Injuries to the Shoulder

Anatomy of the ShoulderAnatomy of the Shoulder

• Bones of shoulder complex:– clavicle (collar bone)– scapula (shoulder blade)– humerus

Provide points of connection between upper extremities and axial skeleton

Articulations of the Shoulder

• Sternoclavicular (SC) joint – Articulation between the sternum and clavicle

• Acromioclavicular (AC) joint– Articulation between clavicle and acromium

process

• Glenohumeral joint– Articulation between head of humerus and

scapula (ball and socket joint)

ROM of Shoulder Joint

• Flexion

• Extension

• Abduction

• Adduction

• External rotation

• Internal rotation

• Horizontal abduction

• Horizontal adduction

• Circumduction

Muscles of the Shoulder Joint

• Deltoid

• Teres Major

• Rotator Cuffs– Supraspinatus– Infraspinatus– Teres minor– Subscapularis

Rotator Cuff Tear

Main Muscles of Upper Arm

• Biceps brachii• Brachialis• Triceps brachii

– Attaches humerus to shoulder girdle

• Trapezius• Rhomboids• Serratus anterior• Pectoralis Major

– Attaches shoulder girdle to trunk of body

Major Arteries and Veins of ArmMajor Arteries and Veins of Arm

• Arteries

– Subclavian

– Axillary

– Brachial

– Radial & Ulnar

• Veins

– Radial & Ulnar

– Brachial

– Axillary

– Subclavian

Major Nerves of the ArmMajor Nerves of the Arm

• Brachial Plexus– Axillary– Musculocutaneous – Radial - extensors– Medial - flexors– Ulnar – flexors

Nerve damage results in numbness, pain, and/or tingling

Injuries to the Shoulder• Fractures

– Usually clavicle or head of humerus

Mechanism of Injury 1. direct blow 2. falling on outstretched hand 3. landing on acromiom process

Symptoms– pain, swelling, deformity– hanging arm to side– and unable to lift arm

• Fractures Special Tests– Percussion Test

• Lightly tap distal aspect of involved arm

– Compression Test• Compress area above and below injured site• Be careful not to place hands on injured area

• Immediate Treatment– Place in sling or splint– Ice only if will not increase pain– Send to physician or call EMS

Injuries to the Shoulder• Dislocation / Subluxations

– Dislocation = head of humerus displaced– Subluxation = partial dislocation

Mechanism of Injury1. Falling on outstretched arm (Anterior)2. Arm in 90° flexion forced back (Posterior)

Symptoms• Pain• Loss of strength & ROM• “dead arm”• Slipping sensation

• Immediate Treatment– Place in comfortable position– Check for loss of circulation– Immobilize the joint & apply ice– Send to physician

** if loss of circulation is present, call EMS

Injuries to the Shoulder• Contusions

Mechanism of Injury– Direct blow

Symptoms

1. point tenderness

2. loss of ROM

3. discoloration

Immediate Treatment– Ice– Protect

Injuries to the Shoulder• Sprains

– Stretching or tearing of ligaments around AC joint, SC joint, and glenohumeral joint capsule

Mechanism of Injury• Outstretched arm• Direct blow

Symptoms1. Point tenderness 3. Swelling2. Weakness 4. Decreased ROM

• Special Tests for Glenohumeral Joint Instability– Sulcus

• Downward distraction of the humerus to assess multidirectional instability of GH joint

– Apprehension• Standing behind the athlete with their arm

abducted 90°, grab their wrist and externally rotate the arm. At the sign of apprehension, stop.

• Assesses instability of anterior GH joint capsule

Injuries to Shoulder

• Acromioclavicular Joint Sprain– also called a “separated shoulder”

Mechanism of injury:

1. blow to the lateral aspect of shoulder

Treatment:

1. ice

2. place in sling

3. if grade 2 or 3, send to physician

Injuries to Shoulder

• Sternoclavicular Joint Sprain

Mechanism of injury:1. blow to distal clavicle or sternum

Treatment:1. ice2. sling3. grade 2 or 3, send to physician

Injuries to Shoulder

• Bursitis/Tendonitis– Inflammation of bursa sacs or tendons in the shoulder

Mechanism of Injury1. overuse

Treatment1. ice2. rest3. stretching and strengthening exercises4. NSAIDS