
• subscapularis

• provide stability of the humerus in the glenohumeral joint with arm motions above 90 degrees
• dynamic stabilizers of the glenohumeral joint during the deceleration phase of throwing

• swelling/effusion
• deformity
• discoloration
• capillary refill time
• COMPARE BILATERALLY

1. cubitis valgus
2. cubitis varus
3. cubitis recurvatus

[image]

[image]

• excessive number of strokes
• incorrect technique
• racket handle that is too small
• change in racket materials
• grip that is too tight
• muscle imbalance

• pain and swelling in the region of one or both epicondyles
• pain that worsens with activity
• radiating pain into forearm muscles
• epicondylar pain associated with resisted wrist movements

• apply ice and compression
• refer to physician if pain persists

repeated episodes of soft tissue injuries

(contusions)

• chronic inflammation of the muscle that results in the development of bone-like tissue within the muscle
• may cause exostosis, a "benign growth projecting from a bone surface capped by cartilage"

• falling backward with elbow locked in extension
• valgus and varus forces that occur as the arm is trapped in a vulnerable position

• poor throwing mechanics
• elbow drops below shoulder & "wings"
• weak rotator cuff muscles

• severe pain in upper arm
• deformity, loss of function
• muscle spasm
• audible snap or pop at the time of injury
• may have sensory loss in forearm

• includes strength training
• progressive conditioning
• proper technique

• swelling/effusion, deformity, capillary refill time, and discolaration
• hand position when relaxed or flexed, dominant hand
• muscle atrophy, especialy thenar eminence
• finger deformities

flexion of the PIP with extension of the MCP and DIP

[image]

having the thumb pulled away from the midline

"game keepers" or "skiers thumb"

[image]

TRUE or FALSE

one should not reduce finger or thumb dislocations

TRUE

refer for xrays, evaluation of nerve and blood supply

• a lost MCP joint
• referred pain with a twist, tap (percussion), and longitudinal compression test
• misalignment of fingers in extension and flexion

an injury unique to the thumb

[image]

• mechanism includes blows with a clenched fist
• fracture involves 4th and/or 5th metacarpal bones near the proximal ends

falling on oustretched hands

[image]

test for tendosynovitis; fist with thumb inside palm and ulnar deviation

[image]

depressed 3rd metacarpal when making a fist

[image]

• pain,
• tingling, and
• numbness in hand

results from a herniation of the synovium surrounding a tendon

[image]

visible swelling with painful, hardened nodule in advanced cases, herniated area becomes filled with fluid (some ganglions are soft while some are hard and painful)

• make sure the splint does not extend beyond the MCP joint or the tip of the finger
• splints can be worn on the backside of finger to improve grip
• hands, fingers, thumbs, and forearms need to be strengthened after injuries to restore grip

1. coup
2. contrecoup
3. repeated subconcious forces, repeated non traumatic blows (heading soccer ball)
4. rotational or shearing forces

TRUE or FALSE

muscle strains in the neck rarely involve neurologic damage

• amnesia
• confusion
• disorientation
• irritability
• lack of coordination
• dizzinness 
• headache
• blurred vision
• photophobia
• nystagmus: cycling of the eyes
• tinnitus: ear ringing
• nausea
• fatigue

• dazed or distant appearance
• pupil size
• PEARL
• aniscoria- unequal pupil size
• eyes should track smoothly together and separately
• nystagmus: involuntary cyclical eye movement
• raccoon eyes, bruising under the eyes from the nasal or skull fracture
• body alignment or posturing
• continue to monitor vital signs
• respiration
• pulse
• blood pressure

• do not palpate skull depressions or deformities
• palpate cervical alignment

• note communication style
• unusual behavior
• irrational thinking
• personality changes
• apparent mental disability

• Romberg's test
• heel-toe walking
• BESS

grade 1: (mild) involves no amnesia but are difficult to identify

grade 2: (moderate) involves loss of conciousness for less than 1 minute and/or post traumatic amnesia lasting longer than 30 minutes

grade 3: (severe) involves loss of conciousness for more that a minute and post traumatic amnesia lasting more than 24 hours

• decreased attention span
• trouble concentrating
• impaired memory
• irritability
• headaches with exercise
• premature fatigue with exercise
• balance disruptions
• decreased cognitive performance

• immobilization of head/neck
• always assume neck injury has also occured
• check vitals
• not body and limb positions as well as helmet/mask/mouthguard positions
• if unconcious, attempt to arouse and note approx time of injury
• if unconcious detect breathing by:
• listening near the athletes face for typical breathing sounds
• looking for movements of the thorax and or abdomen
• if no signs of circulation are present, begin CPR and summon EMS

• conciousness or unconciousness
• extremity strength w/o moving neck
• mental function (if conscious)
• eye signs and movements
• neck pain
• neck musculature spasm

• DO NOT remove helmet
• DO NOT move the athlete
• DO NOT use ammonia capsules to revive the athlete
• DO NOT rush through physical exam

• perform grip strength tests
• check bilateral strength by asking athlete to dorsiflex feet
• check for sensations on both sides of body by pinch tests
• monitor athlete's eyes by checking pupil sizes and response to light and eyes' ability to follow moving object side to side
• note loss of peripheral vision or jerking eye movements
• palpate neck for deformity, moving from base of skull to bottom of neck

• pull helmet, shoes, uniform to ensure that they stay out of practice
• seminar to coaches and athletes regarding policies and expectations
• removal from the field
• requires a patient education sheet outlinging what symptoms to look out for and when to go back to the emergency room
• standard assesment of concussion

• has the athlete recovered or is performance still marginal?
• is the involved activity a contact type of activity?
• is this a recurrence of a previous concussion?
• does the athlete have other medical problems or late complications of a previous concussion?

• the athlete should be asymptomatic at rest and during exertion prior to return 
• there should be no exertion induced headaches, nausea
• no balance, strength, coordination or depth perception problems
• there should be no problems with understanding directions
• eating and sleeping patterns should be back to normal
• it is the physicians responsibility to determine sport participation after a head injury

• fractures are common
• deformity
• loss of normal occlusion of the teeth
• pain when biting down
• bleeding around teeth
• lower lip anesthesia
• treatment is physician referral

temperomandibular typically

• jaw is locked in open position
• jaw movement is impossible
• malocclusion of the teeth

• causes spasming of the mastoid muscle
• limited motion
• mouth is pulled toward the spasm

• caused by direct blow to the cheek
• because of nearness to eye, visual problems may occur

• make athlete comfortable
• refer to dentist
• encourage mouthguard usage
• manually realign teeth that have been knocked crooked

• clean with saline solution and replace if possible
• keep moist if replacement is not possible
• immediately refer to dentist

• may be able to palpate abnormalities or feel crepitus
• may see deformity with shapes of the nostrils
• treatment is to control bleeding and refer the athlete to a physician

• septal hematomas must be drained immediately or an abcess can form causing bone and cartlage loss

• have the athlete sit upright
• use cold compress over nose
• apply pressure to the nostril
• if necessary pack the nose with cotten soaked in an astringent

• blurred vision that does not clear with blinking
• loss of all or part of the visual field
• pain that is sharp, stabbing, or throbbing
• double vision

indications are specks floating before the eye, flashes of light, blurred vision, and complaints of a "curtain falling" over the field of vision

REFER!

black eyes require cold application, rest if vision is distorted, do not blow the nose after injury or hemorrhaging may increase

• treatment should follow basic first aid protocol; clean with mild soap and warm water; apply sterile dressing
• any facial wound, even abrasion can present cosmetic issues; any wound with observable space between margins should be referred to a physician for suturing, after suturing, the return to play decision is made by the physician