THE SHOULDER

ANATOMY

Bones Sternum - middle of chest Clavicle - collar bone Humerus - upper arm Scapula - shoulder blade Acromion process (knob on top of shoulder) Glenoid fossa (socket for the humerus)

SHOULDER COMPLEX JOINTS Sternoclavicular (SC) Joint Only bony attachment between the axial skeleton and the upper extremity

SHOULDER COMPLEX JOINTS Acromioclavicular (AC) Joint Between the lateral end of the clavicle and the acromion process of the scapula Held together by two sets of ligaments Painful when injured

SHOULDER COMPLEX JOINTS Glenohumeral (GH Joint) True shoulder joint Between the head of the humerus and the glenoid fossa of the scapula Most freely movable joint of the body Very unstable Head of the humerus is 60% bigger than the glenoid (golf ball on a tee)

SHOULDER MUSCLES Pectoralis Major Front of chest Horizontal Adduction (like bench press)

SHOULDER MUSCLES Deltoid Over the top of the shoulder Abduction

SHOULDER MUSCLES Latissimus Dorsi Back of shoulder Extension

SHOULDER MUSCLES Rotator Cuff Internal and External Rotation Supraspinatus Infraspinatus Teres Minor Subscapularis Internal and External Rotation

SHOULDER MOTIONS

8 slides with LOTS of info! INJURIES 8 slides with LOTS of info!

Clavicle Fracture Most fracture sites are in middle 1/3 Most common in adolescents and pre-adolescents Cause: Fall on outstretched arm OR tip of shoulder Direct impact S/S Tilts head to side that is injured Supports that arm with other arm Clavicle is tender Care: Immobilize, ice, x-ray, figure-8 brace

Humerus Fracture Not a common injury in sports Cause S/S Care Direct impact Fall on outstretched arm S/S Inability to move arm Pain and swelling in upper arm Care Splint, sling Immediate referral to ER

Sternoclavicular (SC) Sprain Not a common injury - mostly in contact sports Cause Fall on shoulder - force goes up the clavicle S/S – (can be 3 grades) Usually dislocates anterior and superior - obvious deformity Unable abduct or horizontally adduct arm Care RICE, Immobilize shoulder Life threatening if it goes posteriorly

Acromioclavicular (AC) Sprain Very common in athletics Cause Fall on outstretched arm OR tip of shoulder S/S 1st and 2nd degree - tenderness around joint, will not want to flex or horizontally adduct 3rd degree sprain has obvious deformity Care RICE, Immobilize shoulder X-rays will determine the degree best – holding weight

Glenohumeral (GH) Dislocation 95% of all dislocations are anterior Can also go inferior or posterior Once it happens, it is very likely to happen again Cause (anterior): Arm is abducted and externally rotated with extra force S/S Deltoid will appear flat They will hold arm at side and internally rotated Unable to use the arm Treatment Immobilization, ice and referral to MD to reduce

Labral Tear – SLAP Lesion Causes Fall on shoulder Overuse (throwing, lifting) GH Dislocation S/S Pain (especially with overhead throwing) Catching Instability Pain with biceps involvement Tx Rest and rehab first If that does not work - surgical repair (arthroscopy)

Shoulder Impingement Syndrome Cause Repetitive overhead motion (i.e. throwing, swimming, volleyball, etc) The supraspinatus tendon, a bursa and biceps tendon get trapped in a small space S/S Pain with overhead motion Weakness in abduction and external rotation Care Ice and rest for pain Fix the bad habits (biomechanics) that caused the problem

Rotator Cuff Strains Can go hand in hand with impingement Supraspinatus (SSP) is most often injured Cause Overhead motions with force or heavy weight S/S Pain – down into deltoid Weakness – may not be able to abduct arm with full tear of the SSP Care Decrease overhead activity Ice or heat Rehab to strengthen rotator cuff

Biceps Tendinitis Common in athletes who use a lot of overhead motion (throwers) Can go hand in hand with impingement Cause Overhead motion S/S Pain is in anterior, proximal humerus Pain with O/H motion Treatment Deep heat Ice after activity