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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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http://www.pbats.com
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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