 Clavicle  Scapula  Humerus  Articulations:  Sternoclavicular joint  Acromioclavicular joint  Glenohumeral joint

 Ligaments  AC  Glenohumeral lig/joint capsule  Labrum

 Musculature  “Rotator cuff”  Subscapularis  Supraspinatus  Infraspinatus  Teres Minor  Pectoralis major  Deltoid  Trapezius

 Musculature  Pectoralis major  Deltoid  Trapezius

 Subacromial Bursa

 History  Where is the pain?  Clicking, catching, or popping?  Often indicates labrum  Weakness or fatigue?  Rotator cuff  Observation  Symmetry  deltoid contour  clavicle shape & prominence  AC shape & prominence

 Palpation  Walk along all bony structures, esp. AC joint & clavicle  Special tests  Muscle testing  “Empty can” test  IR/ER tests  Instability  Many tests…to be learned in other classes, though

 Special tests  Impingement

 Clavicle Fracture:  Fall On Out-Stretched Hand (FOOSH) or direct blow  Athlete will usually support arm w/ non- injured arm  Gross deformity  Immobilize & treat for shock. Refer for X- rays/consult  Splint in figure 8 brace for 6-8 weeks  Humeral Fracture:  Direct blow, dislocation, or FOOSH  Need X-ray…usually hard to recognize  Splint & refer  Out 2-6 months :(

 Sternoclavicular sprain  Relatively common in sports; FOOSH of direct blow  Usually clavicle will be upward & forward  RICE, immobilization 3-5 weeks  Acromioclavicular sprain  “Separated shoulder”  Direct blow to tip of shoulder or FOOSH  “Piano-key” sign  RICE, immobilize, & refer

 Anterior Glenohumeral Dislocation  Usually posterior force w/ forced external rotation (arm tackle)  Obvious deformity  Flattened deltoid contour  Humerus comes to rest in axilla  Immobilize immediately  RICE

 Shoulder impingement syndrome  Compression of supraspinatus, subacromial bursa, and/or LHBB  Pain, numbness, and tingling  Restore normal biomechanics to shoulder (ther. ex)  Cease causative activity  Rotator cuff tears  Rare in people under 40, but do happen in sports  humeral insertion  Pain & weakness  RICE, exercises to restore function  Low weights!!!!!! High reps okay, though

 Thoracic Outlet Compression Syndrome  Overuse disorder  Numbness, burning & tingling in arms & hands  Caused by compression of brachial plexus between upper ribs and clavicle  Treat with therapeutic exercise  Retraction exercises  Upper rib mobilizations

 Bicipital Tenosynovitis  Common in throwing athletes  Typical inflammation  RICE, NSAIDS, Cross friction massage  Subacromial Bursitis  Pain on palpation, positive impingement tests  RICE, NSAIDS

 Immobilization after injury  General body conditioning  Shoulder joint mobilization  Flexibility  Muscular strength  Regaining neuromuscular control  Functional progression  Return to activity