Systemic Compensations for Sacroiliac Joint Dysfunction - Shoulder Specific

(From the 2013 National Athletic Trainers’ Association’s Annual Symposia.)

American football is a very aggressive sport whose physical contact style of play can lead to numerous and severe injuries.

However, today’s case is a non-contact, off the field injury:

SUBJECTIVE:
20 year old male Division I college football player. His primary position is that of a punter/kicker. During weight training, he was placed with the offensive linemen for pulling day (cleans, snatches, deadlifts). At the top part of the snatch (http://www.youtube.com/watch?v=FOE-PZJq2sk), he felt his right shoulder “give way” and drop down although he was able to keep the weight over his head.

OBJECTIVE:
Limited right shoulder ROM in all planes (esp abduction/IR)
Special Tests: +crank/clunk, +O’Brien, Sulcus sign

ASSESSMENT:
Right labral tear (confirmed via MRI-arthrogram)

DISCUSSION:
Right sided sacroiliac (SI) joint dysfunction created a functionally short right leg. Standing posture demonstrates his right hip and shoulder sit lower than his left. When he is in an overhead press situation, the right arm is taking >50% of the weight. This lead to an inferior glide of the humeral head and subsequent tear of the glenoid labrum.