Transcript Shoulder Complex

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Clavicle
Scapula
Humerus
Articulations:
 Sternoclavicular joint
 Acromioclavicular joint
 Glenohumeral joint
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Ligaments
 AC
 Glenohumeral lig/joint
capsule
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Labrum
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Musculature
 “Rotator cuff”
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Subscapularis
Supraspinatus
Infraspinatus
Teres Minor
 Pectoralis major
 Deltoid
 Trapezius
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Musculature
 Pectoralis major
 Deltoid
 Trapezius
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Subacromial Bursa
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History
 Where is the pain?
 Clicking, catching, or popping?
 Often indicates labrum
 Weakness or fatigue?
 Rotator cuff
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Observation
 Symmetry
 deltoid contour
 clavicle shape & prominence
 AC shape & prominence
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Palpation
 Walk along all bony structures, esp. AC joint &
clavicle
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Special tests
 Muscle testing
 “Empty can” test
 IR/ER tests
 Instability
 Many tests…to be learned in other classes, though
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Special tests
 Impingement
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Clavicle Fracture:
 Fall On Out-Stretched Hand (FOOSH) or
direct blow
 Athlete will usually support arm w/ noninjured arm
 Gross deformity
 Immobilize & treat for shock. Refer for Xrays/consult
 Splint in figure 8 brace for 6-8 weeks
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Humeral Fracture:
 Direct blow, dislocation, or FOOSH
 Need X-ray…usually hard to recognize
 Splint & refer
 Out 2-6 months :(
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Sternoclavicular sprain
 Relatively common in sports; FOOSH of direct blow
 Usually clavicle will be upward & forward
 RICE, immobilization 3-5 weeks
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Acromioclavicular sprain
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“Separated shoulder”
Direct blow to tip of shoulder or FOOSH
“Piano-key” sign
RICE, immobilize, & refer
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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
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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
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Rotator cuff tears
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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
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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
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Bicipital Tenosynovitis
 Common in throwing athletes
 Typical inflammation
 RICE, NSAIDS, Cross friction massage
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Subacromial Bursitis
 Pain on palpation, positive impingement tests
 RICE, NSAIDS
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Immobilization after injury
General body conditioning
Shoulder joint mobilization
Flexibility
Muscular strength
Regaining neuromuscular control
Functional progression
Return to activity