2.  Ball-and-socket joint  Relies on muscular strength for stability  Several bones link up at the shoulder  Entire bony linkage of the shoulder referred to as the shoulder girdle

3.  3 basic bony components  Humerus  Clavicle (aka collarbone)  Scapula (aka shoulder blade)

4.  Rotator Cuff  Consists of 4 muscles (SITS)  Subscapularis  Infraspinatus  Teres Minor  Supraspinatus  Responsible for rotating the arm internally and externally as well as abduction

5.  Deltoid-lies over the head of the humerus.  Abducts, flexes, and extends shoulder  Anterior portion of shoulder-pectoralis major and pectoralis minor  Biceps-flexes the elbow  Triceps-extends the forearm and shoulder.

6.  Shoulder girdle composed of several joints  Most commonly injured joints of the shoulder are:  acromioclavicular joint (Acromion process of scapula and the distal end of clavicle  glenohumeral joint (articulation of the head of the humerus and the glenoid fossa) **articulation-point of contact **glenoid fossa-saucerlike portion of scapula

7.  Muscle weaknesses  Postural problems  Nature of the game

8.  “Out of sight, out of mind”-weight training  Athletes often lift weights only for the muscles they can see in the mirror which leads to weaknesses in opposing muscles  Athletes with rounded shoulders, tight pecs, or weak posterior shoulder muscles may be predisposed to injuries.  Supraspinatus muscle, nerve, and blood vessel run through a very narrow space and narrowing that space can cause those tissues to become pinched

9.  Using arm continually in one direction  Ex. Freestyle swimming or throwing  Need to strengthen the muscles opposing the motion in order to prevent injuries.  Otherwise, it creates a muscle imbalance.  Ex. A swimmer who swims 300 strokes freestyle must swim 300 strokes backstroke to balance the strength of the muscles.

10.  Referred to as a shoulder separation  Can be injured by impact to the top of the shoulder or by falling on an outstreched arm  Athlete will indicate pain with movement  More serious sprains cause the clavicle to move superiorly

11.  3 rd degree separation-large abnormal bump caused by excessive upward desplacement of clavicle.  Unable to move arm and will hold it tight against body  Treatment  1 st degree-PRICE  2 nd & 3 rd –PRICE initially and then referred to an orthopedist.

12.  2 courses of action to treat 3 rd degree tear:  Surgery-joint wired or screwed together  Harness-straps the clavicle downward in an attempt to hold the joint together long enough to allow the ligament to heal.

13.  Especially vulnerable when in abduction and external rotation.  If a 3 rd degree sprain, subluxation or dislocation is likely  Will have pain with motion  Treated by PRICE and referred to a physician

14.  Most muscle and tendon injuries are caused by overuse  Athletes who throw, shoot, or repeat a swim stroke prone to overuse injuries  Require rest, ice application, immobilization, and physician referrals

15.  Occur from excessive motion beyond the normal range  Supraspinatus is most often injured  Pain with motion and sometimes when shoulder is not moving.  Pain generally occurs with abduction  If unable to abduct, complete tear or 3 rd degree strain is suspected

16.  Develops from repetitive overhead types of movement  Supraspinatus and biceps muscles run together through a space beneath acromion process  If space narrows due to swelling, tendinitis, weak posterior muscle strength, or poor posture, the muscles become impinged in the space  Creates pain and discomfort with overhead movements.  Treatment-modified activity, strengthening posterior muscles, improving flexibility of tight pectoralis muscles.

17.  Common in athletes who are constantly raising their arms above their heads  Repetitive nature of the movement causes irritation of the tendon in bicipital groove  Immobilization in a sling will make athlete more comfortable  Physician may prescribe ultrasound therapy and anti-inflammatory medication.

18.  Can rupture from a direct blow or severe contractional forces  Unable to flex elbow  Noticeable change in appearance of muscle (look like a golf ball under the skin)  Arm must be iced and immobilized  Referred to physician  Tendon must be surgically repaired

19.  Most often fractured at its weakest point (distal 3 rd )  Caused by a direct blow or fall on the tip of shoulder  Experience pain and will hold arm close to body to prevent movement  Ice used to decrease swelling and pain  Sling restricts arm movement  Physician can set the clavicle in place using a harness  Fracture takes 6 weeks to heal

20.  Midshaft fractures easy to locate  Humeral head fractures sometimes hard to find if hidden behind shoulder musculature  Shoulder sprain can mimic a fracture so its important to ensure proper assessment.  Unable to move arm and will experience pain  May report feeling or hearing a pop  Will hold arm against body

21.  Easiest way to determine a fracture: palpate circumference of bone  Painful on all sides, most likely a fracture  Physician referral  Severity determines treatment-could just be a sling or surgery with long arm cast  Takes at least 6 weeks to heal

22.  Growth plate susceptible to direct and indirect blows  Same signs and symptoms as humeral fractures  Can cause permanent growth impairment  Ice, splinting, and a sling-what an ATC should do  Physician will determine severity of injury and treatment.

23.  Some injuries require surgery to hold the head of humerus to the shaft of humerus  Teenage pitchers prone to epiphyseal injury from excessive throwing.  Limited in number of games allowed to play as well as number of pitches thrown

24.  May accompany a glenoumeral or acromioclavicular sprain  Ligament or tendon pulls away a small portion of bone  When humerus is dislocating from glenoid fossa, capsular ligament can pull on scapula  Athlete will experience pain associated with the dislocation and avulsion fracture  Impossible to know if avulsion fracture exists: ATC must assume until X-ray reveals otherwise

25.  Glenohumeral dislocation means that head of humerus is out of its socket  Subluxation means that head of humerus came out of socket and then went back in  Cause for both is the same: excessive abduction and external rotation.  Results are completely different  Both require attention by ATC and team physician

26.  Dislocation sometimes causes the humerus head to tear the capsular ligament anteriorly  Instability of capsular ligament allows the humerus head to shift forward (most common type of shoulder dislocation)  Experience pain and inability to use shoulder  ATC will see a deformity at deltoid muscle  Shoulder will be flat, not round  Physician needs to reduce a dislocation

27.  For a subluxation, athlete may feel his shoulder “pop out and then pop back in”  X-ray necessary to determine extent of the dislocation or subluxation  Athlete needs to strengthen the muscles of adduction and internal rotation  If athlete experiences recurrent subluxations or dislocations will require surgery to repair capsular ligaments.