Lesson Objectives

1. Lesson Objectives • Learning the anatomy of the shoulder • Bones • Muscles • Joints • Ligaments • Anatomical Movements & Positions • Shoulder injury prevention

2. Bony Anatomy The Shoulder is comprised of 2 different joints: Name – Glenohumeral (GH) Type – Synovial “Ball & Socket” joint (humerus & scapula) Often referred to as the Shoulder “girdle” Relies on muscular strength for stability Name - Acromioclavicular (AC) Type - Gliding Joint (Clavicle & Scapula) Bones: humerus – upper arm bone Head of the humerus is round, smooth & fits into the glenoidfossa Clavicle – collarbone Scapula – shoulder blade 2 forward projections – Acromion & Coracoid Processes

4. Structures of the shoulder

5. Structures of the Shoulder

6. Structures of the shoulder Bicipital Groove

7. Muscular Anatomy Rotator Cuff – comprised of four muscles: • Subscapularis • Infraspinatus • Teres Minor • Supraspinatus • Responsible for internal & external rotation and abduction of the shoulder.

10. Anterior muscles of the shoulder

13. GH Joint Movements • Abduction – away from the midline • Adduction – toward the midline • Horizontal Abduction/adduction – occurs with shoulder in 90* of flexion • Flexion – arm moves anteriorly in sagittal plane • Extension – arm returns to anatomical position • Internal rotation – toward midline of body • External rotation – away from midline of body • Circumduction – arm transcribes a circle

14. GH Joint Movements Circumduction

15. Scapular Movements • Elevation- scapula moves superiorly • Depression-scapula moves inferiorly • Retraction – scapula moves toward midline • Protraction – scapula moves away from midline • Upward rotation – scapula rotates laterally & superiorly • Downward rotation – scapula rotates medially & inferiorly

16. Scapular Movements

17. Shoulder and Scapular muscles & movements • https://www.youtube.com/watch?v=aSyp3AyseUQ

18. Preventing Shoulder Injuries • Predispositions to shoulder injury include: • Rounded Shoulders – poor posture (excessive Kyphosis) • Tight pectoralis muscles • Muscle imbalance – weak posterior muscles • Causes of injury: • Improper technique • Repetitive movements – overuse • Nature of the game – amount of contact

19. Shoulder Separation • Acromioclavicular Ligament Sprain – • Caused by: • direct impact to the top of the shoulder • Falling on a outstretched arm • Symptoms include pain on movement – • More serious sprains cause clavicle to move superiorly (creating a bump) • Athlete will hold arm in tight next to body • Treatment – 1st or 2nd degree - PRICE • 3rd degree either surgery or use of harness

21. Glenohumeral Ligament Sprain • GH Joint especially vulnerable when abducted & externally rotated • 3rd degree GH Ligament sprain usually results in subluxation or dislocation of the joint.

22. Dislocations & Subluxations • Dislocation (luxation) – when bones come apart and do not go back together on their own • Subluxation – when bones come temporarily come apart but go immediately back on their own • Caused by excessive abduction & external rotation • Most common type of dislocation is an anterior shift of the head of the humerus • Sometimes causes capsular ligament tear • Xray determines extent of damage which could also include, fractures cartilage tears & nerve or blood vessel injury

23. Dislocations & Subluxations (cont’d) • Physician must put dislocation back in place • Repetitive subluxations/dislocations can cause permanent damage • Athlete should: • strengthen adduction & internal rotation muscles. • Can wear a restrictive harness • Surgical repair of the capsular ligaments

24. Shoulder Dislocation X-Ray

25. Braces & Wraps • http://sportsmedicineinternational.com/services/taping-shoulder Rotator Cuff/Dislocation Brace Subluxation/Dislocation Braces

26. Rotator Cuff Strain • Caused by excessive motion • Supraspinatus is most often injured • Symp. Include pain on motion especially abduction • 3rd degree must be surgically repaired • Strains can also lead to crepitus and impingement syndrome

27. Impingement Syndrome • Inflammation of the supraspinatus and biceps tendons or subacromial bursa underneath the AC • Develops from repetitive overhead movements (i.e. freestyle swimming, throwing, tennis serve) • Treatment includes: • modified activity • Strengthening posterior shoulder muscles • Improving flexibility of tight pectoralis muscles

28. Biceps tendon Injuries • Bicipital Tendinitis – • Caused by repetitive overhead movements • Irritation of biceps tendon in bicipital groove • Must avoid action / immobilization (sling) • Biceps Tendon Rupture – • 2 causes – direct blow or severe contractional forces • Muscle & tendon balls up – athlete unable to flex arm • Must be surgically reattached

29. Bone Injuries • Clavicle fractures – caused by direct blow or fall on the tip of the shoulder • Common fracture is the distal 3rd (clavicle’s weakest point) • Uses clavicle harness for approx. 6 weeks • Epiphysis Fractures – common with teenage pitchers (excessive throwing) • Avulsion Fractures – possible injury when AC or GH sprain occurs

30. Labrum Injuries • Labrum is a cartilaginous ring that surrounds the glenoid fossa. • It’s purpose is to deepen the socket (making it harder to dislocate/sublux the humerus) • SLAP lesion is the most common tear of the labrum (Superior Labrum Anterior Posterior)

34. Shoulder evaluation progression https://www.youtube.com/watch?v=VGTrSpX70UM

35. Rotator Cuff Animated Repair • http://www.youtube.com/watch?v=bgv8tmWzmnI • Actual arthroscopic clips – • http://www.youtube.com/watch?v=6-Mm6-Nrus4&feature=related

36. Labrum Repair Animated clip • http://www.youtube.com/watch?v=GhiVHLOJpCY&feature=related • Actual arthroscopic surgery- • http://www.youtube.com/watch?v=RnaZ6s1xqLU http://www.youtube.com/watch?v=yw8X6zvoM0w