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ATC 222

ATC 222. Chapter 21 The Shoulder Complex. Anatomy. Bones clavicle humerus scapula. Ligaments. Sternoclavicular Acromioclavicular Glenohumeral. Muscles. Rotator Cuff S.I.T.S. surrounding musculature. Nerve Supply. Brachial Plexus C5-T1. Blood Supply. Subclavian Artery

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ATC 222

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  1. ATC 222 Chapter 21 The Shoulder Complex

  2. Anatomy • Bones • clavicle • humerus • scapula

  3. Ligaments • Sternoclavicular • Acromioclavicular • Glenohumeral

  4. Muscles • Rotator Cuff • S.I.T.S. • surrounding musculature

  5. Nerve Supply • Brachial Plexus C5-T1

  6. Blood Supply • Subclavian Artery • Axillary Artery • Brachial Artery

  7. Shoulder Assessment • H.O.P.S. • History • Observation • Palpation • Special Tests

  8. Recognition & Management of Specific Injuries

  9. Fractures • Clavicular • Humerus • Shaft • Proximal • Epiphyseal

  10. Clavicular Fractures • Etiology • fall on outstretched arm or tip of shoulder • direct impact • Signs and Symptoms • supports the arm on the injured side tilting the head toward that side and the chin opposite

  11. Clavicular Fractures • Management • apply sling and swathe • refer for x-ray • immobilize 6-8weeks

  12. Humeral Fractures-Shaft • Etiology • direct blow or fall on the arm • Signs and Symptoms • probable deformity • wrist drop and inability to supinate the wrist

  13. Humeral Fractures-Shaft • Management • splint and referral to a physician • 3-4 months

  14. Humeral Fractures-Proximal • Etiology • direct blow, fall on outstretched arm, or dislocation • Signs and Symptoms • often mistaken for a shoulder dislocation • possible severe hemorrhaging

  15. Humeral Fractures-Proximal • Management • sling and swathe and referral • 2-6 months

  16. Humeral Fractures-Epiphyseal • Etiology • direct blow or indirect force along the axis of the humerus • Signs and Symptoms • shortening of the arm • appearance of a false joint • Management • splint and referral to a physician • immobilization for 3 weeks

  17. Sprains • Sternoclavicular • Acromioclavicular • Glenohumeral;

  18. Sternoclavicular Sprain • Etiology • indirect force transmitted through the humerus • twisting of an posteriorly extended arm • Signs and Symptoms • Grade 1 • Grade 2: visible deformity and inability to abduct arm

  19. Sternoclavicular Sprain • Grade 3: complete dislocation, if posterior, it’s a MEDICAL EMERGENCY

  20. Sternoclavicular Sprain • Management • RICE • reduction, immobilization 3-5weeks

  21. Acromioclavicular Sprain • Etiology • direct impact to tip of shoulder • upward force against long axis of humerus, falling on outstretched arm

  22. Acromioclavicular Sprain • Signs and Symptoms • Grade 1: • Grade 2: prominent lateral end of clavicle, unable to completely abduct or horizontally adduct • Grade 3: rupture the AC and Coracoclavicular ligaments resulting in a dislocation of clavicle, very prominent distal clavicle

  23. Acromioclavicular Sprain • Management • apply ice and sling and swathe • referral • Grade 1: 3-4 days • Grade 2: 10-14 days • Grade 3: 2 weeks, Operative vs. Non-operative

  24. Glenohumeral Joint Sprain • Etiology • forceful abduction and ER • forceful movement posteriorly with flexion of arm • Signs and Symptoms • decreased ROM • pain with reproduction of mechanism

  25. Glenohumeral Joint Sprain • Management • ice and sling for comfort • initiate active and passive ROM after 1-3 days

  26. Acute Subluxations & Dislocations • accounts for up to 50% of all dislocations • only 1-4% are posterior • 85-90% recur

  27. Glenohumeral Dislocations-Anterior • Etiology • direct impact on posterolateral or posterior aspect of shoulder • forced abduction and ER

  28. Glenohumeral Disloccations-Anterior • Signs and Symptoms • flattened deltoid contour • humeral head in the axilla • arm carried in slight abduction and ER

  29. Glenohumeral Dislocations-Anterior • Management • immobilize in sling and application of ice • referral to a physician for reduction and x-ray • DO NOT attempt to reduce

  30. Glenohumeral Dislocation-Posterior • Etiology • forced adduction and IR • fall on extended and internally rotated arm • Signs and Symptoms • arm held in adduction and internal rotation • head of humerus may be seen posteriorly

  31. Chronic Shoulder Instabilities • Etiology • traumatic (micro vs. macro), atraumatic, congenital, and neuromuscular • Signs and Symptoms • Anterior • Posterior • Global

  32. Chronic Shoulder Instabilities • Management • Conservative vs. Surgical • shoulder harness

  33. Shoulder Impingement Syndrome • Etiology • repetitive overhead activities • capsular laxity leading to inflammation • forward head and rounded shoulders • hooked shaped acromion process

  34. Rotator Cuff Tears • partial thickness vs. complete thickness tears • acute trauma or impingement • nearly always involves the supraspinatus muscle

  35. Shoulder Impingement Syndrome • Signs and Symptoms • diffuse pain around the acromion • pain with overhead activities • weak external rotators

  36. Shoulder Impingement Syndrome • Stage I • aching after activity • pain with abduction that becomes worst at 90 degrees • pain with flexion and resisted supination and external rotation • Stage II • aching during activity that becomes worst at night, restricted movement

  37. Shoulder Impingement Syndrome • Stage III (25-40) • pain during activity with increase pain at night • possible muscle tear and permanent thickening of rotator cuff & bursa • scar tissue

  38. Shoulder Impingement Syndrome • Stage IV (40+) • infraspinatus and supraspinatus wasting • a lot of pain with abduction to 90 • limited AROM and PROM • weakness during abduction and ER

  39. Shoulder Impingement Syndrome • Management • RICE • Modification of activity • Strengthening of ER and Scapular Stabilizers • Surgery vs. Injection

  40. Shoulder Bursitis • Etiology • fall on tip of shoulder • direct impact or shoulder impingement • Signs and Symptoms • pain with abduction, flexion and IR • Management • cold, antiinflammatory medications

  41. Bicipital Tenosynovitis

  42. Biceps Brachii Rupture

  43. Peripheral Nerve Injuries • Etiology • blunt trauma or stretch • Signs and Symptoms • constant “burning” pain, muscle weakness and atrophy • paralysis

  44. Peripheral Nerve Injuries • Management • ice • resume play when symptoms subside • referral to a physician is ESSENTIAL if symptoms persist

  45. Thoracic Outlet Compression Syndrome • Etiology • compression of brachial plexus, subclavian artery and vein (neurovascular bundle) • compression by the scalene and pectoralis mucles

  46. Thoracic Outlet Compression Syndrome • Signs and Symptoms • paresthesia and pain • impaired circulation in the fingers • muscle weakness and atrophy

  47. Thoracic Outlet Compression Syndrome • Management • stretching of pectorals and scalenes • strengthening of the traps, rhomboids, serratus anterior

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