The shoulder complex

Anatomy - Bones

Anatomy - Ligaments

Anatomy - Muscles Flexors Extensors Pectoralis Major Deltoid Coracobrachialis Biceps Brachii Extensors Latissimus Dorsi Teres Major Triceps Brachii

Anatomy - Muscles Abduction Adduction Deltoid Supraspinatus Biceps Brachii Adduction Pectoralis Major Latissimus Dorsi Infraspinatus Teres Major Coracobrachialis Trapezius (Scapula) Rhomboideus Major & Minor (Scapula)

Anatomy - Muscles Internal Rotation External Rotation Pectoralis Major Latissimus Dorsi Deltoid Subscapularis Teres Major External Rotation Supraspinatus Infraspinatus Teres Minor

Anatomy - Muscles Horizontal Abduction Horizontal Adduction Deltoid Infraspinatus Teres Minor Horizontal Adduction Pectoralis Major

Anatomy - Muscles Elevators Trapezius (Scapula) Levator Scapulae (Scapula) Depressors Latissimus Dorsi (Humerus) Pectoralis Minor (Scapula)

Scapular Motion Elevation Depression Levator scapulae Rhomboid major/minor Serratus Anterior Trapezius (Upper) Depression Trapezius (Lower) Pectoralis Major

Scapular Motion Protraction Retraction Upward Rotation Serratus Anterior Retraction Rhomboid Major/Minor Trapezius (Middle/Lower) Upward Rotation Trapezius (Upper/Lower) Downward Rotation Levator Scapulae

Brachial Plexus

Winging Scapula Can occur because of weakness of the periscapula muscles (especially the serratus anterior and middle/lower trapezius) and occurs secondary to long thoracic nerve trauma Scapula stabilization is necessary for normal arm movement

Forward/Rounded Shoulder Posture Caused by a slouched posture, shortened anterior chest muscles, elongation of the posterior interscapula muscles (lower/middle trapezius and rhomboids), and abnormal cervical and thoracic spine curvatures Consequences of FSP: degeneration of AC joint, bicipital or rotator cuff tendinitis or impingment, muscle weakness, myofascial pain and trigger points, posterior capsular tightness, excessive back flexion, and thoracic outlet syndrome

Shoulder Injuries Sternoclavicular Sprain MOI: Indirect force transmitted through the humerus by a blow that strikes the poorly padded clavicle by twisting of a posteriorly extended arm.

Shoulder Injuries Acromioclavicular Sprain MOI: Direct impact to the tip of the shoulder that forces the acromion process downward, backward, and inward while the clavicle is pushed down against the rib cage Fall on an outstretched arm Step-Off Deformity

Shoulder Injuries Glenohumeral Joint Sprain MOI: Anterior: Arm is forced into abduction, external rotation, or direct blow. Posterior: A forceful movement of the humerus posteriorly when the arm is flexed.

Shoulder Injuries Anterior Glenohumeral Dislocation MOI: Direct impact to the posterior or posterolateral aspect of the shoulder. Forced abduction, external rotation, and extension

Shoulder Injuries Posterior Glenohumeral Dislocation MOI: Forced adduction and internal rotation or a fall on an extended and internally rotated arm

Shoulder Injuries Superior Labrum Anteroposterior (SLAP) Lesion MOI: Compression and inferior traction

Shoulder Injuries Shoulder Impingement Syndrome MOI: Mechanical compression of the supraspinatus tendon, the subacromial bursa, and the biceps brachii (long head) tendon causing a decrease in space in the coracoacromial arch Postural alignments: Forward head, rounded shoulders, increased kyphotic curve

Shoulder Injuries Frozen Shoulder (Adhesive Capsulitis) Contracted and thickened joint capsule that is tight around the humeral head with little synovial fluid. The individual progressively resists any movement to the shoulder making it stiff or “frozen” because of the pain

Shoulder Injuries Thoracic Outlet Compression Syndrome Compression on the brachial plexus, subclavian artery, and subclavian vein in the neck and shoulder. MOI: Compression of the neurovascular bundle between the first rib and clavicle Compression between the anterior and middle scalene muscles Compression by pec minor as the bundle passes beneath the corocoid process or between the clavicle and first rib Presence of a cervical rib (an abnormal rib originating from a cervical vertebra and the thoracic rib)

Shoulder Injuries Biceps Brachii Rupture MOI: Powerful concentric or eccentric contraction

Shoulder Injuries Bicipital Tenosynovitis MOI: Repeated stretching of the biceps in highly ballistic activities (pitchers, tennis players, volleyball players, and javelin throwers) may cause an irritation of the tendon and the synovial sheath

Throwing Mechanics Windup Cocking Acceleration Deceleration Follow-through

Shoulder Pad Fitting Cantilever Non-Cantilever Width of shoulders is measured to determine proper size of pads The inside shoulder pad should cover the tip of the shoulder in a direct line with the lateral aspect of the shoulder Deltoid should be covered, and all motion required by athlete’s positions hould be permitted Neck opening must allow athlete to raise their arms overhead but not allow the pad to slide back and forth Straps underneath the arm must hold pads firmly in place but must not constrict soft- tissue Cantilever Non-Cantilever

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