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Athletic Training Material

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Care and Prevention Chapter 22

The Shoulder Complex

Bones:  clavicle, scapula, humerus, sternum should be listed also
Acromion process
Coracoid process
Scapula spine
Medial and lateral borders
Glenoid fossa 

Joints: Sternoclavicular (SC), acromioclavicular (AC), glenohumeral (G-H), scapulothoracic

Ligaments: sternoclavicular, acromioclavicular, glenohumeral joint capsule, coracoclavicular

G-H joint movements:  flexion, extension, abduction, adduction, internal rotation, external rotation, horizontal abduction, horizontal adduction, circumduction
Shoulder girdle movements:  elevation, depression, protraction, retraction, upward rotation, downward rotation  THESE MOVEMENTS INVOLVE THE SCAPULA, AND ARE INDEPENDENT OF HUMERAL MOVEMENT

Muscles: deltoid-abduction
pectoralis major- horizontal adduction
pectoralis-horizontal adduction, adduction
latissimus dorsi- extension, adduction, internal rotation
teres major- extension, adduction, internal rotation
Rotator cuff muscles (4)
Supraspinatus- abduction
Infraspinatus- external rotation
Teres minor- external rotation
Subscapularus- internal rotation

* The throwing mechanism consists of five phases:  windup, cocking, acceleration, deceleration, follow-through


Brachial plexus compression (burner or stinger)
MOI:  compressive force to superior shoulder
S&S:  tingling, numbness in arm and fingers
Treatment:  Usually temporary with return of full sensations in arm.  HOWEVER, MAY RESULT FROM FRACTURE OF CLAVICLE.  ATTEMPTS SHOULDER BE MADE TO RULE OUT FRACTURE
A/C sprain (shoulder separation) (MAY BE CLASSIFIED UP TO 6 DEGREES)
MOI:  fall on the point of the shoulder
1st degree- point tender, slight loss of ROM, minimal weakness, no deformity=1st degree tear of AC ligament  (stretching of AC ligament, no CC involvement)
2nd degree- point tender, loss of ROM especially with overhead motion, visual and palpable instability (piano key deformity)= 2nd- 3rd degree tear of AC ligament and 1st - 2nd degree tear of CC ligament  (tear of AC ligament, stretching of CC ligament) 
3rd degree- just like second degree, but more unstable AC joint= 3rd degree tear of AC and CC ligament  (tearing of both the AC and CC ligaments)
Treatment: Ice, stabilize the joint by sling and swathe, refer to physician
They will always have this deformity once the injury has occurred, but AC joint will stabilize.  Depending on the severity, AC separation may cause instability which is seen as rubbing or grinding long after initial injury.  This normally doesn't cause any complications. 

*Glenohumeral dislocation:
Usually anterior and inferior dislocation
MOI: abduction with external rotation, humeral head is forced anteriorly and becomes trapped under the coracoid process
S&S: obvious deformity, pain
Treatment: immobilize, ice, refer to physician for reduction, for minors call 911, the more it comes out the easier it is to reduce, the longer it is out, the harder it is to reduce.
Glenoid Labrum- cartilage rim around socket
Hill-Sachs lesion- permanent defect after dislocation to posterior lateral aspect of the humeral head
Bankart lesion- permanent anterior defect on labrum caused by a lesion to glenoid labrum and capsule
SLAP lesion- defect caused by an injury to the superior aspect of labrum that begins posteriorly and extends anteriorly and affects the attachment of the long head of the biceps to the superior labrum

Clavicle Fracture (usually occur to the middle third of clavicle)
MOI: fall on point of shoulder or direct impact
S&S: guarding, injured clavicle appears lower, deformity, crepitus, pain
Treatment: Figure 8 splint, sling, Ice, refer to physician

Sternoclavicular sprain/dislocation
MOI: direct blow to shoulder
S&S: pain, loss of shoulder ROM especially adduction and elevation, deformity
Treatment: ice, sling, figure 8 splint

Humerus Fracture
MOI: Direct blow, dislocation, falling on outstretched arm
S&S: Pain, inability to raise arm, deformity, pnt tenderness, loss of circulation, loss of sensation in distal arm, ecchymosis
Treatment: splint and refer

Rotator Cuff Impingement Syndrome
MOI: mechanical compression of the supraspinatus tendon between acromion and humeral head, resulting in inflammation of the supraspinatus and subacromial bursa. Usually as a result of repetitive over head activities
S&S: loss of ROM, Rotator cuff weakness(especially the supraspinatus), pain, pnt tender in sub-acromion space
Treatment: Ice, E-stim, ultrasound, rehab exercise (no overhead exercises)

Rotator Cuff Strain
MOI: falling on shoulder, over head activities, throwing (deceleration phase)
S&S: pain, decreased ROM, rotator cuff weakness
Treatment: Ice, Rest, E-stim, ultrasound (post acute), light stretching, rehab exercises, NSAID
Injury usually occurs to supraspinatus and infraspinatus because they decelerate the arm during throwing
Empty can test- has the athlete bring both arms into 90 degrees of forward flexionand 30 degrees of horizontal abduction.  In this position, the arms are internally rotated as far as possible, thumbs pointing downward.  Downward pressure is then applied by the evaluator.  Weakness and pain can be detected as well as comparative strength between the two arms. 
Drop arm test- have athlete hold arms abducted as far as possible and then slowly lowers it to 90 degrees.  From this position the athlete with a torn supraspinatus muscle will be unable to lower the arm further with control.  If the athlete can hold the arm in a 90-degree position, pressure on the wrist will cause the arm to fall. If arm falls or athlete is unable to hold it up, test is positive for rotator cuff tear.

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