Shoulder

Terminology Coracoid Process: a hook-like projection on the anterior aspect of scapula Acromion Process: flat lateral edge of scapula Range of Motion: (ROM) the amount of movement allowed at the joint. Anti-inflammatory: treatment that reduces inflammation Dislocation: separation of two bones where they meet at a joint.

Terminology Tendonitis: inflammation of a tendon Inflammation: swelling External rotation: movement of an extremity away from mid-line Internal rotation: movement of an extremity toward mid-line

Bones of Shoulder Humerus Clavicle Scapula Sternum Humerus Sternum

Joints Sternoclavicular (SC) joint Acromioclavicular (AC) joint Coracoclavicular joint Glenohumeral (GH) joint

Glenohumeral (GH) joint Ball & Socket Joint- formed by glenoid fossa (of scapula) and head of humerus

Movement (ROM) Circumduction Abduction Adduction Flexion Extension IROT (internal rotation) EROT (external rotation) The Learning Centre https://courses.stu.qmul.ac.uk Author: PhillipAdds, Learning Centre Teacher

Rotator Cuff (SITS) Supraspinatus Infraspinatus Teres minor Subscapularis

Acromioclavicular Joint Sprain (a separation) Etiology 1. Fall on point of shoulder 2. Fall on outstretched arm Pathology 1st degree – Sprain of the AC joint 2nd degree – Sprain of AC joint, partial sprain of coracoclaviclar ligament 3rd degree – Complete rupture of both ligaments

Acromioclavicular Joint Sprain cont. Signs and Symptoms 1. Localized pain upon palpation 2. May be deformed (2nd and 3rd sprains) 3. Shoulder maybe de drooped 4. Positive spring test 5. Positive traction test *Differentiate from contusions

Acromioclavicular Joint Sprain cont. Treatment 1. Ice and anti-inflammatory medication 2. Sling and/or swath 3. Surgery-for 3rd degree (may or may not be utilized) 4. Padding when return to sport (especially football) *Refer all 2nd and 3rd degree AC sprains to a physician

Sternoclavicular Separation Etiology Blow to the clavicle Fall on out stretched arm Pathology Separation of SC joints

Sternoclavicular Separation cont. Signs and Symptoms Grade 1- has little pain and disability, some point tenderness Grade 2 – shows subluxation of SC joint, slight deformity, pain, swelling, point tenderness and limited ROM Grade 3 – most severe, complete dislocation, pain, swelling, deformity, limited ROM Posteriorly separation can be life threatening

Sternoclavicular Separation cont. Treatment RICE Immobilization Refer all 2nd and 3rd degree AC sprains to a physician

Rotator Cuff Strain Etiology Pathology Excessive motion beyond the normal range Overuse Pathology Over Stretching Tear or third-degree strain

Rotator Cuff Strain cont. Signs and Symptoms Pain at night Pain when arm is in overhead position Weakness Loss of mobility and/or decreased range of movement Popping or clicking sounds when the shoulder is moved Limited ROM

Rotator Cuff Strain cont. Treatment RICE Anti-inflammatory Rehab

Anterior Dislocation (most common type) Etiology Abduction and external rotation of an upper extremity (arm tackle). Dislocation is generally anterior/inferior Pathology Tearing of anterior and inferior capsule May be tearing of rotator cuff May be fracture

Anterior Dislocation cont. Signs and Symptoms Athlete usually reports that shoulder is out Intense pain Flattened deltoid with prominent acromion process May be able to palpate humeral head beneath coracoid process Disfunction

Anterior Dislocation cont. Treatment Ice Sling and/or swath Transport to physician *Always check radial pulse and filling response If under 25 years, 80%-85% chance of reoccurrence so surgery generally considered. Subluxations, recurrent dislocation generally common following acute dislocations.

Clavicle Fractures Etiology Pathology fall on outstretched arm or point of shoulder direct blow to the clavicle Pathology Fracture of the clavicle bone

Clavicle Fractures cont. Signs and Symptoms Visible and palpable deformity Localized pain swelling Treatment Ice Immobilize with sling and/or swath Refer to a physician

Shoulder Bursitis Etiology Pathology Trauma or from overuse May develop from a direct blow, a fall on outstretches hand, or the stress incurred in throwing an object Pathology Inflammation of the bursa

Shoulder Bursitis cont. Signs and Symptoms Pain when moving shoulder Tenderness to palpation Treatment RICE Anti-inflammatory Maintaining ROM Do not immobilize shoulder

Biceps Tendonitis Etiology Pathology Signs and Symptoms Treatment Repeated stretching of the bicep muscle Pathology Tendonitis of the biceps Signs and Symptoms May be tender if palpated in its groove when arm is externally rotated Pain with activities Night pain Treatment RICE Anti-inflammatory

The Five Phase Phase I: Pain Management Phase II: ROM Phase III: Proprioception Phase IV: Strength Phase V: Endurance Phase VI: Sports Specific