SHOULDER COMPLEX

Shoulder Anatomy

Clavicle Scapula Humerus Articulations:

Sternoclavicular joint

Acromioclavicular joint

Glenohumeral joint

Shoulder Anatomy Ligaments

AC Glenohumeral

lig/joint capsule Labrum

Shoulder Anatomy Musculature

“Rotator cuff” Subscapularis Supraspinatus Infraspinatus Teres Minor

Pectoralis major Deltoid Trapezius

Shoulder Anatomy

Musculature Pectoralis major Deltoid Trapezius

Shoulder Anatomy Subacromial

Bursa

Assessing Shoulder Injuries

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

Assessing Shoulder Injuries

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

Assessing Shoulder Injuries

Special tests Impingement

Shoulder Injuries 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 :(

Shoulder Injuries 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

Shoulder Injuries 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

Anterior dislocation

Shoulder Injuries 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 Usually @ humeral insertion Pain & weakness RICE, exercises to restore function

Low weights!!!!!! High reps okay, though

Shoulder Injuries 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

Shoulder Injuries Bicipital Tenosynovitis

Common in throwing athletes Typical inflammation RICE, NSAIDS, Cross friction massage

Subacromial Bursitis Pain on palpation, positive impingement tests RICE, NSAIDS

Rehabilitation of The Shoulder Complex

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