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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