the shoulder chapter 21. the shoulder girdle complex 3 joints make up the shoulder girdle the...
TRANSCRIPT
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. Also called the SC joint Injuries to this joint can be very debilitating,
but are very rarely seen in athletics.
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
Formed by the Humerus and the scapula The head of the
humerus is attached to the glenoid fossa of the scapula Shallowness of the socket
allows for a great deal of movement
Supported by several muscles ligaments Soft tissue
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
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 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 There are several muscles that move the
scapula Levator scapulae Rhomboids
Major and Minor Pectoralis Minor Serratus Anterior Trapezius
Muscles that move the Scapula
Muscles that move the Arm (Humerus)
There are several muscles that move the Humerus Coracobrachialis Pectoralis Major Teres Major/Minor Deltoid Supraspinatus Infraspinatus Latissimus Dorsi
Muscles that move the Arm (Humerus)
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 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 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 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
Shoulder Impingement Exercises
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)
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
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
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
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)
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
Usually are caused by a sudden onset Blow to arm or shoulder Shoulder joint being forced beyond
physiologic limits Common Injuries
Glenohumeral dislocation Acromioclavicular separation Fractures Tendon Ruptures
Anterior Shoulder Dislocation
Results in the head of the humerus being completely out of the glenoid fossa 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)
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
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
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
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
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 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
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