The Shoulder Unit 16

1. The ShoulderUnit 16

2. Upper Extremity Injuries • Upper extremities are vulnerable to a variety of injuries depending on the sport, including: • Sprains • Strains • Dislocations • Fractures

3. Upper Extremity Injuries • Upper extremities are vulnerable to a variety of injuries depending on the sport, including: • Separations to the thoracic cage, shoulder, arm, and hand • Repetitive motion injuries such as arthritis, bursitis, tendonitis

4. Shoulder Complex Physiology • Bones • Muscles • Tendons • Ligaments • Articulations

5. Bones • Humerus • Scapula • Clavicle

9. THE JOINTS • Sternoclavicular joint (SC joint) • Sternoclavicular ligament • Coracoclavicular joint • Coracoclavicular ligament • Acromioclavicular joint (AC joint) • Acromioclavicular ligament • Coracoacromial joint • Coracoacromial ligament

10. Glenohumeral joint • Glenohumeral ligaments • Scapulothoracic articulation

14. Muscles in motion FLEXION • Anterior deltoid • Primary mover • Biceps brachii • Secondary mover

15. EXTENSION • Posterior deltoid • Prim. Mover • Triceps brachii • Sec. Mover

16. ABDUCTION • Supraspinatus • 1st 5-10 degrees • Middle deltoid • Last 90 degrees • Trapezius • Assists in movement above 90 degrees

17. ADDUCTION • Latissimus dorsi • Pectoralis major

18. HORIZONTAL FLEXION • Pectoralis major • Anterior deltoid

19. HORIZONTAL EXTENSION • Posterior deltoid • Infraspinatus • Teres minor/major • Rhomboids • Trapezius • Stabilizer

20. CIRCUMDUCTION • Basically all muscles of the shoulder

21. INTERNAL ROTATION • Subscapularis • Pectoralis major • Little help EXTERNAL ROTATION • Infraspinatus • Teres minor/major

22. Scapular Elevation • Scapular Depression • Scapular protraction • Scapular retraction • ****find muscles that perform these motions

25. Assessing Shoulder Injuries • H • O • P • S

26. History • What is the cause of pain? • Mechanism of injury? • Previous history? • Location, duration and intensity of pain? • Creptitus, numbness, distortion in temperature • Weakness or fatigue? • What provides relief?

27. Observation • Elevation or depression of shoulder tips • Position and shape of clavicle • Acromion process • Biceps and deltoid symmetry • Postural assessment (kyphosis, lordosis, shoulders) • Position of head and arms • Scapular elevation and symmetry • Scapular protraction or winging • Muscle symmetry • Scapulohumeral rhythm

28. Palpation • Bony structure palpation should occur bilaterally and simultaneously if possible • Palpate soft tissue structures for point tenderness, swelling, spasms, lumps, guarding or trigger points • Be sure to palpate anteriorly and posteriorly

29. Special Tests • ROM test for external rotation of the shoulder • ROM test for internal rotation of the shoulder • Specific ROM tests for the shoulder including abduction, adduction, flexion, extension, horizontal adduction, horizontal abduction

30. Manual muscle tests for the shoulder • External rotation strength tests • Internal rotation strength test for the shoulder • Extension strength test for the shoulder • Flexion strength test for the shoulder • Abduction and adduction strength tests for the shoulder • Empty can test

31. Apprehension test (Crank test) • Apprehension test used for anterior glenohumeral instability • This motion should not be forced

32. Test for Shoulder Impingement • Neer’s test and Hawkins-Kennedy test for impingement used to assess impingement of soft tissue structures • Positive test is indicated by pain and grimace

33. Test for Supraspinatus Weakness • Empty Can Test • 90 degrees of shoulder flexion, internal rotation and 30 degrees of horizontal abduction • Downward pressure is applied • Weakness and pain are assessed bilaterally

34. Types of Shoulder Injuries Fractures • Clavicle, humerus, scapula • Cause: fall on outstretched arm, direct blow • S/S: pain, deformity, decreased ROM, swelling • Perform percussion test, compression test

35. Treatment • Sling/splint • PRICE • Physcian/EMS • Follow orders • Prevention: • Instruct how to fall • Proper equipment

38. Hockey Clavicle Fracture

41. Dislocations and subluxations • AC, SC, GH jts • Cause: head of humerus forced/displaced from glenoid • S/S: pop, dead arm, pain, deformity, swelling, loss of ROM/strength

42. Treatment • DO NOT relocated • PRICE • Check circulation/sensation • Physician / x-rays • Follow orders • Prevention • Strengthen jt • Proper equipment • Falling

44. Anterior Posterior

45. Posterior

47. Shoulder dislocation-rugby • Dwayne Wade • http://www.youtube.com/watch?v=09ZZbJzeKUA

48. Contusions • Cause: direct blow/bony area or muscles • S/S: pain, decreased ROM, r/o other injuries • Treatment: ice, padding, rehab, flexibility • Prevention: proper equipment, mechanics • Myositisossificans

49. Sprains • Cause: over stretch/tear ligament, capsule • What motions/events would cause this? • S/S: pt tender, weak, swelling, instability, possible deformity, decreased ROM • Treatment • PRICE • Physician, follow orders • Rehab • Prevention • Proper equipment/technique • Strengthening/stretching • Inspect playing areas • Taping/bracing

50. Sternoclavicular Sprain • Cause of Injury • Indirect force, blunt trauma (may cause displacement) • Signs of Injury • Grade 1 - pain and slight disability • Grade 2 - pain, subluxation w/ deformity, swelling and point tenderness and decreased ROM • Grade 3 - gross deformity (dislocation), pain, swelling, decreased ROM • Possibly life-threatening if dislocates posteriorly • Care • PRICE, immobilization • Immobilize for 3-5 weeks followed by graded reconditioning