1 The Shoulder PE 236 Juan Cuevas, ATC

2 Anatomy Review Shoulder bones: – Consist of shoulder girdle (clavicle & ____________) and humerus. Shoulder joints : – __________________ – ___________clavicular – Sterno_____________

3 Anatomy (continued) Joints are held together with ___________ and joint capsules that provide stability and allow for limited movement. –Shoulder girdle and the ____ joint can move in almost every direction. ___ & SC joints are just under the skin and are vulnerable to injury, even in muscular athletes Major nerves are from a group called the brachial plexus.

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5 Muscular Anatomy

6 Rotator Cuff S.I.T.S. muscles _________________ _________________ _________________ _________________S.I.T.S. muscles _________________ _________________ _________________ _________________

7 Prevention of Shoulder Injuries Proper physical conditioning is key Develop body and specific regions relative to ________ Strengthen through a full ________ –Focus on _____________ muscles in all planes of motion –Be sure to incorporate scapula _______________ muscles Enhances base of function for glenohumeral joint

8 Throwing Mechanics Instruction in proper throwing mechanics is critical for injury prevention

9 ___________ Phase –First movement until ball leaves gloved hand –Lead leg strides forward while both shoulders ________, externally rotate and horizontally abduct ________________ –Max external rotation until ball release (humerus adducts, horizontally adducts and internally rotates) –Scapula elevates and abducts and rotates upward

10 ____________________ Phase –Ball release until max shoulder internal rotation –Eccentric contraction of ext. rotators to decelerate humerus while rhomboids decelerate scapula __________________ Phase –End of motion when athlete is in a balanced position

11 Fractured Clavicle Fractures of this bone are the most common fracture in this region. –This injury usually results from ______ or direct blows. –The adolescent form of this injury is known as a “_____________” fracture. All clavicular fractures are ___________ dangerous.

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13 Fractured Clavicle (continued) Signs and symptoms include: –Swelling. –_____________. –Discoloration. –Broken bone ends may protrude though skin. First Aid –Treat for ___________. –Apply sling & swathe bandage. –Apply sterile dressings on any wounds.

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15 AC Joint Injuries (continued) Typical mechanism is _________ blow to the lateral shoulder or fall on an outstretched arm. –Severity of injury is graded on the amount of damage to ligaments. 1st degree -- no significant ligament damage 2nd degree -- partial tearing of ligaments _________ _____________ 3rd degree -- complete rupture _______________

16 AC Joint Injuries (continued) Mild swelling with point ____________. Any movement of the shoulder region will be _________. In 3rd degree sprain, a snap or ________ may have been sensed along with a visible deformity.

17 AC Joint Injuries (continued) First Aid –Treat for shock. –Apply I.C.E. –Apply sling & swathe bandage. –Refer athlete to a physician.

18 Glenohumeral Joint Injuries GH joint consists of humeral head and the glenoid fossa of scapula. –Extremely _________ but inherently unstable joint. –Typical mechanism of injury is having the arm ___________ and externally rotated, stressing the ___________ glenohumeral ligament. –Most common type of location is an __________ dislocation that may be a subluxation or complete dislocation.

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20 Glenohumeral Joint Injuries (continued) Signs and symptoms include: –Shoulder joint deformity and down-sloping shoulder contour. “ ____________-” –Abnormally long arm on affected side. –Humeral head palpable within __________. –Athlete resists efforts to move GH joint. In cases involving _______________: –GH joint may appear normal. –Movement will be painful. –Joint may be point tender.

21 Glenohumeral Joint Injuries (continued) Glenohumeral Joint Injuries (continued) First Aid Treat for shock. Application of ice and compression by placing ______________ into the axilla. Apply sling & swathe bandage. Dislocations need to be re-located by a ________ Refer to a physician immediately. GH joint injuries tend to be chronic and recur. Surgical treatment may be necessary.

22 Sternoclavicular Joint (SC) Injuries The sternoclavicular joint is formed by the union of the proximal end of the clavicle and the manubrium of the _______________. –SC joint is supported by the several ligaments. –Injuries are rare compared to ______ or GH joints. –Sprains to the SC joint can range in severity. Mechanism is external blow to the shoulder resulting in a ___________ of proximal clavicle; most commonly, the clavicle moving __________ and superiorly.

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24 Sternoclavicular Joint Injuries (continued) First Aid –Treat for shock. –Apply ice and compression. –Sling & swathe bandage.

25 Rotator Cuff Strains Any muscle of the shoulder can suffer a strain. Most common injury is rotator cuff strain. Rotator cuff muscles contribute to GH joint _________ and _________. Errors in the execution of a throw or swing can contribute to overuse injury.

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27 Rotator Cuff Strains Signs and symptoms include: Pain _______ the shoulder, especially during follow through phase. Difficulty bringing arm up and back during _______ phase of throw. Pain and stiffness in shoulder region _________ hours after throwing or swinging. Point tenderness around region of the humeral head that seems to be deep in __________ muscle.

28 Rotator Cuff Strains (continued) First Aid –First aid is NOT practical due to chronic nature of condition. –I.C.E. –Medical referral.

29 GH Joint-Related “Impingement” Syndrome Occurs when a bursa or tendon is __________ between moving structures. –In cases affecting the GH joint, the tendon of the ______________ muscle is commonly impinged.

30 GH Joint-Related “Impingement” Syndrome

31 Impingement Syndrome –Any condition that decreases the size of the ______________ space may result in impingement syndrome. –Athletes in sports that emphasize _____________ arm movements have a high risk of this injury.

32 Impingement Syndrome (continued) Signs and symptoms include: –Pain on ______________________________. –Strength loss. –Pain when arm is abducted beyond 80° to 90°. –_______________________. –Pain felt deep within the shoulder.

33 Impingement Syndrome (continued) First Aid Rest. Anti-inflammatory drugs. (_____________) Physical therapy. In extreme cases, surgery.

34 Labral Tear The labrum is the _________________ tissue located where the shoulder ligaments, which make up the joint capsule, connect to the edge of the ________. The tendon of the ________ muscle attaches to the shoulder at the top of the labrum. How do Labral tears occur? –______________ –A ________ movement of our arm or shoulder –Using arm to break a fall –Repetitive, high velocity overhead movements such as throwing a ball or serving in tennis –____________

35 Labral Tear Signs and Symptoms –Arm and shoulder pain –Arm and shoulder _____________ –Painful overhead movements –Clicking or ___________ sounds or sensations when moving shoulders Diagnosis –_______ (with arthogram)

36 Labral Tear Treatment –Ice –NSAIDs –Shoulder rehabilitation exercises –____________

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38 Apprehension test (_____________) Apprehension test used for anterior glenohumeral instability –This motion should not be forced

39 Test for Shoulder Impingement Test for Shoulder Impingement –_________ test and Hawkins-Kennedy test for impingement used to assess impingement of soft tissue structures –Positive test is indicated by pain and _______

40 Test for Supraspinatus Weakness / Tear _________________ –90 degrees of shoulder flexion, internal rotation and 30 degrees of horizontal abduction –______________ pressure is applied –Weakness and pain are assessed _____________