The shoulder complex

1. The shoulder complex

2. Anatomy - Bones

3. Anatomy - Ligaments

4. Anatomy - Muscles • Flexors • Pectoralis Major • Deltoid • Coracobrachialis • Biceps Brachii • Extensors • LatissimusDorsi • Deltoid • Teres Major • Triceps Brachii

5. Anatomy - Muscles • Abduction • Deltoid • Supraspinatus • Biceps Brachii • Adduction • Pectoralis Major • LatissimusDorsi • Infraspinatus • Teres Major • Coracobrachialis • Trapezius (Scapula) • Rhomboideus Major & Minor (Scapula)

6. Anatomy - Muscles • Internal Rotation • Pectoralis Major • LatissimusDorsi • Deltoid • Subscapularis • Teres Major • External Rotation • Supraspinatus • Infraspinatus • Teres Minor • Deltoid

7. Anatomy - Muscles • Horizontal Abduction • Deltoid • Infraspinatus • Teres Minor • Horizontal Adduction • Deltoid • Pectoralis Major

8. Anatomy - Muscles • Elevators • Trapezius (Scapula) • Levator Scapulae (Scapula) • Depressors • LatissimusDorsi (Humerus) • Trapezius (Scapula) • Pectoralis Minor (Scapula)

9. Scapular Motion • Elevation • Levator scapulae • Rhomboid major/minor • Serratus Anterior • Trapezius (Upper) • Depression • Serratus Anterior • Trapezius (Lower) • Pectoralis Major

10. Scapular Motion • Protraction • Serratus Anterior • Retraction • Rhomboid Major/Minor • Trapezius (Middle/Lower) • Upward Rotation • Serratus Anterior • Trapezius (Upper/Lower) • Downward Rotation • Rhomboid Major/Minor • Levator Scapulae

11. Brachial Plexus

12. Winging Scapula • Can occur because of weakness of the periscapula muscles (especially the serratus anterior and middle/lower trapezius) and occurs secondary to long thoracic nerve trauma • Scapula stabilization is necessary for normal arm movement

13. Forward/Rounded Shoulder Posture • Caused by a slouched posture, shortened anterior chest muscles, elongation of the posterior interscapula muscles (lower/middle trapezius and rhomboids), and abnormal cervical and thoracic spine curvatures • Consequences of FSP: degeneration of AC joint, bicipital or rotator cuff tendinitis or impingment, muscle weakness, myofascial pain and trigger points, posterior capsular tightness, excessive back flexion, and thoracic outlet syndrome

14. Shoulder Injuries • Sternoclavicular Sprain • MOI: Indirect force transmitted through the humerus by a blow that strikes the poorly padded clavicle by twisting of a posteriorly extended arm.

15. Shoulder Injuries • Acromioclavicular Sprain • MOI: • Direct impact to the tip of the shoulder that forces the acromion process downward, backward, and inward while the clavicle is pushed down against the rib cage • Fall on an outstretched arm Step-Off Deformity

16. Shoulder Injuries • Glenohumeral Joint Sprain • MOI: • Anterior: Arm is forced into abduction, external rotation, or direct blow. • Posterior: A forceful movement of the humerusposteriorly when the arm is flexed.

17. Shoulder Injuries • Anterior Glenohumeral Dislocation • MOI: • Direct impact to the posterior or posterolateral aspect of the shoulder. • Forced abduction, external rotation, and extension

18. Shoulder Injuries • Posterior Glenohumeral Dislocation • MOI: Forced adduction and internal rotation or a fall on an extended and internally rotated arm

19. Shoulder Injuries • Superior Labrum Anteroposterior (SLAP) Lesion • MOI: Compression and inferior traction

20. Shoulder Injuries • Shoulder Impingement Syndrome • MOI: • Mechanical compression of the supraspinatus tendon, the subacromial bursa, and the biceps brachii (long head) tendon causing a decrease in space in the coracoacromial arch • Postural alignments: Forward head, rounded shoulders, increased kyphotic curve

21. Shoulder Injuries • Frozen Shoulder (Adhesive Capsulitis) • Contracted and thickened joint capsule that is tight around the humeral head with little synovial fluid. • The individual progressively resists any movement to the shoulder making it stiff or “frozen” because of the pain

22. Shoulder Injuries • Thoracic Outlet Compression Syndrome • Compression on the brachial plexus, subclavian artery, and subclavian vein in the neck and shoulder. • MOI: • Compression of the neurovascular bundle between the first rib and clavicle • Compression between the anterior and middle scalene muscles • Compression by pec minor as the bundle passes beneath the corocoid process or between the clavicle and first rib • Presence of a cervical rib (an abnormal rib originating from a cervical vertebra and the thoracic rib)

23. Shoulder Injuries • Biceps Brachii Rupture • MOI: Powerful concentric or eccentric contraction

24. Shoulder Injuries • BicipitalTenosynovitis • MOI: Repeated stretching of the biceps in highly ballistic activities (pitchers, tennis players, volleyball players, and javelin throwers) may cause an irritation of the tendon and the synovial sheath

25. Throwing Mechanics • Windup • Cocking • Acceleration • Deceleration • Follow-through

26. Shoulder Pad Fitting • Width of shoulders is measured to determine proper size of pads • The inside shoulder pad should cover the tip of the shoulder in a direct line with the lateral aspect of the shoulder • Deltoid should be covered, and all motion required by athlete’s positions hould be permitted • Neck opening must allow athlete to raise their arms overhead but not allow the pad to slide back and forth • Straps underneath the arm must hold pads firmly in place but must not constrict soft-tissue Cantilever Non-Cantilever

27. QUESTIONS/COMMENTS?