Ball-and-socket joint Relies on muscular strength for stability Several bones link up at the shoulder Entire bony linkage of the shoulder

referred to as the shoulder girdle

3 basic bony components Humerus Clavicle (aka collarbone) Scapula (aka shoulder blade)

Rotator Cuff Consists of 4 muscles (SITS)

Subscapularis Infraspinatus Teres Minor Supraspinatus

Responsible for rotating the arm internally and externally as well as abduction

Deltoid-lies over the head of the humerus. Abducts, flexes, and extends shoulder

Anterior portion of shoulder-pectoralis major and pectoralis minor

Biceps-flexes the elbow Triceps-extends the forearm and

shoulder.

Shoulder girdle composed of several joints

Most commonly injured joints of the shoulder are: acromioclavicular joint (Acromion process

of scapula and the distal end of clavicle glenohumeral joint (articulation of the head

of the humerus and the glenoid fossa)**articulation-point of contact**glenoid fossa-saucerlike portion of scapula

Muscle weaknesses Postural problems Nature of the game

“Out of sight, out of mind”-weight training Athletes often lift weights only for the muscles

they can see in the mirror which leads to weaknesses in opposing muscles

Athletes with rounded shoulders, tight pecs, or weak posterior shoulder muscles may be predisposed to injuries. Supraspinatus muscle, nerve, and blood vessel run through a

very narrow space and narrowing that space can cause those tissues to become pinched

Using arm continually in one direction Ex. Freestyle swimming or throwing Need to strengthen the muscles opposing

the motion in order to prevent injuries. Otherwise, it creates a muscle imbalance. Ex. A swimmer who swims 300 strokes

freestyle must swim 300 strokes backstroke to balance the strength of the muscles.

Referred to as a shoulder separation Can be injured by impact to the top of

the shoulder or by falling on an outstreched arm

Athlete will indicate pain with movement

More serious sprains cause the clavicle to move superiorly

3rd degree separation-large abnormal bump caused by excessive upward desplacement of clavicle. Unable to move arm and will hold it tight

against body Treatment

1st degree-PRICE 2nd & 3rd –PRICE initially and then referred

to an orthopedist.

2 courses of action to treat 3rd degree tear: Surgery-joint wired or screwed together Harness-straps the clavicle downward in an

attempt to hold the joint together long enough to allow the ligament to heal.

Especially vulnerable when in abduction and external rotation.

If a 3rd degree sprain, subluxation or dislocation is likely

Will have pain with motion Treated by PRICE and referred to a

physician

Most muscle and tendon injuries are caused by overuse

Athletes who throw, shoot, or repeat a swim stroke prone to overuse injuries

Require rest, ice application, immobilization, and physician referrals

Occur from excessive motion beyond the normal range

Supraspinatus is most often injured Pain with motion and sometimes when

shoulder is not moving. Pain generally occurs with abduction If unable to abduct, complete tear or 3rd

degree strain is suspected

Develops from repetitive overhead types of movement Supraspinatus and biceps muscles run together

through a space beneath acromion process If space narrows due to swelling, tendinitis, weak

posterior muscle strength, or poor posture, the muscles become impinged in the space

Creates pain and discomfort with overhead movements.

Treatment-modified activity, strengthening posterior muscles, improving flexibility of tight pectoralis muscles.

Common in athletes who are constantly raising their arms above their heads

Repetitive nature of the movement causes irritation of the tendon in bicipital groove

Immobilization in a sling will make athlete more comfortable

Physician may prescribe ultrasound therapy and anti-inflammatory medication.

Can rupture from a direct blow or severe contractional forces

Unable to flex elbow Noticeable change in appearance of

muscle (look like a golf ball under the skin)

Arm must be iced and immobilized Referred to physician Tendon must be surgically repaired

Most often fractured at its weakest point (distal 3rd) Caused by a direct blow or fall on the tip of

shoulder Experience pain and will hold arm close to body to

prevent movement Ice used to decrease swelling and pain Sling restricts arm movement Physician can set the clavicle in place using a

harness Fracture takes 6 weeks to heal

Midshaft fractures easy to locate Humeral head fractures sometimes hard to

find if hidden behind shoulder musculature Shoulder sprain can mimic a fracture so its

important to ensure proper assessment. Unable to move arm and will experience

pain May report feeling or hearing a pop Will hold arm against body

Easiest way to determine a fracture: palpate circumference of bone

Painful on all sides, most likely a fracture Physician referral Severity determines treatment-could just

be a sling or surgery with long arm cast Takes at least 6 weeks to heal

Growth plate susceptible to direct and indirect blows

Same signs and symptoms as humeral fractures

Can cause permanent growth impairment Ice, splinting, and a sling-what an ATC

should do Physician will determine severity of injury

and treatment.

Some injuries require surgery to hold the head of humerus to the shaft of humerus

Teenage pitchers prone to epiphyseal injury from excessive throwing. Limited in number of games allowed to

play as well as number of pitches thrown

May accompany a glenoumeral or acromioclavicular sprain

Ligament or tendon pulls away a small portion of bone

When humerus is dislocating from glenoid fossa, capsular ligament can pull on scapula

Athlete will experience pain associated with the dislocation and avulsion fracture

Impossible to know if avulsion fracture exists: ATC must assume until X-ray reveals otherwise

Glenohumeral dislocation means that head of humerus is out of its socket

Subluxation means that head of humerus came out of socket and then went back in

Cause for both is the same: excessive abduction and external rotation.

Results are completely different Both require attention by ATC and team

physician

Dislocation sometimes causes the humerus head to tear the capsular ligament anteriorly

Instability of capsular ligament allows the humerus head to shift forward (most common type of shoulder dislocation)

Experience pain and inability to use shoulder ATC will see a deformity at deltoid muscle Shoulder will be flat, not round Physician needs to reduce a dislocation

For a subluxation, athlete may feel his shoulder “pop out and then pop back in”

X-ray necessary to determine extent of the dislocation or subluxation

Athlete needs to strengthen the muscles of adduction and internal rotation

If athlete experiences recurrent subluxations or dislocations will require surgery to repair capsular ligaments.