2 Anatomy of the Shoulder Ball and Socket JointShallow, which leads to instabilityRelies on muscular strength for stabilityThe shoulder has 4 different joints and only 3 bones.The bones collectively are often called the “Shoulder Girdle”.
3 Anatomy of the Shoulder BonesClavicleAKA: Collar BoneScapulaAKA: Shoulder BladeHumerus
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 side2 forward projections that articulate on the anterior aspect of shoulderAcromion ProcessCoracoid Process
12 Muscles of the Shoulder Rotator CuffSubscapularisInfraspinatusTeres minorSupraspinatusSITS; remember the acronym
13 Muscles of the Shoulder Rotator CuffInternally and externally rotates the humerusAssists in abductionFlexes to keep humerus in socket while throwing and objectDeltoid3 parts: anterior, medial, and posteriorAbducts, flexes, and extends the shoulder
14 Muscles of the Shoulder Pectoralis Major & MinorAttach to sternum and anterior humerusBiceps BrachiiFlexes the elbowAttaches to the humerus and coracoid processTricepsExtend the elbow
17 Joints of the Shoulder Complex Gleno-HumeralHumerus articulates with the glenoid fossaAcromial-ClavicularClavicle articulates with the acromion process of the scapulaCoraco-ClavicularClavicle articulates with the coracoid process of the scapulaSterno-ClavicularClavicle articulates with the sternum
19 Preventing Shoulder Complex Injuries Often due to muscle weaknessOver-training the “mirror” musclesWeakens opposing muscles (rotator cuff)Kyphosis, tight pectorals, or weak posterior muscles are prone to shoulder problems“Stand up straight”….makes sensePressure on the bicipital grooveBalanced training & appropriate padding
20 Ligament Injuries Acromio-clavicular Sprain A-C sprain or separated shoulderImpact to the tip of the shoulder or falling on an out stretched armThe more severe allows more superior movement of the clavicleGraded 1-3; PRICEGrade 3 is either surgery or harness to realign joint
21 Ligament Injuries Gleno-humeral Sprain Most common in abduction and external rotationTreat with PRICEIf 3rd degree, possible subluxation or dislocation- refer to physician
22 Muscle & Tendon Injuries Most injuries are due to overuseRest, ice, immobilization, and rehabMost common is the rotator cuff, impingement syndrome, and bicipital tendon problems.
23 Muscle & Tendon Injuries Rotator Cuff Strain1st degree- Pain, full ROM2nd degree- pain, some loss of ROM, some loss of stability3rd degree- pain, loss of ROM and stabilityMost commonly the supraspinatus muscle is injuredUnable to abduct = 3rd degree sprain- surgeryRepetitive motions lead to crepitus & impingement syndrome
24 Muscle & Tendon Injuries Impingement SyndromeRepetitive, overhead motionsBoth the biceps tendon and the supraspinatus tendons run through small space under the acromion processSpace narrows due to swelling, tendinitis, weak posterior muscle strength, or poor posture- the two muscles get pinched in that spaceModify activity, strengthen posterior muscles, and improve flexibility of pectorals
26 Muscle & Tendon Injuries Bicipital TendinitisRepetitive motion overheadIrritation on biceps tendonPossible crepitusStop activity, ultrasound, anti-inflammatory meds and rehab
27 Muscle & Tendon Injuries Biceps Tendon RuptureThis can happen in two instancesDirect blow to the tendonSevere contractional forcesPain, no flexion of elbowMuscle rolls up, looks like a golf ball under the skinIce, immobilize, doctor will repair in surgery
31 Bone Injuries Humeral Fractures Usually mid-shaft Refer to doctor, out 6-8 weeksBe sure you have a distal pulse at wrist!May have a serious situation if there is no pulsePossible to lose the arm without proper blood supply.
32 Bone Injuries Gleno-humeral Dislocations and Subluxations Head of humerus is out of socketExcessive abduction and external rotationMost common to dislocate anteriorlyDeformity at the deltoid muscleLook flat, not round
33 Bone Injuries Gleno-humeral Dislocations and Subluxations X-ray is needed to r/o bone chipsThere may be permanent damage to nerves blood vessels or cartilageSurgery is probableA lot of rehab!