1. BELLWORK LAST CHAPTER!!!!!!!!!!  In your opinion:
Which sports see the most shoulder injuries?
Why?

2. Chapter 21
The Shoulder

3. Objectives Upon completion of this chapter, you should be able to:
Name the three articulations that constitute the shoulder girdle complex
Describe how stability of the shoulder is maintained
Recite the names of the four muscles that come together to form the rotator cuff

4. Objectives (cont’d.)
Upon completion of this chapter, you should be able to (cont’d.):
Explain the anatomy of the shoulder complex
Identify major injuries and conditions of the shoulder

5. The Shoulder Girdle Complex
Very complex joint
3 articulations:
Glenohumeral (GH) joint; “ball-and-socket”
Acromioclavicular (AC) joint
Sternoclavicular (SC) joint
All together  shoulder girdle
Dynamic stability: mobility w/steadiness of a joint
Only joint with 360° of rotation

6. The Shoulder Girdle Complex (cont’d.)

7. The Shoulder Girdle Complex (cont’d.)
Head of humerus: upper portion of humerus, attaches to scapula
Glenoid fossa: concave projection of scapula
GH joint: head of humerus & scapula
Acromion process: projection of spine of scapula; “tip of shoulder”
AC joint: acromion & clavicle
SC joint: clavicle & sternum
Scapulothoracic joint: area that provides movement of the scapula over back side of ribcage (not a “true” joint)
Synergistics: group of muscles act together to enhance movement of joint or limb

8. Reason for decreased stability…

9. Scapula

10. Muscles

11. Muscles (con’t)

12. Major Muscles of Upper body
FUNCTION
Trapezius
Draws head to one side; rotates scapula
Serratus anterior
Protraction of scapula
Pectoralis major
Flexion, horiz. adduction, int. rotation of arm
Deltoid
Abducts arm
Latissimus dorsi
Extends, adducts, int. rotates arm
RC muscles
Mainly external rotation of arm

13. Rotator Cuff Set of 4 muscles of the GH joint
Originate on scapula & insert on head of humerus
S.I.T.S.
Supraspinatus
Infraspinatus
Teres minor
Subscapularis

14. Rotator Cuff & Deltoid
Work together to maintain stability of the shoulder
Force couple: 2 forces acting in opposite directions to rotate a body part
RC muscles pull down as deltoid lifts up (abducts)
deltoid
rotator cuff

15. Scapulothoracic Mechanics
Scapula is base of support for shoulder complex
Must reposition itself as humerus moves  scapular rhythm

16. Movements

17. Overuse Injuries to the Shoulder
Sports with excessive overhead motion (i.e. swimming, tennis, pitching, volleyball, etc.)
Impingement syndrome
Occurs when space between humeral head and acromion becomes narrowed  structures become “impinged”, or pinched
Mechanical irritation of cuff tendons
Symptoms: pain, tenderness, weakness, limited rotation, and test confirmation
Treatment: prevention, preseason conditioning, cross-training, exercise, taping, and rehabilitation

18. BELLWORK
Name as many movements of the shoulder/scapula as you can remember.
Name the 4 rotator cuff muscles.

19. Overuse Injuries to the Shoulder (cont’d.)
Rotator cuff tears
Partial or full thickness
Symptoms: pain, unable to move full range of motion, unable to lift the arm overhead, “catching” sensation, and varying degrees of disability
Treatment: rehab, surgery

20. Overuse Injuries to the Shoulder (cont’d.)
Muscle strains
Caused by overuse or traumatic injuries
Symptoms: pain and tenderness
Treatment: PRICE, gentle stretching, strengthening program, and cross-training

21. Overuse Injuries to the Shoulder (cont’d.)
Biceps tendonitis: inflammation of biceps tendon (connects biceps to shoulder girdle)
Biceps tendon ruptures
Not common in athletics
Symptoms: sudden pain in the front of the shoulder associated with a “pop”, drooping of muscle (“Popeye”)
Treatment: PRICE; surgery not normally needed

22. Traumatic Shoulder Injuries
Anterior shoulder dislocation
Head of the humerus is dislocated completely off of the glenoid fossa
Arm is abducted to the side, with the elbow bent, and force applied to the arm causes external rotation
Immediate referral

23. Traumatic Shoulder Injuries (cont’d.)
Glenoid labrum injuries
Glenoid labrum: ring of cartilage attached to glenoid fossa; keeps humeral head in position
Occurs with trauma
Symptoms: pain, catching or popping sensation, and weakness
Treatment: strengthening program, physician diagnosis, and sometimes surgery

24. Traumatic Shoulder Injuries (cont’d.)
Acromioclavicular (AC) separations
Traumatic sprains of acromioclavicular joint
Symptoms: pain and deformity
Treatment: physician referral, PRICE, and exercise

25. Traumatic Shoulder Injuries (cont’d.)
Brachial plexus Injury
“stinger” (burner): stretching or compressing of brachial plexus (group of nerves leaving spinal cord and extending from vertebrae to shoulder)
Head or neck is forced to one side
Symptoms: pain, burning, and weakness
Treatment: rest, ice, anti-inflammatory medication, and exercises

26. Traumatic Shoulder Injuries (cont’d.)
Fractures of the shoulder
Usually caused by an impact or blow to shoulder
Symptoms: deformity, ecchymosis, and bruising
Treatment: support and transport to emergency room

27. Animation – Shoulder Injuries

28. Is It a Shoulder Injury?
Pain in the shoulder region does not always indicate a shoulder problem
Referred pain: pain felt in one body part, but originates somewhere else
Referred pain to the shoulder can be due to:
Cardiac problems
Pinched or stretched nerves
Spleen injury

29. Special Tests Neer’s impingement (BT or supraspinatus)
Hawkins-Kennedy (supraspinatus)
Speed’s test (BT tendonitis)
AC compression (AC sprain)
Cross-arm adduction (AC sprain)
Drop arm test (RC tear)
Clunk Test (labral tear)
Apley’s scratch test (ROM)

30. 8 Shoulder Stretches Abduction/ext. rotation Abduction/int. rotation
Flexion/ext. rotation
Flexion/int. rotation
Horizontal adduction
Horizontal abduction
Flexion
Extension

31. Conclusion
The upper extremity is one of the most challenging areas of the body to treat
Understanding the mechanisms of injury will ensure appropriate rehabilitation
The ATC must understand causes of common upper extremity conditions, so they can assess and manage the many different injuries