1 The Shoulder

Read pages and answer the following questions: 1.What three bones make up the shoulder girdle? 2.What three articulations make up the shoulder complex? 3.What bones make up each articulation? 2

Bones of the Shoulder Girdle: _____________ The shoulder complex is made up of four different articulations. __________________: (____) Formed by the head of the humerus and the glenoid fossa of the scapula. ___________________: (____) Formed by the distal end of the clavicle and the acromion process of the scapula ___________________: (____) Formed by the scapula and the thoracic cage. ____________________: (____________) Formed by the proximal end of the clavicle and the manubrium of the sternum. 3

4 Glenoid Fossa Acromion Process Coracoid Process Spine Scapula

5 Greater Tubercle Lesser Tubercle Bicipital Groove Head of Humerus Humerus

Flexion Extension Adduction Abduction Internal Rotation External Rotation Horizontal Flexion Horizontal Extension 6

Scapular Retraction Scapular Protraction Scapular Upward Rotation Scapular Downward Rotation Elevation Depression 7

Glenohumeral Joint ____________ Ligament _____________ Ligament AC Joint _______________ Ligament __________ Ligament ________________ Ligament 8

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What are the four muscles that make up the rotator cuff? 5 minutes 11

Please read pages 452 – 455 and answer the following questions: 1.What is the main function of the rotator cuff? 2.What four muscles make up the rotator cuff? 3.What movement do each produce? (Chart: Pg. 454) 4.Which superficial muscle act to elevate the arm? 5.What is a force couple? 12

Group of four muscles of the G-H joint.  Subscapularis  IR and ADD  Supraspinatus  ABD  Infraspinatus  ER  Teres Minor  ER Functions  Stabilization of the head of the humerus in the glenoid fossa. 13

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_______________ Add, IR, Flex/Ext. _________________ Ext, Add, IR ________________ Abd, IR, Ext/ER, Flex/IR _________________ Add, IR ___________________ Flex, Add. 16

________________ Scapular Elevation ______________ Scapular Retraction Downward Rotation _________________ Elevation Retraction Upward Rotation Depression _________________ Depression _________________ Protraction Upward Rotation ________________ Depression Stabilization of the SC joint 17

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Injuries are common due to the wide range of motion in the _________________ joint. A lot of the injuries to the shoulder complex are sport specific Types of Injuries Fractures Subluxation / Dislocations Sprains Strains 21

Ligament Injuries A-C Injuries G-H Injuries S-C Injuries Muscular Injuries Rotator Cuff Injuries Biceps Tendon Injuries Impingement Syndrome Contusions 22

Clavicle Fracture Scapular Fractures 23

What is the main function of the rotator cuff muscles? 5 minutes 24

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Read pages 464 and 466 and answer the following questions: 1.What are the two types of Rotator Cuff Tears? 2.Which one requires surgery and which one can be treated non-operatively? 3.What are some signs and symptoms of a full thickness rotator cuff tear? 27

Two Types _______________ Thickness Partial tear of the rotator cuff tendon. ________________ __________ Thickness Complete tear of the rotator cuff tendon. Requires ______________ 28

Commonly occur as overuse injuries in the throwing athlete. Throwing can be broken down into five phases: 1.________________ 2.________________ 3.________________ 4.________________ 5.________________ 29

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Pain within the shoulder especially during the ___________ phase of throwing or swinging. Pain and difficulty with ___________ and external rotation (90/90) of the arm. Pain and stiffness __________ hours post practice or competition that involved throwing or swinging. Point tenderness around the _________ head deep within the deltoid muscle. 31

_____________ _________________ A well designed ______________ ___________ strengthening program is essential. Focus on training each individual rotator cuff muscle. ___________________ _____________________ Combination of these movements ______________ training is a must. 32

With a partner Design a 5 step warm-up program for an overhead athlete. Include the parameters (how long, how often, etc) You have access to: UBE upper body ergometer Therabands/Theratubes Manual Therapy 33

Application of ice to relieve pain and swelling. Discontinue activity. Refer to physician for further evaluation. Some rotator cuff injuries can be treated non- operatively (Partial-Thickness Tear) Some must be surgically repaired. (Full- Thickness Tear) Why??? (Think Stabilization) 34

Read pages and answer the following questions: What is impingement syndrome? What three structures are found in the subacromial space? What are the signs and symptoms of impingement syndrome? 35

______________ Space Acromion Process and the Coracoacromial ligament. (Coracoacromial _______ or ___________) The Glenohumeral joint capsule. (________) 36

When the arm is ______________ this space ______________ in size. Contents Long head of the ___________ tendon and joint capsule. ______________ bursa ________________ tendon (most common) Anything that causes a decrease in the size of the subacromial space can cause an _______________ of one or more of these structures. 37

Rotator Cuff Patholgy Congenital defects of the coracoacromial arch.  Odd shaped acromion. Biceps Tendonitis Supraspinatus Tendonitis Bone Spurs on the inferior part of the acromion. Subacromial Bursitis 38

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Athletes that place the arm _____________ during their sport can often suffer from impingement syndrome. The signs and symptoms often mimic those of a _______________ _______ tear. 40

G-H pain Pain when the G-H joint is actively ____________ and __________ ___________. Point tenderness in the Subacromial Space. Limited ____________ Confirmation with special test.  ________________________ 41

Rest Anti-inflammatory drugs Rehabilitation  Strengthen RC and Surrounding Shoulder Muscles. When all else fails surgery may be required to open up the subacromial space. (_______________) 42

What structures are found in the subacromial space? 5 minutes 43

Read page 466 and 469 and answer the following questions: What is DOMS? What does PRICE stand for? What is Biceps Tendonitis? Get with a partner and palpate the Biceps tendon in the bicipital groove. 44

Long Head of the Biceps Tendon Runs through the __________ groove of the humerus. Originates from the supraglenoid tubercle. Lies within the __________ capsule and subacromial space just beneath the acromion process. (Subacromial Space). This puts the tendon at risk for impingement when the arm is __________. 45

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Will develop ___________ over time. As it become inflamed, it no longer fits in the ___________ groove and becomes prone to ______________.  It is usually held in place by the ______________________.  This subluxation can also occur acutely with an extreme force commonly generated in throwing. 47

Painful abduction of the shoulder. Pain in the shoulder when the forearm is ____________against resistance. Subluxation of the biceps tendon when the forearm is _______ and __________ against resistance. Pain with shoulder ________ with the elbow _____________. 48

Ice and compression if a subluxation occurs. Rest Anti-inflammatory drugs Progressive rehabilitation. Surgery may be required if chronic subluxation occurs. 49

What are three signs and symptoms of impingement syndrome? What are three methods of treatment? 5 minutes 50

Muscle Strains  Can be overuse or traumatic.  Often occur at the start of the sports season or with an increase in activity. Signs and Symptoms  Pain and tenderness over the _________ ________. (Palpation)  Pain with muscle contraction.  Pain may be delayed. (_______________) Treatment  _________________  Anti-inflammatory drugs  Gentle Stretching 51

Read pages and answer the following questions: 1.What are the four most common traumatic shoulder injuries? 2.Which direction do most shoulder dislocations occur? 3.What is the mechanism for an anterior shoulder dislocation? What type of activity/sport may cause this? 4.What is the re-injury rate of a shoulder dislocation for an 18 year old athlete. 52

Glenohumeral Joint Dislocations Acromioclavicular Sprain Fractures Tendon Ruptures 53

The __________ head is forced out of the _________ cavity. Can occur in the following directions: _________________ (Front and Down) ____________ (Back) ____________ (Down) ___________ Dislocation is the most common (95%) 54

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Mechanism of Injury  Shoulder ________ with ___________ Rotation.  Tackling with outstretched arm. Signs and Symptoms  Possible ___________ of the shoulder  ___________ arm on affected side  Palpable head of Humerus in _________.  Partially ______________ arm with _______ elbow.  Pain with any G-H movement. 56

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Apply Ice to shoulder and secure with Ace Wrap or Plastic Wrap. Place _________ roll under the axilla. Apply standard ______ and __________. Refer to physician for immediate reduction and X-Rays. Treat for __________ if necessary. 58

____% of all G-H dislocations will recur in athletes younger than ____ years old. Why???? This is due to the stretching of the ____________ ______ and __________ of the supporting musculature. May have to be surgically repaired. Chronic dislocation/subluxation can also cause an injury to the glenoid _______. 59

Read page and answer the following questions: 1.What is the glenoid labrum and where is it located? 2.What is the function of the Glenoid Labrum? 3.What are the signs and symptoms of a Glenoid Labrum tear or injury? 4.How would you treat a glenoid labrum tear? 60

A ring of ________ attached to the margin of the glenoid cavity. 61

Functions to help ________ the head if the humerus within the glenoid cavity. Mechanism of Injury Traumatic __________ of the shoulder. ___________ Tear: Repetitive stress due to an ___________. (GH joint being too loose). 62

Signs and Symptoms Pain deep within the shoulder. __________ or ___________ when the shoulder is rotated. Shoulder weakness. Decrease ability to use the arm. Treatment Refer to physician for diagnosis. MRI, X-Ray Surgery may be required. Shoulder strengthening program. Rotator Cuff 63

Read the section titled “Acromioclavicular Injuries” on pages and answer the following questions. 1.What two boney structures form the A-C joint? 2.What is the number one mechanism of injury for an A-C sprain? 3.How would you care for someone with an A-C joint injury? 64

Articulation between the distal end of the _________ and the __________. Soft Tissue Support  Anterior Deltoid Muscles  Trapezius Muscles  Acromioclavicular Ligaments  Superior  Inferior  Coracoclavicular ligament  Trapezoid ligament  Conoid ligament. 65

Three types of Injuries 1.__________: A-C ligament is partially injured. The articulation is stable. Pain is the primary symptom.** 2.________: AC joint capsule and CC ligaments partially disrupted. Articulation is stable. 3.__________: AC joint capsule and CC ligaments completely disrupted. Superior displacement of the clavicle. (________ key sign) 1.AKA: Shoulder Separation 66  u/Courses/BI108/BI108_2 004_Groups/Group01/mec hSSD.htm u/Courses/BI108/BI108_2 004_Groups/Group01/mec hSSD.htm

Mechanism of Injury  _________ blow to the outer end of the clavicle.  Fall forward on an outstretched arm.  ______________ Signs and Symptoms  Swelling  Point-Tenderness  Discoloration  Pain with any movement  Horizontal Flexion  + Piano Key Sign (Grade __ only) 67

Application of Ice Pack secured with Ace Wrap or Plastic Wrap. Apply sling and swath bandage. Refer to physician for X-ray. Immediately for Grade III or if signs or shock are present. Possible Surgical Intervention may be required. 68

Most occur at the mid-shaft of the bone. This is the thin/flat portion. 69

Mechanism of Injury  Direct Blow  Fall on outstretched hand or tip of shoulder.  FOOSH Signs and Symptoms  Swelling or deformity (Could be an _________ fracture)  Discoloration  Point tenderness  Pain with ___________ flexion  Athlete may hear or feel a “___________”  Athlete will be holding the arm in a ______________ position. Treatment  Treat for shock  Immobilize  Use ice pack  Apply a sterile dressing to any wounds.  Arrange for transport to a medical facility. 70

Commonly happens to ___________- athletes. 71