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Comprehensive Overview of Shoulder Complex Anatomy, Injuries, and Management Strategies

This chapter delves into the intricate anatomy of the shoulder complex, covering bones like the clavicle, humerus, and scapula, as well as the associated ligaments and muscles, including the rotator cuff (S.I.T.S.). It explores the nerve and blood supply, assessment methods, and management of various shoulder injuries, including fractures, sprains, dislocations, and chronic instabilities. Detailed management protocols highlight the use of RICE, immobilization, and surgical options. This resource is essential for understanding the complexities of shoulder injuries in both acute and chronic scenarios.

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Comprehensive Overview of Shoulder Complex Anatomy, Injuries, and Management Strategies

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  1. ATC 222 Chapter 21 The Shoulder Complex

  2. Anatomy • Bones • clavicle • humerus • scapula

  3. Ligaments • Sternoclavicular • Acromioclavicular • Glenohumeral

  4. Muscles • Rotator Cuff • S.I.T.S. • surrounding musculature

  5. Nerve Supply • Brachial Plexus C5-T1

  6. Blood Supply • Subclavian Artery • Axillary Artery • Brachial Artery

  7. Shoulder Assessment • H.O.P.S. • History • Observation • Palpation • Special Tests

  8. Recognition & Management of Specific Injuries

  9. Fractures • Clavicular • Humerus • Shaft • Proximal • Epiphyseal

  10. Clavicular Fractures • Etiology • fall on outstretched arm or tip of shoulder • direct impact • Signs and Symptoms • supports the arm on the injured side tilting the head toward that side and the chin opposite

  11. Clavicular Fractures • Management • apply sling and swathe • refer for x-ray • immobilize 6-8weeks

  12. Humeral Fractures-Shaft • Etiology • direct blow or fall on the arm • Signs and Symptoms • probable deformity • wrist drop and inability to supinate the wrist

  13. Humeral Fractures-Shaft • Management • splint and referral to a physician • 3-4 months

  14. Humeral Fractures-Proximal • Etiology • direct blow, fall on outstretched arm, or dislocation • Signs and Symptoms • often mistaken for a shoulder dislocation • possible severe hemorrhaging

  15. Humeral Fractures-Proximal • Management • sling and swathe and referral • 2-6 months

  16. Humeral Fractures-Epiphyseal • Etiology • direct blow or indirect force along the axis of the humerus • Signs and Symptoms • shortening of the arm • appearance of a false joint • Management • splint and referral to a physician • immobilization for 3 weeks

  17. Sprains • Sternoclavicular • Acromioclavicular • Glenohumeral;

  18. Sternoclavicular Sprain • Etiology • indirect force transmitted through the humerus • twisting of an posteriorly extended arm • Signs and Symptoms • Grade 1 • Grade 2: visible deformity and inability to abduct arm

  19. Sternoclavicular Sprain • Grade 3: complete dislocation, if posterior, it’s a MEDICAL EMERGENCY

  20. Sternoclavicular Sprain • Management • RICE • reduction, immobilization 3-5weeks

  21. Acromioclavicular Sprain • Etiology • direct impact to tip of shoulder • upward force against long axis of humerus, falling on outstretched arm

  22. Acromioclavicular Sprain • Signs and Symptoms • Grade 1: • Grade 2: prominent lateral end of clavicle, unable to completely abduct or horizontally adduct • Grade 3: rupture the AC and Coracoclavicular ligaments resulting in a dislocation of clavicle, very prominent distal clavicle

  23. Acromioclavicular Sprain • Management • apply ice and sling and swathe • referral • Grade 1: 3-4 days • Grade 2: 10-14 days • Grade 3: 2 weeks, Operative vs. Non-operative

  24. Glenohumeral Joint Sprain • Etiology • forceful abduction and ER • forceful movement posteriorly with flexion of arm • Signs and Symptoms • decreased ROM • pain with reproduction of mechanism

  25. Glenohumeral Joint Sprain • Management • ice and sling for comfort • initiate active and passive ROM after 1-3 days

  26. Acute Subluxations & Dislocations • accounts for up to 50% of all dislocations • only 1-4% are posterior • 85-90% recur

  27. Glenohumeral Dislocations-Anterior • Etiology • direct impact on posterolateral or posterior aspect of shoulder • forced abduction and ER

  28. Glenohumeral Disloccations-Anterior • Signs and Symptoms • flattened deltoid contour • humeral head in the axilla • arm carried in slight abduction and ER

  29. Glenohumeral Dislocations-Anterior • Management • immobilize in sling and application of ice • referral to a physician for reduction and x-ray • DO NOT attempt to reduce

  30. Glenohumeral Dislocation-Posterior • Etiology • forced adduction and IR • fall on extended and internally rotated arm • Signs and Symptoms • arm held in adduction and internal rotation • head of humerus may be seen posteriorly

  31. Chronic Shoulder Instabilities • Etiology • traumatic (micro vs. macro), atraumatic, congenital, and neuromuscular • Signs and Symptoms • Anterior • Posterior • Global

  32. Chronic Shoulder Instabilities • Management • Conservative vs. Surgical • shoulder harness

  33. Shoulder Impingement Syndrome • Etiology • repetitive overhead activities • capsular laxity leading to inflammation • forward head and rounded shoulders • hooked shaped acromion process

  34. Rotator Cuff Tears • partial thickness vs. complete thickness tears • acute trauma or impingement • nearly always involves the supraspinatus muscle

  35. Shoulder Impingement Syndrome • Signs and Symptoms • diffuse pain around the acromion • pain with overhead activities • weak external rotators

  36. Shoulder Impingement Syndrome • Stage I • aching after activity • pain with abduction that becomes worst at 90 degrees • pain with flexion and resisted supination and external rotation • Stage II • aching during activity that becomes worst at night, restricted movement

  37. Shoulder Impingement Syndrome • Stage III (25-40) • pain during activity with increase pain at night • possible muscle tear and permanent thickening of rotator cuff & bursa • scar tissue

  38. Shoulder Impingement Syndrome • Stage IV (40+) • infraspinatus and supraspinatus wasting • a lot of pain with abduction to 90 • limited AROM and PROM • weakness during abduction and ER

  39. Shoulder Impingement Syndrome • Management • RICE • Modification of activity • Strengthening of ER and Scapular Stabilizers • Surgery vs. Injection

  40. Shoulder Bursitis • Etiology • fall on tip of shoulder • direct impact or shoulder impingement • Signs and Symptoms • pain with abduction, flexion and IR • Management • cold, antiinflammatory medications

  41. Bicipital Tenosynovitis

  42. Biceps Brachii Rupture

  43. Peripheral Nerve Injuries • Etiology • blunt trauma or stretch • Signs and Symptoms • constant “burning” pain, muscle weakness and atrophy • paralysis

  44. Peripheral Nerve Injuries • Management • ice • resume play when symptoms subside • referral to a physician is ESSENTIAL if symptoms persist

  45. Thoracic Outlet Compression Syndrome • Etiology • compression of brachial plexus, subclavian artery and vein (neurovascular bundle) • compression by the scalene and pectoralis mucles

  46. Thoracic Outlet Compression Syndrome • Signs and Symptoms • paresthesia and pain • impaired circulation in the fingers • muscle weakness and atrophy

  47. Thoracic Outlet Compression Syndrome • Management • stretching of pectorals and scalenes • strengthening of the traps, rhomboids, serratus anterior

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