Lecture # 13 The Shoulder Complex

The Shoulder Complex the loose structure of the shoulder complex allows extreme mobility but provides little stability as a result the shoulder is prone to injury and is involved in 8 t0 13 % of all sports related injuries

shoulder injuries are a major concern in all sports involving overhead activities , ie basketball, volleyball, baseball etc. these activities place significant demands on the shoulder and may lead to acute or chronic injuries

Bony Structures and Articulations 1) Acromiociavicular – acromion process and distal end of clavicle – limited ROM 2) Sternociavicular – superior sternum and proximal end of clavicle - rotation 3) Glenohumeral – glenoid fossa ( of scapula) and the head of the humerous – extensive ROM but poor stability

glenoid fossa is deepened by the glenoid labrum – a narrow rim of fibrocartilage around the edge of the fossa ligaments surround joint but are lax and provide little stability SITS or rotator cuff muscles supraspinatus infraspinatus teres minor subscapularis

Range of Motion in the Shoulder Complex flexion, extension - abduction, adduction horizontal abduction , horizontal adduction plus elevation/depression , protraction/ retraction

Common Injuries to the Shoulder

Shoulder Dislocation/Subluxation 2nd to fingers for dislocations 90% anterior dislocation 70% develop traumatic recurrent dislocation

intense pain, tingling and numbness may extend down the arm into the hand injured arm is often held in slight abduction and external rotated and is usually stabilized by the opposite arm a pulse should be taken to assess circulation as well sensations should be tested management – first time requires reduction by a physician because this may be associated with a fracture or labrum tear and or nerve damage..

3-6 weeks immobilization recurrent dislocations – individual may be able to reduce it their self or with aid of therapist strengthening important factor – but recurrent dislocations usually result in surgical intervention

First Aid Care Immediately apply ice, front and back of gh joint If possible put arm in a sling , or support gh joint with a wrap or shirt ( needs support) Immediate referral to medical centre Treat for shock

AC Sprain aka - shoulder separation the AC joint is weak and easily injured with a direct blow or a fall on the point of the shoulder and occasional from a fall on the outstretched arm Very Common in sports swelling and loss of function are present depending on the degree off injury

with a 2nd to 3rd degree there may be a step deformity – in which the clavicle rides above the scapula Localized pain at AC joint with tenderness pain with movement through most ranges – but especially with horizontal adduction Rx – PIER – NSAIDS, immobilization if necessary, ROM exercise and strengthening

First Aid Care Immediately apply ice on top of AC joint Support with a sling (and swath ) Have athlete rest If needed refer to physician or hospital for xrays .

Stenoclavicular Sprain extremely rare, but usually associated with collision sport or falls directly on point of shoulder point tenderness at the SC joint , swelling and pain with horizontal adduction pain with lateral compression of the shoulders Rx – PEIR – immobilization if necessary

Impingement of Supraspinatus Tendon, lnfraspinatus Tendon, Long Head of Biceps Tendon, and Subacromial Bursa

impingement syndrome is a chronic condition caused by repetitive overhead activity that damages tissues in the shoulder complex initially there is pain with activity – usually only in the impingement position as condition gets worse the individual experiences pain at other times – progressing to pain at night while attempting to sleep there may be crepitus in certain ROM

Factors Contributing to an Impingement Syndrome Excessive amount of overhead movement Limited subacromial space Thickness of supraspinatus and biceps tendon Lack of flexibility and strength of supraspinatus and biceps Weakness in post rotator cuff muscles

Hypermobility of the shoulder joint Imbalance of muscle strength, and or co-ordination of movement Shape of acromion Training devices ( ie hand paddles in swimming)

Rotator Cuff Tendinitis/Strain usually result of repetitive microtraumas may be from a acute trauma muscle balance between int/ext rotators or tightness almost always results in impingement must know throwing mechanics motion (especially when working with sports involving throwing)

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First Aid Care Immediately apply ice, compression and elevate Have athlete rest , use a sling if necessary If needed refer to medical personnel

Clavicular #'s because of S shape it is highly susceptible to compressive forces caused by a blow or fall on the point of the shoulder 80 % take place in midclaviclar region swelling , ecchymosis and deformity Rx involve a figure 8 brace to pull the shoulder backward and upwards for 4 to 6 weeks

First Aid Care Treat for shock apply ice Carefully put into support , a sling wrap or shirt refer to physician or hospital for xrays .

Bicipital Tendon Injuries common in overhead throwing , or repetitive overuse during overhead movements irritation of the tendon (esp. long head) as it passes back and forth in the bicipital groove of the humerous

the tendon may sublux as well from the bicipital groove pain and tenderness over the bicipital groove groove (especially with internal and external rotation), crepitus and weakness Rx – PIER , NSAIDS – modalities .. retraining , stretching and strengthening

Bursitis usually associated with a rotator cuff strain or an impingement syndrome usually injured is the subacromial bursa point tenderness and a painful arc will exist between 70 and 120 degrees of passive abduction difficulty sleeping on effected side Rx- PIER – may need cortizone injection

Burner or Zinger not really a shoulder injury injury to brachial plexus usually a result of a stretch and the neck being forced into hyperextension or opposite side flexion and the shoulder forced into horizontal abduction