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Shoulder Complex

Shoulder Complex

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Shoulder Complex

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  1. Shoulder Complex

  2. Shoulder Anatomy • Clavicle • Scapula • Humerus • Articulations: • Sternoclavicular joint • Acromioclavicular joint • Glenohumeral joint

  3. Shoulder Anatomy • Ligaments • AC • Glenohumeral lig/joint capsule • Labrum

  4. Shoulder Anatomy • Musculature • “Rotator cuff” • Subscapularis • Supraspinatus • Infraspinatus • Teres Minor • Pectoralis major • Deltoid • Trapezius

  5. Shoulder Anatomy • Musculature • Pectoralis major • Deltoid • Trapezius

  6. Shoulder Anatomy • Subacromial Bursa

  7. Assessing Shoulder Injuries • History • Where is the pain? • Clicking, catching, or popping? • Often indicates labrum • Weakness or fatigue? • Rotator cuff • Observation • Symmetry • deltoid contour • clavicle shape & prominence • AC shape & prominence

  8. Assessing Shoulder Injuries • Palpation • Walk along all bony structures, esp. AC joint & clavicle • Special tests • Muscle testing • “Empty can” test • IR/ER tests • Instability • Many tests…to be learned in other classes, though

  9. Assessing Shoulder Injuries • Special tests • Impingement

  10. Shoulder Injuries • Clavicle Fracture: • Fall On Out-Stretched Hand (FOOSH) or direct blow • Athlete will usually support arm w/ non-injured arm • Gross deformity • Immobilize & treat for shock. Refer for X-rays/consult • Splint in figure 8 brace for 6-8 weeks • Humeral Fracture: • Direct blow, dislocation, or FOOSH • Need X-ray…usually hard to recognize • Splint & refer • Out 2-6 months :(

  11. Shoulder Injuries • Sternoclavicular sprain • Relatively common in sports; FOOSH of direct blow • Usually clavicle will be upward & forward • RICE, immobilization 3-5 weeks • Acromioclavicular sprain • “Separated shoulder” • Direct blow to tip of shoulder or FOOSH • “Piano-key” sign • RICE, immobilize, & refer

  12. Shoulder Injuries • Anterior Glenohumeral Dislocation • Usually posterior force w/ forced external rotation (arm tackle) • Obvious deformity • Flattened deltoid contour • Humerus comes to rest in axilla • Immobilize immediately • RICE

  13. Anterior dislocation

  14. Shoulder Injuries • Shoulder impingement syndrome • Compression of supraspinatus, subacromial bursa, and/or LHBB • Pain, numbness, and tingling • Restore normal biomechanics to shoulder (ther. ex) • Cease causative activity • Rotator cuff tears • Rare in people under 40, but do happen in sports • Usually @ humeral insertion • Pain & weakness • RICE, exercises to restore function • Low weights!!!!!! High reps okay, though

  15. Shoulder Injuries • Thoracic Outlet Compression Syndrome • Overuse disorder • Numbness, burning & tingling in arms & hands • Caused by compression of brachial plexus between upper ribs and clavicle • Treat with therapeutic exercise • Retraction exercises • Upper rib mobilizations

  16. Shoulder Injuries • Bicipital Tenosynovitis • Common in throwing athletes • Typical inflammation • RICE, NSAIDS, Cross friction massage • Subacromial Bursitis • Pain on palpation, positive impingement tests • RICE, NSAIDS

  17. Rehabilitation of The Shoulder Complex • Immobilization after injury • General body conditioning • Shoulder joint mobilization • Flexibility • Muscular strength • Regaining neuromuscular control • Functional progression • Return to activity