1 the shoulder. read pages 450-451 and answer the following questions: 1.what three bones make up...

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The Shoulder

• Read pages 450-451 and answer the following questions:

1.What three bones make up the shoulder girdle?

2.What three articulations make up the shoulder complex?

3.What bones make up each articulation?

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• Bones of the Shoulder Girdle:• _____________• _____________• _____________

• The shoulder complex is made up of four different articulations.• __________________: (____) Formed by the head of the

humerus and the glenoid fossa of the scapula.• ___________________: (____) Formed by the distal end of the

clavicle and the acromion process of the scapula• ___________________: (____) Formed by the scapula and the

thoracic cage.• ____________________: (____________) Formed by the

proximal end of the clavicle and the manubrium of the sternum.

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Glenoid FossaAcromion ProcessCoracoid ProcessSpine Scapula

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Greater TubercleLesser TubercleBicipital GrooveHead of HumerusHumerus

• Flexion• Extension• Adduction• Abduction• Internal Rotation• External Rotation• Horizontal Flexion• Horizontal Extension

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• Scapular Retraction• Scapular Protraction• Scapular Upward Rotation• Scapular Downward Rotation• Elevation• Depression

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• Glenohumeral Joint• ____________ Ligament• _____________ Ligament

• AC Joint• _______________

Ligament• _______________

Ligament• __________ Ligament• __________ Ligament• ________________

Ligament

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• What are the four muscles that make up the rotator cuff?

• 5 minutes

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• Please read pages 452 – 455 and answer the following questions:1. What is the main function of the rotator cuff?2. What four muscles make up the rotator cuff?3. What movement do each produce? (Chart:

Pg. 454)4. Which superficial muscle act to elevate the

arm?5. What is a force couple?

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Group of four muscles of the G-H joint . Subscapularis

IR and ADD Supraspinatus

ABD Infraspinatus

ER Teres Minor

ERFunctions

Stabilization of the head of the humerus in the glenoid fossa.

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• _______________• Add, IR, Flex/Ext.

• _________________• Ext, Add, IR

• ________________• Abd, IR, Ext/ER, Flex/IR

• _________________• Add, IR

• ___________________• Flex, Add.

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• ________________• Scapular Elevation

• ______________• Scapular Retraction• Downward Rotation

• _________________• Elevation• Retraction• Upward Rotation• Depression

• _________________• Depression

• _________________• Protraction• Upward Rotation

• ________________• Depression• Stabilization of the SC joint

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• Injuries are common due to the wide range of motion in the _________________ joint.

• A lot of the injuries to the shoulder complex are sport specific

• Types of Injuries•Fractures•Subluxation / Dislocations•Sprains•Strains

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• Ligament Injuries• A-C Injuries• G-H Injuries• S-C Injuries

• Muscular Injuries• Rotator Cuff Injuries• Biceps Tendon Injuries• Impingement Syndrome• Contusions

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• Clavicle Fracture• Scapular Fractures

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• What is the main function of the rotator cuff muscles?

• 5 minutes

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Read pages 464 and 466 and answer the following questions:1. What are the two types of Rotator

Cuff Tears?2. Which one requires surgery and which

one can be treated non-operatively?3. What are some signs and symptoms

of a full thickness rotator cuff tear?

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• Two Types•_______________ Thickness• Partial tear of the rotator cuff tendon.• ________________

•__________ Thickness• Complete tear of the rotator cuff

tendon.• Requires ______________

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Commonly occur as overuse injuries in the throwing athlete.

Throwing can be broken down into five phases: 1. ________________2. ________________3. ________________4. ________________5. ________________

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Pain within the shoulder especially during the ___________ phase of throwing or swinging.

Pain and difficulty with ___________ and external rotation (90/90) of the arm.

Pain and stiffness __________ hours post practice or competition that involved throwing or swinging.

Point tenderness around the _________ head deep within the deltoid muscle.

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• _____________ _________________• A well designed ______________ ___________

strengthening program is essential.• Focus on training each individual rotator cuff

muscle.• ___________________• ___________________• _____________________• Combination of these movements

• ______________ training is a must.

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• With a partner• Design a 5 step warm-up program for an overhead

athlete.• Include the parameters (how long, how often, etc)• You have access to:• UBE upper body ergometer• Therabands/Theratubes• Manual Therapy

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• Application of ice to relieve pain and swelling.• Discontinue activity.• Refer to physician for further

evaluation.• Some rotator cuff injuries can be

treated non-operatively (Partial-Thickness Tear)• Some must be surgically repaired.

(Full-Thickness Tear)•Why??? (Think Stabilization)

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• Read pages 458-461 and answer the following questions:•What is impingement syndrome?•What three structures are found in the subacromial space?•What are the signs and symptoms of impingement syndrome?

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• ______________ Space• Acromion Process and

the Coracoacromial ligament. (Coracoacromial _______ or ___________)

• The Glenohumeral joint capsule. (________)

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• When the arm is ______________ this space ______________ in size.

• Contents•Long head of the ___________ tendon and joint capsule.• ______________ bursa• ________________ tendon (most common)• Anything that causes a decrease in the

size of the subacromial space can cause an _______________ of one or more of these structures.

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Rotator Cuff PatholgyCongenital defects of the

coracoacromial arch.Odd shaped acromion.

Biceps TendonitisSupraspinatus TendonitisBone Spurs on the inferior part of the

acromion.Subacromial Bursitis

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• Athletes that place the arm _____________ during their sport can often suffer from impingement syndrome.• The signs and symptoms often mimic

those of a _______________ _______ tear.

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G-H painPain when the G-H joint is actively

____________ and __________ ___________.

Point tenderness in the Subacromial Space.

Limited ____________Confirmation with special test.________________________

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RestAnti-inflammatory drugsRehabilitationStrengthen RC and Surrounding Shoulder Muscles.

When all else fails surgery may be required to open up the subacromial space. (_______________)

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• What structures are found in the subacromial space?• 5 minutes

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• Read page 466 and 469 and answer the following questions:

•What is DOMS?•What does PRICE stand for?•What is Biceps Tendonitis?•Get with a partner and palpate the Biceps tendon in the bicipital groove.

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• Long Head of the Biceps Tendon•Runs through the __________ groove of the humerus.•Originates from the supraglenoid tubercle.•Lies within the __________ capsule and subacromial space just beneath the acromion process. (Subacromial Space).•This puts the tendon at risk for impingement when the arm is __________. 45

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Will develop ___________ over time.As it become inflamed, it no longer

fits in the ___________ groove and becomes prone to ______________.It is usually held in place by the ______________________.

This subluxation can also occur acutely with an extreme force commonly generated in throwing.

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• Painful abduction of the shoulder.• Pain in the shoulder when the forearm is ____________against resistance.• Subluxation of the biceps tendon when the forearm is _______ and __________ against resistance.• Pain with shoulder ________ with the elbow _____________.

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• Ice and compression if a subluxation occurs.• Rest• Anti-inflammatory drugs• Progressive rehabilitation.• Surgery may be required if chronic subluxation occurs.

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• What are three signs and symptoms of impingement syndrome?

• What are three methods of treatment?• 5 minutes

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Muscle Strains Can be overuse or traumatic . Often occur at the start of the sports season or with an

increase in activity.

Signs and Symptoms Pain and tenderness over the _________ ________.

(Palpation) Pain with muscle contraction. Pain may be delayed. (_______________)

Treatment _________________ Anti-inflammatory drugs Gentle Stretching

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Read pages 468-470 and answer the following questions:1. What are the four most common traumatic

shoulder injuries?2. Which direction do most shoulder

dislocations occur?3. What is the mechanism for an anterior

shoulder dislocation? What type of activity/sport may cause this?

4. What is the re-injury rate of a shoulder dislocation for an 18 year old athlete.

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•Glenohumeral Joint Dislocations•Acromioclavicular Sprain• Fractures• Tendon Ruptures

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• The __________ head is forced out of the _________ cavity.• Can occur in the following directions:•_________________ (Front and Down)•____________ (Back)•____________ (Down)

• ___________ Dislocation is the most common (95%) 54

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Mechanism of InjuryShoulder ________ with ___________

Rotation. Tackling with outstretched arm.

Signs and SymptomsPossible ___________ of the shoulder___________ arm on affected sidePalpable head of Humerus in _________.Partially ______________ arm with _______

elbow.Pain with any G-H movement.

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• Apply Ice to shoulder and secure with Ace Wrap or Plastic Wrap. Place _________ roll under the axilla.• Apply standard ______ and __________.• Refer to physician for immediate reduction and X-Rays.• Treat for __________ if necessary.

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• ____% of all G-H dislocations will recur in athletes younger than ____ years old.• Why????•This is due to the stretching of the ____________ ______ and __________ of the supporting musculature.

• May have to be surgically repaired.• Chronic dislocation/subluxation can

also cause an injury to the glenoid _______. 59

• Read page 470 -471 and answer the following questions:

1. What is the glenoid labrum and where is it located?

2. What is the function of the Glenoid Labrum?

3. What are the signs and symptoms of a Glenoid Labrum tear or injury?

4. How would you treat a glenoid labrum tear?

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• A ring of ________ attached to the margin of the glenoid cavity.

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• Functions to help ________ the head if the humerus within the glenoid cavity.• Mechanism of Injury•Traumatic __________ of the shoulder.•___________ Tear:• Repetitive stress due to an ___________. (GH joint being too loose).

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• Signs and Symptoms• Pain deep within the shoulder.• __________ or ___________ when the shoulder is rotated.• Shoulder weakness.• Decrease ability to use the arm.

• Treatment• Refer to physician for diagnosis.• MRI, X-Ray

• Surgery may be required.• Shoulder strengthening program.• Rotator Cuff

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• Read the section titled “Acromioclavicular Injuries” on pages 473-474 and answer the following questions.1. What two boney structures form the A-

C joint?2. What is the number one mechanism of

injury for an A-C sprain?3. How would you care for someone with

an A-C joint injury?64

Articulation between the distal end of the _________ and the __________.

Soft Tissue SupportAnterior Deltoid MusclesTrapezius MusclesAcromioclavicular Ligaments

Superior Inferior

Coracoclavicular ligament Trapezoid ligament Conoid ligament.

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Three types of Injuries1. __________: A-C ligament is

partially injured. The articulation is stable. Pain is the primary symptom.**

2. ________: AC joint capsule and CC ligaments partially disrupted. Articulation is stable.

3. __________: AC joint capsule and CC ligaments completely disrupted. Superior displacement of the clavicle. (________ key sign) 1. AKA: Shoulder Separation

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http://biomed.brown.edu/Courses/BI108/BI108_2004_Groups/Group01/mechSSD.htm

Mechanism of Injury_________ blow to the outer end of the

clavicle.Fall forward on an outstretched arm.______________

Signs and SymptomsSwellingPoint-TendernessDiscolorationPain with any movement

Horizontal Flexion+ Piano Key Sign (Grade __ only)

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• Application of Ice Pack secured with Ace Wrap or Plastic Wrap.• Apply sling and swath bandage.• Refer to physician for X-ray.• Immediately for Grade III or if signs or shock are present.

• Possible Surgical Intervention may be required.

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• Most occur at the mid-shaft of the bone.•This is the thin/flat portion.

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Mechanism of Injury Direct Blow Fall on outstretched hand or tip of shoulder. FOOSH

Signs and Symptoms Swelling or deformity (Could be an _________ fracture) Discoloration Point tenderness Pain with ___________ flexion Athlete may hear or feel a “___________” Athlete will be holding the arm in a ______________

position.Treatment

Treat for shock Immobilize Use ice pack Apply a sterile dressing to any wounds. Arrange for transport to a medical facility.

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• Commonly happens to ___________- athletes.

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