Download Chapter 11

The Shoulder
PE 236
Juan Cuevas, ATC
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Anatomy Review
Shoulder bones:
– Consist of shoulder
girdle (clavicle &
____________) and
humerus.
Shoulder joints:
– __________________
– ___________clavicular
– Sterno_____________
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Anatomy
(continued)
• Joints are held together with ___________ and
joint capsules that provide stability and allow for
limited movement.
– Shoulder girdle and the ____ joint can move in
almost every direction.
• ___ & SC joints are just under the skin and are
vulnerable to injury, even in muscular athletes
• Major nerves are from a group called the brachial
plexus.
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Muscular Anatomy
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Rotator Cuff
•S.I.T.S. muscles
_________________
_________________
_________________
_________________
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Prevention of Shoulder
Injuries
• Proper physical conditioning is key
• Develop body and specific regions relative
to ________
• Strengthen through a full ________
– Focus on _____________ muscles in all
planes of motion
– Be sure to incorporate scapula
_______________ muscles
• Enhances base of function for glenohumeral joint
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Throwing Mechanics
•Instruction in proper throwing
mechanics is critical for injury prevention
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• ___________ Phase
– First movement until ball leaves gloved hand
– Lead leg strides forward while both shoulders
________, externally rotate and horizontally
abduct
• ________________
– Max external rotation until ball release
(humerus adducts, horizontally adducts and
internally rotates)
– Scapula elevates and abducts and rotates
upward
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• ____________________ Phase
– Ball release until max shoulder internal rotation
– Eccentric contraction of ext. rotators to
decelerate humerus while rhomboids decelerate
scapula
• __________________ Phase
– End of motion when athlete is in a balanced
position
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Fractured Clavicle
Fractures of this bone are the most common
fracture in this region.
– This injury usually results from ______ or
direct blows.
– The adolescent form of this injury is known as
a “_____________” fracture.
All clavicular fractures are ___________ dangerous.
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Fractured Clavicle
(continued)
Signs and symptoms include:
–
–
–
–
Swelling.
_____________.
Discoloration.
Broken bone ends may protrude though skin.
First Aid
– Treat for ___________.
– Apply sling & swathe bandage.
– Apply sterile dressings on any wounds.
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AC Joint Injuries (continued)
Typical mechanism is _________ blow to the
lateral shoulder or fall on an outstretched
arm.
– Severity of injury is graded on the
amount of damage to ligaments.
• 1st degree -- no significant ligament damage
• 2nd degree -- partial tearing of ligaments _________
_____________
• 3rd degree -- complete rupture _______________
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AC Joint Injuries
(continued)
• Mild swelling with point
____________.
• Any movement of the
shoulder region will be
_________.
• In 3rd degree sprain, a snap
or ________ may have been
sensed along with a visible
deformity.
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AC Joint Injuries
(continued)
First Aid
–
–
–
–
Treat for shock.
Apply I.C.E.
Apply sling & swathe bandage.
Refer athlete to a physician.
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Glenohumeral Joint Injuries
GH joint consists of humeral head and the glenoid
fossa of scapula.
– Extremely _________ but inherently unstable
joint.
– Typical mechanism of injury is having the arm
___________ and externally rotated, stressing
the ___________ glenohumeral ligament.
– Most common type of location is an __________
dislocation that may be a subluxation or
complete dislocation.
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Glenohumeral Joint Injuries
(continued)
Signs and symptoms include:
– Shoulder joint deformity and down-sloping shoulder contour.
• “ ____________-”
– Abnormally long arm on affected side.
– Humeral head palpable within __________.
– Athlete resists efforts to move GH joint.
In cases involving _______________:
– GH joint may appear normal.
– Movement will be painful.
– Joint may be point tender.
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Glenohumeral Joint Injuries
(continued)
First Aid
• Treat for shock.
• Application of ice and compression by placing
______________ into the axilla.
• Apply sling & swathe bandage.
• Dislocations need to be re-located by a ________
• Refer to a physician immediately.
GH joint injuries tend to be chronic and recur.
Surgical treatment may be necessary.
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Sternoclavicular Joint (SC)
Injuries
The sternoclavicular joint is formed by the union of the
proximal end of the clavicle and the manubrium of the
_______________.
– SC joint is supported by the several ligaments.
– Injuries are rare compared to ______ or GH joints.
– Sprains to the SC joint can range in severity.
Mechanism is external blow to the shoulder resulting in
a ___________ of proximal clavicle; most commonly,
the clavicle moving __________ and superiorly.
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Sternoclavicular Joint Injuries
(continued)
First Aid
– Treat for shock.
– Apply ice and compression.
– Sling & swathe bandage.
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Rotator Cuff Strains
• Any muscle of the shoulder
can suffer a strain. Most
common injury is rotator
cuff strain.
• Rotator cuff muscles
contribute to GH joint
_________ and _________.
• Errors in the execution of a
throw or swing can
contribute to overuse injury.
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Rotator Cuff Strains
Signs and symptoms include:
• Pain _______ the shoulder, especially during follow
through phase.
• Difficulty bringing arm up and back during _______
phase of throw. Pain and stiffness in shoulder region
_________ hours after throwing or swinging.
• Point tenderness around region of the humeral head
that seems to be deep in __________ muscle.
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Rotator Cuff Strains
(continued)
First Aid
– First aid is NOT practical due to
chronic nature of condition.
– I.C.E.
– Medical referral.
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GH Joint-Related
“Impingement” Syndrome
Occurs when a bursa or
tendon is __________
between moving
structures.
– In cases affecting the
GH joint, the tendon
of the ______________
muscle is commonly
impinged.
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GH Joint-Related “Impingement”
Syndrome
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Impingement Syndrome
– Any condition that decreases
the size of the ______________
space may result in
impingement syndrome.
– Athletes in sports that
emphasize _____________ arm
movements have a high risk
of this injury.
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Impingement Syndrome
(continued)
Signs and symptoms include:
– Pain on ______________________________.
– Strength loss.
– Pain when arm is abducted beyond 80° to
90°.
– _______________________.
– Pain felt deep within the shoulder.
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Impingement Syndrome
(continued)
First Aid
• Rest.
• Anti-inflammatory drugs. (_____________)
• Physical therapy.
• In extreme cases, surgery.
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Labral Tear
• The labrum is the _________________ tissue located where
the shoulder ligaments, which make up the joint capsule,
connect to the edge of the ________.
• The tendon of the ________ muscle attaches to the shoulder
at the top of the labrum.
• How do Labral tears occur?
–
–
–
–
______________
A ________ movement of our arm or shoulder
Using arm to break a fall
Repetitive, high velocity overhead movements such as
throwing a ball or serving in tennis
– ____________
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Labral Tear
• Signs and Symptoms
–
–
–
–
Arm and shoulder pain
Arm and shoulder _____________
Painful overhead movements
Clicking or ___________ sounds or
sensations when moving shoulders
• Diagnosis
– _______ (with arthogram)
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Labral Tear
• Treatment
–
–
–
–
Ice
NSAIDs
Shoulder rehabilitation exercises
____________
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Apprehension test
(_____________)
• Apprehension test
used for anterior
glenohumeral
instability
– This motion
should not be
forced
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Test for Shoulder Impingement
– _________ test and Hawkins-Kennedy test for
impingement used to assess impingement of
soft tissue structures
– Positive test is indicated by pain and _______
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Test for Supraspinatus Weakness / Tear
• _________________
– 90 degrees of
shoulder flexion,
internal rotation
and 30 degrees of
horizontal
abduction
– ______________
pressure is applied
– Weakness and pain
are assessed
_____________
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