The Shoulder

Anatomy of the Shoulder

Bones of the Shoulder Clavicle Scapula Sternum Humerus

Joints of the Shoulder

Acromio-clavicular Sterno-clavicular Gleno-humeral Coroco-clavicular

Motions of the Shoulder

Flexion Extension Adduction Abduction Internal Rotation External Rotation

Ligaments of the Shoulder

Sterno-clavicular-ties sternum and clavicle Acromio-clavicular-ties acromium and clavicle Coroco-clavicular-ties corocoid process and

clavicle Transverse-holds long head of biceps in the

bicepital groove Gleno-humeral-ties glenoid and humerus

Superior Middle Inferior

Ligaments of the Shoulder

Muscles of the Shoulder

Sterno-cleomastoid Billaterally flexes the

neck Unilaterallty rotates the

head Pectoralis Major

Shoulder Flexion Trapezius

Elevates/Depresses shoulder

Extends Head Adducts Scapula Protracts Shoulder Holds scapula to body

Muscles of the Shoulder

Rhomboids Elevates and

protracts scapula

Serratus Anterior Lack of development

causes winged scapula

Muscles of the Shoulder

Deltoid Ties scapula and

clavicle to deltoid tuberosity

Anterior, Middle, and Posterior

Abduction Latissimus Dorsi

Forms posterior wall of the Axilla

Seldom injured Internal rotation,

extension, adduction, depression

Internal Muscles of the Shoulder

All are part of Rotator Cuff Remember by acronym SITS Commonly injured in throwing motions

Subscapularis Supraspinatus Infraspinatus Teres minor

Muscles of Rotator Cuff

Subscapularis Most anterior muscle Becomes stretched in a dislocation Internal Rotation

Muscles of the Rotator Cuff

Supraspinatus Abduction

Infraspinatus External Rotation

Teres Minor External Rotation

Shoulder Injuries

Shoulder Subluxation Fractured Clavicle Shoulder Dislocation AC Joint Injuries Rotator Cuff

Impingement

Humeral Fracture Biceps Tendonitis Bursitis Myositis Ossificans Frozen Shoulder Glenoid Labrum

Injuries

Shoulder Subluxation

Shoulder slips out then reduces on it’s own.

Mechanism of injury is falling on an outstretched arm

Fractured Clavicle

Most frequently fractured bone Lateral 1/3 is the weakest portion Ice and Immobilize

Shoulder Dislocation

Mechanism of Injury is falling on outstretched arm

Types of Dislocation Anterior Inferior Posterior

AC joint Sprains

1st degree Some stretching of ligament No obvious deformity Pt tenderness over AC joint 7-10 days

2nd degree Some or complete tearing of AC ligament Joint Laxity MD Referral

3rd degree Complete loss of AC and CC ligaments Arm Hangs in place Usually surgical repair is needed

Rotator Cuff Impingement

Cuff is swollen or irritated Pain in raising the arm

Labrum Tears

The glenoid labrum deepens the glenoid cavity

It is a cartilage ring Causing clicking in

the shoulder Usually repaired or

resected

Fractured Humerus

Caused by direct blow or falling on arm Needs surgical repair

Little League Shoulder

Caused by too many curve balls Fx of epiphyseal plate Rest for 2 weeks

Biceps Tendonitis

Long head of biceps rubs transverse ligament

Severe cases becomes so inflamned it decays Rest Modalities Can lead to surgical intervention if not

cared for

Bursitis (Frozen Shoulder)

Sub Acromial Bursa inflamed Could lead to Frozen Shoulder where

bursa hardens and restricts motion

Myositis Ossificans

Same as Quadriceps Repeated blows to the same area Frequently occurs in the belly of biceps