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Shoulder: Anatomy & Injuries

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1 Shoulder: Anatomy & Injuries

2 High degree of mobility Limited stability Susceptible to injury
Complicated joint High degree of mobility Limited stability Susceptible to injury Functional Anatomy Round humeral head with flat glenoid

3 Shoulder Anatomy We will focus on four major bones. 1. Humerus
2. Scapula 3. Sternum 4. Clavicle

4 Humerus There are two landmarks on the humerus we need to locate.
1. Head of the Humerus 2. Bicipital Groove

5 Humerus Landmarks

6 Scapula There are four landmarks on the scapula we need to locate.
Acromium Process Coracoid Process Glenoid Fossa Spine of the scapula

7 Scapula - Landmarks

8 Sternum There are two landmarks We need to locate on the Sternum.
Zyphoid process Manubrium

9 Stermum Landmarks

10 Clavicle

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14 Basic Ligaments

15 Basic Ligaments Sternoclavicular Ligament Coracoclavicular Ligament
Acromioclavicular Ligament Capsule

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17 Labrum – what holds the shoulder together

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19 Links you need to check out!

20 Musculature Supraspinatus – abductor Infraspinatus – rotator
Teres minor – rotator Subscapularis – rotator Page 55

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25 Musculature Deltoid – flexion & extension & abduction & horizontal abduction Pectoralis major – horizontal abduction Latissimus dorsi – extension Teres major – extension Coracobrachialis – flexion Biceps brachii – resisted flexion Triceps brachii (long head) - extension

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31 Injuries of the Shoulder
Mechanism, Evaluation and Treatment

32 Rotator Cuff Strain Mechanism
Typically from a violent pull of arm, an abnormal rotation force, or a fall on outstretched arm (foosh). Sometimes from repetitive motion (throwing, tennis, swimming)

33 Rotator Cuff Strain Signs & Symptoms Special Tests Loss of function
Pain and tenderness Lack of normal shoulder flexibility and strength Special Tests Drop Arm Test – Supraspinatus – abduct as far as possible then return to 90 and try to hold – if drop then torn Empty Can Test – checks supraspinatus – check strength in empty can motion at approx 45 degrees Apley’s Scratch Test – checks all muscle motions

34 Drop Arm Test

35 Empty Can Test

36 Rotator Cuff Strain Management Rest if necessary and Ice
Rehabilitation emphasizing stretching & strengthening Surgery on a rare occasion

37 Acromioclavicular Sprain or Separated Shoulder
Mechanism Direct blow to tip of shoulder or foosh driving arm against the acromion Damages the ligaments and acromion and clavicle may separate. May be classified as first, second, or third degree sprains.

38 Acromioclavicular Sprain or Separated Shoulder
Signs and Symptoms Pain and tenderness at end of the collar bone Deformity caused by upward displacement of collar bone Loss of function Special Tests Distraction (Piano Key)

39 Acromioclavicular Sprain or Separated Shoulder
Management Ice to control bleeding and swelling Immobilization with sling and swathe Rehab to restore normal strength & flexibility Protective taping and padding Out how long???? Depends on degree of separation and amount of pain can tolerate

40 Anterior Dislocation Mechanism –
when arm is forcefully abducted and externally rotated (ex. Abnormal force to an arm that is executing a throw or and arm tackle) A fall on an arm Humeral head slips forward out of the glenoid fossa. Often causes a labral tear.

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42 Anterior Dislocation Signs and Symptoms Special Tests
Pain and Tenderness Deformity – flattened shoulder contour – stair step defect Loss of function – arm will just hang Special Tests Apprehension – abduct arm to 90 degrees then force arm into external rotation Relocation test – do apprehension test but hold glenohumeral head in place

43 Shoulder Dislocation

44 Apprehension Test

45 Relocation Test

46 Anterior Dislocation Management Cold Application Immobilization
AS IS – DO NOT RELOCATE ON OWN. Rehabilization Restore normal strength and flexibility Brace Sully Brace – Limit ROM – esp. Abduction/External Rotation Surgery

47 Glenoid Labrum Tear (Labral Tear)
Mechanism Anterior Dislocation/Subluxation of glenohumeral joint Repetitive shoulder motion Acute trauma

48 Glenoid Labrum Tear (Labral Tear)
Signs & Symptoms Pain changes smooth motion of shoulder Feels or hears pop with forced external rotation Pain with external rotation at 90 degrees of abduction – apprehension test Weakness of rotator cuff Possible positive clunk test Pain with forced horizontal adduction

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52 Clunk Test

53 Long Thoracic Nerve Contusion
Mechanism Indirect trauma to shoulder or thoracic wall, overuse or prolonged traction (as in cycling) Signs & Symptoms Pain, dull ache in shoulder Protruding/winging scapula due to weak serratus anterior muscle due to damage to nerve

54 Long Thoracic Nerve Contusion
Special Test Wall push up

55 Clavicle Fracture Broken Collar Bone Mechanism Signs & Symptoms Foosh
fall or hit on tip of shoulder Signs & Symptoms Holding up arm Head toward injured side Possible deformity & crepitus

56 Clavicle Fracture Treatment X-ray Surgery

57 Bicep Tendinitis Mechanism Signs & Symptoms Special Tests
Irritation of the Bicep Tendon Signs & Symptoms Pain, feel like bicep is moving Special Tests Speed’s Test – resist shoulder flexion Yergason Test – athlete tries to keep arm from externally rotating and extending the elbow – checks for bicep stability

58 Bicep Rupture Mechanism Signs and symptoms Treatment
Violent contraction Signs and symptoms Hears/feels a sensation of rolling up of the arm Protruding bulge in the bicep – divet in arm Loss of function/strength Treatment Refer to orthopedic surgeon

59 Bicep Rupture

60 Rotator Cuff Impingement
Mechanism Caused due to swelling in AC joint. No where for swelling to go. Rotator cuff is impinged in the joint. Special Tests Impingement Tests Force arm into horizontal adduction Empty Can Test Resisted as empty can motion at 45 degree angle

61 Rotator Cuff Impingement

62 Impingement Test

63 Other Typical Injuries
Bursitis Contusion Fracture

64 Prevention of Shoulder Injuries
Overall Conditioning Strengthen in Full ROM Warm Up properly before explosive arm movements Instruct in proper falling techniques Protective equipment Teach proper mechanics Avoid overuse Sport Specific Training

65 Videos Shoulder Injuries (9:58)
Shoulder Injuries (Part 1) (15:03) Shoulder Injuries (Part 2) (11:38) Shoulder Dislocation (X-ray) (1:00)

66 Videos Understanding Shoulder Pain (Sports Injuries #3) (2:59)
Shoulder Dislocation Dwyane Wade (3:00) Shoulder Injury Campbell (Raiders) (1:13) Shoulder dislocation wrestling (0:19)


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