the shoulder. anatomy bones 1. sternum - middle of chest 2. clavicle - collar bone 3. humerus -...
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THE SHOULDER
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ANATOMY
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Bones
1. Sternum - middle of chest
2. Clavicle - collar bone
3. Humerus - upper arm
4. Scapula - shoulder blade• Acromion process (knob on top of shoulder)
• Glenoid fossa (socket for the humerus)
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SHOULDER COMPLEX JOINTS Sternoclavicular (SC) Joint
• Only bony attachment between the axial skeleton and the upper extremity
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SHOULDER COMPLEX JOINTS
Acromioclavicular (AC) Joint• Between the lateral end of the clavicle and the
acromion process of the scapula
• Held together by two sets of ligaments
• Painful when injured
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SHOULDER COMPLEX JOINTS Glenohumeral (GH Joint)
• True shoulder joint• Between the head of the humerus and the
glenoid fossa of the scapula• Most freely movable joint of the body• Very unstable
• Head of the humerus is 60% bigger than the glenoid (golf ball on a tee)
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SHOULDER MUSCLES
Pectoralis Major• Front of chest• Horizontal Adduction (like bench press)
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SHOULDER MUSCLES
Deltoid• Over the top of the shoulder• Abduction
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SHOULDER MUSCLES
Latissimus Dorsi• Back of shoulder• Extension
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SHOULDER MUSCLES
Rotator Cuff• Supraspinatus
• Infraspinatus
• Teres Minor
• Subscapularis
• Internal and External Rotation
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SHOULDER MOTIONS
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INJURIES
8 slides with LOTS of info!
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Clavicle Fracture Most fracture sites are in middle 1/3 Most common in adolescents and pre-adolescents Cause:
• Fall on outstretched arm OR tip of shoulder
• Direct impact
S/S• Tilts head to side that is injured
• Supports that arm with other arm
• Clavicle is tender
Care: Immobilize, ice, x-ray, figure-8 brace
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Humerus Fracture Not a common injury in sports Cause
• Direct impact• Fall on outstretched arm
S/S• Inability to move arm• Pain and swelling in upper arm
Care• Splint, sling• Immediate referral to ER
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Sternoclavicular (SC) Sprain Not a common injury - mostly in contact sports Cause
• Fall on shoulder - force goes up the clavicle
S/S – (can be 3 grades)• Usually dislocates anterior and superior - obvious
deformity
• Unable abduct or horizontally adduct arm
Care • RICE, Immobilize shoulder
• Life threatening if it goes posteriorly
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Acromioclavicular (AC) Sprain Very common in athletics Cause
• Fall on outstretched arm OR tip of shoulder
S/S• 1st and 2nd degree - tenderness around joint, will not
want to flex or horizontally adduct
• 3rd degree sprain has obvious deformity
Care• RICE, Immobilize shoulder
• X-rays will determine the degree best – holding weight
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Glenohumeral (GH) Dislocation 95% of all dislocations are anterior
• Can also go inferior or posterior
Once it happens, it is very likely to happen again Cause (anterior):
• Arm is abducted and externally rotated with extra force
S/S• Deltoid will appear flat
• They will hold arm at side and internally rotated
• Unable to use the arm
Treatment • Immobilization, ice and referral to MD to reduce
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Shoulder Impingement Syndrome Cause
• Repetitive overhead motion (i.e. throwing, swimming, volleyball, etc)
• The supraspinatus tendon, a bursa and biceps tendon get trapped in a small space
S/S• Pain with overhead motion
• Weakness in abduction and external rotation
Care• Ice and rest for pain
• Fix the bad habits (biomechanics) that caused the problem
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Rotator Cuff Strains Can go hand in hand with impingement Supraspinatus (SSP) is most often injured Cause
• Overhead motions with force or heavy weight
S/S• Pain – down into deltoid
• Weakness – may not be able to abduct arm with full tear of the SSP
Care• Decrease overhead activity
• Ice or heat
• Rehab to strengthen rotator cuff
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Biceps Tendinitis Common in athletes who use a lot of overhead
motion (throwers) Can go hand in hand with impingement Cause
• Overhead motion
S/S• Pain is in anterior, proximal humerus
• Pain with O/H motion
Treatment• Deep heat
• Ice after activity