1. Shoulder Complex Injuries

2. 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”.

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

5. 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)

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

8. 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

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

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

13. 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

14. 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

17. 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

19. 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

20. 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

21. 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

22. 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.

23. 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

24. 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

25. Impingement Syndrome

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

27. 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

28. Biceps Tendon Rupture

29. 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

30. Clavicular Fracture

31. 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.

32. 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

33. 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!

34. G-H Dislocation

35. G-H Dislocation