Download Shoulder

UNDERSTANDING ATHLETICRELATED INJURIES TO THE
UPPER EXTREMITY
Shoulder Injuries
David Smith
ANATOMY OF THE SHOULDER
 Ball

and Socket Joint
Great degree of mobility, therefore it is highly
susceptible to injury
 Many
sports activities, in particular those
that involve repetitive overhead
movements place a great deal of stress on
the supporting structures

Throwers, swimmers, football, serving in
tennis or volleyball
MAJOR BONES OF SHOULDER JOINT
Humerus
Scapula
Clavicle
Sternum
HUMERUS
Head of the humerus
articulates with the
scapula’s shallow
glenoid fossa
Bicipital groove for
biceps tendon. It fits
between the greater and
lesser tuberosity
SCAPULA

Glenoid Cavity
 Situated laterally
on the scapula
inferior to the
acromion and is
relatively shallow
 The glenoid labrum
increases the depth
of the articulation
SCAPULA

Three prominent projections
 Spine
 Divides the posterior scapula unequally
 Supraspinatus fossa and Infraspinatus fossa


Acromion
 Sits at the lateral tip of the spine of the
scapula. Tip of the shoulder
Coracoid Process
 “Hooklike Projection” arises anteriorly from
the scapula. Curves upward, forward, and
outward in front of the glenoid fossa
CLAVICLE
S- shaped bone
Supports the
anterior portion
of the shoulder
Articulates at tip
of shoulder with
the acromion and
at the sternum
near throat

CLAVICLE
Medial 2/3 bends convexly forward, and the
lateral 1/3 is concave
 The point at which the clavicle changes shape
and contour presents a structural weakness
 Fractures occur at this point (The Middle
1/3)

ANATOMY OF THE SHOULDER CONT…

Scapula
Serves mainly as an articulating surface for the head of the
humerus
 Glenoid Cavity
 Situated laterally on the scapula inferior to the acromion
and is relatively shallow
 The glenoid labrum increases the depth of the
articulation
 Serves as the site for many muscle attachements

A. Bony Components
1. Clavicle: Collarbone
2. Scapula: Shoulder
blade
3. Humerus: Upper
arm
ANATOMY OF THE SHOULDER CONT…

Articulations
Sternum and Clavicle
 Acromion and Clavicle
 Glenoid cavity and Humerus
 Scapula and Thoracic cage

ANATOMY OF THE SHOULDER CONT…

Joints

Acromioclavicular
Joint (AC)
Acromion Process of
Scapula and distal
end of Clavicle
 Weak junction

ANATOMY OF THE SHOULDER CONT…

Glenohumeral
Joint (GH Joint)
Head of humerus
and glenoid fossa
 Ball and socket,
very mobile
 Very shallow,
very
susceptible to
injury
 Deepend by
the glenoid
labrum

ANATOMY OF THE SHOULDER CONT…

Sternoclavicular
Joint (SC Joint)
Clavicle articulates
with the
manubrium of the
sterum
 Allows the clavicle
to move up and
down, forward and
backward, in
combination, and in
rotation

ANATOMY OF THE SHOULDER CONT…

Scapulothoracic Joint
Not a true jointmovement of the
scapula on the wall of
thoracic cage is critical
to shoulder joint motion
 Scapular muscles
attach the scapula to
the axial skeleton is
critical to stabilizing
the scaupla

F. Major Joints of
the Shoulder Region
Sternoclavicular
joint (SC): Sternum
articulates with the
clavicle
 Acromioclavicular
joint (AC): Scapulas
acromion process
and clavicle
articulate. Very
weak joint

3. Coracoclavicular
Joint
(CC): Clavicle and the
scapulas coracoid process
articulate
4. Glenohumeral joint: ball
and socket joint, humerus
articulates with the
scapulas glenoid cavity.
Glenoid labrum deepens
the joint so the humerus
can move. The joint is
surrounded by synovial
capsule
Other Anatomy
ANATOMY OF THE SHOULDER CONT…

Muscles Acting on the Glenohumeral Joint


Originating on the scapula and attaching to the
humerus
Rotator Cuff (Decelerator Muscles)
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

All responsible for internally and externally rotating
the arm, as well as abduction
B. Muscles:
see handout for location of rotator cuff
muscles
Four muscles of the rotator cuff: SITS




Supraspinatus: abduction of the arm
Infraspinatus: external rotation of the arm
Teres Minor: external rotation of the arm
Subscapularis: internal rotation of the arm
ANATOMY OF THE SHOULDER CONT…

Deltoid

Abducts, flexes, and extends the shoulder
Pectoralis Major and Minor
 Biceps and Triceps

MAJOR MOVEMENTS OF THE SHOULDER
Flexion
 Extension
 IR
 ER
 Abduction
 Adduction

PREVENTING SHOULDER INJURIES

Most often caused by:
Weakness
 Postural problems
 Nature of game
(overhead movements)

MUSCULAR WEAKNESS AND POSTURAL
PROBLEMS CAN CAUSE INJURIES
 Out


of sight, out of mind
Weakness on posterior side
Rotator Cuff (Decelerators)!!
 Rounded

Tight pectorals and weak posterior muscles
 Constant



shoulders
use of one muscle
Swim, baseball, volleyball…etc
Balancing out the use
Proper techniques
LIGAMENT INJURIES

Sternoclavicular Ligament Sprain (SC)
Separation of SC Joint
 Injured by falling on lateral side of shoulder
 Hit in sternum with violent force


Acromioclavicular Ligament Sprain (AC)
Shoulder separation, 1-3° sprain
 Injured by impact to the top of shoulder or by
falling on an outstretched arm


Glenohumeral Ligament Sprain (GH)
Vulnerable when in abduction and external
rotation
 Dislocation and subluxation


Sprains to Joint-can occur in 3 major joints

Sternoclavicular Sprain: Uncommon injury, occurs
when the Medial end of clavicle is displaced. A 3rd
degree is life threatening due to pressure placed on
blood vessels, esophagus, or trachea
GRADES OF AN SC SPRAIN
2.
Acromioclavicular Sprain (separated shoulder): AC
joint is extremely vulnerable to sprains. Caused by a
direct blow to tip of the shoulder or landing on an
outstretched arm or elbow, may also occur with a blow
from behind the shoulder

1st degree: Minor
stretching and
tearing, AC has
point tenderness

2nd degree: Partial
tearing, cannot fully
abduct arm

3rd degree: complete
rupture of ligament,
dislocation.
ACROMIOCLAVICULAR SEPERATION
AC JOINT SEPARATION
CLINICAL APPEARANCE
SEPARATION
OF
AC
MUSCLE AND TENDON INJURIES
 Most
caused by overuse
 Throwing,
shooting, or repeating a
swim stroke
MUSCLE AND TENDON INJURIES
Rotator
 1°-
Cuff Strain
pain with no loss of ROM or
stability
 2°- pain with some loss of ROM
and stability
 3°- pain with partial or complete
loss of ROM and stability
MUSCLE AND TENDON INJURIES CONT…
Rotator
Cuff Strain
 Occur
because of excessive motion
beyond the normal range

Most often, Supraspinatus
 Repetitive
motions -> result in
crepitus and impingement
syndrome
 Rehab- RICE and gentle
strengthening and flexibility
exercises
MUSCLE AND TENDON INJURIES CONT…
 Impingement

Syndrome
Repetitive overhead types of
movement
freestyle swimmers, throwers, and tennis
players
 Supraspinatus and biceps run through
space beneath acromion process


Rehab- strengthening posterior
muscles, modifying activity, and
improving flexibility of pectorals
IMPINGEMENT SYNDROME
Rotator Cuff Impingement Syndrome: Impression of
supraspinatus tendon between head of the humerus
and the acromion process.
Symptoms: Aching and pain when abducting the arm above
90 degrees.
MUSCLE AND TENDON INJURIES CONT…
Bicipital
Tendonitis
 Very
common
 Repetitive nature causes
irritation of tendon in bicipital
groove
 Rehab-
stop repetitive action,
immobilization, heat, antiinflammatory medications
7.
Bicipital Tendonitis: Irritation of the long head of the
biceps tendon in the bicipital groove
MUSCLE AND TENDON INJURIES CONT…
Biceps
tendon rupture
 Direct
forces
blow or severe contractile
Unable to flex elbow
Looks like a golf ball under skin

 Rehab-
ice and immobilization,
refer to physician for surgical
repair
BONE INJURIES
Clavicle
 At
Fracture
weakest pt- middle 1/3
 Immobilization and Ice, physician
will set clavicle in place using a
harness
 May need surgery if displaced
Clavicle Fracture: Nearly 80% of all clavicle
fractures occur in the middle 1/3 of clavicle.
Caused by direct blow or fall on outstretched arm.
Athlete will hold arm and tilt head toward clavicle
and chin is turned the opposite side.
CLAVICLE FRACTURE
CLAVICLE FRACTURE
CLAVICLE SURGERY REPAIR
Humeral
Fractures-
 May
be hard to detect because
of musculature
unable to move arm and
experiencing pain, most likely
felt or heard a pop

 Splint,
and check distal pulse
BONE INJURIES CONT…
 Epiphysis
Injury
Growth plate in young athlete
 Direct or indirect blow
 Mimic humeral fx- pain, inability to
use arm, guarding, feeling/hearing pop
 Can cause permanent growth
impairment
 Rehab- ice, splint, and refer to
physician

BONE INJURIES CONT…
Avulsion
 Tearing
Fracture
bone off with ligament
 May accompany a AC or GH
sprain
 P! associated with fx
 Almost IMPOSSIBLE to detect
unless r/o by x-ray
 Splint and ice, refer to MD
BONE INJURIES CONT…
 GH

Dislocation: Head of humerus is out
of the socket


Dislocations and Subluxations
Complete disruption of joint
Subluxation: Head of humerus went
out of socket and then back in

Partial disruption of joint
DISLOCATIONS AND SUBLUXATIONS

Excessive abduction and external
rotation

Anterior is most common

Pain and inability to use shoulder,
deformity at deltoid muscle
 GH
Dislocations and Subluxations

X-ray is necessary to determine extent of
injury

Permanent changes to the nerves,
cartilage, and blood vessels
Rehab:
 strengthen muscles of adduction and
internal rotation, restrict abduction and
external rotation,
 Harness and Surgery is likely

4.
Dislocation to the Glenohumeral Joint: Anterior
displacement of the humerus is caused by forced
abduction and external rotation. Dislocation can tear
the capsule, ligaments and labrum. Displays a
flattened deltoid and severe pain and disability. Injury
is beyond the scope of an athletic trainer’s duties,
athlete needs a referral for x-rays and reduction.
SHOULDER DISLOCATION
QUESTIONS

What are the bones of the shoulder joint? (4
Bones)

What are the 4 joints of the shoulder girdle? (4)

What are the 4 muscles of the rotator cuff?

What is the rotator cuff known as? (Think
function)

What are the differences in rotator cuff strains?

What is the difference b/n dislocation and
END OF SHOULDER ANATOMY
HANDS ON….

Point to each bones in the shoulder girdle

Locate each joint in the shoulder girdle

Demonstrate special tests?