1. The Shoulder

2. Shoulder Girdle Complex
Glenohumeral joint
Acromioclavicular joint
Scapulothoracic joint

3. Glenohumeral Joint
Glenoid fossa
Head of humerus

4. Acromioclavicular Joint
Acromion process of scapula
Clavicle

5. Scapulothoracic Joint
Scapula
Posterior ribcage

6. Bony Landmarks Sternum Clavicle Humerus Head of humerus
Greater tubercle
Lesser tubercle
Bicipital groove
Epicondyles
Lesser tubercle
Greater tubercle

7. Bony Landmarks
Scapula
Acromion
Coracoid process
Glenoid fossa
Spine

9. Shoulder Girdle

10. Peer-Share-Review
Bones & Markings
Ready, Set, Go

11. Muscles of the Shoulder
Deltoid
Trapezius
Pectoralis Major
Pectoralis Minor
Serratus anterior
Rhomboid major
Rhomboid minor
Levator scapulae
Coracobrachialis
Biceps brachii

12. Deltoid
Abducts shoulder

13. Trapezius
Rotates scapula

14. Shoulder depression
Scapular depression
Punching
Flex shoulder
Adduct shoulder
IR shoulder

15. Rhomboid Major/Minor Levator Scapulae Retract scapula Elevate scapula
Elevates scapula

16. Coracobrachialis
Flexes shoulder
Adducts shoulder

17. Biceps Brachii Weakly flexes shoulder Two proximal heads
Long head— supraglenoid tubercle of scapula
Short head—coracoid process of scapula

18. Rotator Cuff Muscles
Collective set of four deep muscles of the GH joint
Supraspinatus
Abduction of the arm
Infraspinatus
External Rotation of the shoulder
Teres Minor
External rotation of the shoulder
Subscapularis
Internal rotation of the shoulder

19. Rotator Cuff Muscles

20. Ligaments of the Shoulder
Coracoclavicular
Coracoacromial
Coracohumeral
Glenohumeral
Acromioclavicular

21. Levator Scapula
Trapezius
Rhomboids Minor
Deltoids
Acromioclavicular (AC) joint
Infraspinatus
Rhomboids Major
Serratus Anterior
Teres Minor

22. Pectoralis Major
Biceps (short & long head)
Pectoralis Minor

23. Overuse injuries to the shoulder
Common Injuries of the Shoulder
Overuse injuries to the shoulder

24. Shoulder Impingement Syndrome
Widely used term to describe pain occurring when space between humeral head and acromion become narrowed
Bones “impinge” or compress structures that occupy the subacromial space
Three structures:
Joint capsule
Tendons of rotator cuff
Bursa

25. Impingement Syndrome Overhead sports Signs & Symptoms
Baseball, tennis, swimming, volleyball
Signs & Symptoms
Pain and tenderness in GH
Pain and/or weakness with active abduction in mid-range
Limited IR
Confirmation with special tests
Empty can
Point tenderness in subacromial area

26. Impingement Syndrome— Treatment
Address biomechanics
Substitute with cross-training until condition resolves
Limit excessive overhead movement
Rehab exercises & stretching

27. Rotator-Cuff Strain/Tears
Traumatic injury
i.e. FOOSH
Unusual demands on young athlete
Repetitive use leads to chronic condition
Ultimately tear in tendons
Partial thickness tear
Not completely severe tendon
May respond well to non-op treatment
Full thickness tear
Require surgery

28. Rotator-Cuff Strains/Tears- Signs & Symptoms
Pain with muscle contraction
“Catching” sensation when arm moved
Inability to sleep on affected side
Varying degrees of disability
Decreased strength
Swelling

29. Rotator-Cuff Strains/Tears- Treatment
RICE
Limit activity - asymptomatic
Shoulder strengthening
Progressive RTP throwing program

30. Biceps Tendonitis Discomfort in anterior shoulder
Often confused with RC tendonitis
Can be caused by impingement

31. Traumatic Shoulder injuries
Common Injuries of the Shoulder
Traumatic Shoulder injuries

32. Glenohumeral Dislocation
Forced abduction, external rotation of shoulder
Signs and Symptoms
Flattened deltoid
Pain and Swelling
Disability
Requires immediate care by physician
Additionally injuries include:
Fractures
Glenoid labral tears
Axillary nerve damage

33. Glenoid Labrum
Cartilaginous ring that acts to keep the humeral head positioned on the glenoid by blocking unwanted movement

34. Glenoid Labrum Injuries
Injury occur with :
Acute trauma (dislocation)
Repeated trauma
Degenerated tear (baseball pitchers)
Repetitive subluxation
Labral rim degenerate over time
Signs & Symptoms
Pain
Catching or popping sensation
Limited ROM
Varying degrees of weakness
Special Tests
MRI

35. SLAP Tear Superior Labrum from Anterior to Posterior
Occurs at point where biceps tendon inserts on labrum
Area of relatively poor blood supply
FOOSH
Repetitive overhead actions
Lifting a heavy object

36. Acromioclavicular Separation
Direct blow to tip of shoulder
FB player falling on tip of shoulder or FOOSH
Signs & Symptoms
Pain in vicinity of AC joint
Possible deformity of joint depending on degree of sprain

37. AC Separation—Treatment
RICE
Rehab
ROM & strengthening as tolerated
Overhead exs not recommended
2nd degree
3-4 weeks immob
Most painful
3rd degree
6-8 weeks immob
May leave permanent deformity

38. Acromioclavicular Separation

39. Clavicle Fracture Fall on tip of shoulder Direct impact
FOOSH
Direct impact
Signs and Symptoms
Pain, deformity, and swelling
Refer to physician

40. Brachial Plexus Injury
Stinger
Burner
Occurs when head and neck forcibly moved/hit to one side
Nerves and brachial plexus compressed on that side
Painful and disabling

41. Brachial Plexus Group of peripheral nerves
Leave spinal cord & extend from vertebrae into shoulder
Give arm ability to function

42. Brachial Plexus Injury— Signs & Symptoms
Intense pain from neck down to arm
Arm will feel like it’s on fire or have pins- and-needles sensation
Arm/hand may be weak and numb
Intense pain in area of brachial plexus
Symptoms last several minutes to several hours or more
Weakness may last for several days
depends on severity of injury

43. Brachial Plexus Injury— Treatment
Resting neck/arm until pain & symptoms go away
Ice pack 20 minutes every 3-4 hours
Anti-inflammatories
Strengthening exercises
RTP determined by sports medicine staff
Subsequent stingers cause for further testing

44. Brachial Plexus Injury— Treatment
Chronic stingers may eliminate athlete from contact sports
Scar tissue develops around nerve
® Causes nerves to become entrapped
If athlete receives another blow, brachial plexus may not be able to flex
shatters instead, tearing major nerves of arm
Causes permanent neurological damage
Avoid by:
Keeping neck and shoulders as strong as possible
Properly fitted equipment
Proper tackling & blocking techniques

45. Special Tests

46. Special Tests for Shoulder
Hawkin’s-Kennedy Impingement
Anterior Apprehension
Piano Sign
Apley’s Scratch
Empty Can
Drop-arm Sign

47. Hawkin’s-Kennedy Seated
Shoulder in 90 degrees of flexion, slight horizontal adduction, & maximal internal rotation
(+) reproduction of pain
Subacromial Impingement

48. Drop Arm Sign

49. Apprehension-relocation
Supine with 90 degrees of abduction & external rotation
1 had placed as a fulcrum just posterior to humeral head then passively move shoulder into maximal external rotation against fulcrum of other hand
(+) reproduction of shoulder pain, or apprehension with movement
Glenohumeral subluxlation

50. Piano Key/Sign – AC Separation
Seated or standing
Clinician presses downward on elevated end of clavicle
(+) pain or excessive movement of clavicle
AC separation

51. Empty Can Test—Supraspinatus
Seated
Elevate UE to degrees in plane of scapula with internal rotation (thumb down); resist elevation
(+) pain & weakness

52. Apley’s Scratch – shoulder mobility
Sitting
3 part test
Reach across chest & place hand on opposite sholder
Reach overhead to place hand between scapula
Reach behind back as high as possible
*compare bilaterally
(+) asymetrical motion
Restriction in horizontal adduction, IR, scapular protraction
Restriction I abduction, ER, scapular upward rotation and elevation
Restriction in adduction, IR, scapular downward rotation and retraction

53. Find a partner and let’s practice
Questions?
Find a partner and let’s practice