The Shoulder ComplexCare and Prevention of

Athletic Injuries

Bony Anatomy

Shoulder Complex and Joint are made up primarily of the....

Clavicle

Humerus

Scapula

Each bone has its own parts

Bony Anatomy cont’d

Important projections (parts) to remember!

Articulations

Sternoclavicular Joint

Acromioclavicular Joint

Glenohumeral Joint (mistakingly thought of as the ONLY joint in the shoulder)

Scapulothoracic Joint

Shoulder ligaments

GH Jt

glenohumeral ligaments

AC Jt

acromioclavicular lig

coracoclavicular lig

SC jt

sternoclavicular

costoclavicular

Ligaments cont’d

Muscles

Anterior Muscles

Deltoids

Pectoralis Major

Biceps brachii

Triceps brachii

Posterior Muscles

Rhomboids

Rotator Cuff

function?

supraspinatus

infraspinatus

teres minor

subscapularis

Muscles cont’d

Shoulder ROM

Shoulder complex can perform NINE ROM

1.Flexion

2.Extension

3.Abduction

4.Adduction

5. Internal Rotation

6. External Rotation

7. Horizontal adduction

8. Horizontal abduction

9. Circumduction

CLASSWORK

Based on your knowledge that muscles PULL not push, try to guess the function of each of the muscles we reviewed today.

Then, based on your knowledge/past experiences list exercises that would workout these muscles during a rehab program.

Clavicle Fractures

• MOI:

• FOOSH

• Direct

• Fall on tip of shoulder

• S&S:

• Obvious deformity/TTP

• Head tilt toward fx

• Step deformity

• Management:

• 6-8 week immobilization

• SX

• PT

Humerus Fracture

• MOI:

• Direct impact

• fall on arm

• dislocation

• S&S:

• Pain

• Swelling, TTP, ROM

• Ecchymosis

• Dropped wrist…why?

• Management/TX

• Splint and refer to MD

• XRAY to confirm DX

• Casted for 3 weeks…..RTP 3-4 months

Shaft FX

What fx

type is

this?

Sternoclavicular Sprain (SC jt)

• Rare

• MOI:

Indirect force?

Direct blow

Risks?

Posterior dislocation

Life threatening?

Grade 1 Minimal pain & TTP, no obvious deformity

Grade 2 Subluxation of SC jt, obvious deformity, pn,swelling, Abd

Grade 3 Swelling, displacement of clavicle, complete tear of ligs

SC Jt Sprain

• Management:

RICE

Refer to MD

Reduce dislocation

Splint for 3-5 weeks

Acromioclavicular Jt. Sprain

• MOI:

• FOOSH

• Fall on tip of shoulder

• Extent of ligamentous injury determines severity

• Grade from 1-6

AC Jt Cont’d

• Management:

• Grades 1-3 treated conservatively

• Grade 4-6 typically need surgery

• Splinted

• Length of time depends on grade

• Aggressive rehab

Acute Subluxations/Dislocations

• MOI: forced abd, ER, and Ext

• GH ligaments can tear

• Labrum tears

• Rotator cuff tendon tears

• Possible fx to post. Humeral head

GH Dislocation Cont’d

• S&S

• Flat deltoid

• Pain, swelling

• ROM loss

• Management

• Splint, ice, refer to ER to reduce

Shoulder Bursitis

• MOI:

• Overuse

• Direct impact, impingement, fall on tip of shoulder

• S&S:

• Pn in abd,flex,add,ext

• TTP in subacromial space

Bursitis Cont’d

• Management:

• Ice

• Anti-inflammatories

• Examples?

• Stretching

• Rehab exercises

Biceps Brachii Ruptures

• MOI: Powerful concentric/eccentric contraction

• S&S:

• Loud “Snap”

• Visible bulge

• Trouble flexing, supinating arm

• Management:

• Ice, sling, refer to MD

• Surgery to reattach biceps tendon

Bicipital Tensynovitis

• Popular in overhead activities

• MOI:

• Overuse

• Repeated stretching of biceps tendon

• S&S:

• TTP over bicipital groove

• Swelling,pain,crepitus

• Management:

• Ice

• Anti-inflammatories

• Rehab including stretching and strengthing the biceps and surrounding muscles