Download Chapter 21

BELLWORK
• LAST CHAPTER!!!!!!!!!! 
• In your opinion:
– Which sports see the most shoulder
injuries?
– Why?
Chapter 21
The Shoulder
Objectives
• Upon completion of this chapter, you should be
able to:
– Name the three articulations that constitute the
shoulder girdle complex
– Describe how stability of the shoulder is maintained
– Recite the names of the four muscles that come
together to form the rotator cuff
Objectives (cont’d.)
• Upon completion of this chapter, you should be
able to (cont’d.):
– Explain the anatomy of the shoulder complex
– Identify major injuries and conditions of the
shoulder
The Shoulder Girdle Complex
• Very complex joint
• 3 articulations:
– Glenohumeral (GH) joint; “ball-and-socket”
– Acromioclavicular (AC) joint
– Sternoclavicular (SC) joint
• All together  shoulder girdle
• Dynamic stability: mobility w/steadiness of a
joint
• Only joint with 360° of rotation
The Shoulder Girdle Complex (cont’d.)
The Shoulder Girdle Complex
(cont’d.)
• Head of humerus: upper
portion of humerus, attaches
to scapula
• Glenoid fossa: concave
projection of scapula
• GH joint: head of humerus
& scapula
• Acromion process:
projection of spine of
scapula; “tip of shoulder”
• AC joint: acromion &
clavicle
• SC joint: clavicle & sternum
• Scapulothoracic joint: area
that provides movement of
the scapula over back side of
ribcage (not a “true” joint)
• Synergistics: group of
muscles act together to
enhance movement of joint
or limb
Reason for decreased stability…
Scapula
Muscles
Muscles (con’t)
Major Muscles of Upper body
MUSCLE
FUNCTION
Trapezius
Draws head to one side; rotates scapula
Serratus anterior
Protraction of scapula
Pectoralis major
Deltoid
Flexion, horiz. adduction, int. rotation of
arm
Abducts arm
Latissimus dorsi
Extends, adducts, int. rotates arm
RC muscles
Mainly external rotation of arm
Rotator Cuff
• Set of 4 muscles of
the GH joint
• Originate on
scapula & insert on
head of humerus
• S.I.T.S.
–
–
–
–
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Rotator Cuff & Deltoid
• Work together to maintain stability of the
shoulder
• Force couple: 2 forces acting in opposite
directions to rotate a body part
– RC muscles pull down as deltoid lifts up (abducts)
deltoid
rotator cuff
Scapulothoracic Mechanics
• Scapula is base of support for shoulder complex
– Must reposition itself as humerus moves 
scapular rhythm
Movements
Overuse Injuries to the Shoulder
• Sports with excessive overhead motion (i.e.
swimming, tennis, pitching, volleyball, etc.)
• Impingement syndrome
– Occurs when space between humeral head and
acromion becomes narrowed  structures become
“impinged”, or pinched
– Mechanical irritation of cuff tendons
• Symptoms: pain, tenderness, weakness, limited rotation,
and test confirmation
• Treatment: prevention, preseason conditioning, crosstraining, exercise, taping, and rehabilitation
BELLWORK
• Name as many movements of the
shoulder/scapula as you can remember.
• Name the 4 rotator cuff muscles.
Overuse Injuries to the Shoulder
(cont’d.)
• Rotator cuff tears
– Partial or full thickness
• Symptoms: pain, unable to move full range of motion,
unable to lift the arm overhead, “catching” sensation, and
varying degrees of disability
• Treatment: rehab, surgery
Overuse Injuries to the Shoulder
(cont’d.)
• Muscle strains
– Caused by overuse or traumatic injuries
• Symptoms: pain and tenderness
• Treatment: PRICE, gentle stretching, strengthening
program, and cross-training
Overuse Injuries to the Shoulder
(cont’d.)
• Biceps tendonitis:
inflammation of biceps
tendon (connects biceps to
shoulder girdle)
• Biceps tendon ruptures
– Not common in athletics
• Symptoms: sudden pain in the
front of the shoulder
associated with a “pop”,
drooping of muscle
(“Popeye”)
• Treatment: PRICE; surgery
not normally needed
Traumatic Shoulder Injuries
• Anterior shoulder
dislocation
– Head of the humerus is
dislocated completely off
of the glenoid fossa
• Arm is abducted to the
side, with the elbow bent,
and force applied to the
arm causes external
rotation
– Immediate referral
Traumatic Shoulder Injuries (cont’d.)
• Glenoid labrum injuries
– Glenoid labrum: ring of
cartilage attached to
glenoid fossa; keeps
humeral head in position
– Occurs with trauma
• Symptoms: pain, catching
or popping sensation, and
weakness
• Treatment: strengthening
program, physician
diagnosis, and sometimes
surgery
Traumatic Shoulder Injuries (cont’d.)
• Acromioclavicular (AC)
separations
– Traumatic sprains of
acromioclavicular joint
• Symptoms: pain and
deformity
• Treatment: physician
referral, PRICE, and
exercise
Traumatic Shoulder Injuries (cont’d.)
• Brachial plexus Injury
– “stinger” (burner): stretching or compressing of
brachial plexus (group of nerves leaving spinal cord
and extending from vertebrae to shoulder)
– Head or neck is forced to one side
• Symptoms: pain, burning, and weakness
• Treatment: rest, ice, anti-inflammatory medication, and
exercises
Traumatic Shoulder Injuries (cont’d.)
• Fractures of the shoulder
– Usually caused by an impact or blow to shoulder
• Symptoms: deformity, ecchymosis, and bruising
• Treatment: support and transport to emergency room
Animation – Shoulder Injuries
Is It a Shoulder Injury?
• Pain in the shoulder region does not always
indicate a shoulder problem
• Referred pain: pain felt in one body part, but
originates somewhere else
– Referred pain to the shoulder can be due to:
• Cardiac problems
• Pinched or stretched nerves
• Spleen injury
Special Tests
• Neer’s impingement
(BT or supraspinatus)
• Cross-arm adduction
(AC sprain)
• Hawkins-Kennedy
(supraspinatus)
• Drop arm test (RC tear)
• Speed’s test (BT
tendonitis)
• AC compression (AC
sprain)
• Clunk Test (labral tear)
• Apley’s scratch test
(ROM)
8 Shoulder Stretches
1. Abduction/ext. rotation
5. Horizontal adduction
2. Abduction/int. rotation
6. Horizontal abduction
3. Flexion/ext. rotation
7. Flexion
4. Flexion/int. rotation
8. Extension
Conclusion
• The upper extremity is one of the most
challenging areas of the body to treat
– Understanding the mechanisms of injury will ensure
appropriate rehabilitation
– The ATC must understand causes of common upper
extremity conditions, so they can assess and manage
the many different injuries