SLAP Tears

slap tear anatomy shoulder

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

SLAP is an acronym for superior labrum anterior to posterior. The labrum is a rim of tissue that adds depth to the bony socket of the shoulder. The superior or « top » portion or the labrum is important and frequently injured because the biceps attaches to this region.

How

SLAP tears happens because of physical activity with repetitive overhead movements or physical shock. Tears created because of overhead movements are common among athletes as basball pitchers or tennis players. Tears created due to physical shocks are often a fall on a hand stretched with the arm over the head or fall directly on the shoulder.

Diagnosis

slap tear anatomy shoulder

SLAP tears are very difficult to diagnose only with a physical exam because of different shoulder problems. Using a MRI with or without contrast helps a lot.

Treatment

The first step is to do a nonsurgical treatment. While the SLAP tear likely will not heal, a study confirmed that many have improvement of symptoms and function. If nonsurgical treatment (such as physical therapy) isn’t successful, surgery is being considered.

Surgery is usually done arthroscopically and involves reattaching the torn labrum to the top of the cavity. Generally, bone anchors loaded with sutures are inserted into the top of the cavity. The sutures are passed through the torn area of the labrum. The sutures are tied, which brings the torn labrum to the bone.

Prevention

Although it’s difficult to avoir acute SLAP tears, it’s possible to prevent chronic tears, especially with athletes who make overhead movements, maintaining balance in the shoulder.

Exercices that strengthen the muscles around the shoulder blades and exercises that stretch posterior shoulders are recommended to reduce the risk of SLAP chronic tears.

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-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food, click here .

Shoulder Instability Or Dislocations

shoulder instability anatomy

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Shoulder is the most mobile joint of the body. This allows you to lift your arm, rotate your arm and lift your arm over your head. It’s possible to have a greater range of motion with less stability.

How

Shoulder instability

This happens when the humerus head (the upper arm bone) is forced out of the shoulder’s cavity. Usually this happens as a result of a sudden traumatic injury.

Once the shoulder is dislocated, the shoulder is vulnerable to repeat. When the shoulder is loose and slips several times, it’s called a chronic shoulder instability.

The shoulder is made of 3 bones : humerus (upper arm bone), scapula (shoulder blade) and clavicle (collarbone).

Dislocation shoulder

shoulder dislocation anatomy

This may be partial, which means that the arm’s ball partially comes out from the cavity. This is called a subluxation. This can be complete which means that the arm’s ball comes out completely from the cavity.

Symptoms

Symptoms of chronic shoulder instability are :

  • Pain caused by the shoulder injury

  • Repeated shoulder’s dislocation

  • Repeated instance of the shoulder giving out

  • A persistent sensation of the shoulder that is loose, slipping out of the joint or hanging.

Diagnosis

Specific tests help assess shoulder instability (including general relaxation of ligaments). A doctor may prescribe imaging tests such as X-rays, CT Scan or MRI to confirm the diagnosis and identify other problems.

Treatment

First, chronic shoulder instability treated with nonsurgical options. If these options don’t relieve pain and instability, surgery may be needed.

Nonsurgical treatment

shoulder dislocation treatment non surgical

Generally, it often takes several months of nonsurgical treatment before success can be assessed. Nonsurgical treatments includes :

  • Activity modification

  • Non-steroidal anti-inflammatory medication

  • Physical therapy

Surgical treatment

shoulder dislocation treatment surgery bankart repair

Often, surgery is often required to repair torn or stretched ligaments so that they can maintain the shoulder joint in place.

Bankart lesions (tearing of the front labrum from the cavity) can be repaired surgically using suture anchors to reattach the ligaments to the bone.

Arthroscopy => Soft tissues of the shoulder can be repaired using tiny instruments and small incisions. It’s a procedure that is done the same day or outpatient. Arthroscopy is a minimally invasive surgery. The surgeon examines the inside of the shoulder with a small camera and performs the operation with special instruments.

Open surgery => These are patients who require open surgical intervention. This involves making a wider incision on the shoulder and performing the repair under direct visualization.

Rehabilitation

After surgery, the shoulder can be temporarily immobilized with a sling. When the sling is removed, it’s essential to do ligament rehabilitation exercises. These exercises improve the range of motion of the shoulder and avoid scarring during ligament healing. Thereafter, exercises for strengthening the shoulder will be added in the rehabilitation program.

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-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food, click here .

MRSA Infections

mrsa infection anatomy

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Methicillin-Resistant Staphylococcus aureus (S. Aureaus), or MRSA, is a bacterium that creates skin infections and other types of infections. The first time that MRSA was seen in US hospitals during the 1970s. Recently, there is a new strain of MRSA know as Community Acquired Methicillin-Resistant Staphylococcus aureus, or CA-MRSA, has left hospitals and began to spread in the community.

This is the strain that is prevalent among athletes. The difference between CA-MRSA and Healthcare-Associated MRSA (HA-MRSA) is in their effects. CA-MRSA usually creates skin infections while HA-MRSA causes bloodstream, urinary tract and surgical site infections. This make CA-MRSA less dangerous than HA-MRSA. Another difference is that CA-MRSA is more vulnerable to antimicrobial.

Symptoms

Signs of infections are :

  • Redness

  • Warmth, Swelling

  • Pus

  • Pain at sites where there are skin wounds

  • Abrasions or cuts

MRSA has the ability to spread to other organs in the body and when that happens, symptoms are more severe.

At this stage, symptoms are :

  • Fever

  • Chills

  • Low blood pressure

  • Joint pain

  • Severe headaches

  • Shortness of breath

  • An extensive rash over the body

These more advanced systemic symptoms require immediate medical attention.

Treatment

The 1st choice for treating MRSA skin infection is to use an antibiotic that has been created to kill bacteria with mild side effects. Most early infections with no widespread symptoms can be treated with oral antibiotics. Because of the nature of this decease and antibiotic options, many patients think they’re « cured » after only a few doses and decide by themselves to stop taking the prescribed drugs. However, MRSA is able to re-infect the patient and become resistant to antibiotics used previously.

For moderate to severe infections, treatment may be with intravenous antibiotics.

These infections associated with deep abscesses or boils require open surgical drainage in addition to antibiotic therapy. Most infections resolve in 7-10 days with an adequate treatment despite the fact that a deep abscess can take up to 4 weeks to eradicate the infection by resolving the abscess cavity.

Early identification and treatment of MRSA infections decrease the amount of playing time lost and decrease the chance that the infection will become severe. Skin may be protected by protective clothing or gear designed to prevent skin abrasions or cuts.

Prevention

mrsa infection anatomy

It’s necessary that athletes have good personal hygiene but it must be added that athletes and visitors to athletes facilities must also keep their hands clean by washing them often with soap and water or using an alcohol-based hand rub. The minimum is to have clean hands before and after sports and activities. For example when we use weight training equipment that is shared by all gym members, it’s important to have clean hands after using toilette or when someone is injured taking care the wounds (including changing bandage).

Ordinary and antimicrobial soaps are effective for washing hands. It’s noted that liquid soap is a better option because it’s not possible to share this type of soap compared to bar soap. Alcohol-based hand sanitizer that contain at least 60% alcohol are the perfect choice.

Athletes should shower immediately after exercise and shouldn’t share soap and towels. Washing all uniforms and clothes after each use is important. Athlete should avoid sharing items that are in contact with the skin and avoid sharing personal items as they contact the skin. Fortunately, most surfaces don’t provoke a risk of spreading staph and MRSA.

Athletes who have had MRSA

Several high school, college and professional athletes have contracted MRSA infections. There have already been epidemics among athletes on the same team. A study published in « The New England Journal of Medicine » shows an infection MRSA among St. Louis Rams professional football franchise (USA) athletes. During a single season, MRSA infections were found among 5 of 58 Rams athletes (9 percents) that was tested. All infections developed on areas of the body that are common places for turf injury.

Stats

  • Today, MRSA accounts for about 50-70% of the S. Aureus infections that are present in healthcare facilities across the world.

  • Statistics fro the Kaiser foundation in 2007 indicated that approximately 1.2 million hospitalized patients contract MRSA infections.

  • Serious MRSA infection is still predominantly related to exposure in the healthcare setting, where approximately 85 percent of all serious MRSA infections occur.

  • Fortunately, in children under 18 years old, mortality rates are much lower (1%), even though the number of hospitalized children with MRSA has almost tripled since 2002.

Subscribe to my newsletter and share this article if you think it can help someone you know. Thank you.

-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food, click here .

Standing Machine Hip Abduction

standing machine hip abduction gluteus medius

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Standing on the machine on one leg. The outer side of the other leg is gluted to the pad below the knee joint (close to your ankle) :

  • Raise the leg as high as possible and slowly return to the starting position by controlling the movement.

Attention

standing machine hip abduction gluteus minimus

Abduction is limited because the femur’s neck is quickly bumping on the edge of the cotyloid cavity.

This exercise works gluteus medius and gluteus maximus. For best results, it’s advisable to work with high reps.

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-Steph

Individual Variations In Hip Mobility

hip mobility

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Without taking into account the individual differences in muscle elasticity and ligament laxity, it’s bone shape of the hip joint that determines the main variation in hip mobility.

It’s mainly in the amplitude of hip abduction that bone configuration plays an important role.

Examples

  • An almost horizontal femoral neck (coxo vara) with an upper edge of the important cotyloid cavity and covering, will limit abduction movements.

  • An almost vertical femoral neck (coxa valga) with an upper edge of the less important cotyloid cavity will facilitate abduction movements.

This means that it is useless to raise the leg very high laterally if the morphology doesn’t allow it.

Attention

If someone forces the hip’s abductions, femur’s neck will bump on the cotyloid cavity edge. And this person will compensate the lateral raise of the leg with a pelvic tilt on the femur head of the other leg. It should be added that forcing oneself to make abduction sets may, over time, create microtraumas in some people that will cause excessive development of the cotyloid cavity upper edge. This has the consequence of limiting the hip’s mobility and creating painful inflammations.

hip mobility abduction

hip mobility abduction

hip mobility abduction coxa vara valga bone morphology

Share this article if you think it can help someone you know. Thank you.

-Steph

Shoulder Injury (Part 1)

shoulder

I read a Frederic Delavier’s book « Strength Training Anatomy » and there is good stuff.

Shoulders injuries are frequent in bodybuilding because we want develop all deltoid muscles. To do this, we must perform a signigicant number of repetition and movements thus multiplying the risk of injury.

It’s worth remembering that, in comparison with the solid hip’s articulation where the femur head is deeply embedded in the pelvic cavity of the pelvis, shoulder’s articulation, which must be very mobile to allow arms to move in all direction, is very little embedded.

Shoulders can thus be defined as a joint to muscular fixation, the maintenance of the humerus head on the scapula’s glenoid cavity is mainly ensured by a complex musculo-tendinous ensemble.

Although in bodybuilding most injuries occur during shoulders training, it’s rare to see this muscle directly injured. The wound are generally much deeper and appear most often during a false movement or after a long wear by friction of tendon structure reinforcing the articular capsule.

While in other sports of violent contact (such American football) or rapid arms movements (such as throwers) can result in serious injuries with dislocations and enven tendon pull. The main lesion observed is what we call subacromial bursitis.

Some people when performing elevated arm movements, such as back press or lateral raise, the supra-spinous tendon is rubbed and compressed between humerus head and osteoligamentous vault formed by the underside of the aromion and the coracoacromial ligament.

Consequence

shoulder anatomy

The result is an inflammation which generally begins with the synovial bursa, which normally protects the supra-spinous tendon from excessive friction. And it continue by the supra-spinous tendon itself and ends, if this inflammation isn’t treaed, by touching the adjacent tendons of the infraspinatus at the back and the long portion of the biceps at the front.

Arms elevation becomes extremely painful and there may be an irreversible deterioration of the supraspinatus tendon with calcification and sometimes even rutpure. The latter being observed in general only with people over 40 year old.

The space between the humerus and osteoligamentous vault can vary from one individual to another. Some athletes will not be able to lifte their arms laterally without generating excessive friction. These individuals must therefore avoid all back press, lateral raise to high and also when they train back, pulldown behind the neck.

All exercices with barbell for shoulders should be done in front of, with elbows slightly forward. With dumbbells lateral raise, the correct working angle should be sought, the right movement being the one that is realized painless.

It’s interesting to note that for the same shoulder injury all individuals don’t respond in the same way. Some people can perform all sort of arms raise, compressing and sometimes even deteriorating their tendons without ever triggering a painful inflammatory process. Thus, in the course of an examination, some people have discovered a rupture of the supra-spinous muscle’s tendon without ever having complained of any pain.

Another cause of shoulder pain may be due to an imbalance in the distribution of muscle tension around the joint capsule. Recall that the humerus head is firmly held against the scapula’s glenoid cavity by a muscular system with tendons adhering or passing through the articular capsule. This set is composed at the front by the subscapular, a little more on the outside by the long portion of the biceps, above by the supra-spinous and finally at the back by the infraspinatus and the teres major muscle. Spasm, hypertonicity or, on the contrary, a lack of tonicity of one or more of these muscles, can lead to a bad position of the shoulder joint. This bad position will be the cause, during the movements of the arm, of friction likely to generate inflammatory pathologies.

Exemple : A contracture or a spasm of the teres major muscle and infraspinatus will cause an external rotation of the humerus head which will generate during the movements of the arm, friction in the front of the shoulder joint. And with the time can injure the tendon of the long portion of the brachial biceps.

It will therefore be necessary to ensure to train in a balanced way all the muscles of the shoulder avoiding all the exercices where one will feel a discomfort, a pain or a friction.

Note : Hand massage or better with a vibrator, as well as electostimulation, give very good results to diminish and eliminate spasms and contractures of teres major muscle and infraspinatus.

-Steph

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