1. The Shoulder Complex
Chapter 18
Pages

2. Anatomy Bony anatomy: clavicle, scapula, and humerus 4 Articulations:
Sternoclavicular joint (SC)
Acromnioclavicular joint (AC)
Glenohumeral joint (GH)
Scapulothoracic joint (ST)
Muscular Anatomy: can be divided into 3 groups.
Explained on the next slide.
ROM: flexion, extension, abduction, adduction, external rotation, and internal rotation.

3. Shoulder Musculature
Group 1: muscles that originate on axial skeleton and attach on humerus.
Latissimus Dorsi, Pectoralis Muscles
Group 2: muscles that originate on the scapula and attach on humerus.
Deltoid, Coracobrachialis, Rotator Cuff Muscles (SITS)
Group 3: muscles that attach the axial skeleton to the scapula.
Levator Scalpula, Trapezius, Rhomboids, Serratus Anterior/Posterior

4. Prevention of Shoulder Injuries
Proper physical conditioning.
Proper warm-up/cool-down that is sport specific.
Proper instruction on how to fall.
Properly fitted protective equipment.
USING CORRECT BIOMECHANICS
Correct Technique for Throwing
Wind-up
Cocking
Acceleration
Deceleration
Follow-through

6. Assessment: History What happened to cause this pain?
Have you ever had this problem before?
What is the duration and intensity of the pain?
Where is the pain located?
Is there crepitus during movement or numbness or distortion in temperature?
Is there a feeling of weakness/fatigue?
What should movements/positions aggravate/relieve the pain?
If therapy has been given before what offered pain relief?

7. Assessment: Observation
Anterior Observation
Are both shoulder tips even with one another or is one depressed?
Is one shoulder held higher because of muscle spasm or guarding?
Is the lateral end of the clavicle prominent?
Is one lateral acromion process more prominent?
Does the clavicular shift appear deformed?
Is there loss of the normal lateral deltoid muscle contour?
Is there an indentation in the upper biceps region?
Lateral Observation
Is there thoracic kyphosis or are the shoulders slumped forward?
Is there forward or backward arm hang?
Posterior Observation
Is there asymmetry such as a low shoulder, uneven scapulae, or winging of one scapula and not the other?
Is the scapula protracted because of constricted pectoral muscles?
Is there a distracted/winged scapula on one or both sides?

8. Assessment: Palpation and Special Tests
Bony palpation should be done with the coach standing in front of and then behind the athlete.
Both shoulders are palpated at the same time for pain and/or deformity.
Palpation of muscles can detect point tenderness, muscle guarding, swelling, and/or trigger points.
Special Tests
Apprehension test
Tests for shoulder impingement
Tests for supraspinatus muscle weakness

9. Special Tests

10. Shoulder Injuries Clavicle fractures Humerus fractures
Sternoclavicular joint sprain
Acromioclavicular joint sprain
Glenohumeral dislocations
Shoulder impingement syndrome
Rotator cuff strains
Shoulder bursitis
Biceps tenosynovitis
Upper arm contusions

11. Clavicle Fractures MOI: S&S: Treatment:
FOOSH, a fall on the tip of the shoulder, and/or direct trauma.
S&S:
Supports arm on the injured side and tilts head toward that side.
Clavicle appears lower than the other side.
Swelling, point tenderness, and mild deformity.
Treatment:
Immobilize the shoulder, treat for shock, and refer to physician.
Immobilize for a period of 8 weeks, gentle isometric and mobilization exercises, and a sling for an additional 3-4 weeks.

12. Humerus Fracture MOI: S&S: Treatment: Direct blow, dislocation, FOOSH.
Pain, inability to move arm, swelling, point tenderness, discoloration. X-ray.
Treatment:
Splint, sling, treat for shock, and refer to physician. Out of participation 2-6 months.

13. SC Joint Sprain MOI: S&S: Treatment:
Indirect force transmitted through the humerus, shoulder joint, and/or clavicle, or by direct trauma.
Usually displaced upward and outward.
S&S:
G 1, 2, 3
Treatment:
RICE, immobilization for 3-5 weeks, reconditioning exercises.

14. AC Joint Sprain MOI: S&S: Treatment:
FOOSH, direct impact to the tip of the shoulder that forces the acromion downward, backward, and inward.
S&S:
G 1, 2, 3
Treatment:
Application of cold and pressure, stabilization of the shoulder, referral to physician.
Aggressive rehabilitation program: joint mobilization, flexibility, strengthening.

15. GH Dislocation MOI: S&S: Treatment:
Humerus is forced out of the joint capsule in an anterior direction past the glenoid labrum and then downward to rest on the coracoid process.
This accomplished by abduction, external rotation, and extension.
S&S:
Flattened deltoid contour, arm carried in slight abduction and external rotation, unable to touch opposite shoulder with affected arm.
Treatment:
Immobilization and referral.
Muscle reconditioning should begin immediately. A sling should be worn for 1 week.

16. Shoulder Impingement MOI: S&S: Treatment:
Compression of the supraspinatus tendon, subacromial bursa, and long head of the biceps tendon.
Repetitive activities.
S&S:
Pain around the acromion whenever the arm is in the overhead position, painful AROM degrees, external rotators are weaker than internal rotators, tightness in the posterior and inferior joint capsule.
Treatment:
Restore normal biomechanics, RICE, strengthen the rotator cuff and scapula muscles, and stretching the capsule.
Activity must be modified.

17. Rotator Cuff Strains MOI: S&S: Treatment:
Dynamic rotation of the arm at a high velocity as occurs with overhead throwing and/or any other activity that causes a rotation of the humerus.
Supraspinatus muscle is the most common.
S&S:
Pain with muscle contraction, tenderness on palpation, loss of strength.
Treatment:
RICE, exercises to strengthen the rotator cuff muscles, and gradual increase in activity.

18. Rotator Cuff Muscles

19. Contusions of the Upper Arm
MOI:
Most common: lateral aspect of upper arm.
Repeated contusions can lead to myositis ossificans.
S&S:
Pain, tenderness, increased warmth, discoloration, difficulty achieving full extension and flexion of the elbow.
Treatment:
RICE for 24 hours, pad the area, and address ROM.

20. Shoulder dislocations
A dislocation is when the shoulder stays out its joint
A subluxation is when the shoulder pops out then back in again quickly
The most common subluxation is anterior
Occurs when the arm is in the position
Signs include the inability to move the arm, a divot in the shoulder and a bulge at the front of the shoulder
Inferior dislocations are less common and posterior dislocations are rare

21. Visual Aids Courtesy of the Following Websites: