1. Shoulder: Anatomy & Injuries

2. 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

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

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

5. Humerus Landmarks

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

7. Scapula - Landmarks

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

9. Stermum Landmarks

10. Clavicle

14. Basic Ligaments

15. Basic Ligaments Sternoclavicular Ligament Coracoclavicular Ligament
Acromioclavicular Ligament
Capsule

17. Labrum – what holds the shoulder together

19. Links you need to check out!

20. Musculature Supraspinatus – abductor Infraspinatus – rotator
Teres minor – rotator
Subscapularis – rotator
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25. 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

31. Injuries of the Shoulder
Mechanism, Evaluation and Treatment

32. 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)

33. 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

34. Drop Arm Test

35. Empty Can Test

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

37. 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.

38. 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)

39. 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

40. 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.

42. 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

43. Shoulder Dislocation

44. Apprehension Test

45. Relocation Test

46. 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

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

48. 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

52. Clunk Test

53. 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

54. Long Thoracic Nerve Contusion
Special Test
Wall push up

55. 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

56. Clavicle Fracture
Treatment
X-ray
Surgery

57. 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

58. 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

59. Bicep Rupture

60. 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

61. Rotator Cuff Impingement

62. Impingement Test

63. Other Typical Injuries
Bursitis
Contusion
Fracture

64. 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

65. Videos Shoulder Injuries (9:58)
Shoulder Injuries (Part 1) (15:03)
Shoulder Injuries (Part 2) (11:38)
Shoulder Dislocation (X-ray) (1:00)

66. Videos Understanding Shoulder Pain (Sports Injuries #3) (2:59)
Shoulder Dislocation Dwyane Wade (3:00)
Shoulder Injury Campbell (Raiders) (1:13)
Shoulder dislocation wrestling (0:19)