The Shoulder Complex
Chapter 18
Pages 435-457
Anatomy
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Bony anatomy: clavicle,
scapula, and humerus
4 Articulations:
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Muscular Anatomy: can be
divided into 3 groups.
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Sternoclavicular joint (SC)
Acromnioclavicular joint
(AC)
Glenohumeral joint (GH)
Scapulothoracic joint (ST)
Explained on the next
slide.
ROM: flexion, extension,
abduction, adduction,
external rotation, and
internal rotation.
Shoulder Musculature

Group 1: muscles that
originate on axial skeleton
and attach on humerus.
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Group 2: muscles that
originate on the scapula and
attach on humerus.
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Latissimus Dorsi,
Pectoralis Muscles
Deltoid,
Coracobrachialis,
Rotator Cuff Muscles
(SITS)
Group 3: muscles that
attach the axial skeleton to
the scapula.

Levator Scalpula,
Trapezius, Rhomboids,
Serratus
Anterior/Posterior
Prevention of Shoulder Injuries
Proper physical conditioning.
Proper warm-up/cool-down that is sport
specific.
Proper instruction on how to fall.
Properly fitted protective equipment.
USING CORRECT BIOMECHANICS
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Correct Technique for Throwing
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Wind-up
Cocking
Acceleration
Deceleration
Follow-through
Assessment: History
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What happened to cause this pain?
Have you ever had this problem before?
What is the duration and intensity of the pain?
Where is the pain located?
Is there crepitus during movement or numbness
or distortion in temperature?
Is there a feeling of weakness/fatigue?
What should movements/positions
aggravate/relieve the pain?
If therapy has been given before what offered
pain relief?
Assessment: Observation
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Anterior Observation
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Are both shoulder tips even
with one another or is one
depressed?
Is one shoulder held higher
because of muscle spasm or
guarding?
Is the lateral end of the
clavicle prominent?
Is one lateral acromion
process more prominent?
Does the clavicular shift
appear deformed?
Is there loss of the normal
lateral deltoid muscle
contour?
Is there an indentation in the
upper biceps region?
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Lateral Observation
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Is there thoracic kyphosis or
are the shoulders slumped
forward?
Is there forward or backward
arm hang?
Posterior Observation
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Is there asymmetry such as a
low shoulder, uneven
scapulae, or winging of one
scapula and not the other?
Is the scapula protracted
because of constricted
pectoral muscles?
Is there a distracted/winged
scapula on one or both sides?
Assessment: Palpation and Special Tests
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Palpation
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Bony palpation should be done with the coach standing
in front of and then behind the athlete.
Both shoulders are palpated at the same time for pain
and/or deformity.
Palpation of muscles can detect point tenderness,
muscle guarding, swelling, and/or trigger points.
Special Tests
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Apprehension test
Tests for shoulder impingement
Tests for supraspinatus muscle weakness
Special Tests
Shoulder Injuries
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Clavicle fractures
Humerus fractures
Sternoclavicular joint
sprain
Acromioclavicular joint
sprain
Glenohumeral dislocations
Shoulder impingement
syndrome
Rotator cuff strains
Shoulder bursitis
Biceps tenosynovitis
Upper arm contusions
Clavicle Fractures
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MOI:
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S&S:
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FOOSH, a fall on the tip of the shoulder, and/or direct
trauma.
Supports arm on the injured side and tilts head toward
that side.
Clavicle appears lower than the other side.
Swelling, point tenderness, and mild deformity.
Treatment:
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Immobilize the shoulder, treat for shock, and refer to
physician.
Immobilize for a period of 8 weeks, gentle isometric and
mobilization exercises, and a sling for an additional 3-4
weeks.
Humerus Fracture
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MOI:
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S&S:
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Direct blow, dislocation, FOOSH.
Pain, inability to move arm, swelling, point
tenderness, discoloration. X-ray.
Treatment:
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Splint, sling, treat for shock, and refer to
physician. Out of participation 2-6 months.
SC Joint Sprain
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MOI:
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S&S:
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Indirect force transmitted
through the humerus,
shoulder joint, and/or
clavicle, or by direct
trauma.
Usually displaced upward
and outward.
G 1, 2, 3
Treatment:
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RICE, immobilization for
3-5 weeks, reconditioning
exercises.
AC Joint Sprain
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MOI:
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S&S:
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FOOSH, direct impact to
the tip of the shoulder that
forces the acromion
downward, backward, and
inward.
G 1, 2, 3
Treatment:
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Application of cold and
pressure, stabilization of
the shoulder, referral to
physician.
Aggressive rehabilitation
program: joint
mobilization, flexibility,
strengthening.
http://www.youtube.com/watch?v=MozYKCapvWs
GH Dislocation
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MOI:
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S&S:
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Humerus is forced out of the joint capsule in an anterior
direction past the glenoid labrum and then downward to
rest on the coracoid process.
This accomplished by abduction, external rotation, and
extension.
Flattened deltoid contour, arm carried in slight abduction
and external rotation, unable to touch opposite shoulder
with affected arm.
Treatment:
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Immobilization and referral.
Muscle reconditioning should begin immediately. A sling
should be worn for 1 week.
Shoulder Impingement
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MOI:
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S&S:
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Compression of the supraspinatus tendon, subacromial
bursa, and long head of the biceps tendon.
Repetitive activities.
Pain around the acromion whenever the arm is in the
overhead position, painful AROM 70-120 degrees,
external rotators are weaker than internal rotators,
tightness in the posterior and inferior joint capsule.
Treatment:
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Restore normal biomechanics, RICE, strengthen the
rotator cuff and scapula muscles, and stretching the
capsule.
Activity must be modified.
Rotator Cuff Strains
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MOI:
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S&S:
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Dynamic rotation of the arm at a high velocity as occurs
with overhead throwing and/or any other activity that
causes a rotation of the humerus.
Supraspinatus muscle is the most common.
Pain with muscle contraction, tenderness on palpation,
loss of strength.
Treatment:
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RICE, exercises to strengthen the rotator cuff muscles,
and gradual increase in activity.
Rotator Cuff Muscles
Contusions of the Upper Arm
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MOI:
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S&S:
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Most common: lateral aspect of upper arm.
Repeated contusions can lead to myositis
ossificans.
Pain, tenderness, increased warmth,
discoloration, difficulty achieving full extension
and flexion of the elbow.
Treatment:

RICE for 24 hours, pad the area, and address
ROM.
Shoulder dislocations
A dislocation is when the shoulder stays
out its joint
 A subluxation is when the shoulder pops
out then back in again quickly
 The most common subluxation is anterior

Occurs when the arm is in the 90 90 position
Signs include the inability to move the arm, a
divot in the shoulder and a bulge at the front
of the shoulder
Inferior dislocations are less common and
posterior dislocations are rare
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http://www.youtube.com/watch?v=09ZZbJzeKUA
http://www.youtube.com/watch?v=-Hv8FM78I7I&feature=related
Visual Aids Courtesy of the Following
Websites:
http://www.eorthopod.com/images/Conte
ntImages/shoulder/shoulder_sternoclavicu
lar/shoulder_stclav_anatomy02.jpg
 http://www.yess.uk.com/patient_informati
on/anatomy/index.html
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