Transcript THE SHOULDER
THE SHOULDER
ANATOMY
Bones
1.
2.
3.
4.
Sternum - middle of chest Clavicle - collar bone Humerus - upper arm • • Scapula - shoulder blade Acromion process (knob on top of shoulder) Glenoid fossa (socket for the humerus)
SHOULDER COMPLEX JOINTS
Sternoclavicular (SC) Joint
• Only bony attachment between the axial skeleton and the upper extremity
SHOULDER COMPLEX JOINTS
Acromioclavicular (AC) Joint
• Between the lateral end of the clavicle and the acromion process of the scapula • • Held together by two sets of ligaments Painful when injured
SHOULDER COMPLEX JOINTS
Glenohumeral (GH Joint) • • True shoulder joint Between the head of the humerus and the glenoid fossa of the scapula • • Most freely movable joint of the body Very unstable • Head of the humerus is 60% bigger than the glenoid (golf ball on a tee)
SHOULDER MUSCLES
Pectoralis Major • Front of chest • Horizontal Adduction (like bench press)
SHOULDER MUSCLES
Deltoid • Over the top of the shoulder • Abduction
SHOULDER MUSCLES
Latissimus Dorsi • Back of shoulder • Extension
SHOULDER MUSCLES
Rotator Cuff • • • • Supraspinatus Infraspinatus Teres Minor Subscapularis • Internal and External Rotation
SHOULDER MOTIONS
INJURIES
8 slides with LOTS of info!
Clavicle Fracture
Most fracture sites are in middle 1/3 Most common in adolescents and pre-adolescents Cause: • • Fall on outstretched arm OR tip of shoulder Direct impact S/S • Tilts head to side that is injured • • Supports that arm with other arm Clavicle is tender Care: Immobilize, ice, x-ray, figure-8 brace
Humerus Fracture
Not a common injury in sports Cause • Direct impact • Fall on outstretched arm S/S • • Inability to move arm Pain and swelling in upper arm Care • • Splint, sling Immediate referral to ER
Sternoclavicular (SC) Sprain
Not a common injury - mostly in contact sports Cause • Fall on shoulder - force goes up the clavicle S/S – (can be 3 grades) • Usually dislocates anterior and superior - obvious deformity • Unable abduct or horizontally adduct arm Care • • RICE, Immobilize shoulder Life threatening if it goes posteriorly
Acromioclavicular (AC) Sprain
Very common in athletics Cause • Fall on outstretched arm OR tip of shoulder S/S • 1st and 2nd degree - tenderness around joint, will not want to flex or horizontally adduct • 3rd degree sprain has obvious deformity Care • RICE, Immobilize shoulder • X-rays will determine the degree best – holding weight
Glenohumeral (GH) Dislocation
95% of all dislocations are anterior • Can also go inferior or posterior Once it happens, it is very likely to happen again Cause (anterior): • Arm is abducted and externally rotated with extra force S/S • Deltoid will appear flat • • They will hold arm at side and internally rotated Unable to use the arm Treatment • Immobilization, ice and referral to MD to reduce
Shoulder Impingement Syndrome
Cause • Repetitive overhead motion (i.e. throwing, swimming, volleyball, etc) • The supraspinatus tendon, a bursa and biceps tendon get trapped in a small space S/S • • Pain with overhead motion Weakness in abduction and external rotation Care • • Ice and rest for pain Fix the bad habits (biomechanics) that caused the problem
Rotator Cuff Strains
Can go hand in hand with impingement Supraspinatus (SSP) is most often injured Cause • Overhead motions with force or heavy weight S/S • • Pain – down into deltoid Weakness – may not be able to abduct arm with full tear of the SSP Care • • • Decrease overhead activity Ice or heat Rehab to strengthen rotator cuff
Biceps Tendinitis
Common in athletes who use a lot of overhead motion (throwers) Can go hand in hand with impingement Cause • Overhead motion S/S • • Pain is in anterior, proximal humerus Pain with O/H motion Treatment • • Deep heat Ice after activity