Shoulder Complex Injuries

Anatomy of the Shoulder

• Ball and Socket Joint– Shallow, which leads to instability– Relies on muscular strength for

stability• The shoulder has 4 different joints and

only 3 bones.• The bones collectively are often called

the “Shoulder Girdle”.

Anatomy of the Shoulder

• BonesBones–Clavicle

•AKA: Collar Bone–Scapula

•AKA: Shoulder Blade–Humerus

Bones of the Shoulder

• Humerus– The rounded end of the humerus fits

into the glenoid fossa of the scapula.

– The humerus has a groove near the top that the biceps tendon slides through (Bicipital groove)

Bones of the Shoulder

• Clavicle–Articulates at the sternum near

the throat and at the tip of the shoulder with the scapula

Bones of the Shoulder

• Scapula– Flat like with a spinous process that runs

laterally across the posterior side

– 2 forward projections that articulate on the anterior aspect of shoulder

• Acromion Process

• Coracoid Process

Ligaments of the Shoulder Complex

• Acromio-clavicular

• Coraco-clavicular

• Coraco-acromial

• Sterno-clavicular

Muscles of the Shoulder

• Rotator Cuff–Subscapularis

–Infraspinatus

–Teres minor

–Supraspinatus

• SITS; remember the acronym

Muscles of the Shoulder

• Rotator Cuff– Internally and externally rotates the humerus– Assists in abduction– Flexes to keep humerus in socket while

throwing and object

• Deltoid– 3 parts: anterior, medial, and posterior– Abducts, flexes, and extends the shoulder

Muscles of the Shoulder

• Pectoralis Major & Minor

– Attach to sternum and anterior humerus

• Biceps Brachii

– Flexes the elbow

– Attaches to the humerus and coracoid process

• Triceps

– Extend the elbow

Joints of the Shoulder Complex

• Gleno-Humeral– Humerus articulates with the glenoid fossa

• Acromial-Clavicular– Clavicle articulates with the acromion process

of the scapula

• Coraco-Clavicular– Clavicle articulates with the coracoid process of

the scapula

• Sterno-Clavicular– Clavicle articulates with the sternum

Preventing Shoulder Complex Injuries

• Often due to muscle weakness

• Over-training the “mirror” muscles

• Weakens opposing muscles (rotator cuff)

• Kyphosis, tight pectorals, or weak posterior muscles are prone to shoulder problems

• “Stand up straight”….makes sense

• Pressure on the bicipital groove

• Balanced training & appropriate padding

Ligament Injuries

• Acromio-clavicular Sprain– A-C sprain or separated shoulder– Impact to the tip of the shoulder or falling on an

out stretched arm– The more severe allows more superior

movement of the clavicle– Graded 1-3; PRICE– Grade 3 is either surgery or harness to realign

joint

Ligament Injuries

• Gleno-humeral Sprain– Most common in abduction and external

rotation– Treat with PRICE– If 3rd degree, possible subluxation or

dislocation- refer to physician

Muscle & Tendon Injuries

• Most injuries are due to overuse

• Rest, ice, immobilization, and rehab

• Most common is the rotator cuff, impingement syndrome, and bicipital tendon problems.

Muscle & Tendon Injuries

• Rotator Cuff Strain– 1st degree- Pain, full ROM– 2nd degree- pain, some loss of ROM, some loss

of stability– 3rd degree- pain, loss of ROM and stability– Most commonly the supraspinatus muscle is

injured– Unable to abduct = 3rd degree sprain- surgery– Repetitive motions lead to crepitus &

impingement syndrome

Muscle & Tendon Injuries

• Impingement Syndrome– Repetitive, overhead motions– Both the biceps tendon and the supraspinatus

tendons run through small space under the acromion process

– Space narrows due to swelling, tendinitis, weak posterior muscle strength, or poor posture- the two muscles get pinched in that space

– Modify activity, strengthen posterior muscles, and improve flexibility of pectorals

Impingement Syndrome

Muscle & Tendon Injuries

• Bicipital Tendinitis– Repetitive motion overhead

– Irritation on biceps tendon

– Possible crepitus

– Stop activity, ultrasound, anti-inflammatory meds and rehab

Muscle & Tendon Injuries

• Biceps Tendon Rupture– This can happen in two instances

• Direct blow to the tendon• Severe contractional forces

– Pain, no flexion of elbow– Muscle rolls up, looks like a golf ball

under the skin– Ice, immobilize, doctor will repair in

surgery

Biceps Tendon Rupture

Bone Injuries

• Clavicular Fractures– Most often fractured at its anatomical

weakness (distal 1/3)

– Deformity, pain, loss of use

– PRICE

– Out of r 6-8 weeks

Clavicular Fracture

Bone Injuries

• Humeral Fractures– Usually mid-shaft

– Refer to doctor, out 6-8 weeks

– Be sure you have a distal pulse at wrist!• May have a serious situation if there is no

pulse• Possible to lose the arm without proper

blood supply.

Bone Injuries

• Gleno-humeral Dislocations and Subluxations– Head of humerus is out of socket

– Excessive abduction and external rotation

– Most common to dislocate anteriorly

– Deformity at the deltoid muscle• Look flat, not round

Bone Injuries

• Gleno-humeral Dislocations and Subluxations– X-ray is needed to r/o bone chips

– There may be permanent damage to nerves blood vessels or cartilage

– Surgery is probable

– A lot of rehab!

G-H Dislocation

G-H Dislocation