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The Shoulder. Chapter 21. Shoulder Girdle Complex. Glenohumeral joint Acromioclavicular joint Scapulothoracic joint. Glenohumeral Joint. Glenoid fossa Head of humerus. Acromioclavicular Joint. Acromion process of scapula Clavicle. Scapulothoracic Joint. Scapula Posterior ribcage.

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The Shoulder

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The shoulder

The Shoulder

Chapter 21

Shoulder girdle complex

Shoulder Girdle Complex

  • Glenohumeral joint

  • Acromioclavicular joint

  • Scapulothoracic joint

Glenohumeral joint

Glenohumeral Joint

  • Glenoid fossa

  • Head of humerus

Acromioclavicular joint

Acromioclavicular Joint

  • Acromion process of scapula

  • Clavicle

Scapulothoracic joint

Scapulothoracic Joint

  • Scapula

  • Posterior ribcage

Bony landmarks

Bony Landmarks

  • Sternum

  • Clavicle

  • Humerus

    • Head of humerus

    • Greater tubercle

    • Lesser tubercle

    • Bicipital groove

Lesser tubercle

Greater tubercle

Bony landmarks1

Bony Landmarks

  • Scapula

    • Acromion

    • Coracoid process

    • Glenoid fossa

    • Spinous process

Shoulder girdle

Shoulder Girdle

Muscles of the shoulder

Muscles of the Shoulder

  • Deltoid

  • Trapezius

  • Pectoralis Major

  • Pectoralis Minor

  • Serratus anterior

  • Rhomboid major

  • Rhomboid minor

  • Levator scapulae

  • Coracobrachialis

  • Latissimus dorsi

The shoulder

  • Deltoid

    • Abducts shoulder

The shoulder

  • Trapezius

    • Rotates scapula

The shoulder

  • Shoulder depression

  • Scapular depression

  • Punching

  • Flex shoulder

  • Adduct shoulder

  • IR shoulder

The shoulder

  • Levator Scapulae

    • Elevates scapula

  • Rhomboid Major/Minor

    • Retract scapula

    • Elevate scapula

The shoulder

  • Flexes shoulder

  • Adducts shoulder

Biceps brachii

Biceps Brachii

  • Weakly flexes shoulder

  • Two proximal heads

    • Long head—supraglenoid tubercle of scapula

    • Short head—coracoid process of scapula

Rotator cuff muscles

Rotator Cuff Muscles

Collective set of four deep muscles of the GH joint

  • Supraspinatus

    • Inserts into humerus anteriosuperiorly

  • Infraspinatus

    • Inserts onto the humerus posterosuperiorly

  • Teres Minor

    • Inserts onto the humerus posteriorly

  • Subscapularis

    • Inserts onto humerus anteriorly

Rotator cuff muscles1

Rotator Cuff Muscles

Rotator cuff muscles2

Rotator Cuff Muscles

Ligaments of the shoulder

Ligaments of the Shoulder

  • Coracoclavicular

  • Coracoacromial

  • Coracohumeral

  • Glenohumeral

  • Acromioclavicular

Overuse injuries to the shoulder

Common Injuries of the Shoulder

Overuse injuries to the shoulder

Impingement syndrome

Impingement Syndrome

  • Widely used term to describe pain occurring when space between humeral head and acromion become narrowed

  • Bones “impinge” or squeeze structures that occupy the subacromial space

  • Three structures:

    • Joint capsule

    • Tendons of rotator cuff

    • Bursa

Impingement syndrome1

Impingement Syndrome

  • Overhead sports

    • Baseball, tennis, swimming, volleyball

  • Signs & Symptoms

    • Pain and tenderness in GH

    • Pain and/or weakness with active abduction in mid-range

    • Limited IR

    • Confirmation with special tests

    • Point tenderness in subacromial area

Impingement syndrome treatment

Impingement Syndrome—Treatment

  • Address biomechanics

  • Substitute with cross-training until condition resolves

  • Limit excessive overhead movement

  • Rehab exercises & stretching

Rotator cuff tears

Rotator-Cuff Tears

  • Traumatic injury

    • i.e. FOOSH

  • Unusual demands on young athlete

  • Repetitive use leads to chronic condition

    • Ultimately tear in tendons

  • Partial thickness tear

    • Not completely sever tendon

    • May respond well to non-op treatment

  • Full thickness tear

    • Require surgery

Rotator cuff tears signs symptoms

Rotator-Cuff Tears—Signs & Symptoms

  • Vague pain in shoulder area

  • “Catching” sensation when arm moved

  • Inability to sleep on affected side

  • Varying degrees of disability

Muscle strains

Muscle Strains

  • Caused by overuse or traumatic injuries

  • Signs & Symptoms

    • Pain, tenderness in muscle belly

    • Symptoms provoked by:

      • Direct palpation

      • Stretch

      • Contraction against resistance

  • Mild strains can resolve within few days

  • Severe strains can take several months to heal

Muscle strains treatment

Muscle Strains—Treatment


  • Gentle stretching

  • Strengthening program

  • Cross-train

  • Functional progression

Biceps tendonitis

Biceps Tendonitis

  • Discomfort in anterior shoulder

  • Often confused with RC tendonitis

  • Can be caused by impingement

Proximal biceps tendon rupture

Proximal Biceps Tendon Rupture

  • Not common in athletics

  • Sudden onset of pin in front of shoulder

  • Associated with a “pop” during vigorous activity

  • Drooping biceps muscle at distal arm

    • “Popeye” muscle

Proximal biceps tendon rupture1

Proximal Biceps Tendon Rupture

Traumatic shoulder injuries

Common Injuries of the Shoulder

Traumatic Shoulder injuries

Shoulder dislocation

Shoulder Dislocation

  • Direction depends on nature of injury

    • Antero-inferiorly (most common direction)

    • Inferiorly

    • Posteriorly

  • Requires immediate care by physician

  • Additionally injuries include:

    • Fractures

    • Glenoid labral tears

    • Axillary nerve damage

Glenoid labrum

Glenoid Labrum

  • Cartilaginous ring that acts to keep the humeral head positioned on the glenoid by blocking unwanted movement

Glenoid labrum injuries

Glenoid Labrum Injuries

  • Injury occur with :

    • Acute trauma (dislocation)

    • Repeated trauma

      • Degenerated tear (baseball pitchers)

    • Repetitive subluxation

      • Labral rim degenerate over time

  • Signs & Symptoms

    • Pain

    • Catching or popping sensation

    • Limited ROM

    • Varying degrees of weakness

    • Special Tests

    • MRI

Slap tear


  • Superior Labrum from Anterior to Posterior

  • Occurs at point where biceps tendon inserts on labrum

  • Area of relatively poor blood supply


  • Repetitive overhead actions

  • Lifting a heavy object

Multidirectional instabilities

Multidirectional Instabilities

  • Hyper-elastic or overly flexible individuals, often can sublux shoulder voluntarily

  • May have problems with overhead sports

  • Positive Sulcus sign

  • Weight-bearing exercises & weight training helpful

  • Condition normally not improved with surgery

Acromioclavicular separation

Acromioclavicular Separation

  • Direct blow to tip of shoulder

    • FB player falling on tip of shoulder or FOOSH

  • Signs & Symptoms

    • Pain in vicinity of AC joint

    • Possible deformity of joint depending on degree of sprain

Ac separation treatment

AC Separation—Treatment


  • Rehab

    • ROM & strengthening as tolerated

    • Overhead exs not recommended

  • 2nd degree

    • 3-4 weeks immob

    • Most painful

  • 3rd degree

    • 6-8 weeks immob

    • May leave permanent deformity

Acromioclavicular separation1

Acromioclavicular Separation

Brachial plexus injury

Brachial Plexus Injury

  • Stinger

  • Burner

  • Occurs when head and neck forcibly moved/hit to one side

  • Nerves n brachial plexus compressed on that side

  • Painful and disabling

Brachial plexus

Brachial Plexus

  • Group of peripheral nerves

  • Leave spinal cord & extend from vertebrae into shoulder

  • Give arm ability to function

Brachial plexus injury signs symptoms

Brachial Plexus Injury—Signs & Symptoms

  • Intense pain from neck down to arm

  • Arm will feel like it’s on fire or have pins-and-needles sensation

  • Arm/hand may be weak and numb

  • Intense pain in area of brachial plexus

  • Symptoms last several minutes to several hours or more

  • Weakness may last for several days

    • depends on severity of injury

Brachial plexus injury treatment

Brachial Plexus Injury—Treatment

  • Resting neck/arm until pain & symptoms go away

  • Ice pack 20 minutes every 3-4 hours

  • Anti-inflammatories

  • Strengthening exercises

  • RTP determined by sports medicine staff

  • Subsequent stingers cause for further testing

Brachial plexus injury treatment1

Brachial Plexus Injury—Treatment

  • Chronic stingers may eliminate athlete from contact sports

  • Scar tissue develops around nerve

    • ® Causes nerves to become entrapped

  • If athlete receives another blow, brachial plexus may not be able to flex

    • shatters instead, tearing major nerves of arm

    • Causes permanent neurological damage

  • Avoid by:

    • Keeping neck and shoulders as strong as possible

    • Properly fitted equipment

    • Proper tackling & blocking techniques

Fractures of shoulder

Fractures of Shoulder

  • Usually caused by impact or blow to shoulder

  • Common areas: clavicle & humerus

    • Scapular fx not show on x-ray; use bone scan

  • Clavicleobvious deformity

  • Ecchymoses may be present

  • Consider injury to joints, muscles, ligaments, vessels, and nerves

Special tests

Special Tests

Special tests for shoulder

Special Tests for Shoulder

  • Neer’s Impingement

  • Hawkin’s-Kennedy Impingement

  • Cross-over Impingement

  • Speed’s test

  • Empty Can

  • Drop-arm Sign

  • Shoulder Hike

  • Cross-arm adduction

  • Anterior apprehension

  • Posterior glide

  • Feagin’s Test

  • Sulcus sign

  • Clunk test

  • AC Shear Test

  • Roos Test

  • Piano Sign

Neer s impingement

Neer’s Impingement

Hawkin s kennedy


Cross over impingement

Cross-Over Impingement

Speed s test

Speed’s Test

Empty can test supraspinatus

Empty Can Test—Supraspinatus

Lift off test subscapularis

Lift Off Test—Subscapularis

Drop arm sign

Drop Arm Sign

Shoulder hike

Shoulder Hike

Cross arm adduction

Cross-Arm Adduction

Anterior apprehension

Anterior Apprehension

Posterior glide

Posterior Glide

Feagin s test

Feagin’s Test

Sulcus sign

Sulcus Sign

Clunk test

Clunk Test

Ac shear test

AC Shear Test

Roos test

Roos Test

Piano sign

Piano Sign

Shoulder rehab

Shoulder rehab



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