Bones: clavicle, scapula, humerus, sternum should
be listed also
SCAPULA
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
trapezius-elevation
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
COMMON INJURIES
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
S&S:
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.
