Download The Shoulder Complex - Doral Academy Preparatory

The Shoulder Complex
Anatomy
Joint type

Ball and socket joint
◦ Same as hip, but much shallower
◦ Relies on musculature for stability
Bones
Clavicle
Sternum
Scapula
Humerus
Clavicle
shaped bone
 Spans between sternum to tip
of shoulder
 Supports anterior shoulder
 Lying superficial w/ no muscle
or fat protection subjects
clavicle to direct blow

“S”
Sternum
 AKA “breastbone”
 Divided
into 3 parts:
◦ Manubrium
◦ Body
◦ Xiphoid process
 Only
source of axial attachment
for shoulder complex
Scapula
 Flat
and triang-
ular
 3 projections:
◦ Spine (supraspinous/infraspinous)
◦ Acromion (lateral tip)
◦ Coracoid process (hook-like
projection)
 Glenoid
Fossa
◦ Receives the head of the humerus
3 views of scapula
Humerus
Bicipital
groove
◦Bicep tendon moves up and
down in grove during flex/ext
of elbow
◦Proximal end of Humerus
Humerus
Articulations
4 Articulations
◦Sternoclavicalar (SC joint)
◦Acromioclavicular (AC joint)
◦Glenohumeral (GH joint)
◦Scapulothoracic – not a true
joint
 SC
Joint
 Medial
 AC
shock absorber
Joint
 Thin
fibrous capsule surrounds
joint. Weak and easily injured
 GH
Joint
◦ Enarthrodial (ball and socket joint)
◦ Deepened by labrum in Glenoid Fossa
 Scapulothoracic
Joint
◦ Not a true joint due to lack of bony
articulation
◦ Important for stabilization of shoulder
joint
◦ Motions – elevation, depression,
protraction, retraction, abductions,
adduction
Ligaments – able to identify
Coracoacromial lig
 Coracohumeral lig
 Superior GH lig
 Middle GH lig
 Inferior GH lig
 Transverse humeral lig

Muscles

Rotator Cuff
◦ Consist of four muscles:




Subscapularis
Infraspinatous
Teres Minor
Supraspinatous
 Assoc tendons insert on humerous
◦ Responsible for InRot, ExRot, AB-duction

Triceps
◦ 3 heads
◦ Lays over humerus, but acts on Elbow;
secondary shoulder extention
Muscles Cont’d

Deltoid
◦ Found over head of humerus
◦ 4 heads
◦ ROM: AB-ducts, Flex, Extend Shoulder

Pecs
◦ Major and Minor

Biceps
◦ Lays over Humerus, but act on Elbow w/
secondary shoulder flexion
◦ 2 heads
ROM
Flexion
*circumduction
 Extension (/)
 Abduction (abd)
 Adduction (add)
 Horizontal adduction (H add)
 Horizontal abduction (H abd)
 Internal rotation (In rot)
 External rotations (Ex rot)

Injuries
Shallow structure of the shoulder joint
makes it very susceptible to injury
 Ways to prevent injury:

◦ Address muscular weakness
 Important to strengthen muscles OPPOSING
common motion
◦ Use padding
 Contact sports with shoulder contact
◦ Modify Activity
 Overuse injury
 Ath 9-14 no curve balls; 75 pitch/game; 600/season
Bone Injuries

s/s:
◦ Pain, Inability to move arm, desire to hold or
“coddle” arm, hearing/feeling “pop”, obvious
deformity

Clavicular Fx:
◦ Distal 1/3 where “S” changes direction, most
common site for fx
◦ MOI: Direct Blow or falling on tip of shoulder
◦ Tx: fig-8 harness; ORIF if necessary; 6 to 8
wks to heal, minimal PT after release

Humeral Fx:
◦ Musculature can hide fx to humeral head
◦ Sprains can often mimic fx
◦ MOI: Direct blow (most common), falling on
elbow (axial load), overuse (least common)
◦ Tx: cast, ORIF (if necessary), modify activity
(stress fx)

Epiphyseal Injuries
◦ Injury to growth plate
◦ MOI: Direct blow, falling on elbow,
overuse (most common)
◦ Can cause permanent growth impairment

Avulsion Fx:
◦ Lig/tendon pulls away from bone
◦ Most commonly occurs during shoulder
dislocation

Dislocation/Subluxation
◦ MOI: excessive abduction and external
rotation
◦ Shoulder appears flat
◦ May be assoc fx or labral tear, must f/u with
Ortho
 Multiple disloc occur, surgery may be necessary
Muscle & Tendon Injuries

Rotator Cuff Strain
◦ MOI: most commonly – overuse; excessive
motion
◦ Graded 1, 2, 3
 Supraspinatus most commonly injuries
◦ C/O p w/ and w/o movement, p w/ sleeping
◦ Tx: RICE, ROM activites, PRE

Impingement Syndrome:
 MOI: untreated Rotator Cuff injury
 Supraspinatus and Biceps tendon run through space
beneath acromion process. When space narrows
from swelling, tendinitis, poor posture, it impinges
the muscle and tendon.
 P w/ overhead movement
 Tx: modify activity, PRE for posterior muscles, ROM
(to improve flexibility of tight pecs)

Biceps Tendinitis
◦ Inflamed tendon in Bicipital groove
◦ Tx: same as other tendinitis injuries.
Immobilizing in sling may provide further
comfort

Biceps Tendon Ruptre
◦ MOI: Direct blow, sever contraction forces.
◦ Ath unable to flex elbow, muscles balls up by
elbow
◦ Tx: immediate immob, surgery
Ligament and Joint Injuries
AC Joint and GH Joint most commonly
injured.
 Acromioclavicular Joint Sprain

◦ “Separated shoulder”
◦ MOI: impact to top of shoulder; FOOSH;
falling on bent elbow shoving head of
Humerus up and into AC joint
◦ C/O P w/ ROM, “Step Deformity”
Step Deformity

Glenohumeral Joint Strain
◦ MOI: Direct blow when arm is AB-ducted and
externally rotated (most often from disloc or
sublux)
 Can tear labrum as well
THE
END