Download THE SHOULDER

THE SHOULDER
ANATOMY
Bones
Sternum - middle of chest
2. Clavicle - collar bone
3. Humerus - upper arm
4. Scapula - shoulder blade
1.
• Acromion process (knob on top of shoulder)
• Glenoid fossa (socket for the humerus)
SHOULDER COMPLEX JOINTS

Sternoclavicular (SC) Joint
• Only bony attachment between the axial skeleton
and the upper extremity
SHOULDER COMPLEX JOINTS

Acromioclavicular (AC) Joint
• Between the lateral end of the clavicle and the
acromion process of the scapula
• Held together by two sets of ligaments
• Painful when injured
SHOULDER COMPLEX JOINTS

Glenohumeral (GH Joint)
• True shoulder joint
• Between the head of the humerus and the
glenoid fossa of the scapula
• Most freely movable joint of the body
• Very unstable
• Head of the humerus is 60% bigger than the
glenoid (golf ball on a tee)
SHOULDER MUSCLES

Pectoralis Major
• Front of chest
• Horizontal Adduction (like bench press)
SHOULDER MUSCLES

Deltoid
• Over the top of the shoulder
• Abduction
SHOULDER MUSCLES

Latissimus Dorsi
• Back of shoulder
• Extension
SHOULDER MUSCLES

Rotator Cuff
•
•
•
•
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
• Internal and External Rotation
SHOULDER MOTIONS
INJURIES
8 slides with LOTS of info!
Clavicle Fracture

Most fracture sites are in middle 1/3
 Most common in adolescents and pre-adolescents
 Cause:
• Fall on outstretched arm OR tip of shoulder
• Direct impact

S/S
• Tilts head to side that is injured
• Supports that arm with other arm
• Clavicle is tender

Care: Immobilize, ice, x-ray, figure-8 brace
Humerus Fracture


Not a common injury in sports
Cause
• Direct impact
• Fall on outstretched arm

S/S
• Inability to move arm
• Pain and swelling in upper arm

Care
• Splint, sling
• Immediate referral to ER
Sternoclavicular (SC) Sprain

Not a common injury - mostly in contact sports
 Cause
• Fall on shoulder - force goes up the clavicle

S/S – (can be 3 grades)
• Usually dislocates anterior and superior - obvious
deformity
• Unable abduct or horizontally adduct arm

Care
• RICE, Immobilize shoulder
• Life threatening if it goes posteriorly
Acromioclavicular (AC) Sprain

Very common in athletics
 Cause
• Fall on outstretched arm OR tip of shoulder

S/S
• 1st and 2nd degree - tenderness around joint, will not
want to flex or horizontally adduct
• 3rd degree sprain has obvious deformity

Care
• RICE, Immobilize shoulder
• X-rays will determine the degree best – holding weight
Glenohumeral (GH) Dislocation

95% of all dislocations are anterior
• Can also go inferior or posterior

Once it happens, it is very likely to happen again
 Cause (anterior):
• Arm is abducted and externally rotated with extra force

S/S
• Deltoid will appear flat
• They will hold arm at side and internally rotated
• Unable to use the arm

Treatment
• Immobilization, ice and referral to MD to reduce
Shoulder Impingement Syndrome

Cause
• Repetitive overhead motion (i.e. throwing, swimming,
volleyball, etc)
• The supraspinatus tendon, a bursa and biceps tendon
get trapped in a small space

S/S
• Pain with overhead motion
• Weakness in abduction and external rotation

Care
• Ice and rest for pain
• Fix the bad habits (biomechanics) that caused the
problem
Rotator Cuff Strains

Can go hand in hand with impingement
 Supraspinatus (SSP) is most often injured
 Cause
• Overhead motions with force or heavy weight

S/S
• Pain – down into deltoid
• Weakness – may not be able to abduct arm with full
tear of the SSP

Care
• Decrease overhead activity
• Ice or heat
• Rehab to strengthen rotator cuff
Biceps Tendinitis

Common in athletes who use a lot of overhead
motion (throwers)
 Can go hand in hand with impingement
 Cause
• Overhead motion

S/S
• Pain is in anterior, proximal humerus
• Pain with O/H motion

Treatment
• Deep heat
• Ice after activity