THE SHOULDER GIRDLE Chapter 20

THE SHOULDER Is a ball and socket joint Relies mainly on muscular and ligamentous support (weak bony structure)

Has a great range of motion (ROM) – all mvmnts allowed Repeated overhead motions (throwing, serving in tennis,...) often cause problems

The shoulder is comprised of 3 bones: I. SHOULDER ANATOMY A. BONES The shoulder is comprised of 3 bones: 1. Clavicle 2. Scapula 3. Humerus Top picture=posterior view: humerus and scapula Bottom picture = anterior view: clavicle, rib, scapula (anterior part) and humerus

B. MUSCLES The main muscles acting upon the shoulder girdle are: Top picture shows supraspinatus and teres major (not part of RC) & the bottom pic shows infraspinatus and teres minor

1. Rotator Cuff a. Supraspinatus (abduction) b. Infraspinatus (external rotation)

c. Teres Minor (internal rotation) d. Subscapularis (external rotation) Together the RC stabilizes the scapula so that the arm can use it to work off of it D C

a. Anterior (shoulder flexion) b. Middle (shoulder abduction) 2. Deltoid Has 3 portions a. Anterior (shoulder flexion) b. Middle (shoulder abduction) c. Posterior (shoulder extension) Bottom Pic: to the right of the blue vein is the anterior deltoid, then the middle, and furthest to right is the posterior deltoid...all feeding into one common tendon that attaches to the humerus...individual nerve fibers show that each part can be innervated individually

3. Pectoralis Has 2 parts (major and minor) that horizontally adduct the shoulder (e.g. Scatching your opposite shoulderblade or throwing)

4. Biceps Brachii a. Only the long head acts on the shoulder b. Shoulder flexion c. The tendon of the long head runs through a canal in the humerus called the bicepital groove

5. Triceps Shoulder extension

C. Joints There are several joints in the shoulder region The two most comonly injured joints are the: 1. Acromioclavicular Joint (AC Joint) Connects scapula and clavicle 2. Glenohumeral Joint (GH Joint) Connects scapula and humerus

3. Sternoclavicular Joint (SC Joint): - Connects the sternum and clavicle 4. Scapulothoarcic Joint: - scapula and thoracic vertebrae 1. 3. 2. 4.

II. SHOULDER INJURIES

Are often a result of 1. muscle weakness or imbalance 2. Postural problems 3. Nature of various sports

I. LIGAMENTOUS INJURIES A. Acromioclavicular Joint Sprain Also referred to as a shoulder separation A result of 1. Direct impact 2. Falling on outstretched arm

Signs and Symptoms 1. Pain with movement (especially abduction, and horizontal adduction, and internal rotation) 2. Swelling 3. Deformity and inability to move shoulder with 2nd and 3rd degree (distal end of clavicle will pop up)

Treatment 1. Initially PRICE (place athlete in a sling) 2. Refer to physician for 2nd and 3rd degree separation to rule out fracture 3. 2nd and 3rd degree can be surgically repaired (low success rate...mainly cosmetic reasons)

B. Glenohumeral Joint Sprain Also referred to as a shoulder luxation (complete dislocation) or subluxation (jumps out and back into place) Common mechanism is abduction and external rotation (QB throwing a pass and defender pushing the arm back)

Signs and Symptoms 1. Obvious deformity (bulge on one side and a divit on the other) 2. Pain 3. Inability to move 4. Usually athlete is cradeling involved arm and is bent forward Treatment 1. CALL 911 2. Check for circulation 3. Splint in position found!!!

II. Muscle & Tendon Injuries Usually occur as a result of overuse Swimmers and throwers are prone Commonly involve the Rotator Cuff Rotator Cuff problems and/or weakness can also lead to impingement syndrome and biceps tendon problems The Rotator Cuff has 2 major functions in shoulder movement: 1. It stabilizes the scapula so the humerus can work off of it and 2. It depresses the head of the humerus so that tendons (supraspinatus and long biceps) aren‘t compressed into the acromion process.

A. Rotator Cuff Strain 2. Can occur as a result of 1. Usually involves the supraspinatus 2. Can occur as a result of a. Throwing an object b. Violent pull on the arm c. Abnormal rotation d. Fall on outstreched arm

Signs and Symptoms 1. Pain 2. 1st degree strain: no loss of motion 3. 2nd degree strain: some loss of motion (especially abduction) 4. 3rd degree strain/rupture: very limited/no Range of Motion

Treatment 1st and 2nd degree strain: PRICE and Rehab before returning to activity 3rd degree strain: Send to physician (needs surgical repair and rehabilitation)

B. Impingement Syndrome 1. Caused by repetitive overhead motion (throwing, swimming (butterfly stroke), ...) 2. Involves the supraspinatus and long head biceps where they run together in a narrow space under the acromion process 3. Space narrows as result of bad posture, tendinitis, muscle weakness/ imbalance Sorry, not so good a picture...the big red muscle is the supraspinatus

1. Pain with certain or all movements Signs and Symptoms 1. Pain with certain or all movements 2. Point tenderness over biceps tendon Treatment 1. Ice & rest 2. Strengthening of Rotator Cuff Muscles 3. Correct faulty posture see Notes to slide 18

C. Bicepital Tendinitis Involves the long head of the biceps Repetitive overhead movement causes the biceps tendon to rub inside the bicepital groove and become inflamed

Signs and Symptoms 1. Pain, especially when performing the movement that causes it 2. Palpatable thickening of the tendon due to swelling Treatment 1. Ice 2. Rest 3. Place arm in a sling for acute pain management 4. Send to physician for anti-inflammatory medication

D. Biceps Tendon Rupture Usually occurs during powerful contraction (lifting heavy object fast) Signs and Symptoms 1. Athlete will probably hear/feel a pop 2. Acute Pain 3. Inability to fully flex elbow 4. Obvious deformity - looks as if a golf ball lies under skin because the tendon will roll up on itself

III. Bone Injuries

A. Clavicular Fractures 1. 80% occur to the middle 1/3 of the bone 2. Usually occur as a result of a direct impact or falling on an outstretched arm

Signs and Symptoms Treatment 1. Pain & point tenderness 2. Swelling 3. Popping sensation 4. Obvious deformity 5. Shoulder and arm movement become very painful Treatment 1. Ice 2. Place arm in a sling and secure sling around body 3. Send to physician for X-rays

2. Pose considerable danger to nerves and bloodvessels in that area B. Humerus Fractures 1. When Fx is proximal, often mistaken for shoulder dislocation 2. Pose considerable danger to nerves and bloodvessels in that area The brachial nerve and artery wrap around the humerus and are very likely to be cut by sharp bone edges in case of a Fx. The reason Fx are often mistaken as dislocations by lay persons is that the musculature pulls the arm upwards. Therefore it is shortened and people think it popped out of the socket.

Signs and Symptoms 1. Extreme pain 2. Inability to move arm 3. Popping sensations 4. Signs of shock Treatment 1. Splint in position found 2. Check circulation before and after splinting 3. Call 911!!!

III. INJURY PREVENTION

A. Correct posture B. Muscular balance 1. most athletes focus on training the anterior muscles because they see them in the mirror, forgetting about strengtheing the rotator cuff. 2. Strong front and weak back causes problems (just like flat tires on one side do on your car) C. Good flexibility

Special Tests

Speed’s – bicep Empty can – supraspinatus Posterior glide – glenohumeral instability Sulcus – inferior shoulder stability Feagin’s – inferior glenohumeral instability Apprehension – anterior shoulder instability Roos – thoracic outlet syndrome (Brachial plexus injury)