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ATC 222. Chapter 21 The Shoulder Complex. Anatomy. Bones clavicle humerus scapula. Ligaments. Sternoclavicular Acromioclavicular Glenohumeral. Muscles. Rotator Cuff S.I.T.S. surrounding musculature. Nerve Supply. Brachial Plexus C5-T1. Blood Supply. Subclavian Artery

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Atc 222

ATC 222

Chapter 21

The Shoulder Complex


Anatomy
Anatomy

  • Bones

    • clavicle

    • humerus

    • scapula


Ligaments
Ligaments

  • Sternoclavicular

  • Acromioclavicular

  • Glenohumeral


Muscles
Muscles

  • Rotator Cuff

    • S.I.T.S.

    • surrounding musculature


Nerve supply
Nerve Supply

  • Brachial Plexus C5-T1


Blood supply
Blood Supply

  • Subclavian Artery

  • Axillary Artery

  • Brachial Artery


Shoulder assessment
Shoulder Assessment

  • H.O.P.S.

    • History

    • Observation

    • Palpation

    • Special Tests



Fractures
Fractures

  • Clavicular

  • Humerus

    • Shaft

    • Proximal

    • Epiphyseal


Clavicular fractures
Clavicular Fractures

  • Etiology

    • fall on outstretched arm or tip of shoulder

    • direct impact

  • Signs and Symptoms

    • supports the arm on the injured side tilting the head toward that side and the chin opposite


Clavicular fractures1
Clavicular Fractures

  • Management

    • apply sling and swathe

    • refer for x-ray

    • immobilize 6-8weeks


Humeral fractures shaft
Humeral Fractures-Shaft

  • Etiology

    • direct blow or fall on the arm

  • Signs and Symptoms

    • probable deformity

    • wrist drop and inability to supinate the wrist


Humeral fractures shaft1
Humeral Fractures-Shaft

  • Management

    • splint and referral to a physician

    • 3-4 months


Humeral fractures proximal
Humeral Fractures-Proximal

  • Etiology

    • direct blow, fall on outstretched arm, or dislocation

  • Signs and Symptoms

    • often mistaken for a shoulder dislocation

    • possible severe hemorrhaging


Humeral fractures proximal1
Humeral Fractures-Proximal

  • Management

    • sling and swathe and referral

    • 2-6 months


Humeral fractures epiphyseal
Humeral Fractures-Epiphyseal

  • Etiology

    • direct blow or indirect force along the axis of the humerus

  • Signs and Symptoms

    • shortening of the arm

    • appearance of a false joint

  • Management

    • splint and referral to a physician

    • immobilization for 3 weeks


Sprains
Sprains

  • Sternoclavicular

  • Acromioclavicular

  • Glenohumeral;


Sternoclavicular sprain
Sternoclavicular Sprain

  • Etiology

    • indirect force transmitted through the humerus

    • twisting of an posteriorly extended arm

  • Signs and Symptoms

    • Grade 1

    • Grade 2: visible deformity and inability to abduct arm


Sternoclavicular sprain1
Sternoclavicular Sprain

  • Grade 3: complete dislocation, if posterior, it’s a MEDICAL EMERGENCY


Sternoclavicular sprain2
Sternoclavicular Sprain

  • Management

    • RICE

    • reduction, immobilization 3-5weeks


Acromioclavicular sprain
Acromioclavicular Sprain

  • Etiology

    • direct impact to tip of shoulder

    • upward force against long axis of humerus, falling on outstretched arm


Acromioclavicular sprain1
Acromioclavicular Sprain

  • Signs and Symptoms

    • Grade 1:

    • Grade 2: prominent lateral end of clavicle, unable to completely abduct or horizontally adduct

    • Grade 3: rupture the AC and Coracoclavicular ligaments resulting in a dislocation of clavicle, very prominent distal clavicle


Acromioclavicular sprain2
Acromioclavicular Sprain

  • Management

    • apply ice and sling and swathe

    • referral

    • Grade 1: 3-4 days

    • Grade 2: 10-14 days

    • Grade 3: 2 weeks, Operative vs. Non-operative


Glenohumeral joint sprain
Glenohumeral Joint Sprain

  • Etiology

    • forceful abduction and ER

    • forceful movement posteriorly with flexion of arm

  • Signs and Symptoms

    • decreased ROM

    • pain with reproduction of mechanism


Glenohumeral joint sprain1
Glenohumeral Joint Sprain

  • Management

    • ice and sling for comfort

    • initiate active and passive ROM after 1-3 days


Acute subluxations dislocations
Acute Subluxations & Dislocations

  • accounts for up to 50% of all dislocations

  • only 1-4% are posterior

  • 85-90% recur


Glenohumeral dislocations anterior
Glenohumeral Dislocations-Anterior

  • Etiology

    • direct impact on posterolateral or posterior aspect of shoulder

    • forced abduction and ER


Glenohumeral disloccations anterior
Glenohumeral Disloccations-Anterior

  • Signs and Symptoms

    • flattened deltoid contour

    • humeral head in the axilla

    • arm carried in slight abduction and ER


Glenohumeral dislocations anterior1
Glenohumeral Dislocations-Anterior

  • Management

    • immobilize in sling and application of ice

    • referral to a physician for reduction and x-ray

    • DO NOT attempt to reduce


Glenohumeral dislocation posterior
Glenohumeral Dislocation-Posterior

  • Etiology

    • forced adduction and IR

    • fall on extended and internally rotated arm

  • Signs and Symptoms

    • arm held in adduction and internal rotation

    • head of humerus may be seen posteriorly


Chronic shoulder instabilities
Chronic Shoulder Instabilities

  • Etiology

    • traumatic (micro vs. macro), atraumatic, congenital, and neuromuscular

  • Signs and Symptoms

    • Anterior

    • Posterior

    • Global


Chronic shoulder instabilities1
Chronic Shoulder Instabilities

  • Management

    • Conservative vs. Surgical

    • shoulder harness


Shoulder impingement syndrome
Shoulder Impingement Syndrome

  • Etiology

    • repetitive overhead activities

    • capsular laxity leading to inflammation

    • forward head and rounded shoulders

    • hooked shaped acromion process


Rotator cuff tears
Rotator Cuff Tears

  • partial thickness vs. complete thickness tears

  • acute trauma or impingement

  • nearly always involves the supraspinatus muscle


Shoulder impingement syndrome1
Shoulder Impingement Syndrome

  • Signs and Symptoms

    • diffuse pain around the acromion

    • pain with overhead activities

    • weak external rotators


Shoulder impingement syndrome2
Shoulder Impingement Syndrome

  • Stage I

    • aching after activity

    • pain with abduction that becomes worst at 90 degrees

    • pain with flexion and resisted supination and external rotation

  • Stage II

    • aching during activity that becomes worst at night, restricted movement


Shoulder impingement syndrome3
Shoulder Impingement Syndrome

  • Stage III (25-40)

    • pain during activity with increase pain at night

    • possible muscle tear and permanent thickening of rotator cuff & bursa

    • scar tissue


Shoulder impingement syndrome4
Shoulder Impingement Syndrome

  • Stage IV (40+)

    • infraspinatus and supraspinatus wasting

    • a lot of pain with abduction to 90

    • limited AROM and PROM

    • weakness during abduction and ER


Shoulder impingement syndrome5
Shoulder Impingement Syndrome

  • Management

    • RICE

    • Modification of activity

    • Strengthening of ER and Scapular Stabilizers

    • Surgery vs. Injection


Shoulder bursitis
Shoulder Bursitis

  • Etiology

    • fall on tip of shoulder

    • direct impact or shoulder impingement

  • Signs and Symptoms

    • pain with abduction, flexion and IR

  • Management

    • cold, antiinflammatory medications




Peripheral nerve injuries
Peripheral Nerve Injuries

  • Etiology

    • blunt trauma or stretch

  • Signs and Symptoms

    • constant “burning” pain, muscle weakness and atrophy

    • paralysis


Peripheral nerve injuries1
Peripheral Nerve Injuries

  • Management

    • ice

    • resume play when symptoms subside

    • referral to a physician is ESSENTIAL if symptoms persist


Thoracic outlet compression syndrome
Thoracic Outlet Compression Syndrome

  • Etiology

    • compression of brachial plexus, subclavian artery and vein (neurovascular bundle)

    • compression by the scalene and pectoralis mucles


Thoracic outlet compression syndrome1
Thoracic Outlet Compression Syndrome

  • Signs and Symptoms

    • paresthesia and pain

    • impaired circulation in the fingers

    • muscle weakness and atrophy


Thoracic outlet compression syndrome2
Thoracic Outlet Compression Syndrome

  • Management

    • stretching of pectorals and scalenes

    • strengthening of the traps, rhomboids, serratus anterior


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