The 65-year old veteran athlete was diagnosed with a SLAP lesion of the shoulder joint after experiencing painful throwing of the javelin. Yergason’s and Speed’s manual tests confirmed this diagnosis by producing pain in the biceps tendon and bicipital groove region. A SLAP lesion is a tear in the superior labrum that can impact the attached long head of the biceps brachii tendon.
This document summarizes the physical characteristics and clinical examination of the shoulder in overhead throwing athletes. It discusses that overhead throwing athletes exhibit adaptations in shoulder range of motion, with increased external rotation and decreased internal rotation compared to the non-dominant arm. The document also notes that total rotation range of motion remains equal between arms. Additional physical characteristics discussed include increased anterior scapular tilt and upward rotation in the dominant arm. The summary provides an overview of the unique physical attributes clinicians should be aware of when evaluating and treating overhead throwing athletes.
This document summarizes current concepts in evaluating and treating shoulder injuries in overhead throwing athletes. It discusses the unique physical characteristics of overhead throwers, including increased shoulder range of motion (ROM) with excessive external rotation and decreased internal rotation. It also notes adaptations in scapular positioning. The summary provides an overview of evaluating the throwing shoulder through examination of ROM, joint laxity, scapular positioning, and strength as well as understanding the athlete's injury history and symptoms. Adaptations like increased external rotation are normal for overhead athletes while decreased total ROM or a hard end feel during internal rotation may indicate pathology.
1) The document reviews literature on landing and jumping biomechanics as they relate to injury risk, particularly for the ACL. Improper mechanics can increase injury risk, and prevention programs have shown success in correcting mechanics.
2) Female adolescents are most at risk for ACL injury due to changes during puberty. A training program was shown to limit loss of knee control in female athletes. Prevention programs have had success reducing injuries by focusing on balance, flexibility, strength, and proper technique education.
3) The Landing Error Scoring System has been shown to accurately assess landing mechanics and identify errors related to injury risk. It can help evaluate the effectiveness of interventions aimed at correcting landing techniques.
1) Rotator cuff tears in overhead athletes like baseball pitchers usually result from chronic overuse of the muscles during the deceleration and follow-through phases of throwing.
2) Conservative rehabilitation for rotator cuff tears focuses on reducing inflammation, regaining full range of motion, strengthening muscles, and completing sport-specific exercises before returning to play.
3) The overhead throwing motion involves wind-up, early cocking, late cocking, acceleration, and follow-through phases that place high stresses on the rotator cuff muscles, making tears most common in the deceleration and follow-through phases.
Current concept in scientific and clinical rationale behind exercises for gh ...Satoshi Kajiyama
The article provides an overview of the biomechanical and clinical implications of rehabilitation exercises for the glenohumeral and scapulothoracic joints. It reviews the function and biomechanics of specific muscles, and examines common rehabilitation exercises through the lens of electromyography and biomechanics research. The goal is to help clinicians develop safe and effective exercise programs by understanding how exercises target specific muscles and how pathology may alter muscle firing patterns. Exercises that minimize deltoid activity relative to rotator cuff muscles, avoid positions linked to impingement risk, and recruit key muscles at various angles are discussed to optimize rehabilitation.
This study investigated hip muscle activation during common closed-chain rehabilitation exercises and running in runners. Electromyography was used to measure gluteus maximus and medius activation during a resisted hip external rotation exercise, single leg squat with trunk rotation, forward lunge with resisted abduction, and running. The forward lunge elicited the highest hip muscle activation, but activation was still substantially less than during running. While the exercises activated the hip muscles more than non-weight bearing exercises, there remains a disconnect between activation during exercises and running. Further research is needed to identify exercises that more closely mimic muscle demands during running.
This document summarizes the physical characteristics and clinical examination of the shoulder in overhead throwing athletes. It discusses that overhead throwing athletes exhibit adaptations in shoulder range of motion, with increased external rotation and decreased internal rotation compared to the non-dominant arm. The document also notes that total rotation range of motion remains equal between arms. Additional physical characteristics discussed include increased anterior scapular tilt and upward rotation in the dominant arm. The summary provides an overview of the unique physical attributes clinicians should be aware of when evaluating and treating overhead throwing athletes.
This document summarizes current concepts in evaluating and treating shoulder injuries in overhead throwing athletes. It discusses the unique physical characteristics of overhead throwers, including increased shoulder range of motion (ROM) with excessive external rotation and decreased internal rotation. It also notes adaptations in scapular positioning. The summary provides an overview of evaluating the throwing shoulder through examination of ROM, joint laxity, scapular positioning, and strength as well as understanding the athlete's injury history and symptoms. Adaptations like increased external rotation are normal for overhead athletes while decreased total ROM or a hard end feel during internal rotation may indicate pathology.
1) The document reviews literature on landing and jumping biomechanics as they relate to injury risk, particularly for the ACL. Improper mechanics can increase injury risk, and prevention programs have shown success in correcting mechanics.
2) Female adolescents are most at risk for ACL injury due to changes during puberty. A training program was shown to limit loss of knee control in female athletes. Prevention programs have had success reducing injuries by focusing on balance, flexibility, strength, and proper technique education.
3) The Landing Error Scoring System has been shown to accurately assess landing mechanics and identify errors related to injury risk. It can help evaluate the effectiveness of interventions aimed at correcting landing techniques.
1) Rotator cuff tears in overhead athletes like baseball pitchers usually result from chronic overuse of the muscles during the deceleration and follow-through phases of throwing.
2) Conservative rehabilitation for rotator cuff tears focuses on reducing inflammation, regaining full range of motion, strengthening muscles, and completing sport-specific exercises before returning to play.
3) The overhead throwing motion involves wind-up, early cocking, late cocking, acceleration, and follow-through phases that place high stresses on the rotator cuff muscles, making tears most common in the deceleration and follow-through phases.
Current concept in scientific and clinical rationale behind exercises for gh ...Satoshi Kajiyama
The article provides an overview of the biomechanical and clinical implications of rehabilitation exercises for the glenohumeral and scapulothoracic joints. It reviews the function and biomechanics of specific muscles, and examines common rehabilitation exercises through the lens of electromyography and biomechanics research. The goal is to help clinicians develop safe and effective exercise programs by understanding how exercises target specific muscles and how pathology may alter muscle firing patterns. Exercises that minimize deltoid activity relative to rotator cuff muscles, avoid positions linked to impingement risk, and recruit key muscles at various angles are discussed to optimize rehabilitation.
This study investigated hip muscle activation during common closed-chain rehabilitation exercises and running in runners. Electromyography was used to measure gluteus maximus and medius activation during a resisted hip external rotation exercise, single leg squat with trunk rotation, forward lunge with resisted abduction, and running. The forward lunge elicited the highest hip muscle activation, but activation was still substantially less than during running. While the exercises activated the hip muscles more than non-weight bearing exercises, there remains a disconnect between activation during exercises and running. Further research is needed to identify exercises that more closely mimic muscle demands during running.
The document summarizes several studies on upper extremity injuries in pitchers. Key findings include:
1) UCL tears and SLAP tears can decrease shoulder range of motion and pitching mechanics.
2) Improper trunk rotation and humeral torsion are linked to greater shoulder stress and injuries.
3) Surgical repair and tenodesis can restore pitching ability, though nonsurgical options have similar return-to-play rates.
4) Partial effort throwing programs have been shown to reduce shoulder stress compared to maximum effort programs.
Lower limb alignment in young female athletes is associated with knee joint m...peertechzpublication
Background: Increased rotational forces and knee valgus forces puts strain on the anterior cruciate
ligament, frequently ruptured in female athletes. Increased internal hip rotation and increased knee valgus
alignment, possible risk factors for anterior cruciate ligament rupture, are more common in women than
men.
The Achilles tendon evolved approximately 2 million years ago to allow humans to run faster. It is prone to injury due to its limited blood supply. A rupture typically occurs when a load is applied while the tendon is stretched, often due to pre-existing tendonitis. Treatment options include operative repair through open surgery or minimally invasive surgery, or non-operative casting and rehabilitation. Rehabilitation programs focus on regaining range of motion and strength over 4-6 months. Future research could investigate genetic risk factors, standardized strength testing for different treatment options, and outcomes of surgery for primary versus recurrent ruptures.
See discussions, stats, and author profiles for this publicati.docxedgar6wallace88877
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/231740008
Cruciate ligament loading during common knee rehabilitation exercises
Article in Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine · September 2012
DOI: 10.1177/0954411912451839 · Source: PubMed
CITATIONS
11
READS
2,866
5 authors, including:
Some of the authors of this publication are also working on these related projects:
1) Pitching Biomechanics View project
Rafael F Escamilla
California State University, Sacramento
99 PUBLICATIONS 5,543 CITATIONS
SEE PROFILE
Toran D MacLeod
California State University, Sacramento
61 PUBLICATIONS 477 CITATIONS
SEE PROFILE
James R Andrews
American Sports Medicine Institute
188 PUBLICATIONS 9,583 CITATIONS
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ht.
This randomized clinical trial compared the effectiveness of anterior versus posterior glide joint mobilization techniques for improving shoulder external rotation range of motion in patients with adhesive capsulitis. Twenty subjects with primary adhesive capsulitis and external rotation deficits were randomly assigned to receive either anterior or posterior glide mobilization plus therapeutic ultrasound and exercise over six sessions. Shoulder external rotation range of motion was measured initially and after each session. The group receiving posterior glide mobilization showed significantly greater improvement in external rotation range of motion compared to the group receiving anterior glide mobilization. Both groups had significant decreases in pain.
Shoulder dislocations are the most common joint dislocations, and only 2% of these are seen as posterior shoulder dislocations. The floating elbow was first described in children, after that shown in adults. Floating elbow cases are very rare, and usually seen with high-energy trauma. Classical definition is the coexistence of the humeral diaphyseal and forearm fracture, but there are other definitions as well.
This study aims to define gait for shoulder-produced locomotion using the double-poling technique from sledge hockey. A solid-static prototype mimicking the average male torso was used to determine baseline measures during the preparation phase. The prototype's trajectory and reaction forces supported that preparation initiation should begin slightly below the horizon to produce the greatest force. Results from sledge hockey players and able-bodied controls will be used to illustrate the complete seated gait cycle, including phases for static-start, start cycle, contact, and recovery. This evidence could improve training and rehabilitation for people who use their shoulders for mobility.
An experimental study on scapulothoracic and glenohumeral kinematics followin...pharmaindexing
This study examined the effects of rotator cuff fatigue on scapulothoracic and glenohumeral kinematics in tennis players. 20 male tennis players without shoulder injuries were divided into experimental and control groups. The experimental group underwent an external rotator fatigue protocol, while the control group received traditional coaching. Shoulder range of motion and function were assessed before and after with both groups showing improvements, but the experimental group demonstrated significantly greater improvements, suggesting external rotator strengthening provides benefits to tennis players beyond traditional coaching alone.
An experimental study on scapulothoracic and glenohumeral kinematics followin...pharmaindexing
Aim
This study aimed to find out the effect of rotator cuff fatigue on humeral head migration during dynamic shoulder external rotation activity (combination of flexion, abduction, external rotation) in tennis players.
Objectives
The purpose for physiotherapist in sports performance enhancement assessment of shoulder kinematics provides a reliable tool for studying kinematics during arm elevation.
To understand the importance of external rotation strengthening on clearing superior glenohumeral joint migration for tennis professionals.
Materials and Methods
A total of 20 men of tennis players without shoulder disorders were recruited in the study. The study was conducted in the Tamilnadu tennis association (TNTA) and Gandhi nagar tennis club (GNC adayar). Pre and post tests were performed.
Results
The data was analyzed using SPSS. The experimental group (who received external rotator fatigue protocol) showed significance with (p=0.001) value when compared with the control group. Also, the post-test mean value of the experimental group showed a significant improvement after the protocol.
Conclusion
External rotators stretching and strengthening protocol showed significant improvement in functional status of glenohumeral joint than conventional traditional coaching program alone on tennis professionals.
This study examined core stability measures in male and female athletes to determine if these measures predict lower extremity injury risk. The study tested hip abduction, external rotation, trunk endurance, and abdominal strength in 80 female and 60 male athletes. Males showed greater strength and endurance compared to females. Athletes who avoided injury also showed greater hip strength. Logistic regression revealed that weaker hip external rotation predicted injury risk. The study suggests that improving core stability may help prevent lower extremity injuries, especially in female athletes.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
The document summarizes several studies on upper extremity injuries in pitchers. Key findings include:
1) UCL tears and SLAP tears can decrease shoulder range of motion and pitching mechanics.
2) Improper trunk rotation and humeral torsion are linked to greater shoulder stress and injuries.
3) Surgical repair and tenodesis can restore pitching ability, though nonsurgical options have similar return-to-play rates.
4) Partial effort throwing programs have been shown to reduce shoulder stress compared to maximum effort programs.
Lower limb alignment in young female athletes is associated with knee joint m...peertechzpublication
Background: Increased rotational forces and knee valgus forces puts strain on the anterior cruciate
ligament, frequently ruptured in female athletes. Increased internal hip rotation and increased knee valgus
alignment, possible risk factors for anterior cruciate ligament rupture, are more common in women than
men.
The Achilles tendon evolved approximately 2 million years ago to allow humans to run faster. It is prone to injury due to its limited blood supply. A rupture typically occurs when a load is applied while the tendon is stretched, often due to pre-existing tendonitis. Treatment options include operative repair through open surgery or minimally invasive surgery, or non-operative casting and rehabilitation. Rehabilitation programs focus on regaining range of motion and strength over 4-6 months. Future research could investigate genetic risk factors, standardized strength testing for different treatment options, and outcomes of surgery for primary versus recurrent ruptures.
See discussions, stats, and author profiles for this publicati.docxedgar6wallace88877
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/231740008
Cruciate ligament loading during common knee rehabilitation exercises
Article in Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine · September 2012
DOI: 10.1177/0954411912451839 · Source: PubMed
CITATIONS
11
READS
2,866
5 authors, including:
Some of the authors of this publication are also working on these related projects:
1) Pitching Biomechanics View project
Rafael F Escamilla
California State University, Sacramento
99 PUBLICATIONS 5,543 CITATIONS
SEE PROFILE
Toran D MacLeod
California State University, Sacramento
61 PUBLICATIONS 477 CITATIONS
SEE PROFILE
James R Andrews
American Sports Medicine Institute
188 PUBLICATIONS 9,583 CITATIONS
SEE PROFILE
All content following this page was uploaded by Toran D MacLeod on 05 April 2015.
The user has requested enhancement of the downloaded file.
https://www.researchgate.net/publication/231740008_Cruciate_ligament_loading_during_common_knee_rehabilitation_exercises?enrichId=rgreq-8852a600dafd042a7f3518b6537ffee9-XXX&enrichSource=Y292ZXJQYWdlOzIzMTc0MDAwODtBUzoyMTQ2OTAzMzM0OTkzOTJAMTQyODE5NzU3Mjg2Mg%3D%3D&el=1_x_2&_esc=publicationCoverPdf
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ht.
This randomized clinical trial compared the effectiveness of anterior versus posterior glide joint mobilization techniques for improving shoulder external rotation range of motion in patients with adhesive capsulitis. Twenty subjects with primary adhesive capsulitis and external rotation deficits were randomly assigned to receive either anterior or posterior glide mobilization plus therapeutic ultrasound and exercise over six sessions. Shoulder external rotation range of motion was measured initially and after each session. The group receiving posterior glide mobilization showed significantly greater improvement in external rotation range of motion compared to the group receiving anterior glide mobilization. Both groups had significant decreases in pain.
Shoulder dislocations are the most common joint dislocations, and only 2% of these are seen as posterior shoulder dislocations. The floating elbow was first described in children, after that shown in adults. Floating elbow cases are very rare, and usually seen with high-energy trauma. Classical definition is the coexistence of the humeral diaphyseal and forearm fracture, but there are other definitions as well.
This study aims to define gait for shoulder-produced locomotion using the double-poling technique from sledge hockey. A solid-static prototype mimicking the average male torso was used to determine baseline measures during the preparation phase. The prototype's trajectory and reaction forces supported that preparation initiation should begin slightly below the horizon to produce the greatest force. Results from sledge hockey players and able-bodied controls will be used to illustrate the complete seated gait cycle, including phases for static-start, start cycle, contact, and recovery. This evidence could improve training and rehabilitation for people who use their shoulders for mobility.
An experimental study on scapulothoracic and glenohumeral kinematics followin...pharmaindexing
This study examined the effects of rotator cuff fatigue on scapulothoracic and glenohumeral kinematics in tennis players. 20 male tennis players without shoulder injuries were divided into experimental and control groups. The experimental group underwent an external rotator fatigue protocol, while the control group received traditional coaching. Shoulder range of motion and function were assessed before and after with both groups showing improvements, but the experimental group demonstrated significantly greater improvements, suggesting external rotator strengthening provides benefits to tennis players beyond traditional coaching alone.
An experimental study on scapulothoracic and glenohumeral kinematics followin...pharmaindexing
Aim
This study aimed to find out the effect of rotator cuff fatigue on humeral head migration during dynamic shoulder external rotation activity (combination of flexion, abduction, external rotation) in tennis players.
Objectives
The purpose for physiotherapist in sports performance enhancement assessment of shoulder kinematics provides a reliable tool for studying kinematics during arm elevation.
To understand the importance of external rotation strengthening on clearing superior glenohumeral joint migration for tennis professionals.
Materials and Methods
A total of 20 men of tennis players without shoulder disorders were recruited in the study. The study was conducted in the Tamilnadu tennis association (TNTA) and Gandhi nagar tennis club (GNC adayar). Pre and post tests were performed.
Results
The data was analyzed using SPSS. The experimental group (who received external rotator fatigue protocol) showed significance with (p=0.001) value when compared with the control group. Also, the post-test mean value of the experimental group showed a significant improvement after the protocol.
Conclusion
External rotators stretching and strengthening protocol showed significant improvement in functional status of glenohumeral joint than conventional traditional coaching program alone on tennis professionals.
This study examined core stability measures in male and female athletes to determine if these measures predict lower extremity injury risk. The study tested hip abduction, external rotation, trunk endurance, and abdominal strength in 80 female and 60 male athletes. Males showed greater strength and endurance compared to females. Athletes who avoided injury also showed greater hip strength. Logistic regression revealed that weaker hip external rotation predicted injury risk. The study suggests that improving core stability may help prevent lower extremity injuries, especially in female athletes.
Similar to case study 3 part 3 - presentation.pptx (12)
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Are you looking for a long-lasting solution to your missing tooth?
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Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
1. Case study 3- Part 3:
A 65-year old veteran athlete has a painful throwing
shoulder during delivery of the javelin and is diagnosed
as having a superior labral anterior posterior lesion of
the shoulder joint (SLAP lesion). The long head of the
biceps brachii muscle tendon is impacted in this injury.
Yergason’s- and Speed’s manual tests confirmed the
diagnosis.
NICOLE POTTINGER -217111777
THAPELO SITOTO – 217271715
HMBV311- ANATOMY III
2. INTRODUCTION
Superior labrum anterior to posterior (SLAP) lesions are tears in the superior anterior
and posterior part of the glenoid labrum. The glenoid labrum serves as an attachment
site for the long head of the biceps tendon; together these structure help with
stabilization of the humeral head into the glenohumeral joint during abduction and
external rotation of the arm (Nuri, Evrim & Alp, 2014).
There are several types of SLAP lesions mainly caused by overuse, injury and
degeneration; the symptoms include locking and grinding as well as reduced range of
motion, strength and stability in the shoulder joint (Bonvissuto, 2018). Diagnosis is
through physical examination tests, namely: O’Briens’s, Biceps Load, O’Driscoll’s
Dynamic Labral Shear and Speed’s tests. Treatment of SLAP lesion is determined by
severity of the tear which could range from non-operative methods (such as rest and
physical rehabilitation) and operative methods such as (repair and tenodesis).
In relation to the case study, the objective of this assignment is to determine what might
have caused the SLAP lesion in the 65- year old javelin thrower; to prove why the tests
used for diagnosis were appropriate and to provide the appropriate intervention
strategies that could be followed to ensure that the glenoid labrum is repaired.
4. Scapulohumeral Rhythm
https://www.youtube.com/watch?v=H4nfQEeJmFo
Brachial plexus https://www.youtube.com/watch?v=gTas7ijp0YE
According to (Drake, et al., 2015) the brachial plexus is a somatic plexus that is formed by
the anterior rami of C5 to C8 and most of the anterior ramus of T1. The originates from
the neck and passes laterally and inferiorly over rib pair 1 and enters the axilla. The
brachial plexus innervates the upper limb.
Biomechanics of Javelin throw https://www.youtube.com/watch?v=7GqhqmYjMpE
5. There are 6 phases of throwing: Wind up, stride, arm cocking, acceleration, deceleration
and follow-through.
The phases that influence injuries in the shoulder is arm cocking, acceleration,
deceleration and follow-through.
Arm cocking- The athlete’s shoulder is at maximum external rotation.
Acceleration phase- Shoulder is at maximal external rotation and begins to transition to
internal rotation.
transition phase is where the greatest risk of injury may occur. Biceps muscles contracts to
valgus stress and hyperextension at the elbow. This leads to extreme tension on the superior
labrum and origin of the long head biceps tendon at the supraglenoid tubercle. (Lin, et al.,
2018).
Deceleration phase- Shoulder is in maximal internal rotation. In this phase, greatest
glenohumeral joint loading occurs, increased compressive forces, adduction torque and
inferior forces. The posterior musculature helps to dissipate all these components.
Follow-through: The athletes arm continues to decelerate via eccentric contraction of the
shoulder, scapula and elbow muscles. Follow-through phase is necessary to dissipate the
energy generated during the throwing motion, thus is associated with overuse injuries of the
posterior arm.
6. PATHOPHYSIOLOGY
https://www.youtube.com/watch?v=WOWJacen9A0
In the 65-year-old, the SLAP lesion could have been caused by overuse, injury
and degeneration. The follow- through phase, used for energy dissipation
during javelin throwing, is associated with overuse injuries of the posterior
arm. The other phases influence injury in that the athlete’s shoulder is at
maximal external rotation during the arm cocking phase; going into the
acceleration phase, the arm goes into internal rotation; the transition phase
subjects the athlete to the greatest risk for a SLAP lesion, in that the biceps
muscles contracts to valgus stress and hyperextension occurs at the elbow,
leading to extreme tension on the superior labrum and origin of the long head
biceps tendon at the supraglenoid tubercle. During the deceleration phase, the
shoulder is in maximal internal rotation, thus there is greatest glenohumeral
joint loading, increased compressive forces, adduction torque and inferior
forces which could cause injury. The SLAP lesion could have also been caused
by degeneration of tissue of the glenohumeral joint caused by aging.
8. Illustration of the different types of slap lesions (A. most severe type 4 SLAP lesion, B. Type 3,
Type 2, D. Type 1) (Stathellis, et al., 2018).
A. B. C. D.
9. TREATMENT/ INTERVENTION
Diagnosing of SLAP lesions can be challenging as SLAP lesions don’t have a specific pain associated with it. Patients
complain about localized or radial pain that moves anterior to posterior part of the shoulder or pain is sharp or
aching deep within the shoulder. The pain can mimic other shoulder pathologies.
Diagnosis of SLAP lesion is through physical examination tests, namely: O’Briens’s, Biceps Load, O’Driscoll’s Dynamic
Labral Shear and Speed’s tests. The Yergason’s and Speed’s tests have been used for diagnoses for this case study.
The Yergason’s and Speeds’s test are positive when there is pain at the bicep tendon and in the region of the
bicipital groove, respectively; the athlete complains of pain during the delivery of the javelin emphasising thus the
structures mentioned are involved during a SLAP lesion. These tests are appropriate in that they test for paining of
the structures involved during a SLAP lesion.
The type of treatment depends on the type of lesion, the age of the patient, the gender of the patient, the cause of
lesion (traumatic or non-traumatic), the functional requirement of the patient and the level of sporting activity
(Stathellis et al., 2018). A non-operative treatment is initially done. Some of the non-operative treatments are anti-
inflammatory drugs, physiotherapy or change or improvement in sporting technique. Non-operative treatment
should last for three to six months. If the non-operative treatment is not successful, surgery is considered
According to (Hester, et al., 2018) three basic principles are followed when initial management of all SLAP injuries
occur. Decrease inflammation via cryotherapy, medications and/or injections. Postural correction via scapular
retraction exercises, posture bracing and taping, and biofeedback exercises. Balanced rotator cuff rehabilitation and
proprioceptive neuromuscular rehabilitation exercises to return to function.
10. CONCLUSION
The SLAP lesion in the 65- year old javelin thrower was as a result of
overuse, injury and degeneration; paining of the shoulder during delivery
is caused by injury to the biceps tendon and injury in the region of the
bicipital groove which is confirmed by the Yergason’s and Speeds’s test.
Operational methods would be optional to the youth which would yield
better results, however since the operational method is less effective for
the elderly, management is rather advised for SLAP lesions and these
include cryotherapy, medications and/or injections, postural correction and
rotator cuff rehabilitation and proprioceptive neuromuscular rehabilitation
exercises.
11. REFERENCES
Bonvissuto, D. (2018). What Is a Labrum SLAP Tear? [online] WebMD. Available at: https://www.webmd.com/pain-management/labrum-slap-tear [Accessed 8 Mar.
2019].
Drake, R.L., Vogl, W. and Mitchell, A.W.M. (2015). Gray’s atlas of anatomy. Philadelphia, Pa: Churchill Livingstone/Elsevier, p 708-709.
Hester, W. A., Brian, M. L. O., Heard, W. M. & Savoie, F. H., 2018. Current concepts in the evaluation and management of type II superior labral lesions of the
shoulder. The Open Ortgopaedics Journal, Volume 12, pp. 331-341.
Lin, D. J., T.Wong, T. & K.Kazam, J., 2018. Shoulder injuries in the overhead- throwing athlete: Epidemiology, mechanisms of injury, and image findings. Radiology,
286(2).
Nuri Aydin, Evrim Sirin, Alp Arya. Superior labrum anterior to posterior lesions of the shoulder: Diagnosis and arthroscopic management. World Journal of
Orthopedics, 5(3), p.344.
Pappas, N. D., C.Hall, D. & Lee, D. H., 2013. Prevalence of labral tears in the elderly. Journal of Shoulder and Elbow surgery, Volume 22, pp. 11-15.
Prentice, W.E. (2017). Principles of athletic training: a guide to evidence-based clinical practice. New York, Ny: Mcgraw-Hill Education, p.669-677.
Stathellis, A. et al., 2018. Treatment of SLAP lesions. The open Orthopaedics Journal, 12(Suppl-1, M4), pp. 288-294.
Woldt, J. (n.d.). Javelin: The run-up & crossover phases. [online] Available at: http://javelinbiomechanics.blogspot.com/2015/06/thetwo-most-important-and-
controllable.html.
Editor's Notes
Glenoidlabrum, ring of fibrous tissue attached to rim of glenoid fossa, increase depth cavity and will increase stability od shoulder joint, propricep, muscle control and spreads load
Primary attachment for shoulder capsule and glenohumeral ligaments (draw)
Superior aspect of labrum= attach for long head of biceps
Know the drawing!!! Able to draw
NB scap rhythm
Know types of lesions and complexity and type of rehab due to type of lesion.
Tests of which slap lesion and diagnose the slap
Know principles of rehab and phases are same as