Shoulder Complex Injuries

Anatomy of the Shoulder Ball and Socket Joint Shallow, which leads to instability Relies on muscular strength for stability The shoulder has 4 different joints and only 3 bones. The bones collectively are often called the “Shoulder Girdle”.

Anatomy of the Shoulder Bones Clavicle AKA: Collar Bone Scapula AKA: Shoulder Blade Humerus

Bones of the Shoulder Humerus The rounded end of the humerus fits into the glenoid fossa of the scapula. The humerus has a groove near the top that the biceps tendon slides through (Bicipital groove)

Bones of the Shoulder Clavicle Articulates at the sternum near the throat and at the tip of the shoulder with the scapula

Bones of the Shoulder Scapula Flat like with a spinous process that runs laterally across the posterior side 2 forward projections that articulate on the anterior aspect of shoulder Acromion Process Coracoid Process

Ligaments of the Shoulder Complex Acromio-clavicular Coraco-clavicular Coraco-acromial Sterno-clavicular

Muscles of the Shoulder Rotator Cuff Subscapularis Infraspinatus Teres minor Supraspinatus SITS; remember the acronym

Muscles of the Shoulder Rotator Cuff Internally and externally rotates the humerus Assists in abduction Flexes to keep humerus in socket while throwing and object Deltoid 3 parts: anterior, medial, and posterior Abducts, flexes, and extends the shoulder

Muscles of the Shoulder Pectoralis Major & Minor Attach to sternum and anterior humerus Biceps Brachii Flexes the elbow Attaches to the humerus and coracoid process Triceps Extend the elbow

Joints of the Shoulder Complex Gleno-Humeral Humerus articulates with the glenoid fossa Acromial-Clavicular Clavicle articulates with the acromion process of the scapula Coraco-Clavicular Clavicle articulates with the coracoid process of the scapula Sterno-Clavicular Clavicle articulates with the sternum

Preventing Shoulder Complex Injuries Often due to muscle weakness Over-training the “mirror” muscles Weakens opposing muscles (rotator cuff) Kyphosis, tight pectorals, or weak posterior muscles are prone to shoulder problems “Stand up straight”….makes sense Pressure on the bicipital groove Balanced training & appropriate padding

Ligament Injuries Acromio-clavicular Sprain A-C sprain or separated shoulder Impact to the tip of the shoulder or falling on an out stretched arm The more severe allows more superior movement of the clavicle Graded 1-3; PRICE Grade 3 is either surgery or harness to realign joint

Ligament Injuries Gleno-humeral Sprain Most common in abduction and external rotation Treat with PRICE If 3rd degree, possible subluxation or dislocation- refer to physician

Muscle & Tendon Injuries Most injuries are due to overuse Rest, ice, immobilization, and rehab Most common is the rotator cuff, impingement syndrome, and bicipital tendon problems.

Muscle & Tendon Injuries Rotator Cuff Strain 1st degree- Pain, full ROM 2nd degree- pain, some loss of ROM, some loss of stability 3rd degree- pain, loss of ROM and stability Most commonly the supraspinatus muscle is injured Unable to abduct = 3rd degree sprain- surgery Repetitive motions lead to crepitus & impingement syndrome

Muscle & Tendon Injuries Impingement Syndrome Repetitive, overhead motions Both the biceps tendon and the supraspinatus tendons run through small space under the acromion process Space narrows due to swelling, tendinitis, weak posterior muscle strength, or poor posture- the two muscles get pinched in that space Modify activity, strengthen posterior muscles, and improve flexibility of pectorals

Impingement Syndrome

Muscle & Tendon Injuries Bicipital Tendinitis Repetitive motion overhead Irritation on biceps tendon Possible crepitus Stop activity, ultrasound, anti-inflammatory meds and rehab

Muscle & Tendon Injuries Biceps Tendon Rupture This can happen in two instances Direct blow to the tendon Severe contractional forces Pain, no flexion of elbow Muscle rolls up, looks like a golf ball under the skin Ice, immobilize, doctor will repair in surgery

Biceps Tendon Rupture

Bone Injuries Clavicular Fractures Most often fractured at its anatomical weakness (distal 1/3) Deformity, pain, loss of use PRICE Out of r 6-8 weeks

Clavicular Fracture

Bone Injuries Humeral Fractures Usually mid-shaft Refer to doctor, out 6-8 weeks Be sure you have a distal pulse at wrist! May have a serious situation if there is no pulse Possible to lose the arm without proper blood supply.

Bone Injuries Gleno-humeral Dislocations and Subluxations Head of humerus is out of socket Excessive abduction and external rotation Most common to dislocate anteriorly Deformity at the deltoid muscle Look flat, not round

Bone Injuries Gleno-humeral Dislocations and Subluxations X-ray is needed to r/o bone chips There may be permanent damage to nerves blood vessels or cartilage Surgery is probable A lot of rehab!

G-H Dislocation

G-H Dislocation