BELLWORK LAST CHAPTER!!!!!!!!!!  In your opinion: Which sports see the most shoulder injuries? Why?

Chapter 21 The Shoulder

Objectives Upon completion of this chapter, you should be able to: Name the three articulations that constitute the shoulder girdle complex Describe how stability of the shoulder is maintained Recite the names of the four muscles that come together to form the rotator cuff

Objectives (cont’d.) Upon completion of this chapter, you should be able to (cont’d.): Explain the anatomy of the shoulder complex Identify major injuries and conditions of the shoulder

The Shoulder Girdle Complex Very complex joint 3 articulations: Glenohumeral (GH) joint; “ball-and-socket” Acromioclavicular (AC) joint Sternoclavicular (SC) joint All together  shoulder girdle Dynamic stability: mobility w/steadiness of a joint Only joint with 360° of rotation

The Shoulder Girdle Complex (cont’d.)

The Shoulder Girdle Complex (cont’d.) Head of humerus: upper portion of humerus, attaches to scapula Glenoid fossa: concave projection of scapula GH joint: head of humerus & scapula Acromion process: projection of spine of scapula; “tip of shoulder” AC joint: acromion & clavicle SC joint: clavicle & sternum Scapulothoracic joint: area that provides movement of the scapula over back side of ribcage (not a “true” joint) Synergistics: group of muscles act together to enhance movement of joint or limb

Reason for decreased stability…

Scapula

Muscles

Muscles (con’t)

Major Muscles of Upper body FUNCTION Trapezius Draws head to one side; rotates scapula Serratus anterior Protraction of scapula Pectoralis major Flexion, horiz. adduction, int. rotation of arm Deltoid Abducts arm Latissimus dorsi Extends, adducts, int. rotates arm RC muscles Mainly external rotation of arm

Rotator Cuff Set of 4 muscles of the GH joint Originate on scapula & insert on head of humerus S.I.T.S. Supraspinatus Infraspinatus Teres minor Subscapularis

Rotator Cuff & Deltoid Work together to maintain stability of the shoulder Force couple: 2 forces acting in opposite directions to rotate a body part RC muscles pull down as deltoid lifts up (abducts) deltoid rotator cuff

Scapulothoracic Mechanics Scapula is base of support for shoulder complex Must reposition itself as humerus moves  scapular rhythm

Movements

Overuse Injuries to the Shoulder Sports with excessive overhead motion (i.e. swimming, tennis, pitching, volleyball, etc.) Impingement syndrome Occurs when space between humeral head and acromion becomes narrowed  structures become “impinged”, or pinched Mechanical irritation of cuff tendons Symptoms: pain, tenderness, weakness, limited rotation, and test confirmation Treatment: prevention, preseason conditioning, cross-training, exercise, taping, and rehabilitation

BELLWORK Name as many movements of the shoulder/scapula as you can remember. Name the 4 rotator cuff muscles.

Overuse Injuries to the Shoulder (cont’d.) Rotator cuff tears Partial or full thickness Symptoms: pain, unable to move full range of motion, unable to lift the arm overhead, “catching” sensation, and varying degrees of disability Treatment: rehab, surgery

Overuse Injuries to the Shoulder (cont’d.) Muscle strains Caused by overuse or traumatic injuries Symptoms: pain and tenderness Treatment: PRICE, gentle stretching, strengthening program, and cross-training

Overuse Injuries to the Shoulder (cont’d.) Biceps tendonitis: inflammation of biceps tendon (connects biceps to shoulder girdle) Biceps tendon ruptures Not common in athletics Symptoms: sudden pain in the front of the shoulder associated with a “pop”, drooping of muscle (“Popeye”) Treatment: PRICE; surgery not normally needed

Traumatic Shoulder Injuries Anterior shoulder dislocation Head of the humerus is dislocated completely off of the glenoid fossa Arm is abducted to the side, with the elbow bent, and force applied to the arm causes external rotation Immediate referral

Traumatic Shoulder Injuries (cont’d.) Glenoid labrum injuries Glenoid labrum: ring of cartilage attached to glenoid fossa; keeps humeral head in position Occurs with trauma Symptoms: pain, catching or popping sensation, and weakness Treatment: strengthening program, physician diagnosis, and sometimes surgery

Traumatic Shoulder Injuries (cont’d.) Acromioclavicular (AC) separations Traumatic sprains of acromioclavicular joint Symptoms: pain and deformity Treatment: physician referral, PRICE, and exercise

Traumatic Shoulder Injuries (cont’d.) Brachial plexus Injury “stinger” (burner): stretching or compressing of brachial plexus (group of nerves leaving spinal cord and extending from vertebrae to shoulder) Head or neck is forced to one side Symptoms: pain, burning, and weakness Treatment: rest, ice, anti-inflammatory medication, and exercises

Traumatic Shoulder Injuries (cont’d.) Fractures of the shoulder Usually caused by an impact or blow to shoulder Symptoms: deformity, ecchymosis, and bruising Treatment: support and transport to emergency room

Animation – Shoulder Injuries

Is It a Shoulder Injury? Pain in the shoulder region does not always indicate a shoulder problem Referred pain: pain felt in one body part, but originates somewhere else Referred pain to the shoulder can be due to: Cardiac problems Pinched or stretched nerves Spleen injury

Special Tests Neer’s impingement (BT or supraspinatus) Hawkins-Kennedy (supraspinatus) Speed’s test (BT tendonitis) AC compression (AC sprain) Cross-arm adduction (AC sprain) Drop arm test (RC tear) Clunk Test (labral tear) Apley’s scratch test (ROM)

8 Shoulder Stretches Abduction/ext. rotation Abduction/int. rotation Flexion/ext. rotation Flexion/int. rotation Horizontal adduction Horizontal abduction Flexion Extension

Conclusion The upper extremity is one of the most challenging areas of the body to treat Understanding the mechanisms of injury will ensure appropriate rehabilitation The ATC must understand causes of common upper extremity conditions, so they can assess and manage the many different injuries