Slide 1

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 2

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 3

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 4

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 5

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 6

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 7

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 8

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 9

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 10

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 11

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 12

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 13

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 14

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 15

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 16

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 17

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 18

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 19

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 20

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 21

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 22

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 23

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 24

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 25

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 26

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 27

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 28

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 29

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 30

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries


Slide 31

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?

Chapter 21
The Shoulder

Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff

Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder

The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint

• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”

• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body
MUSCLE

FUNCTION

Trapezius

Draws head to one side; rotates scapula

Serratus anterior

Protraction of scapula

Pectoralis major
Deltoid

Flexion, horiz. adduction, int. rotation of
arm
Abducts arm

Latissimus dorsi

Extends, adducts, int. rotates arm

RC muscles

Mainly external rotation of arm

Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)

deltoid
rotator cuff

Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm

Movements

Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation

BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery

Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training

Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed

Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation

– Immediate referral

Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery

Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise

Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)

– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises

Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury

Special Tests
• Neer’s impingement
(BT or supraspinatus)

• Cross-arm adduction
(AC sprain)

• Hawkins-Kennedy
(supraspinatus)

• Drop arm test (RC tear)

• Speed’s test (BT
tendonitis)

• AC compression (AC
sprain)

• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)

8 Shoulder Stretches
1. Abduction/ext. rotation

5. Horizontal adduction

2. Abduction/int. rotation

6. Horizontal abduction

3. Flexion/ext. rotation

7. Flexion

4. Flexion/int. rotation

8. Extension

Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries