1. The Shoulder Complex Care and Prevention of Athletic Injuries

2. Bony Anatomy Shoulder Complex and Joint are made up primarily of the.... Clavicle Humerus Scapula Each bone has its own parts

3. Bony Anatomy cont’d Important projections (parts) to remember!

4. Articulations Sternoclavicular Joint Acromioclavicular Joint Glenohumeral Joint (mistakingly thought of as the ONLY joint in the shoulder) Scapulothoracic Joint

5. Shoulder ligaments GH Jt glenohumeral ligaments AC Jt acromioclavicular lig coracoclavicular lig SC jt sternoclavicular costoclavicular

6. Ligaments cont’d

7. Muscles Anterior Muscles Deltoids Pectoralis Major Biceps brachii Triceps brachii Posterior Muscles Rhomboids Rotator Cuff function? supraspinatus infraspinatus teres minor subscapularis

8. Muscles cont’d

9. Shoulder ROM Shoulder complex can perform NINE ROM 1. Flexion 2. Extension 3. Abduction 4. Adduction 5. Internal Rotation 6. External Rotation 7. Horizontal adduction 8. Horizontal abduction 9. Circumduction

10. CLASSWORK Based on your knowledge that muscles PULL not push, try to guess the function of each of the muscles we reviewed today. Then, based on your knowledge/past experiences list exercises that would workout these muscles during a rehab program.

11. Clavicle Fractures MOI: FOOSH Direct Fall on tip of shoulder S&S: Obvious deformity/TTP Head tilt toward fx Step deformity Management: 6-8 week immobilization SX PT

12. Humerus Fracture MOI: Direct impact fall on arm dislocation S&S: Pain Swelling, TTP, ROM Ecchymosis Dropped wrist…why? Management/TX Splint and refer to MD XRAY to confirm DX Casted for 3 weeks…..RTP 3-4 months

13. Shaft FX What fx type is this?

14. Sternoclavicular Sprain (SC jt) Rare MOI:  Indirect force?  Direct blow  Risks?  Posterior dislocation  Life threatening? Grade 1Minimal pain & TTP, no obvious deformity Grade 2Subluxation of SC jt, obvious deformity, pn,swelling, Abd Grade 3Swelling, displacement of clavicle, complete tear of ligs

15. SC Jt Sprain Management:  RICE  Refer to MD  Reduce dislocation  Splint for 3-5 weeks

16. Acromioclavicular Jt. Sprain MOI: FOOSH Fall on tip of shoulder Extent of ligamentous injury determines severity Grade from 1-6

17. AC Jt Cont’d Management: Grades 1-3 treated conservatively Grade 4-6 typically need surgery Splinted Length of time depends on grade Aggressive rehab

18. Acute Subluxations/Dislocations MOI: forced abd, ER, and Ext GH ligaments can tear Labrum tears Rotator cuff tendon tears Possible fx to post. Humeral head

19. GH Dislocation Cont’d S&S Flat deltoid Pain, swelling ROM loss Management Splint, ice, refer to ER to reduce

20. Shoulder Bursitis MOI: Overuse Direct impact, impingement, fall on tip of shoulder S&S: Pn in abd,flex,add,ext TTP in subacromial space

21. Bursitis Cont’d Management: Ice Anti-inflammatories Examples? Stretching Rehab exercises

22. Biceps Brachii Ruptures MOI: Powerful concentric/eccentric contraction S&S: Loud “Snap” Visible bulge Trouble flexing, supinating arm Management: Ice, sling, refer to MD Surgery to reattach biceps tendon

23. Bicipital Tensynovitis Popular in overhead activities MOI: Overuse Repeated stretching of biceps tendon S&S: TTP over bicipital groove Swelling,pain,crepitus Management: Ice Anti-inflammatories Rehab including stretching and strengthing the biceps and surrounding muscles