THE SHOULDER COMPLEX

Anatomy - Bones

Anatomy - Ligaments

Anatomy - Muscles Flexors

Pectoralis Major Deltoid Coracobrachialis Biceps Brachii

Extensors Latissimus Dorsi Deltoid Teres Major Triceps Brachii

Anatomy - Muscles

Abduction Deltoid Supraspinatus Biceps Brachii

Adduction Pectoralis Major Latissimus Dorsi Infraspinatus Teres Major Coracobrachialis Trapezius (Scapula) Rhomboideus Major & Minor (Scapula)

Anatomy - Muscles

Internal Rotation Pectoralis Major Latissimus Dorsi Deltoid Subscapularis Teres Major

External Rotation Supraspinatus Infraspinatus Teres Minor Deltoid

Anatomy - Muscles

Horizontal Abduction Deltoid Infraspinatus Teres Minor

Horizontal Adduction Deltoid Pectoralis Major

Anatomy - Muscles Elevators

Trapezius (Scapula) Levator Scapulae (Scapula)

Depressors Latissimus Dorsi (Humerus) Trapezius (Scapula) Pectoralis Minor (Scapula)

Scapular Motion

Elevation Levator scapulae Rhomboid major/minor Serratus Anterior Trapezius (Upper)

Depression Serratus Anterior Trapezius (Lower) Pectoralis Major

Scapular Motion

Protraction Serratus Anterior

Retraction Rhomboid Major/Minor Trapezius (Middle/Lower)

Upward Rotation Serratus Anterior Trapezius (Upper/Lower)

Downward Rotation Rhomboid Major/Minor Levator Scapulae

Brachial Plexus

Winging Scapula

Can occur because of weakness of the periscapula muscles (especially the serratus anterior and middle/lower trapezius) and occurs secondary to long thoracic nerve trauma

Scapula stabilization is necessary for normal arm movement

Forward/Rounded Shoulder Posture Caused by a slouched posture,

shortened anterior chest muscles, elongation of the posterior interscapula muscles (lower/middle trapezius and rhomboids), and abnormal cervical and thoracic spine curvatures

Consequences of FSP: degeneration of AC joint, bicipital or rotator cuff tendinitis or impingment, muscle weakness, myofascial pain and trigger points, posterior capsular tightness, excessive back flexion, and thoracic outlet syndrome

Shoulder Injuries

Sternoclavicular Sprain MOI: Indirect force transmitted through

the humerus by a blow that strikes the poorly padded clavicle by twisting of a posteriorly extended arm.

Shoulder Injuries

Acromioclavicular Sprain MOI:

Direct impact to the tip of the shoulder that forces the acromion process downward, backward, and inward while the clavicle is pushed down against the rib cage

Fall on an outstretched armStep-Off Deformity

Shoulder Injuries

Glenohumeral Joint Sprain MOI:

Anterior: Arm is forced into abduction, external rotation, or direct blow.

Posterior: A forceful movement of the humerus posteriorly when the arm is flexed.

Shoulder Injuries

Anterior Glenohumeral Dislocation MOI:

Direct impact to the posterior or posterolateral aspect of the shoulder.

Forced abduction, external rotation, and extension

Shoulder Injuries

Posterior Glenohumeral Dislocation MOI: Forced adduction and internal

rotation or a fall on an extended and internally rotated arm

Shoulder Injuries

Superior Labrum Anteroposterior (SLAP) Lesion MOI: Compression and inferior traction

Shoulder Injuries

Shoulder Impingement Syndrome MOI:

Mechanical compression of the supraspinatus tendon, the subacromial bursa, and the biceps brachii (long head) tendon causing a decrease in space in the coracoacromial arch

Postural alignments: Forward head, rounded shoulders, increased kyphotic curve

Shoulder Injuries Frozen Shoulder (Adhesive

Capsulitis) Contracted and thickened joint capsule

that is tight around the humeral head with little synovial fluid.

The individual progressively resists any movement to the shoulder making it stiff or “frozen” because of the pain

Shoulder Injuries Thoracic Outlet Compression

Syndrome Compression on the brachial plexus,

subclavian artery, and subclavian vein in the neck and shoulder.

MOI: Compression of the neurovascular

bundle between the first rib and clavicle Compression between the anterior and

middle scalene muscles Compression by pec minor as the

bundle passes beneath the corocoid process or between the clavicle and first rib

Presence of a cervical rib (an abnormal rib originating from a cervical vertebra and the thoracic rib)

Shoulder Injuries

Biceps Brachii Rupture MOI: Powerful concentric or eccentric

contraction

Shoulder Injuries

Bicipital Tenosynovitis MOI: Repeated stretching of the biceps

in highly ballistic activities (pitchers, tennis players, volleyball players, and javelin throwers) may cause an irritation of the tendon and the synovial sheath

Throwing Mechanics

Windup Cocking Acceleration Deceleration Follow-through

Shoulder Pad Fitting

Width of shoulders is measured to determine proper size of pads The inside shoulder pad should cover the tip of the shoulder in a

direct line with the lateral aspect of the shoulder Deltoid should be covered, and all motion required by athlete’s

positions hould be permitted Neck opening must allow athlete to raise their arms overhead but not

allow the pad to slide back and forth Straps underneath the arm must hold pads firmly in place but must

not constrict soft-tissueCantileverNon-

Cantilever

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