the shoulder complex sp2010
DESCRIPTION
TRANSCRIPT
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The Shoulder Complex
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Complicated Region of the Body.
Bones: Clavicle: “S” shaped
Vulnerable to injury Scapula:
flat and triangular Humerus:
spherical
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Scapula and the HumerusScapula and the Humerus
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Articulations: Sternoclavicular Joint Acromoclavicular Joint Glenohumeral Joint Scapulothoracic Joint
Ligaments Sternoclavicular Acromioclavicular
Anterior, posterior, superior, inferior portions Coracoclavicular ligament which is divided into two other
ligaments. Glenohumeral
Surrounded by a capsule Reinforced by the superior, middle, and inferior GH
ligament and a tough coracohumeral ligament
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MUSCULATURE
Two Groups in GH Joint Produce dynamic motion and establish stability to
compensate for arrangement of bone and ligaments for a great deal of mobility
• Originate on the axial skeleton – attach to humerus Latissiumus dorsi & pectoralis major
• Originate on the scapula – attach to humerus Deltoid, teres major, coracobrachialis
• Other Muscles: Subscapularis, Infraspinatus, Teres Minor, Supraspinatus Short rotator muscles Triceps and Biceps
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Rotator Cuff Muscles
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SCAPULAR MUSCLES
Third group of muscles Attaches axial skeleton to scapula
Levator scapula Trapezius Rhomboids Serratus anterior and posterior
Provide dynamic stability to shoulder complex
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Scapular Muscles
levator scapulaedeltoid
infraspinatusteres minorteres major
levator scapulaeinfraspinatusteres major
supraspinatusteres minor
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Bursae Subacromial Bursa
Most important Easily subjected to trauma when the humerus is in the
overhead position• compresses
Nerve Supply Cervical Vertebrae (C5 – C6, & T1)
Blood Supply Subclavian artery Becomes the Brachial artery just after the 1st rib
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Bursae, and Nerve Supply
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BLOOD SUPPLY
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FUNCTIONAL ANATOMY
Movement of the shoulder is critical to maintain the positioning of the humeral head relative to the glenoid.
Helps control humeral head movement Rotator Cuff contraction, they dynamically
tighten the capsule Helps center the humeral head relative to the glenoid.
Crucial with ANY over head activity Scapulohumeral Rhythm
As humerus elevates to 30’ no movement 30-90’ scapula abducts & upwardly rotates 180’ humeral abduction & sternoclavicular jt. moves
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RECOGNITION OF SPECIFIC INJURIES Fractures:
Acromioclavicular (common) Caused by outstretched arm, fall on the tip of shoulder, direct impact Athletes usually supports the fx’d. side, tilts head and chin to opposite
side Deformity, pain, swelling
Scapular (infrequent) Direct impact, or when force is transmitted through humerus to
scapula Pain with movement
Humeral Shaft- (occasionally)
• Direct blow, fall on the arm• Comminuted or transverse with deformity due to muscular pull
Proximal – dangerous to nerves and blood supply• Direct blow, dislocation, impact received by falling on an outstretched arm
Head of humerus (Epiphyseal fx)• Occur in ages 10 or younger• Direct blow or indirect blow• Difficult to recognize
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Fracture of ClavicleFracture of Clavicle
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Humeral shaft, Proximal & Epiphyseal
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Injuries ContinuedInjuries Continued
Sprains Sternoclavicular (uncommon)
Initiated by a direct force transmitted through the humerus
Acromioclavicular Extremely vulnerable especially in collision sports Direct impact to the TIP of the shoulder that forces
the acromion process downward, backward, and inward
• The clavicle is pushed down against the rib cage
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Rockwood’s Classification of AC SprainsRockwood’s Classification of AC Sprains
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Sternoclavicular & Acromioclavicular Sternoclavicular & Acromioclavicular SprainsSprains
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DISLOCATIONSDISLOCATIONS
Account for 50% of all dislocations Two Types
Anterior• Most common• Direct impact to the posterior aspect of shoulder
Forced abduction, external rotation, and extension that forces the humeral head out (arm tackle)
• Bankart’s Lesion (Labrum tear)• Hill Sachs Lesion (creates a divot in humeral head)• Slap Lesion (injury to labrum and long head of biceps)
Posterior• Account for 1 – 4.3%• Extremely Rare• Forced Adduction and Internal rotation of shoulder or fall on an
extended internally rotated arm
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DislocationsDislocations
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Impingements Involves mechanical compression of
Supraspinatus tendon, subacromial bursa, and long head of biceps tendon
Related to shoulder instability and overhead activities Failure of RC muscles to maintain position
Bursitis Overuse Chronic Inflammation
Biceps Brachii Ruptures Caused by powerful concentric & eccentric contraction
Occurs near the origin of muscle Athlete will hear a “SNAP”, then feels sudden intense pain
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Biceps Tendon RuptureBiceps Tendon Rupture
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Throwing MechanicsThrowing Mechanics
Consists of 5 Phases
Windup or Preparation 1st movement until ball leaves glove Lead leg strides forward Both shoulders abduct, externally rotate and horizontally rotate
Cocking Begins when hands separate Ends when Maximum external rotation of humerus has ocurred Lead foot touches ground
Acceleration Lasts from Maximum external rotation until ball release Humerus abducts, horizontally abducts, and internally rotates Scapula elevates, abducts, and rotates upward
Deceleration From ball release until Maximum shoulder internal rotation External rotators of the RC muscles contract eccentrically (lengthening) to decelerate
the humerus Rhomboids contract eccentrically to decelerate the scapula
Follow-through From Maximum shoulder internal rotation until the end of motion When athlete is in balanced position
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Phases of ThrowingPhases of Throwing
www.chrisoleary.com/projects/Baseball/Pitchin...
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Nolan Ryan & Jake PeavyNolan Ryan & Jake Peavy
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Randy JohnsonRandy Johnson