1

The Shoulder

• Read pages 450-451 and answer the following questions:

1.What three bones make up the shoulder girdle?

2.What three articulations make up the shoulder complex?

3.What bones make up each articulation?

2

• Bones of the Shoulder Girdle:• _____________• _____________• _____________

• The shoulder complex is made up of four different articulations.• __________________: (____) Formed by the head of the

humerus and the glenoid fossa of the scapula.• ___________________: (____) Formed by the distal end of the

clavicle and the acromion process of the scapula• ___________________: (____) Formed by the scapula and the

thoracic cage.• ____________________: (____________) Formed by the

proximal end of the clavicle and the manubrium of the sternum.

3

4

Glenoid FossaAcromion ProcessCoracoid ProcessSpine Scapula

5

Greater TubercleLesser TubercleBicipital GrooveHead of HumerusHumerus

• Flexion• Extension• Adduction• Abduction• Internal Rotation• External Rotation• Horizontal Flexion• Horizontal Extension

6

• Scapular Retraction• Scapular Protraction• Scapular Upward Rotation• Scapular Downward Rotation• Elevation• Depression

7

• Glenohumeral Joint• ____________ Ligament• _____________ Ligament

• AC Joint• _______________

Ligament• _______________

Ligament• __________ Ligament• __________ Ligament• ________________

Ligament

8

9

10

• What are the four muscles that make up the rotator cuff?

• 5 minutes

11

• Please read pages 452 – 455 and answer the following questions:1. What is the main function of the rotator cuff?2. What four muscles make up the rotator cuff?3. What movement do each produce? (Chart:

Pg. 454)4. Which superficial muscle act to elevate the

arm?5. What is a force couple?

12

Group of four muscles of the G-H joint . Subscapularis

IR and ADD Supraspinatus

ABD Infraspinatus

ER Teres Minor

ERFunctions

Stabilization of the head of the humerus in the glenoid fossa.

13

14

15

• _______________• Add, IR, Flex/Ext.

• _________________• Ext, Add, IR

• ________________• Abd, IR, Ext/ER, Flex/IR

• _________________• Add, IR

• ___________________• Flex, Add.

16

• ________________• Scapular Elevation

• ______________• Scapular Retraction• Downward Rotation

• _________________• Elevation• Retraction• Upward Rotation• Depression

• _________________• Depression

• _________________• Protraction• Upward Rotation

• ________________• Depression• Stabilization of the SC joint

17

18

19

20

• Injuries are common due to the wide range of motion in the _________________ joint.

• A lot of the injuries to the shoulder complex are sport specific

• Types of Injuries•Fractures•Subluxation / Dislocations•Sprains•Strains

21

• Ligament Injuries• A-C Injuries• G-H Injuries• S-C Injuries

• Muscular Injuries• Rotator Cuff Injuries• Biceps Tendon Injuries• Impingement Syndrome• Contusions

22

• Clavicle Fracture• Scapular Fractures

23

• What is the main function of the rotator cuff muscles?

• 5 minutes

24

25

26

Read pages 464 and 466 and answer the following questions:1. What are the two types of Rotator

Cuff Tears?2. Which one requires surgery and which

one can be treated non-operatively?3. What are some signs and symptoms

of a full thickness rotator cuff tear?

27

• Two Types•_______________ Thickness• Partial tear of the rotator cuff tendon.• ________________

•__________ Thickness• Complete tear of the rotator cuff

tendon.• Requires ______________

28

Commonly occur as overuse injuries in the throwing athlete.

Throwing can be broken down into five phases: 1. ________________2. ________________3. ________________4. ________________5. ________________

29

30

http://www.pbats.com

Pain within the shoulder especially during the ___________ phase of throwing or swinging.

Pain and difficulty with ___________ and external rotation (90/90) of the arm.

Pain and stiffness __________ hours post practice or competition that involved throwing or swinging.

Point tenderness around the _________ head deep within the deltoid muscle.

31

• _____________ _________________• A well designed ______________ ___________

strengthening program is essential.• Focus on training each individual rotator cuff

muscle.• ___________________• ___________________• _____________________• Combination of these movements

• ______________ training is a must.

32

• With a partner• Design a 5 step warm-up program for an overhead

athlete.• Include the parameters (how long, how often, etc)• You have access to:• UBE upper body ergometer• Therabands/Theratubes• Manual Therapy

33

• Application of ice to relieve pain and swelling.• Discontinue activity.• Refer to physician for further

evaluation.• Some rotator cuff injuries can be

treated non-operatively (Partial-Thickness Tear)• Some must be surgically repaired.

(Full-Thickness Tear)•Why??? (Think Stabilization)

34

• Read pages 458-461 and answer the following questions:•What is impingement syndrome?•What three structures are found in the subacromial space?•What are the signs and symptoms of impingement syndrome?

35

• ______________ Space• Acromion Process and

the Coracoacromial ligament. (Coracoacromial _______ or ___________)

• The Glenohumeral joint capsule. (________)

36

• When the arm is ______________ this space ______________ in size.

• Contents•Long head of the ___________ tendon and joint capsule.• ______________ bursa• ________________ tendon (most common)• Anything that causes a decrease in the

size of the subacromial space can cause an _______________ of one or more of these structures.

37

Rotator Cuff PatholgyCongenital defects of the

coracoacromial arch.Odd shaped acromion.

Biceps TendonitisSupraspinatus TendonitisBone Spurs on the inferior part of the

acromion.Subacromial Bursitis

38

39

• Athletes that place the arm _____________ during their sport can often suffer from impingement syndrome.• The signs and symptoms often mimic

those of a _______________ _______ tear.

40

G-H painPain when the G-H joint is actively

____________ and __________ ___________.

Point tenderness in the Subacromial Space.

Limited ____________Confirmation with special test.________________________

41

RestAnti-inflammatory drugsRehabilitationStrengthen RC and Surrounding Shoulder Muscles.

When all else fails surgery may be required to open up the subacromial space. (_______________)

42

• What structures are found in the subacromial space?• 5 minutes

43

• Read page 466 and 469 and answer the following questions:

•What is DOMS?•What does PRICE stand for?•What is Biceps Tendonitis?•Get with a partner and palpate the Biceps tendon in the bicipital groove.

44

• Long Head of the Biceps Tendon•Runs through the __________ groove of the humerus.•Originates from the supraglenoid tubercle.•Lies within the __________ capsule and subacromial space just beneath the acromion process. (Subacromial Space).•This puts the tendon at risk for impingement when the arm is __________. 45

46

Will develop ___________ over time.As it become inflamed, it no longer

fits in the ___________ groove and becomes prone to ______________.It is usually held in place by the ______________________.

This subluxation can also occur acutely with an extreme force commonly generated in throwing.

47

• Painful abduction of the shoulder.• Pain in the shoulder when the forearm is ____________against resistance.• Subluxation of the biceps tendon when the forearm is _______ and __________ against resistance.• Pain with shoulder ________ with the elbow _____________.

48

• Ice and compression if a subluxation occurs.• Rest• Anti-inflammatory drugs• Progressive rehabilitation.• Surgery may be required if chronic subluxation occurs.

49

• What are three signs and symptoms of impingement syndrome?

• What are three methods of treatment?• 5 minutes

50

Muscle Strains Can be overuse or traumatic . Often occur at the start of the sports season or with an

increase in activity.

Signs and Symptoms Pain and tenderness over the _________ ________.

(Palpation) Pain with muscle contraction. Pain may be delayed. (_______________)

Treatment _________________ Anti-inflammatory drugs Gentle Stretching

51

Read pages 468-470 and answer the following questions:1. What are the four most common traumatic

shoulder injuries?2. Which direction do most shoulder

dislocations occur?3. What is the mechanism for an anterior

shoulder dislocation? What type of activity/sport may cause this?

4. What is the re-injury rate of a shoulder dislocation for an 18 year old athlete.

52

•Glenohumeral Joint Dislocations•Acromioclavicular Sprain• Fractures• Tendon Ruptures

53

• The __________ head is forced out of the _________ cavity.• Can occur in the following directions:•_________________ (Front and Down)•____________ (Back)•____________ (Down)

• ___________ Dislocation is the most common (95%) 54

55

Mechanism of InjuryShoulder ________ with ___________

Rotation. Tackling with outstretched arm.

Signs and SymptomsPossible ___________ of the shoulder___________ arm on affected sidePalpable head of Humerus in _________.Partially ______________ arm with _______

elbow.Pain with any G-H movement.

56

57

• Apply Ice to shoulder and secure with Ace Wrap or Plastic Wrap. Place _________ roll under the axilla.• Apply standard ______ and __________.• Refer to physician for immediate reduction and X-Rays.• Treat for __________ if necessary.

58

• ____% of all G-H dislocations will recur in athletes younger than ____ years old.• Why????•This is due to the stretching of the ____________ ______ and __________ of the supporting musculature.

• May have to be surgically repaired.• Chronic dislocation/subluxation can

also cause an injury to the glenoid _______. 59

• Read page 470 -471 and answer the following questions:

1. What is the glenoid labrum and where is it located?

2. What is the function of the Glenoid Labrum?

3. What are the signs and symptoms of a Glenoid Labrum tear or injury?

4. How would you treat a glenoid labrum tear?

60

• A ring of ________ attached to the margin of the glenoid cavity.

61

• Functions to help ________ the head if the humerus within the glenoid cavity.• Mechanism of Injury•Traumatic __________ of the shoulder.•___________ Tear:• Repetitive stress due to an ___________. (GH joint being too loose).

62

• Signs and Symptoms• Pain deep within the shoulder.• __________ or ___________ when the shoulder is rotated.• Shoulder weakness.• Decrease ability to use the arm.

• Treatment• Refer to physician for diagnosis.• MRI, X-Ray

• Surgery may be required.• Shoulder strengthening program.• Rotator Cuff

63

• Read the section titled “Acromioclavicular Injuries” on pages 473-474 and answer the following questions.1. What two boney structures form the A-

C joint?2. What is the number one mechanism of

injury for an A-C sprain?3. How would you care for someone with

an A-C joint injury?64

Articulation between the distal end of the _________ and the __________.

Soft Tissue SupportAnterior Deltoid MusclesTrapezius MusclesAcromioclavicular Ligaments

Superior Inferior

Coracoclavicular ligament Trapezoid ligament Conoid ligament.

65

Three types of Injuries1. __________: A-C ligament is

partially injured. The articulation is stable. Pain is the primary symptom.**

2. ________: AC joint capsule and CC ligaments partially disrupted. Articulation is stable.

3. __________: AC joint capsule and CC ligaments completely disrupted. Superior displacement of the clavicle. (________ key sign) 1. AKA: Shoulder Separation

66

http://biomed.brown.edu/Courses/BI108/BI108_2004_Groups/Group01/mechSSD.htm

Mechanism of Injury_________ blow to the outer end of the

clavicle.Fall forward on an outstretched arm.______________

Signs and SymptomsSwellingPoint-TendernessDiscolorationPain with any movement

Horizontal Flexion+ Piano Key Sign (Grade __ only)

67

• Application of Ice Pack secured with Ace Wrap or Plastic Wrap.• Apply sling and swath bandage.• Refer to physician for X-ray.• Immediately for Grade III or if signs or shock are present.

• Possible Surgical Intervention may be required.

68

• Most occur at the mid-shaft of the bone.•This is the thin/flat portion.

69

Mechanism of Injury Direct Blow Fall on outstretched hand or tip of shoulder. FOOSH

Signs and Symptoms Swelling or deformity (Could be an _________ fracture) Discoloration Point tenderness Pain with ___________ flexion Athlete may hear or feel a “___________” Athlete will be holding the arm in a ______________

position.Treatment

Treat for shock Immobilize Use ice pack Apply a sterile dressing to any wounds. Arrange for transport to a medical facility.

70

• Commonly happens to ___________- athletes.

71