Lecture # 13

The Shoulder Complex

The Shoulder Complex

the loose structure of the shoulder complex allows extreme mobility but provides little stability

as a result the shoulder is prone to injury and is involved in 8 t0 13 % of all sports related injuries

shoulder injuries are a major concern in all sports involving overhead activities , ie basketball, volleyball, baseball etc.

these activities place significant demands on the shoulder and may lead to acute or chronic injuries

Bony Structures and Articulations1) Acromiociavicular – acromion process

and distal end of clavicle – limited ROM

2) Sternociavicular – superior sternum and proximal end of clavicle - rotation

3) Glenohumeral – glenoid fossa ( of scapula) and the head of the humerous – extensive ROM but poor stability

glenoid fossa is deepened by the glenoid labrum – a narrow rim of fibrocartilage around the edge of the fossa

ligaments surround joint but are lax and provide little stability

SITS or rotator cuff muscles supraspinatus infraspinatus teres minor subscapularis

Range of Motion in the Shoulder Complex flexion, extension - abduction, adduction horizontal abduction , horizontal adduction plus elevation/depression , protraction/

retraction

Common Injuries to the Shoulder

Shoulder Dislocation/Subluxation

2nd to fingers for dislocations

90% anterior dislocation

70% develop traumatic recurrent dislocation

intense pain, tingling and numbness may extend down the arm into the hand

injured arm is often held in slight abduction and external rotated and is usually stabilized by the opposite arm

a pulse should be taken to assess circulation as well sensations should be tested

management – first time requires reduction by a physician because this may be associated with a fracture or labrum tear and or nerve damage..

3-6 weeks immobilization recurrent dislocations – individual may be

able to reduce it their self or with aid of therapist

strengthening important factor – but recurrent dislocations usually result in surgical intervention

First Aid Care

Immediately apply ice, front and back of gh joint

If possible put arm in a sling , or support gh joint with a wrap or shirt ( needs support)

Immediate referral to medical centre Treat for shock

AC Sprain aka - shoulder separation the AC joint is weak and easily injured with

a direct blow or a fall on the point of the shoulder and occasional from a fall on the outstretched arm

Very Common in sports swelling and loss of function are present

depending on the degree off injury

with a 2nd to 3rd degree there may be a step deformity – in which the clavicle rides above the scapula

Localized pain at AC joint with tenderness pain with movement through most ranges

– but especially with horizontal adduction Rx – PIER – NSAIDS, immobilization if

necessary, ROM exercise and strengthening

First Aid Care

Immediately apply ice on top of AC joint

Support with a sling (and swath )

Have athlete rest If needed refer to

physician or hospital for xrays .

Stenoclavicular Sprain extremely rare, but usually associated

with collision sport or falls directly on point of shoulder

point tenderness at the SC joint , swelling and pain with horizontal adduction

pain with lateral compression of the shoulders

Rx – PEIR – immobilization if necessary

Impingement of Supraspinatus Tendon, lnfraspinatus Tendon, Long Head of Biceps Tendon, and Subacromial Bursa

impingement syndrome is a chronic condition caused by repetitive overhead activity that damages tissues in the shoulder complex

initially there is pain with activity – usually only in the impingement position

as condition gets worse the individual experiences pain at other times – progressing to pain at night while attempting to sleep

there may be crepitus in certain ROM

Factors Contributing to an Impingement Syndrome

Excessive amount of overhead movement Limited subacromial space Thickness of supraspinatus and biceps

tendon Lack of flexibility and strength of

supraspinatus and biceps Weakness in post rotator cuff muscles

Hypermobility of the shoulder joint Imbalance of muscle strength, and or co-

ordination of movement Shape of acromion Training devices ( ie hand paddles in

swimming)

Rotator Cuff Tendinitis/Strain

usually result of repetitive microtraumas may be from a acute trauma muscle balance between int/ext rotators

or tightness almost always results in impingement must know throwing mechanics motion

(especially when working with sports involving throwing)

22-5

First Aid Care

Immediately apply ice, compression and elevate

Have athlete rest , use a sling if necessary

If needed refer to medical personnel

Clavicular #'s

because of S shape it is highly susceptible to compressive forces caused by a blow or fall on the point of the shoulder

80 % take place in midclaviclar region swelling , ecchymosis and deformity Rx involve a figure 8 brace to pull the

shoulder backward and upwards for 4 to 6 weeks

First Aid Care

Treat for shock apply ice Carefully put into support , a sling wrap or

shirt refer to physician or hospital for xrays .

Bicipital Tendon Injuries

common in overhead throwing , or repetitive overuse during overhead movements

irritation of the tendon (esp. long head) as it passes back and forth in the bicipital groove of the humerous

the tendon may sublux as well from the bicipital groove

pain and tenderness over the bicipital groove groove (especially with internal and external rotation), crepitus and weakness

Rx – PIER , NSAIDS – modalities .. retraining , stretching and strengthening

Bursitis usually associated with a rotator cuff

strain or an impingement syndrome usually injured is the subacromial bursa point tenderness and a painful arc will

exist between 70 and 120 degrees of passive abduction difficulty sleeping on effected side

Rx- PIER – may need cortizone injection

Burner or Zinger

not really a shoulder injury injury to brachial plexus usually a result of a stretch and the neck

being forced into hyperextension or opposite side flexion and the shoulder forced into horizontal abduction