Shoulder

Terminology

• Coracoid Process: a hook-like projection on the anterior aspect of scapula

• Acromion Process: flat lateral edge of scapula • Range of Motion: (ROM) the amount of

movement allowed at the joint.• Anti-inflammatory: treatment that reduces

inflammation• Dislocation: separation of two bones where

they meet at a joint.

Terminology

• Tendonitis: inflammation of a tendon• Inflammation: swelling• External rotation: movement of an extremity

away from mid-line• Internal rotation: movement of an extremity

toward mid-line

Bones of Shoulder

Humerus

ClavicleScapulaSternum

Sternum

Humerus

Joints Sternoclavicular (SC)

jointAcromioclavicular (AC)

jointCoracoclavicular jointGlenohumeral (GH) joint

Glenohumeral (GH) joint

Ball & Socket Joint- formed by glenoid fossa (of scapula) and head of humerus

Movement (ROM)

• Circumduction• Abduction• Adduction• Flexion• Extension

• IROT (internal rotation)• EROT (external rotation)

The Learning Centre https://courses.stu.qmul.ac.uk Author: PhillipAdds, Learning Centre Teacher

Rotator Cuff (SITS)

• Supraspinatus

• Infraspinatus

• Teres minor

• Subscapularis

Acromioclavicular Joint Sprain(a separation)

Etiology1. Fall on point of shoulder2. Fall on outstretched arm

Pathology1st degree – Sprain of the AC joint2nd degree – Sprain of AC joint, partial sprain of coracoclaviclar ligament3rd degree – Complete rupture of both ligaments

Acromioclavicular Joint Sprain cont.

Signs and Symptoms1. Localized pain upon palpation2. May be deformed (2nd and 3rd sprains)3. Shoulder maybe de drooped4. Positive spring test5. Positive traction test

*Differentiate from contusions

Acromioclavicular Joint Sprain cont.

Treatment1. Ice and anti-inflammatory medication2. Sling and/or swath3. Surgery-for 3rd degree (may or may not be utilized)4. Padding when return to sport

(especially football)

*Refer all 2nd and 3rd degree AC sprains to a physician

Sternoclavicular Separation

Etiology• Blow to the clavicle • Fall on out stretched arm

Pathology• Separation of SC joints

Sternoclavicular Separation cont.

Signs and Symptoms• Grade 1- has little pain and disability, some point tenderness• Grade 2 – shows subluxation of SC joint, slight deformity,

pain, swelling, point tenderness and limited ROM• Grade 3 – most severe, complete dislocation, pain, swelling,

deformity, limited ROM• Posteriorly separation can be life threatening

Sternoclavicular Separation cont.

Treatment• RICE• Immobilization• Refer all 2nd and 3rd degree AC sprains to a

physician

Rotator Cuff Strain

Etiology• Excessive motion beyond the normal range• Overuse

Pathology• Over Stretching • Tear or third-degree strain

Rotator Cuff Strain cont.

Signs and Symptoms• Pain at night• Pain when arm is in overhead position• Weakness • Loss of mobility and/or decreased range of movement • Popping or clicking sounds when the shoulder is moved • Limited ROM

Rotator Cuff Strain cont.

Treatment• RICE• Anti-inflammatory• Rehab

Anterior Dislocation(most common type)

EtiologyAbduction and external rotation of an upper extremity (arm tackle).Dislocation is generally anterior/inferior

Pathology1. Tearing of anterior and inferior capsule2. May be tearing of rotator cuff3. May be fracture

Anterior Dislocation cont.

Signs and Symptoms1. Athlete usually reports that shoulder is out2. Intense pain3. Flattened deltoid with prominent acromion process4. May be able to palpate humeral head beneath coracoid process5. Disfunction

Anterior Dislocation cont.

Treatment1. Ice 2. Sling and/or swath3. Transport to physician

*Always check radial pulse and filling responseIf under 25 years, 80%-85% chance of reoccurrence so surgery

generally considered. Subluxations, recurrent dislocation generally common following

acute dislocations.

Clavicle Fractures

Etiology• fall on outstretched arm or point of shoulder• direct blow to the clavicle

Pathology• Fracture of the clavicle bone

Clavicle Fractures cont.

Signs and Symptoms• Visible and palpable deformity• Localized pain• swelling

Treatment• Ice• Immobilize with sling and/or swath• Refer to a physician

Shoulder Bursitis

Etiology• Trauma or from overuse • May develop from a direct blow, a fall on outstretches hand,

or the stress incurred in throwing an object

Pathology• Inflammation of the bursa

Shoulder Bursitis cont.

Signs and Symptoms• Pain when moving shoulder• Tenderness to palpation

Treatment • RICE• Anti-inflammatory• Maintaining ROM• Do not immobilize shoulder

Biceps Tendonitis

Etiology• Repeated stretching of the bicep muscle

Pathology• Tendonitis of the biceps

Signs and Symptoms• May be tender if palpated in its groove when arm is externally rotated• Pain with activities• Night pain

Treatment • RICE• Anti-inflammatory

The Five Phase • Phase I: Pain Management• Phase II: ROM• Phase III: Proprioception• Phase IV: Strength• Phase V: Endurance• Phase VI: Sports Specific