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The shoulder . Chapter 21. The Shoulder Girdle Complex. 3 joints make up the shoulder girdle The Sternoclavicular joint The Acromioclavicular joint The Glenohumeral joint. The Sternoclavicular Joint. Formed through the articulation of the sternum and the clavicle.

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the shoulder

The shoulder

Chapter 21

the shoulder girdle complex
The Shoulder Girdle Complex
  • 3 joints make up the shoulder girdle
    • The Sternoclavicular joint
    • The Acromioclavicular joint
    • The Glenohumeral joint
the sternoclavicular joint
The Sternoclavicular Joint
  • Formed through the articulation of the sternum and the clavicle.
    • Also called the SC joint
    • Injuries to this joint can be very debilitating, but are very rarely seen in athletics.
acromioclavicular joint
Acromioclavicular Joint
  • Formed by the articulation of the acromion process of the scapula and the distal end of the clavicle.
    • Also called the AC joint
  • Its is located superiorly to the glenohumeral joint and is commonly exposed to injury in contact sports.
glenohumeral joint
Glenohumeral Joint
  • Formed by the Humerus and the scapula
    • The head of the humerus is attached to the glenoidfossa of the scapula
      • Shallowness of the socket allows for a great deal of movement
  • Supported by
    • several muscles
    • ligaments
    • Soft tissue
structure and function
Structure and Function
  • Dynamic Stability refers to mobility with stability
    • Shoulder accomplishes this through the coordinated movement of the scapula in concert with the humerus
    • Several muscle groups work together synergistically to create the dynamic stability of the shoulder.
rotator cuff
Rotator Cuff
  • A set of 4 deep muscles of the glenohumeral joint
    • They originate on the scapula and insert onto the superior aspect of the humerus
    • Will often be referred to as the SITS muscles
      • Supraspinatus
      • Infraspinaus
      • Teres Minor
      • Subscapularis
muscles of the shoulder girdle
Muscles of the Shoulder Girdle
  • Muscle Force Coupe
    • Formed by the actions of the deltoid and rotator cuff muscles
    • Allows the humeral head to spin while remaining in place on the glenoid
  • Scapulothoracic Mechanics
    • Allows the scapula to move in several

places using the following muscles

      • Trapezius
      • Rhomboids
      • Serratus
      • Pectoralis Minor
muscles that move the scapula
Muscles that move the Scapula
  • There are several muscles that move the scapula
    • Levator scapulae
    • Rhomboids
      • Major and Minor
    • Pectoralis Minor
    • Serratus Anterior
    • Trapezius
muscles that move the arm humerus
Muscles that move the Arm (Humerus)
  • There are several muscles that move the Humerus
    • Coracobrachialis
    • Pectoralis Major
    • Teres Major/Minor
    • Deltoid
    • Supraspinatus
    • Infraspinatus
    • LatissimusDorsi
overuse injuries to the shoulder
Overuse Injuries to the Shoulder
  • Overuse injuries of the shoulder are usually limited to the soft tissues.
    • Usually caused by repetitive activity to the point of causing tissue damage and inflammation
      • Common among athletes that participate in overhead movements
      • Many athletes are unaware that an injury is occurring until symptoms manifest
  • Overuse Injuries include
    • Impingement syndrome
    • Tendonitis
    • Bursitis
    • Muscle strains
impingement syndrome
Impingement Syndrome
  • Impingement syndrome describes a situation causing injury when the space between the humeral head and acromion becomes narrowed.
    • The bones “impinge” or squeeze structures within the space
    • Structures affected are the joint capsule, tendons of the rotator cuff, and a bursa
  • Impingement causes mechanical irritation of the cuff tendons, resulting in hemorrhage and swelling
    • Commonly called tendonits of the rotator cuff
      • Supraspinatus is the muscle usually involved
    • If the bursa is involved, bursitis is the result.
impingement syndrome symptoms
Impingement Syndrome - Symptoms
  • Symptoms
    • Pain and tenderness in GH area
    • Pain and/or weakness with ABD in midrange
    • Limited IR
    • + results from special tests
      • Hawkin’s impingement
    • Tenderness to palpation in subacromial area
impingement syndrome treatment
Impingement Syndrome - Treatment
  • Treatment options
    • Correction of improper sport technique
    • Preseason conditioning
    • Specialized taping
  • Rehabilitation and Prevention
    • Most rehab techniques involve strengthening the weakened muscles of the shoulder girdle
rotator cuff tears
Rotator Cuff Tears
  • Could be partial tear or full thickness of the tendon
    • Can happen to people of any age
      • In younger people often caused by more traumatic injuries
        • Falling on outstretched arm
        • Unusual demands on the joint
      • Older people
        • Usually caused by degeneration of the muscle and tendon tissues
  • Treatment
    • Usually determined by severeity of injury and how it responds to rehab
    • Small and partial tears respond well to non-operative rehab program
    • Moderate to large tears, and small tears that are non-responsive to rehab, require surgery
rotator cuff tears cont d
Rotator Cuff tears (cont’d)
  • Symptoms
    • Pain
    • Full ROM with partial tears
    • Loss of ROM with full tears
    • Athlete will not be able to lift the arm overhead, and often when they try, the can be observed to hike or shrug
muscle strains
Muscle Strains
  • Can be caused by excessive overuse or traumatic injury
  • Symptoms
    • Pain
    • Tenderness in muscle belly caused by
      • Palpation
      • RROM
      • Stretch
    • There could be a delay of a day or two before symptoms actually show
  • Treatment
    • PRICE
    • Gentle stretching
    • Strengthening program
biceps long head tendonitis
Biceps (long head) Tendonitis
  • Can cause discomfort in the front of the shoulder and will often be confused with rotator-cuff tendonitis.
  • Both can be caused by impingement and will have the same treatment
biceps tendon rupture
Biceps Tendon Rupture
  • Not common in athletics, but results from vigorous activity
    • Described as a sudden onset of pain in the front of the shoulder and an associated “pop”
  • Symptoms
    • Drooping of the biceps muscle near the distal upper arm
    • Ecchymosis
biceps tendon rupture cont d
Biceps Tendon Rupture (cont’d)
  • This injury is considered a Grade III injury and usually affects the biceps tendon long head.
  • People who have a prior history of tendonitis may be more prone to this injury
  • Treatment
    • Surgery is usually not needed
    • PRICE
    • Gradual return to strengthening and activity
  • Athletes can usually return to full activity after a period of conservative care
  • There may be a small loss of shoulder flexion in the long term, but not enough to result in loss of high-level functioning
traumatic shoulder injuries
Traumatic Shoulder Injuries
  • Usually are caused by a sudden onset
    • Blow to arm or shoulder
    • Shoulder joint being forced beyond physiologic limits
  • Common Injuries
    • Glenohumeral dislocation
    • Acromioclavicularseparation
    • Fractures
    • Tendon Ruptures
anterior shoulder dislocation
Anterior Shoulder Dislocation
  • Results in the head of the humerus being completely out of the glenoidfossa
    • Usually caused by shoulder being forced into abduction, extension and external rotation.
      • Most common means of dislocation is anterioinferiorly
  • Immediate transport to a physician is required
  • Physician should also check for other injuries
    • Fractures
    • Glenoid labial tears
    • Axillary nerve damage
    • Hill-Sachs lesions can occur if the head of the humerus hits the front of the glenoid hard enough to cause an indentation
anterior shoulder dislocation cont d
Anterior Shoulder Dislocation (cont’d)
  • If the injury is not properly managed and fully rehabilitated, there is a high risk for recurrent dislocations.
    • Immobilization may be as long as 8 weeks
glenoid labrum injuries
Glenoid Labrum Injuries
  • These injuries involve the deepest soft tissue in the shoulder
    • Can often occur along with dislocations
    • Happens commonly with baseball pitchers when degenerative changes in the labrum cause it to become loose
      • Permits humeral head to slip forward
  • Symptoms
    • Pain
    • Popping sensation
    • Limited use of the arm
    • Varying degrees of weakness
    • Special tests and MRI will confirm diagnosis
  • Treatment includes specialized rehab program
    • Suspected tears must be referred to a physician
multidirectional instability
Multidirectional Instability
  • Refers to the ability of the athlete to voluntarily dislocate their shoulders
    • usually due to athlete being hyperelastic or overly flexible
      • This causes problems with athlete playing overhead sports.
  • Weight bearing exercises can be helpful in dealing with this problem
    • Push-ups
    • Plyometrics
    • Weight training
acromioclavicular separation
Acromioclavicular Separation
  • This injury is a traumatic sprain of the AC joint
    • Usually caused by a blow to the tip of the shoulder
  • Symptoms
    • Pain near the AC joint
    • Obvious deformity
  • Treatment
    • Physician referral
    • 1st degree sprains
      • PRICE
    • 2nd / 3rd degree sprains
      • Require 6-8 weeks of immobilization
brachial plexus injury
Brachial Plexus Injury
  • Is often called a stinger or burner
    • Usually caused by a stretching of the brachial plexus on the opposite side
  • Symptoms
    • Intense pain from the neck down to the arm
    • On-fire or pins-and-needles sensation
    • Weakness
    • Numbness
  • Treatment
    • Referral to specialist
    • Rest
    • Ice
    • Anti-inflammtory meds
    • Strengthening exercises for neck and shoulders
  • Prevention
    • Keeping neck and shoulders strong
    • Wearing properly fitted equipment that distributes forces during collision
    • Using proper technique
fractures
Fractures
  • Fractures of the shoulder girdle most commonly involve the clacivle and humerus
  • Scapular fractures may not be seen on standard x-rays
    • Present on bone scans
  • Any suspected fracture should be referred to an emergency room physician
is it a shoulder injury
Is it a Shoulder Injury
  • Often times pain in the shoulder can be referred pain from another injury.
    • Pain in the shoulder does not always indicate a shoulder problem
  • Cardiac problems or Heart attack
    • Referred pain to the left shoulder, neck and arms
  • Spleen Injury
    • Refer pain to the left shoulder and down the upper portion of the left arm
      • Kehr’s sign