1. The shoulder complex

2. Anatomy - Bones

3. Anatomy - Ligaments

4. Anatomy - Muscles Flexors Extensors Pectoralis Major Deltoid
Coracobrachialis
Biceps Brachii
Extensors
Latissimus Dorsi
Teres Major
Triceps Brachii

5. Anatomy - Muscles Abduction Adduction Deltoid Supraspinatus
Biceps Brachii
Adduction
Pectoralis Major
Latissimus Dorsi
Infraspinatus
Teres Major
Coracobrachialis
Trapezius (Scapula)
Rhomboideus Major & Minor (Scapula)

6. Anatomy - Muscles Internal Rotation External Rotation Pectoralis Major
Latissimus Dorsi
Deltoid
Subscapularis
Teres Major
External Rotation
Supraspinatus
Infraspinatus
Teres Minor

7. Anatomy - Muscles Horizontal Abduction Horizontal Adduction Deltoid
Infraspinatus
Teres Minor
Horizontal Adduction
Pectoralis Major

8. Anatomy - Muscles Elevators Trapezius (Scapula)
Levator Scapulae (Scapula)
Depressors
Latissimus Dorsi (Humerus)
Pectoralis Minor (Scapula)

9. Scapular Motion Elevation Depression Levator scapulae
Rhomboid major/minor
Serratus Anterior
Trapezius (Upper)
Depression
Trapezius (Lower)
Pectoralis Major

10. Scapular Motion Protraction Retraction Upward Rotation
Serratus Anterior
Retraction
Rhomboid Major/Minor
Trapezius (Middle/Lower)
Upward Rotation
Trapezius (Upper/Lower)
Downward Rotation
Levator Scapulae

11. Brachial Plexus

12. Winging Scapula
Can occur because of weakness of the periscapula muscles (especially the serratus anterior and middle/lower trapezius) and occurs secondary to long thoracic nerve trauma
Scapula stabilization is necessary for normal arm movement

13. Forward/Rounded Shoulder Posture
Caused by a slouched posture, shortened anterior chest muscles, elongation of the posterior interscapula muscles (lower/middle trapezius and rhomboids), and abnormal cervical and thoracic spine curvatures
Consequences of FSP: degeneration of AC joint, bicipital or rotator cuff tendinitis or impingment, muscle weakness, myofascial pain and trigger points, posterior capsular tightness, excessive back flexion, and thoracic outlet syndrome

14. Shoulder Injuries Sternoclavicular Sprain
MOI: Indirect force transmitted through the humerus by a blow that strikes the poorly padded clavicle by twisting of a posteriorly extended arm.

15. Shoulder Injuries Acromioclavicular Sprain MOI:
Direct impact to the tip of the shoulder that forces the acromion process downward, backward, and inward while the clavicle is pushed down against the rib cage
Fall on an outstretched arm
Step-Off Deformity

16. Shoulder Injuries Glenohumeral Joint Sprain MOI:
Anterior: Arm is forced into abduction, external rotation, or direct blow.
Posterior: A forceful movement of the humerus posteriorly when the arm is flexed.

17. Shoulder Injuries Anterior Glenohumeral Dislocation MOI:
Direct impact to the posterior or posterolateral aspect of the shoulder.
Forced abduction, external rotation, and extension

18. Shoulder Injuries Posterior Glenohumeral Dislocation
MOI: Forced adduction and internal rotation or a fall on an extended and internally rotated arm

19. Shoulder Injuries Superior Labrum Anteroposterior (SLAP) Lesion
MOI: Compression and inferior traction

20. Shoulder Injuries Shoulder Impingement Syndrome MOI:
Mechanical compression of the supraspinatus tendon, the subacromial bursa, and the biceps brachii (long head) tendon causing a decrease in space in the coracoacromial arch
Postural alignments: Forward head, rounded shoulders, increased kyphotic curve

21. Shoulder Injuries Frozen Shoulder (Adhesive Capsulitis)
Contracted and thickened joint capsule that is tight around the humeral head with little synovial fluid.
The individual progressively resists any movement to the shoulder making it stiff or “frozen” because of the pain

22. Shoulder Injuries Thoracic Outlet Compression Syndrome
Compression on the brachial plexus, subclavian artery, and subclavian vein in the neck and shoulder.
MOI:
Compression of the neurovascular bundle between the first rib and clavicle
Compression between the anterior and middle scalene muscles
Compression by pec minor as the bundle passes beneath the corocoid process or between the clavicle and first rib
Presence of a cervical rib (an abnormal rib originating from a cervical vertebra and the thoracic rib)

23. Shoulder Injuries Biceps Brachii Rupture
MOI: Powerful concentric or eccentric contraction

24. Shoulder Injuries Bicipital Tenosynovitis
MOI: Repeated stretching of the biceps in highly ballistic activities (pitchers, tennis players, volleyball players, and javelin throwers) may cause an irritation of the tendon and the synovial sheath

25. Throwing Mechanics Windup Cocking Acceleration Deceleration
Follow-through

26. Shoulder Pad Fitting Cantilever Non-Cantilever
Width of shoulders is measured to determine proper size of pads
The inside shoulder pad should cover the tip of the shoulder in a direct line with the lateral aspect of the shoulder
Deltoid should be covered, and all motion required by athlete’s positions hould be permitted
Neck opening must allow athlete to raise their arms overhead but not allow the pad to slide back and forth
Straps underneath the arm must hold pads firmly in place but must not constrict soft- tissue
Cantilever
Non-Cantilever

27. QUESTIONS/COMMENTS?