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

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Sternoclavicular (SC) Joint

• Only bony attachment between the axial skeleton and the upper extremity

SHOULDER COMPLEX JOINTS

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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