Slide 1

BELLWORK LAST CHAPTER!!!!!!!!!! In your opinion: Which sports see the most shoulder injuries? Why? Slide 2 Chapter 21 The Shoulder Slide 3 Objectives Upon completion of this chapter, you should be able to: Name the three articulations that constitute the shoulder girdle complex Describe how stability of the shoulder is maintained Recite the names of the four muscles that come together to form the rotator cuff Slide 4 Objectives (contd.) Upon completion of this chapter, you should be able to (contd.): Explain the anatomy of the shoulder complex Identify major injuries and conditions of the shoulder Slide 5 The Shoulder Girdle Complex Very complex joint 3 articulations: Glenohumeral (GH) joint; ball-and-socket Acromioclavicular (AC) joint Sternoclavicular (SC) joint All together shoulder girdle Dynamic stability: mobility w/steadiness of a joint Only joint with 360 of rotation Slide 6 The Shoulder Girdle Complex (contd.) Slide 7 Head of humerus: upper portion of humerus, attaches to scapula Glenoid fossa: concave projection of scapula GH joint: head of humerus & scapula Acromion process: projection of spine of scapula; tip of shoulder AC joint: acromion & clavicle SC joint: clavicle & sternum Scapulothoracic joint: area that provides movement of the scapula over back side of ribcage (not a true joint) Synergistics: group of muscles act together to enhance movement of joint or limb Slide 8 Reason for decreased stability Slide 9 Scapula Slide 10 Muscles Slide 11 Muscles (cont) Slide 12 Major Muscles of Upper body MUSCLEFUNCTION TrapeziusDraws head to one side; rotates scapula Serratus anteriorProtraction of scapula Pectoralis majorFlexion, horiz. adduction, int. rotation of arm DeltoidAbducts arm Latissimus dorsiExtends, adducts, int. rotates arm RC musclesMainly external rotation of arm Slide 13 Rotator Cuff Set of 4 muscles of the GH joint Originate on scapula & insert on head of humerus S.I.T.S. Supraspinatus Infraspinatus Teres minor Subscapularis Slide 14 Rotator Cuff & Deltoid Work together to maintain stability of the shoulder Force couple: 2 forces acting in opposite directions to rotate a body part RC muscles pull down as deltoid lifts up (abducts) deltoid rotator cuff Slide 15 Scapulothoracic Mechanics Scapula is base of support for shoulder complex Must reposition itself as humerus moves scapular rhythm Slide 16 Movements Slide 17 Overuse Injuries to the Shoulder Sports with excessive overhead motion (i.e. swimming, tennis, pitching, volleyball, etc.) Impingement syndrome Occurs when space between humeral head and acromion becomes narrowed structures become impinged, or pinched Mechanical irritation of cuff tendons Symptoms: pain, tenderness, weakness, limited rotation, and test confirmation Treatment: prevention, preseason conditioning, cross- training, exercise, taping, and rehabilitation Slide 18 BELLWORK Name as many movements of the shoulder/scapula as you can remember. Name the 4 rotator cuff muscles. Slide 19 Overuse Injuries to the Shoulder (contd.) Rotator cuff tears Partial or full thickness Symptoms: pain, unable to move full range of motion, unable to lift the arm overhead, catching sensation, and varying degrees of disability Treatment: rehab, surgery Slide 20 Overuse Injuries to the Shoulder (contd.) Muscle strains Caused by overuse or traumatic injuries Symptoms: pain and tenderness Treatment: PRICE, gentle stretching, strengthening program, and cross-training Slide 21 Overuse Injuries to the Shoulder (contd.) Biceps tendonitis: inflammation of biceps tendon (connects biceps to shoulder girdle) Biceps tendon ruptures Not common in athletics Symptoms: sudden pain in the front of the shoulder associated with a pop, drooping of muscle (Popeye) Treatment: PRICE; surgery not normally needed Slide 22 Traumatic Shoulder Injuries Anterior shoulder dislocation Head of the humerus is dislocated completely off of the glenoid fossa Arm is abducted to the side, with the elbow bent, and force applied to the arm causes external rotation Immediate referral Slide 23 Traumatic Shoulder Injuries (contd.) Glenoid labrum injuries Glenoid labrum: ring of cartilage attached to glenoid fossa; keeps humeral head in position Occurs with trauma Symptoms: pain, catching or popping sensation, and weakness Treatment: strengthening program, physician diagnosis, and sometimes surgery Slide 24 Traumatic Shoulder Injuries (contd.) Acromioclavicular (AC) separations Traumatic sprains of acromioclavicular joint Symptoms: pain and deformity Treatment: physician referral, PRICE, and exercise Slide 25 Traumatic Shoulder Injuries (contd.) Brachial plexus Injury stinger (burner): stretching or compressing of brachial plexus (group of nerves leaving spinal cord and extending from vertebrae to shoulder) Head or neck is forced to one side Symptoms: pain, burning, and weakness Treatment: rest, ice, anti-inflammatory medication, and exercises Slide 26 Traumatic Shoulder Injuries (contd.) Fractures of the shoulder Usually caused by an impact or blow to shoulder Symptoms: deformity, ecchymosis, and bruising Treatment: support and transport to emergency room Slide 27 Animation Shoulder Injuries Slide 28 Is It a Shoulder Injury? Pain in the shoulder region does not always indicate a shoulder problem Referred pain: pain felt in one body part, but originates somewhere else Referred pain to the shoulder can be due to: Cardiac problems Pinched or stretched nerves Spleen injury Slide 29 Special Tests Neers impingement (BT or supraspinatus) Hawkins-Kennedy (supraspinatus) Speeds test (BT tendonitis) AC compression (AC sprain) Cross-arm adduction (AC sprain) Drop arm test (RC tear) Clunk Test (labral tear) Apleys scratch test (ROM) Slide 30 8 Shoulder Stretches 1.Abduction/ext. rotation 2.Abduction/int. rotation 3.Flexion/ext. rotation 4.Flexion/int. rotation 5.Horizontal adduction 6.Horizontal abduction 7.Flexion 8.Extension Slide 31 Conclusion The upper extremity is one of the most challenging areas of the body to treat Understanding the mechanisms of injury will ensure appropriate rehabilitation The ATC must understand causes of common upper extremity conditions, so they can assess and manage the many different injuries