The Shoulder
Shoulder Girdle Complex
Glenohumeral joint
 Acromioclavicular joint
 Scapulothoracic joint

Glenohumeral Joint
Glenoid fossa
 Head of humerus

Acromioclavicular Joint
Acromion process of scapula
 Clavicle

Scapulothoracic Joint
Scapula
 Posterior ribcage

Bony Landmarks
Sternum
 Clavicle
 Humerus

◦
◦
◦
◦
◦
Head of humerus
Greater tubercle
Lesser tubercle
Bicipital groove
Epicondyles
Lesser tubercle
Greater tubercle
Bony Landmarks

Scapula
◦
◦
◦
◦
Acromion
Coracoid process
Glenoid fossa
Spine
Shoulder Girdle
Muscles of the Shoulder





Deltoid
Trapezius
Pectoralis Major
Pectoralis Minor
Serratus anterior





Rhomboid major
Rhomboid minor
Levator scapulae
Coracobrachialis
Biceps brachii

Deltoid
◦ Abducts shoulder

Trapezius
◦ Rotates scapula


Shoulder depression
Scapular depression

Punching
Flex shoulder
 Adduct shoulder
 IR shoulder


Rhomboid Major/Minor
◦ Retract scapula
◦ Elevate scapula

Levator Scapulae
◦ Elevates scapula
Coracobrachialis
Flexes shoulder
 Adducts shoulder

Biceps Brachii
Weakly flexes
shoulder
 Two proximal heads

◦ Long head—
supraglenoid tubercle
of scapula
◦ Short head—coracoid
process of scapula
Rotator Cuff Muscles
Collective set of four deep muscles of the
GH joint
 Supraspinatus
◦ Abduction of the arm

Infraspinatus
◦ External Rotation of the shoulder

Teres Minor
◦ External rotation of the shoulder

Subscapularis
◦ Internal rotation of the shoulder
Rotator Cuff Muscles
Ligaments of the Shoulder





Coracoclavicular
Coracoacromial
Coracohumeral
Glenohumeral
Acromioclavicular
Levator Scapula
Trapezius
Deltoids
Infraspinatus
Rhomboids Minor
Acromioclavicular (AC) joint
Rhomboids Major
Serratus Anterior
Teres Minor
Pectoralis Major
Pectoralis Minor
Biceps (short & long head)
Common Injuries of the Shoulder
OVERUSE INJURIES TO
THE SHOULDER
Shoulder Impingement Syndrome
Widely used term to describe pain
occurring when space between humeral
head and acromion become narrowed
 Bones “impinge” or compress structures
that occupy the subacromial space
 Three structures:

◦ Joint capsule
◦ Tendons of rotator cuff
◦ Bursa
Impingement Syndrome

Overhead sports
◦ Baseball, tennis, swimming, volleyball

Signs & Symptoms
◦ Pain and tenderness in GH
◦ Pain and/or weakness with
abduction in mid-range
◦ Limited IR
◦ Confirmation with special tests
active
 Empty can
◦ Point tenderness in
area
subacromial
Impingement Syndrome—
Treatment
Address biomechanics
 Substitute with cross-training until
condition resolves
 Limit excessive overhead movement
 Rehab exercises & stretching

Rotator-Cuff Strain/Tears

Traumatic injury
◦ i.e. FOOSH
Unusual demands on young athlete
 Repetitive use leads to chronic condition

◦ Ultimately tear in tendons

Partial thickness tear
◦ Not completely severe tendon
◦ May respond well to non-op treatment

Full thickness tear
◦ Require surgery
Rotator-Cuff Strains/TearsSigns & Symptoms
Pain with muscle contraction
 “Catching” sensation when arm moved
 Inability to sleep
on affected side
 Varying degrees
of disability
 Decreased
strength
 Swelling

Rotator-Cuff Strains/TearsTreatment
RICE
 Limit activity - asymptomatic
 Shoulder strengthening
 Progressive RTP throwing program

Biceps Tendonitis
Discomfort in
anterior shoulder
 Often confused with
RC tendonitis
 Can be caused by
impingement

Common Injuries of the Shoulder
TRAUMATIC
SHOULDER INJURIES
Glenohumeral Dislocation
Forced abduction,
external rotation of
shoulder
 Signs and Symptoms

◦ Flattened deltoid
◦ Pain and Swelling
◦ Disability

Requires immediate
care by physician

Additionally injuries
include:
◦ Fractures
◦ Glenoid labral tears
◦ Axillary nerve damage
Glenoid Labrum

Cartilaginous ring that acts to keep the
humeral head positioned on the glenoid
by blocking unwanted movement
Glenoid Labrum Injuries

Injury occur with :
◦ Acute trauma (dislocation)
◦ Repeated trauma
 Degenerated tear (baseball
pitchers)
◦ Repetitive subluxation
 Labral rim degenerate over
time

Signs & Symptoms
◦ Pain
◦ Catching or popping
sensation
◦ Limited ROM
◦ Varying degrees of
weakness
◦ Special Tests
◦ MRI
SLAP Tear
Superior Labrum
from Anterior to
Posterior
 Occurs at point
where biceps tendon
inserts on labrum
 Area of relatively
poor blood supply

FOOSH
 Repetitive overhead
actions
 Lifting a heavy object

Acromioclavicular Separation

Direct blow to tip of
shoulder
◦ FB player falling on tip
of shoulder or
FOOSH

Signs & Symptoms
◦ Pain in vicinity of AC
joint
◦ Possible deformity of
joint depending on
degree of sprain
AC Separation—Treatment


RICE
Rehab
◦ ROM & strengthening as
tolerated
◦ Overhead exs not
recommended

2nd degree
◦ 3-4 weeks immob
◦ Most painful

3rd degree
◦ 6-8 weeks immob
◦ May leave permanent
deformity
Acromioclavicular Separation
Clavicle Fracture
•
Fall on tip of shoulder
o FOOSH
•
•
Direct impact
Signs and Symptoms
o Pain, deformity, and swelling
•
Refer to physician
Brachial Plexus Injury





Stinger
Burner
Occurs when head
and neck forcibly
moved/hit to one
side
Nerves and brachial
plexus compressed
on that side
Painful and disabling
Brachial Plexus
Group of peripheral
nerves
 Leave spinal cord &
extend from
vertebrae into
shoulder
 Give arm ability to
function

Brachial Plexus Injury—
Signs & Symptoms
Intense pain from neck down to arm
 Arm will feel like it’s on fire or have pinsand-needles sensation
 Arm/hand may be weak and numb
 Intense pain in area of brachial plexus
 Symptoms last several minutes to several
hours or more
 Weakness may last for several days

◦ depends on severity of injury
Brachial Plexus Injury—
Treatment
Resting neck/arm until pain & symptoms
go away
 Ice pack 20 minutes every 3-4 hours
 Anti-inflammatories
 Strengthening exercises
 RTP determined by sports medicine staff
 Subsequent stingers cause for further
testing

Brachial Plexus Injury—
Treatment


Chronic stingers may
eliminate athlete from
contact sports
Scar tissue develops
around nerve
◦ ® Causes nerves to
become entrapped

If athlete receives
another blow, brachial
plexus may not be able
to flex
◦ shatters instead, tearing
major nerves of arm
◦ Causes permanent
neurological damage

Avoid by:
◦ Keeping neck and
shoulders as strong as
possible
◦ Properly fitted equipment
◦ Proper tackling & blocking
techniques
SPECIAL TESTS
Special Tests for Shoulder






Hawkin’s-Kennedy Impingement
Anterior Apprehension
Piano Sign
Apley’s Scratch
Empty Can
Drop-arm Sign
Hawkin’s-Kennedy
• Seated
• Shoulder in 90
degrees of flexion,
slight horizontal
adduction, & maximal
internal rotation
• (+) reproduction of
pain
• Subacromial
Impingement
Drop Arm Sign
Apprehension-relocation
• Supine with are @ 90 degrees
of abduction & external
rotation
• 1 had placed as a fulcrum just
posterior to humeral head then
passively move shoulder into
maximal external rotation
against fulcrum of other hand
• (+) reproduction of shoulder
pain, or apprehension with
movement
• Glenohumeral subluxlation
Piano Key/Sign – AC Separation
• Seated or standing
• Clinician presses downward on
elevated end of clavicle
• (+) pain or excessive movement
of clavicle
• AC separation
Empty Can Test—Supraspinatus
• Seated
• Elevate UE to
30-45
degrees in
plane of
scapula with
internal
rotation
(thumb
down); resist
elevation
• (+) pain &
weakness
Apley’s Scratch – shoulder mobility
• Sitting
• 3 part test
1. Reach across chest
& place hand on
opposite sholder
2. Reach overhead to
place hand between
scapula
3. Reach behind back
as high as possible
*compare bilaterally
• (+) asymetrical motion
1. Restriction in horizontal adduction, IR, scapular protraction
2. Restriction I abduction, ER, scapular upward rotation and elevation
3. Restriction in adduction, IR, scapular downward rotation and retraction
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