Download Chapter 22: The Shoulder Complex

Chapter 22: The Shoulder Complex
Overview
The shoulder complex, as the name implies, is an extremely complicated region of
the body. Sports using the shoulder in repetitive activities, such as throwing, blocking,
tacking, or rolling over, as in tumbling, may produce a serious injury. Injuries to the shoulder
joint usually result from its structural vulnerability coupled with its extensive freedom of
movement, and the relatively poor correlation between the articular surfaces and the great
strength of some of the surrounding musculature. Subjected to both acute and chronic
problems, the shoulder complex is one of the most difficult regions of the body to evaluate.
The athletic trainer should become familiar with the various conditions of the
shoulder complex and the specific exercises used to strengthen the various structures.
Shoulder rehabilitation is highly complicated and depends on the nature of the injury and
whether surgery has been performed. The athletic trainer and the physician should work
together to develop an appropriate program that will lead to the athlete's swift and total
recovery.
Learning Objectives
After completing this chapter, the student will be able to:
 Point out the critical anatomical features of the four articulations in the shoulder
complex.
 Perform an in-depth evaluation of the shoulder complex.
 Recognize those steps that can be taken to minimize the chances of injury to the
shoulder complex.
 Explain how shoulder stability is maintained by the joint capsule, ligaments, and
muscles.
 Summarize the anatomical and functional relationship between shoulder stability and
shoulder impingement.
 Identify the etiology and recognize the signs and symptoms of specific injuries that
occur around the shoulder joint, and discuss plans for management.
 Formulate a general plan that may be effectively incorporated into a rehabilitation
program for treating a variety of injuries in the shoulder complex.
Visit connect.mcgraw-hill.com for further exercises:
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Clinical application scenarios covering assessment and recognition of shoulder injuries, etiology,
symptoms and signs, and management of shoulder injuries, and rehabilitation for the shoulder
Click and drag questions covering structural anatomy of the shoulder, assessment of shoulder injuries,
and rehabilitation plan of the shoulder
Multiple choice questions covering anatomy, assessment, etiology, management and rehabilitation of
shoulder injuries
Selection questions covering rehabilitation plan for various injuries to the shoulder
Video identification of special tests for the shoulder injuries, rehabilitation techniques for the shoulder,
taping and wrapping for shoulder injuries
Picture identification of major anatomical components of the shoulder, rehabilitation techniques of the
shoulder, and therapeutic modalities for management
Key Terminology
ERG - External Rotation Gain
GIRD - Glenohumeral internal rotation deficit
Other terms
Superior labrum anterior posterior (SLAP) lesion - anteroposterior tear in the superior
glenoid labrum
Bankart lesion - a permanent anterior defect on the labrum following the detached
labrum and capsule after dislocation
Hill-Sachs Lesion - Another defect that can occur after dislocation is a humeral head
divot found on the posterior lateral aspect of the humeral head after dislocation,
caused by the compression of the cancellous bone of the head of the humerus against
the anterior glenoid rim.
Anterior scalene syndrome - Subclavian artery is depressed between the two scalene
muscles, reducing the blood flow to the upper extremity.
Bicipital groove - Groove on the humerus formed in the depression between the greater and
lesser tuberosities where the long head of the biceps brachii passes through.
Supraspinatus muscle test - Test designed to determine the extent of strength of the
supraspinatus muscle.
Costoclavicular syndrome - Subclavian artery is compressed between the costoclavicular
ligament and ribs.
Drop-arm test - Tests the strength of the rotator cuff, especially the supraspinatus muscle.
Force couple - Depressor action of the infraspinatus and teres major on the head of the
humerus that keeps it from jamming under the acromion process when the deltoid
contracts.
Frozen shoulder - Chronic irritation of the shoulder joint causing extreme limitation of
movement in the area.
Greenstick fracture - Incomplete fracture seen in children and adolescents.
Hyperabduction syndrome - The subclavian and axillary vessels and the brachial plexus are
compressed as they move behind the pectoral muscle and beneath the coracoid.
Little League shoulder - Osteochondritis of the proximal humeral epiphysis.
Rotator cuff - Internal muscles of the shoulder that are main rotators; includes the
supraspinatus, infraspinatus, teres minor, and subscapularis.
Rotator cuff impingement syndrome - Muscles of the cuff, especially supraspinatus, are
impinged between the anterior acromion and the coracoacromial ligaments.
Shoulder pointer - Contusion to the distal end of the clavicle.