Sports injuries of upper limb , with different sports and different injuries

1. THROWING
INJURIES (UL)

2. SPORTS WITH HIGHEST RISK OF INJURY
• Tennis
• Baseball and softball
• Swimming
• Football
• Volleyball
• Basketball
• Golf
• Water polo

3. • THROWING INJURIES
▫ Throwing injuries are seen in the shoulder and
elbow of the athletes in common.
▫ It includes tendonitis to several structures, shoulder
instability, bursitis ,and ligament damage
(SPRAINS).
▫ These types of injuries are primarily seen in
baseball , softball and football and also common in
volleyball and water polo athletes.

4. • CAUSES
▫ Improper techniques
▫ Repetition
▫ Overuse
▫ Muscle imbalance
▫ Training errors
▫ Too much too fast

5. • SYMPTOMS OF THROWING INJURY
• Pain
• Weakness
• Loss of range of motion
• Loss of control or velocity to throw
• Constant discomfort
• Swelling
• Tender to touch at point of injury

6. • INJURIES
▫ Rotator cuff injuries
▫ Acromioclavicular joint injury
▫ Labral tears
▫ Biceps injuries
▫ Bursitis
▫ SLAP tears
▫ Shoulder dislocation
▫ Throwers shoulder , Rugby shoulder

7. ▫ Flexor tendinitis
▫ Extensor tendinitis
▫ Valgus extension overload
▫ Ulnar collateral ligament injury
▫ Olecranan stress factor
▫ Ulnar neuritis

8. • SHOULDER INJURIES
▫ It has been estimated that shoulder injuries account for
8% to 13% of all sports injuries. (Rogerio Teixeira da Silva-
sports Injuries Of The Upper Limbs )
• Thrower’s shoulder
▫ Throwers shoulder is common in overhead throwing
sports and predisposing factor for this injury is
increased external rotation and decreased internal
rotation.
▫ It is often observed amongst athletes in sports that
involve large ranges of motion .
▫ when an athlete develops throwers shoulder the load on
the shoulder exceeds the load capacity .

9. ▫ The anterior part of the shoulder joint capsule is gradually
pulled and stretched this may decrease the shoulder
stability and cause rotator cuff injury.
▫ The rotator cuff can initially compensate for this by
increasing muscle activity if it goes for long time it can
cause overuse injury to labrum and rotator cuff muscles
and also the normal shoulder mechanics will be affected.

11. • WIND UP PHASE
▫ It is the initial movement of maximum knee lift of
stride leg.
▫ In this the muscle activities are low and the reason for
risk of injury is also low.
▫ EMG studies shown that upper trapezius has a
maximum voluntary isometric contraction of 18% and
serattus anterior 20% and anterior deltoid 15%.

12. • STRIDE PHASE
▫ Because of the increased anterior force on the
shoulder, it can be assumed that over time the anterior
ligamentous structures to the glenohumeral joint may
be compromised.
▫ This finding is consistent with the anterior
glenohumeral instability found in many throwing
athletes and emphasizes the importance of proper
mechanics throughout the activity.

13. • ARM COCKING PHASE
▫ The arm cocking phase can be defined as the beginning of
lead foot contact and ends at maximum shoulder external
rotation.
▫ Approximately 80% bodyweight, from the lower
extremities and trunk rotation.
▫ Due to the circumstances the scapula and shoulder
muscles are highly activated to promote and sustain
movements of the shoulder, especially external rotation.

14. ▫ The biceps brachii and supraspinatus are shown to be
initiated or excited by these mechanoreceptors and
assist with prevention of anterior instability.
▫ Overtime the excessive utilization of the biceps brachii
could lead to a superior labrum anterior to posterior
(SLAP) tear. Simultaneously the pectoralis major,
subscapularis, and serratus anterior are inhibited.

16. • ARM ACCELERATION PHASE
▫ The arm acceleration phase begins at maximum shoulder
external rotation and ends at ball release.
▫ In this internal rotation angular velocity will be
approximately 6500⁰/sec near ball release.
▫ Improper stabilization of the scapula may be the cause of
increased risk of shoulder impingement in this phase.

17. • ARM DECELERATION PHASE
▫ The arm deceleration phase begins at ball release and
ends at maximum shoulder internal rotation.
▫ Escamilla et al states that a posterior shear force of
40–50% of bodyweight is generated to resist shoulder
anterior subluxation.
▫ Due to the high forces generated in this phase, this
may lead to tensile overload, undersurface cuff tears,
labrum and bicep injuries , capsule injuries,
and internal impingement.

18. SLAP TEAR
 Superior laberal antero posterior tear of the shoulder are
common in overhead throwing and heavy lifting, tackling
sports.
 The biceps anchor in the shoulder is forcibly peeled or
pulled off its bone attachment by
large pulling force this can occur
during heavy lift, throw or fall .

19. ▫ SLAP tears are caused by forceful eccentric
traction exerted on the biceps tendon and in
throwers by the chronic stress placed on
the labrum when the shoulder is forcefully
abducted and externally rotated
(eg, cocking position of throwing).

20. • SUBACROMIAL IMPINGEMENT
▫ Subacromial impingement occurs with repeated use of
overhead arm activities.
▫ Primary subacromial impingement (above 35yrs)
 Compression of subacromial space which contains
supraspinatus tendon , tendon of long head of biceps and
subacromial bursae.
▫ Secondary subacromial impingement (young athletes)
It is due to inherent instability of the humeral head within
the glenoid, and is one of the most common forms of
impingement in overhead-throwing athletes.

21. • INJURIES IN DIFFERENT SPORTS
▫ TENNIS
 SLAP tear
 Shoulder weakness chances of subluxation
 Pain in the overhead swinging
 Decreased range of motion
BASEBALL AND SOFTBALL
• Shoulder instability
• Slap tear
• Subluxation or dislocation
• Rotator cuff injuries

22. • FOOTBALL
▫ Shoulder pain is due to repetitive throwing in
quarterbacks .
▫ Shoulder impingement
▫ Rotator cuff injuries
▫ Slap tears
▫ Tendinitis
▫ Shoulder injuries and dislocation can also happen
during tackle.

23. • VOLLEYBALL
▫ It puts your shoulder through lot of repetitive and
sternuous movements like,
 Serving
 Spiking
 Blocking
It leads to overuse and acute injuries.
SLAP tears also affect volleyball players, as does the
internal shoulder impingement.

24. • SWIMMING
▫ Swimming is non impact sport and it is less injury
prone sport .
▫ Repetitive actions in it puts shoulder at the risk of
injury each strokes puts shoulder through extreme
range of motion.
▫ Common injuries are SLAP tear , rotator cuff injuries,
or subacromial impingement and also pain .
▫ Biceps tendonitis, neck and low back pain, tears in the
cartilage around the shoulder socket.

25. • CAUSES OF SWIMMING INJURIES
▫ Overtraining
▫ Poor stroke mechanisms , breathing technique ,
core strength or stability.
▫ Inadequate rest
▫ Decreased hip muscle strength
▫ Poor ROM , Flexibility
▫ Decreased rotator cuff and scapular muscles
strength.

26. • ELBOW INJURIES
▫ FLEXOR TENDINITIS
 Repetitive throwing can irritate and inflame the flexor tendons
where they attach to the humerus bone on the inner side of the
elbow. Athletes will have pain on the inside of the elbow when
throwing, and if the tendinitis is severe, pain will also occur
during rest
 EXTENSOR TENDINITIS
 Its is also due to overuse.
 Lateral epicondylitis, or tennis elbow, involves the muscles
and tendons of your forearm that are responsible for the
extension of your wrist and fingers.

27. ▫ The tendon usually involved in tennis elbow is extensor
Carpi radialis brevis.

28. • ULNAR COLLATERAL LIGAMENT INJURY
▫ UCL is the most commonly injured ligament in the
elbow it can range from minor damage to complete
tear of ligament .
▫ Injury to this structure causes pain in the inside of
the elbow and decreased throwing velocity.

29. • VALGUS EXTENSION OVERLOAD
▫ The olecranon and humerus bones are twisted and
forced against each other during throwing motion.
▫ This leads to valgus extension overload in which the
cartilage on olecranon is worn away and spur formation
takes place .
▫ Athletes with VEO experience pain and swelling at site
of maximum contact of bones.

31. • OLECRANON STRESS FRACTURE
▫ The olecranon is the most common location for stress
fractures in throwers
▫ Stress fractures occur when muscles become fatigued
and are unable to absorb added shock.
▫ Fatigued muscle transfers the overload of stress to the
bone that cause tiny cracking called stress fracture

32. • ULNAR NEURITIS
▫ When the elbow is bent the ulnar nerve stretches
around the bony bump at the end of humerus.
▫ During throwing ulnar nerve is stretched repeatedly and
can slip out of place causing pain.
▫ This stretching or snapping leads to irritation of the
nerve that leads to ulnar neuritis.