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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

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



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


The shoulder


The shoulder

  • Punching

  • Flex shoulder

  • Adduct shoulder

  • IR shoulder


The shoulder

  • Levator Scapulae

    • Elevates scapula

  • Rhomboid Major/Minor

    • Retract scapula

    • Elevate scapula


The 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




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

  • PRICE

  • 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



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
SLAP Tear

  • Superior Labrum from Anterior to Posterior

  • Occurs at point where biceps tendon inserts on labrum

  • Area of relatively poor blood supply

  • FOOSH

  • 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

  • PRICE

  • 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



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 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





Empty can test supraspinatus
Empty Can Test—Supraspinatus


Lift off test subscapularis
Lift Off Test—Subscapularis