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Shoulder Complex Injuries
Anatomy of the Shoulder
• Ball and Socket Joint– Shallow, which leads to instability– Relies on muscular strength for
stability• The shoulder has 4 different joints and
only 3 bones.• The bones collectively are often called
the “Shoulder Girdle”.
Anatomy of the Shoulder
• BonesBones–Clavicle
•AKA: Collar Bone–Scapula
•AKA: Shoulder Blade–Humerus
Bones of the Shoulder
• Humerus– The rounded end of the humerus fits
into the glenoid fossa of the scapula.
– The humerus has a groove near the top that the biceps tendon slides through (Bicipital groove)
Bones of the Shoulder
• Clavicle–Articulates at the sternum near
the throat and at the tip of the shoulder with the scapula
Bones of the Shoulder
• Scapula– Flat like with a spinous process that runs
laterally across the posterior side
– 2 forward projections that articulate on the anterior aspect of shoulder
• Acromion Process
• Coracoid Process
Ligaments of the Shoulder Complex
• Acromio-clavicular
• Coraco-clavicular
• Coraco-acromial
• Sterno-clavicular
Muscles of the Shoulder
• Rotator Cuff–Subscapularis
–Infraspinatus
–Teres minor
–Supraspinatus
• SITS; remember the acronym
Muscles of the Shoulder
• Rotator Cuff– Internally and externally rotates the humerus– Assists in abduction– Flexes to keep humerus in socket while
throwing and object
• Deltoid– 3 parts: anterior, medial, and posterior– Abducts, flexes, and extends the shoulder
Muscles of the Shoulder
• Pectoralis Major & Minor
– Attach to sternum and anterior humerus
• Biceps Brachii
– Flexes the elbow
– Attaches to the humerus and coracoid process
• Triceps
– Extend the elbow
Joints of the Shoulder Complex
• Gleno-Humeral– Humerus articulates with the glenoid fossa
• Acromial-Clavicular– Clavicle articulates with the acromion process
of the scapula
• Coraco-Clavicular– Clavicle articulates with the coracoid process of
the scapula
• Sterno-Clavicular– Clavicle articulates with the sternum
Preventing Shoulder Complex Injuries
• Often due to muscle weakness
• Over-training the “mirror” muscles
• Weakens opposing muscles (rotator cuff)
• Kyphosis, tight pectorals, or weak posterior muscles are prone to shoulder problems
• “Stand up straight”….makes sense
• Pressure on the bicipital groove
• Balanced training & appropriate padding
Ligament Injuries
• Acromio-clavicular Sprain– A-C sprain or separated shoulder– Impact to the tip of the shoulder or falling on an
out stretched arm– The more severe allows more superior
movement of the clavicle– Graded 1-3; PRICE– Grade 3 is either surgery or harness to realign
joint
Ligament Injuries
• Gleno-humeral Sprain– Most common in abduction and external
rotation– Treat with PRICE– If 3rd degree, possible subluxation or
dislocation- refer to physician
Muscle & Tendon Injuries
• Most injuries are due to overuse
• Rest, ice, immobilization, and rehab
• Most common is the rotator cuff, impingement syndrome, and bicipital tendon problems.
Muscle & Tendon Injuries
• Rotator Cuff Strain– 1st degree- Pain, full ROM– 2nd degree- pain, some loss of ROM, some loss
of stability– 3rd degree- pain, loss of ROM and stability– Most commonly the supraspinatus muscle is
injured– Unable to abduct = 3rd degree sprain- surgery– Repetitive motions lead to crepitus &
impingement syndrome
Muscle & Tendon Injuries
• Impingement Syndrome– Repetitive, overhead motions– Both the biceps tendon and the supraspinatus
tendons run through small space under the acromion process
– Space narrows due to swelling, tendinitis, weak posterior muscle strength, or poor posture- the two muscles get pinched in that space
– Modify activity, strengthen posterior muscles, and improve flexibility of pectorals
Impingement Syndrome
Muscle & Tendon Injuries
• Bicipital Tendinitis– Repetitive motion overhead
– Irritation on biceps tendon
– Possible crepitus
– Stop activity, ultrasound, anti-inflammatory meds and rehab
Muscle & Tendon Injuries
• Biceps Tendon Rupture– This can happen in two instances
• Direct blow to the tendon• Severe contractional forces
– Pain, no flexion of elbow– Muscle rolls up, looks like a golf ball
under the skin– Ice, immobilize, doctor will repair in
surgery
Biceps Tendon Rupture
Bone Injuries
• Clavicular Fractures– Most often fractured at its anatomical
weakness (distal 1/3)
– Deformity, pain, loss of use
– PRICE
– Out of r 6-8 weeks
Clavicular Fracture
Bone Injuries
• Humeral Fractures– Usually mid-shaft
– Refer to doctor, out 6-8 weeks
– Be sure you have a distal pulse at wrist!• May have a serious situation if there is no
pulse• Possible to lose the arm without proper
blood supply.
Bone Injuries
• Gleno-humeral Dislocations and Subluxations– Head of humerus is out of socket
– Excessive abduction and external rotation
– Most common to dislocate anteriorly
– Deformity at the deltoid muscle• Look flat, not round
Bone Injuries
• Gleno-humeral Dislocations and Subluxations– X-ray is needed to r/o bone chips
– There may be permanent damage to nerves blood vessels or cartilage
– Surgery is probable
– A lot of rehab!
G-H Dislocation
G-H Dislocation