Shoulder: Anatomy & Injuries

High degree of mobility Limited stability Susceptible to injury Complicated joint High degree of mobility Limited stability Susceptible to injury Functional Anatomy Round humeral head with flat glenoid

Shoulder Anatomy We will focus on four major bones. 1. Humerus 2. Scapula 3. Sternum 4. Clavicle

Humerus There are two landmarks on the humerus we need to locate. 1. Head of the Humerus 2. Bicipital Groove

Humerus Landmarks

Scapula There are four landmarks on the scapula we need to locate. Acromium Process Coracoid Process Glenoid Fossa Spine of the scapula

Scapula - Landmarks

Sternum There are two landmarks We need to locate on the Sternum. Zyphoid process Manubrium

Stermum Landmarks

Clavicle

Basic Ligaments

Basic Ligaments Sternoclavicular Ligament Coracoclavicular Ligament Acromioclavicular Ligament Capsule

Labrum – what holds the shoulder together

Links you need to check out! http://www.scoi.com/sholanat.htm http://www.vh.org/adult/patient/orthopaedics/shoulder/

Musculature Supraspinatus – abductor Infraspinatus – rotator Teres minor – rotator Subscapularis – rotator Page 55

Musculature Deltoid – flexion & extension & abduction & horizontal abduction Pectoralis major – horizontal abduction Latissimus dorsi – extension Teres major – extension Coracobrachialis – flexion Biceps brachii – resisted flexion Triceps brachii (long head) - extension

Injuries of the Shoulder Mechanism, Evaluation and Treatment

Rotator Cuff Strain Mechanism Typically from a violent pull of arm, an abnormal rotation force, or a fall on outstretched arm (foosh). Sometimes from repetitive motion (throwing, tennis, swimming)

Rotator Cuff Strain Signs & Symptoms Special Tests Loss of function Pain and tenderness Lack of normal shoulder flexibility and strength Special Tests Drop Arm Test – Supraspinatus – abduct as far as possible then return to 90 and try to hold – if drop then torn Empty Can Test – checks supraspinatus – check strength in empty can motion at approx 45 degrees Apley’s Scratch Test – checks all muscle motions

Drop Arm Test

Empty Can Test

Rotator Cuff Strain Management Rest if necessary and Ice Rehabilitation emphasizing stretching & strengthening Surgery on a rare occasion

Acromioclavicular Sprain or Separated Shoulder Mechanism Direct blow to tip of shoulder or foosh driving arm against the acromion Damages the ligaments and acromion and clavicle may separate. May be classified as first, second, or third degree sprains.

Acromioclavicular Sprain or Separated Shoulder Signs and Symptoms Pain and tenderness at end of the collar bone Deformity caused by upward displacement of collar bone Loss of function Special Tests Distraction (Piano Key)

Acromioclavicular Sprain or Separated Shoulder Management Ice to control bleeding and swelling Immobilization with sling and swathe Rehab to restore normal strength & flexibility Protective taping and padding Out how long???? Depends on degree of separation and amount of pain can tolerate

Anterior Dislocation Mechanism – when arm is forcefully abducted and externally rotated (ex. Abnormal force to an arm that is executing a throw or and arm tackle) A fall on an arm Humeral head slips forward out of the glenoid fossa. Often causes a labral tear.

Anterior Dislocation Signs and Symptoms Special Tests Pain and Tenderness Deformity – flattened shoulder contour – stair step defect Loss of function – arm will just hang Special Tests Apprehension – abduct arm to 90 degrees then force arm into external rotation Relocation test – do apprehension test but hold glenohumeral head in place

Shoulder Dislocation

Apprehension Test

Relocation Test

Anterior Dislocation Management Cold Application Immobilization AS IS – DO NOT RELOCATE ON OWN. Rehabilization Restore normal strength and flexibility Brace Sully Brace – Limit ROM – esp. Abduction/External Rotation Surgery

Glenoid Labrum Tear (Labral Tear) Mechanism Anterior Dislocation/Subluxation of glenohumeral joint Repetitive shoulder motion Acute trauma

Glenoid Labrum Tear (Labral Tear) Signs & Symptoms Pain changes smooth motion of shoulder Feels or hears pop with forced external rotation Pain with external rotation at 90 degrees of abduction – apprehension test Weakness of rotator cuff Possible positive clunk test Pain with forced horizontal adduction

Clunk Test

Long Thoracic Nerve Contusion Mechanism Indirect trauma to shoulder or thoracic wall, overuse or prolonged traction (as in cycling) Signs & Symptoms Pain, dull ache in shoulder Protruding/winging scapula due to weak serratus anterior muscle due to damage to nerve

Long Thoracic Nerve Contusion Special Test Wall push up

Clavicle Fracture Broken Collar Bone Mechanism Signs & Symptoms Foosh fall or hit on tip of shoulder Signs & Symptoms Holding up arm Head toward injured side Possible deformity & crepitus

Clavicle Fracture Treatment X-ray Surgery

Bicep Tendinitis Mechanism Signs & Symptoms Special Tests Irritation of the Bicep Tendon Signs & Symptoms Pain, feel like bicep is moving Special Tests Speed’s Test – resist shoulder flexion Yergason Test – athlete tries to keep arm from externally rotating and extending the elbow – checks for bicep stability

Bicep Rupture Mechanism Signs and symptoms Treatment Violent contraction Signs and symptoms Hears/feels a sensation of rolling up of the arm Protruding bulge in the bicep – divet in arm Loss of function/strength Treatment Refer to orthopedic surgeon

Bicep Rupture

Rotator Cuff Impingement Mechanism Caused due to swelling in AC joint. No where for swelling to go. Rotator cuff is impinged in the joint. Special Tests Impingement Tests Force arm into horizontal adduction Empty Can Test Resisted as empty can motion at 45 degree angle

Rotator Cuff Impingement

Impingement Test

Other Typical Injuries Bursitis Contusion Fracture

Prevention of Shoulder Injuries Overall Conditioning Strengthen in Full ROM Warm Up properly before explosive arm movements Instruct in proper falling techniques Protective equipment Teach proper mechanics Avoid overuse Sport Specific Training

Videos Shoulder Injuries (9:58) http://www.bing.com/videos/watch/video/shoulder-injuries/a31bc6c1eb13284489f0a31bc6c1eb13284489f0-289506132305?q=shoulder%20injury%20videos Shoulder Injuries (Part 1) (15:03) http://www.youtube.com/watch?v=yVoFmYJLx74 Shoulder Injuries (Part 2) (11:38) http://www.youtube.com/watch?v=Q4fFV07ITNE&feature=channel Shoulder Dislocation (X-ray) (1:00) http://www.youtube.com/watch?v=8_tQJDR7ORc&feature=related

Videos Understanding Shoulder Pain (Sports Injuries #3) (2:59) http://www.youtube.com/watch?v=HULJU_ROdCI&feature=rec-LGOUT-exp_fresh+div-HM Shoulder Dislocation Dwyane Wade (3:00) http://www.bing.com/videos/watch/video/dwyane-wade-shoulder-injury/27b33922cf2f85a7e6cf27b33922cf2f85a7e6cf-302259110559?q=shoulder%20injury%20videos Shoulder Injury Campbell (Raiders) (1:13) http://www.nfl.com/videos/nfl-game-highlights/09000d5d81a17e3b/Campbell-injury Shoulder dislocation wrestling (0:19) http://www.youtube.com/watch?v=-Hv8FM78I7I