1. THE SHOULDER

2. ANATOMY

3. 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)

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

5. 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

6. 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)

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

8. SHOULDER MUSCLES
Deltoid
Over the top of the shoulder
Abduction

9. SHOULDER MUSCLES
Latissimus Dorsi
Back of shoulder
Extension

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

11. SHOULDER MOTIONS

12. 8 slides with LOTS of info!
INJURIES
8 slides with LOTS of info!

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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)

19. 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

20. 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

21. 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