shoulder - davis school district / overvie · muscles of the shoulder ... rotator cuff muscles...
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Bony Landmarks
Sternum
Clavicle
Humerus
◦ Head of humerus
◦ Greater tubercle
◦ Lesser tubercle
◦ Bicipital groove
◦ Epicondyles
Greater tubercle
Lesser tubercle
Muscles of the Shoulder
Deltoid
Trapezius
Pectoralis Major
Pectoralis Minor
Serratus anterior
Rhomboid major
Rhomboid minor
Levator scapulae
Coracobrachialis
Biceps brachii
Biceps Brachii
Weakly flexes
shoulder
Two proximal heads
◦ Long head—
supraglenoid tubercle
of scapula
◦ Short head—coracoid
process of scapula
Rotator Cuff Muscles
Collective set of four deep muscles of the GH joint
Supraspinatus
◦ Abduction of the arm
Infraspinatus
◦ External Rotation of the shoulder
Teres Minor
◦ External rotation of the shoulder
Subscapularis
◦ Internal rotation of the shoulder
Ligaments of the Shoulder
Coracoclavicular
Coracoacromial
Coracohumeral
Glenohumeral
Acromioclavicular
Levator Scapula
Rhomboids Minor
Rhomboids Major
Acromioclavicular (AC) joint
Serratus Anterior
Trapezius
Deltoids
Infraspinatus
Teres Minor
OVERUSE INJURIES TO THE SHOULDER
Common Injuries of the Shoulder
Shoulder Impingement Syndrome
Widely used term to describe pain
occurring when space between humeral
head and acromion become narrowed
Bones “impinge” or compress structures
that occupy the subacromial space
Three structures:
◦ Joint capsule
◦ Tendons of rotator cuff
◦ Bursa
Impingement Syndrome
Overhead sports
◦ Baseball, tennis, swimming, volleyball
Signs & Symptoms
◦ Pain and tenderness in GH
◦ Pain and/or weakness with active abduction in mid-range
◦ Limited IR
◦ Confirmation with special tests
Empty can
◦ Point tenderness in subacromial area
Impingement Syndrome—
Treatment
Address biomechanics
Substitute with cross-training until
condition resolves
Limit excessive overhead movement
Rehab exercises & stretching
Rotator-Cuff Strain/Tears
Traumatic injury
◦ i.e. FOOSH
Unusual demands on young athlete
Repetitive use leads to chronic condition
◦ Ultimately tear in tendons
Partial thickness tear
◦ Not completely severe tendon
◦ May respond well to non-op treatment
Full thickness tear
◦ Require surgery
Rotator-Cuff Strains/Tears-
Signs & Symptoms Pain with muscle contraction
“Catching” sensation when arm moved
Inability to sleep on affected side
Varying degrees of disability
Decreased strength
Swelling
Rotator-Cuff Strains/Tears-
Treatment RICE
Limit activity - asymptomatic
Shoulder strengthening
Progressive RTP throwing program
Biceps Tendonitis Discomfort in
anterior shoulder
Often confused with RC tendonitis
Can be caused by impingement
Glenohumeral Dislocation
Forced abduction,
external rotation of
shoulder
Signs and Symptoms
◦ Flattened deltoid
◦ Pain and Swelling
◦ Disability
Requires immediate
care by physician
Additionally injuries
include:
◦ Fractures
◦ Glenoid labral tears
◦ Axillary nerve damage
Glenoid Labrum
Cartilaginous ring that acts to keep the
humeral head positioned on the glenoid
by blocking unwanted movement
Glenoid Labrum Injuries
Injury occur with :
◦ Acute trauma (dislocation)
◦ Repeated trauma
Degenerated tear (baseball
pitchers)
◦ Repetitive subluxation
Labral rim degenerate over
time
Signs & Symptoms
◦ Pain
◦ Catching or popping
sensation
◦ Limited ROM
◦ Varying degrees of
weakness
◦ Special Tests
◦ MRI
SLAP Tear
Superior Labrum
from Anterior to
Posterior
Occurs at point
where biceps tendon
inserts on labrum
Area of relatively
poor blood supply
FOOSH
Repetitive overhead
actions
Lifting a heavy object
Acromioclavicular Separation
Direct blow to tip of
shoulder
◦ FB player falling on tip
of shoulder or
FOOSH
Signs & Symptoms
◦ Pain in vicinity of AC
joint
◦ Possible deformity of
joint depending on
degree of sprain
AC Separation—Treatment
RICE
Rehab
◦ ROM & strengthening as tolerated
◦ Overhead exs not recommended
2nd degree
◦ 3-4 weeks immob
◦ Most painful
3rd degree
◦ 6-8 weeks immob
◦ May leave permanent deformity
Clavicle Fracture
• Fall on tip of shoulder
o FOOSH
• Direct impact
• Signs and Symptoms
o Pain, deformity, and swelling
• Refer to physician
Brachial Plexus Injury
Stinger
Burner
Occurs when head
and neck forcibly
moved/hit to one
side
Nerves and brachial
plexus compressed
on that side
Painful and disabling
Brachial Plexus Group of peripheral
nerves
Leave spinal cord & extend from vertebrae into shoulder
Give arm ability to function
Brachial Plexus Injury—
Signs & Symptoms
Intense pain from neck down to arm
Arm will feel like it’s on fire or have pins-
and-needles sensation
Arm/hand may be weak and numb
Intense pain in area of brachial plexus
Symptoms last several minutes to several
hours or more
Weakness may last for several days
◦ depends on severity of injury
Brachial Plexus Injury—
Treatment Resting neck/arm until pain & symptoms
go away
Ice pack 20 minutes every 3-4 hours
Anti-inflammatories
Strengthening exercises
RTP determined by sports medicine staff
Subsequent stingers cause for further
testing
Brachial Plexus Injury—
Treatment Chronic stingers may
eliminate athlete from contact sports
Scar tissue develops around nerve
◦ ® Causes nerves to become entrapped
If athlete receives another blow, brachial plexus may not be able to flex
◦ shatters instead, tearing major nerves of arm
◦ Causes permanent neurological damage
Avoid by:
◦ Keeping neck and shoulders as strong as possible
◦ Properly fitted equipment
◦ Proper tackling & blocking techniques
Special Tests for Shoulder
Neer’s Impingement
Hawkin’s-Kennedy
Impingement
Speed’s test
Empty Can
Drop-arm Sign
Cross-arm adduction
Anterior apprehension
Posterior glide
Sulcus sign
AC Shear Test
Piano Sign
Apley’s Scratch
Neer’s Impingement
• Seated; stabilize
scapula
• Passively take UE
into full shoulder
flexion with
humerus in
internal rotation
• (+) pain
• Subacromial
Impingement
Hawkin’s-Kennedy • Seated
• Shoulder in 90
degrees of flexion,
slight horizontal
adduction, & maximal
internal rotation
• (+) reproduction of
pain
• Subacromial
Impingement
Speed’s Test
• Seated
• shoulder elevated
75-90 degrees in
sagittal plane, elbow
extended, & forearm
supinated. Resist
elevation
• (+) pain
• Biceps
tendonitis
• Labral instability
Drop Arm Sign
• Sitting/standing
• Passively abduct
shoulder to 90
degrees, then slowly
lowers arm to the
waist
• (+) arm drop to side
or athlete is unable
to slowly lower arm
Apprehension-relocation
• Supine with are @ 90 degrees
of abduction & external
rotation
• 1 had placed as a fulcrum just
posterior to humeral head then
passively move shoulder into
maximal external rotation
against fulcrum of other hand
• (+) reproduction of shoulder
pain, or apprehension with
movement
• Glenohumeral subluxlation
Clunk Test
• Sitting or supine
• Place one hand on
arm above elbow &
other hand on the
posterior aspect of
the humerus; bring
arm into full
abduction; push
humeral head
anterior while other
hand laterally rotates
the humerus
• (+) grind or clunk
• Labrum
instability
AC Shear Test
• Seated
• Upper extremity at
side, clinician
interlaces fingers &
surrounds AC joint;
squeeze hands
together to
compress AC joint
• (+) pain or
excessive
movement at AC
joint
• AC impairment
Piano Key/Sign – AC Separation • Seated or standing
• Clinician presses downward on
elevated end of clavicle
• (+) pain or excessive movement
of clavicle
• AC separation
Empty Can Test—Supraspinatus
• Seated
• Elevate UE to
30-45
degrees in
plane of
scapula with
internal
rotation
(thumb
down); resist
elevation
• (+) pain &
weakness
Lift Off Test—Subscapularis
• Seated
• Hand in the curve of the lumbar spine; lift hand off back &
maintain internal rotation against resistance
• (+) pain or weakness, inability to lift hand off back
Apley’s Scratch – shoulder mobility
• Sitting
• 3 part test
1. Reach across chest
& place hand on
opposite sholder
2. Reach overhead to
place hand between
scapula
3. Reach behind back
as high as possible
*compare bilaterally
• (+) asymetrical motion
1. Restriction in horizontal adduction, IR, scapular protraction
2. Restriction I abduction, ER, scapular upward rotation and elevation
3. Restriction in adduction, IR, scapular downward rotation and retraction
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