🎾 S7.1 Renstrom Overview Shoulder Injuries In Sports¶
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S7.1 Renstrom Overview Shoulder Injuries In Sports — tài liệu 11 trang từ thư viện sách tennis.
Chủ đề chính: Shoulder, Overhead
Tóm tắt nội dung (trích từ tài liệu gốc): Overview shoulder 6/12/2013 injuries in sports Well functioning shoulders are Per Renstr�m, MD, PhD key to success in many Overhead Sports Professor emeritus, Karolinska Institutet, Stockholm, Sweden Tennis Baseball Member ATP and ITF Sports Science Badminton and Medical Committees Swimming Physician Swedish Football Association Volleyball Presentation at the IOC Advanced Javelin team physician course at V�r G�rd, Water Polo Saltsj�baden, May 23. 2013 Football (QB) Handball Throwing and serving motions Overview shoulder ACLinjpurliaessitniksp, oertrsfarenheter av tidig kirurgisk behandling Inj
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Overview shoulder 6/12/2013
injuries in sports
Well functioning shoulders are
Per Renstr�m, MD, PhD key to success in many
Overhead Sports
Professor emeritus,
Karolinska Institutet, Stockholm, Sweden Tennis
Baseball
Member ATP and ITF Sports Science Badminton
and Medical Committees Swimming
Physician Swedish Football Association Volleyball
Presentation at the IOC Advanced Javelin
team physician course at V�r G�rd, Water Polo
Saltsj�baden, May 23. 2013 Football (QB)
Handball
Throwing and serving motions
Overview shoulder
ACLinjpurliaessitniksp, oertrsfarenheter av
tidig kirurgisk behandling
Injury profile Karl Eriksson, Doc, �L
S�dersjukhuset,
Karolinska Institutet
Stockholm
Shoulder overhead injury Overview shoulder
Most tennis injuries occur in ACLinjuprileas sintsipko,rtserfarenheter av
tidig kirurgisk behandling
Lower extremity (31%�67%),
Upper extremity (20%�49%) Karl Eriksson, Doc, �L
Trunk (3%�21%) S�dersjukhuset,
Abrams, Renstr�m, Safran Br J Sports Med. 2012 Karolinska Institutet
Jun;46(7):492-8.
Throwing and serving Stockholm
Commonly related to overhead motions
scapular dyskinesis, rotator cuff pathology or 1
glenohumeral internal rotation deficit
which results in internal impingement and/or
labral pathology.
Neuman et al Am J Sports Med 2011;39:1883�8.
6/12/2013
The overhead serve motion Importance of kinetic chain
in overhead activities
The serve was the predominant stroke
accounting for 50% of total kinetic energy and total forces of
the overhead throw and tennis serve are
� 45% in French Open and � developed in the leg, hip, trunk while the
� 60% in Wimbledon of strokes during � shoulder has 21% contribution to total force
service games. Toyoshima, Miyashita, Res.Q. Mar;44(1):86-95. 1973
Johnsson et al. Br J Sports Med, 187: 901, 2006 This means that
� Optimal shoulder function requires good throwing and serving involves most of the
kinetic chain function, optimal stability, and � 640 skeletal muscles and
coordination of the scapula in the overhead action. � 4000 tendons in the human body
Van der Hoven, Kibler: Br J Sports Med, May;40(5):435, 2006
Overhand Mechanics Stance or Ready Phase
Phases
Ready
Wind-Up
Cocking
Early & Late
Accleration
Early & Late
Follow Through
Wind-Up Phase Early Cocking Phase
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6/12/2013
Late Cocking Phase Tennis Serve
--Cocking Phase
Begins after ball toss and
terminates with point of
maximal external
rotation
Risks for injury
Competitive throwing can
stretch out the shoulder
capsule and increase
shoulder flexibility
Tennis Serve Tennis Serve
Pathomechanics - SLAP Pathomechanics - Cuff
Late Cocking I II Late Cocking
Position Position
III IV
� Repeated � SLAP Lesion ?
Rotation
� Increased Laxity
� SLAP Lesion??
� Increased Reliance On
Rotator Cuff
� Overload Cuff
Tennis Serve Tennis Serve
Acceleration Phase --Acceleration Phase
� Begins at maximal external rotation
� The explosive phase as trunk flexes forward
� Ends when the ball is released
Risks for injury
� The shoulder internal rotator muscles
contract to produce maximal internal
rotation velocity
� The rotator cuff muscles are
highly active
3
Follow Through Phase 6/12/2013
Tennis serve
Deceleration and
Follow-Through Phase
Begins at maximal shoulder internal rotation
Ends when the arm is across the body
The risk for injury is increased
� Maximal internal rotation of the shoulder
� The back muscles are subjected to large load
� The elbow is extended maximally and affected
� The wrist is forced forward in the serve
Pathomechanics - Cuff Pathomechanics - Cuff
Follow Through Rotator Cuff
Overload
� Joint Distraction
� Stretch Capsulo- � Cannot Maintain X
Ligamentous Structures Humeral Head In
� Overload Cuff
Glenoid
� Deltoid Pull
Secondary Impingement
Overview shoulder Outlet Impingement
ACLinjuprileas sintsipko,rtserfarenheter av Can Occur
tidig kirurgisk behandling
Without Rotator
Karl Eriksson, Doc, �L Cuff Overload /
S�dersjukhuset,
Dysfunction
Karolinska Institutet
Outlet Impingement Stockholm
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Outlet Impingement 6/12/2013
CoracoAcromial Arch Pathomechanics - Cuff
Acromial Morphology
Type I Type II Type III
Flat Curved Hooked
Overview shoulder Physical maladaptation
of the shoulder
ACLinjuprileas sintsipko,rtserfarenheter av
Maladaptation
tidig kirurgisk behandling
= adaptation that cause more harm than help
Maladaptation and Karl Eriksson, Doc, �L
S�dersjukhuset, Exists in 60-86% of all tennis players
In the dominant shoulder
Karolinska Institutet � Increased external rotation
Stockholm � Decreased internal rotation
instability key factors This maladaption
� Cause biomechanical changes that will
result in injury in shoulder and elbow
Biomechanics Mechanism Debated
Tennis Two schools of thought
causing further injury
Greater Arc Over
Which To Instability based
Accelerate the Arm,
Ball or Racquet 20 Cuff problems
More external
rotation Capsular tightness
More Motion Internal Impingement
Enhanced Function
Less Stability
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6/12/2013
Overview shoulder Pathomechanics - Instability
ACLinjuprileas sintsipko,rtserfarenheter av Anterior Translation
With Late Cocking
tidig kirurgisk behandling
� Anterior capsular laxity
Instability and cuff Karl Eriksson, Doc, �L � Labral injury
S�dersjukhuset,
Karolinska Institutet
Stockholm
pathomechanics
Pathomechanics Overview shoulder
Cuff
ACLinjuprileas sintsipko,rtserfarenheter av
Loss of Internal Rotation tidig kirurgisk behandling
Inflammation & Scarring Karl Eriksson, Doc, �L
Posterior Shoulder Capsule S�dersjukhuset,
Maladaptation (increased Karolinska Institutet
with external rotation)
Instability and labrum Stockholm
Ant-Sup Translation & pathomechanics
Impingement
Pathomechanics - Labrum Pathomechanics - Labrum
Late Cocking Labral Tear
Position
Loss of labral function
Load Labral Rim Further instability
Further overload to
rotator cuff
6
6/12/2013
Overview shoulder Dynamic Stabilizers
play some role
ACLinjuprileas sintsipko,rtserfarenheter av
Serratus Anterior
tidig kirurgisk behandling
Stabilizes Scapula
Pathomechanics - Karl Eriksson, Doc, �L
Instability S�dersjukhuset, Moves Scapula on Chest
Wall � Rotate Coraco-
Karolinska Institutet Acromial Arch
Stockholm
Allows Stable Base for
Shoulder Motion
Pathomechanics Overview shoulder
Impingement � ACLinjuprileas sintsipko,rtserfarenheter av
Instability tidig kirurgisk behandling
Paradigm
Karl Eriksson, Doc, �L
S�dersjukhuset,
Karolinska Institutet
Stockholm
Internal Impingement
Internal Impingement What Is The Cause?
What Is It? 1. Unknown
2. Occurs Normally
Pinching of Posterior 3. Pathologic Contact
Rotator Cuff
Postero-Superior Overhead Athletes
Glenoid
Greater Tuberosity Tennis
Volleyball
Baseball
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What is the cause of 6/12/2013
Internal Impingement?
What is the cause of
Etiology Internal Impingement?
Rotational Etiology --Scapular Dyskinesis
/ Retroversion
Courtesy of Marc Safran, Stanford Video Courtesy of W. Benjamin
Loose Anterior University, USA Kibler, MD
Capsule
Tight Posterior Overview shoulder
Capsule
ACLinjuprileas sintsipko,rtserfarenheter av
What is the cause of
Internal Impingement? tidig kirurgisk behandling
Glenohumeral Internal Management Tight Karl Eriksson, Doc, �L
Rotation Deficit (GIRD) Posterior Capsule S�dersjukhuset,
Decreased Scapular Upward Karolinska Institutet
Rotation Stockholm
Increased Protraction
GIRD Affects Scapular
Position & Motion
Thomas, et al, CORR 2010
Management Management
Tight Posterior Capsule Tight Posterior Capsule
Roll-Over Sleeper Cross Body Stretch
Stretch
Door Way Stretch
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6/12/2013
Post Capsule Stretch Results Post Capsule Stretch
Surgery Results
Prospective Study of High Level Tennis
and pitching over 2 years 124 Baseball Pitchers
2-7 yrs After SLAP Repair, Cuff
2 Groups: Posterior Inferior Capsular Stretch + Control - No Stretch Debridement, GIRD Reduction
Results group 1 with stretching: Results after 2 years
Significant Increase IR & Total rotation All Resumed Pitching
38% Decrease in Shoulder Problems 90% Excellent, 10% Good
Pre-op GIRD: 53 deg
Conclusion: Post-op GIRD: 18 deg
Stretching Successful in Preventing Shoulder Problems 1-7 yr Results Same
Burkhart, Morgan, Kibler, Arthroscopy. Morgan, unpublished
2003 Apr;19(4):404-20.
Overview shoulder Management without surgery
ACLinjuprileas sintsipko,rtserfarenheter av Partial Thickness Cuff Tear
tidig kirurgisk behandling Non-Operative
Management Karl Eriksson, Doc, �L
without surgery S�dersjukhuset,
Karolinska Institutet
Stockholm
Management without surgery Management without surgery
Loose Anterior Capsule Scapular Dyskinesis
Non-Operative � Rehab
� Rehab
Scapula Stabilizers � Rehab
� Scapular
Stabilizers
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6/12/2013
Management without surgery Overview shoulder
Bracing ACLinjuprileas sintsipko,rtserfarenheter av
� Alignmed S3 tidig kirurgisk behandling
� Scapular Stabilization Karl Eriksson, Doc, �L
S�dersjukhuset,
� Proprioception
Karolinska Institutet
Role for surgery?? Stockholm
Role for surgery?? Role for surgery??
Loose Anterior Capsule Results Capsular Plication
Return to sport variable
Open
68 � 92%
Jobe 1995 & 1996
Risks
Loss of Motion
Loss of Velocity
Loss of Career
60% RTS Same Level
Overview shoulder Take home message
ACLinjuprileas sintsipko,rtserfarenheter av � Strengthen
� Scapula Stabilizers
tidig kirurgisk behandling � Rotator Cuff
� Subscapularis
Take home message Karl Eriksson, Doc, �L
S�dersjukhuset, � Stretch Posterior Cuff
Karolinska Institutet � When to scope the shoulder ?
Stockholm
Debridement
SLAP Repair
If GIRD >250
Posterior Capsulotomy
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6/12/2013
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