1. Joints
    •Sternoclavicular – stability, hold collarbone to body

    •Acromioclavicular – muscles run around it

    •Glenohumeral – main joint – ball in socket, rotation

    • •Coracoclavicular –more stability for scapula and collarbone
    • •Scapularthoracic -
  2. Brachial Plexus
    • C5 to T1
    • Run under clavicle with subclavian artery
  3. Rotator Cuff
    • supraspinatus
    • Infraspinatus
    • Teres Minor
    • Subscapularis
  4. Scapular rhythm
    • •0-30º:No Scapular movement– glenohumeral
    • joint

    •30-90º: Scapula moves 1º for every 2º of humeral movement

    •90º-180+º: Scapula and humerus move at same rate
  5. Functional Anatomy
    •Great degree of mobility w/ limited stability

    –Round humeral head that articulates w/ a flat glenoid – big golf ball on small tee

    –Ability of the rotator cuff & long head of the biceps provide dynamic stability

    • –Supraspinatus compresses the head while the other rotator cuff muscles depress the humeral
    • head during overhead motion

    • •Integration of the capsule (labrum) and rotator
    • cuff

    –Muscle contractions dynamically control the capsule
  6. planes of movement
    • Flexion, extension
    • Internal, external rotation
    • adduction, abduction
  7. Test for SC Joint Instability
    • •With athlete seated, pressure is applied to the SC joint anteriorly, superiorly and
    • inferiorly to determine stability or pain associated w/ a joint sprain
  8. Test for AC Joint instability
    •Palpate for displacement of acromion and distal head of clavicle

    •Apply pressure in all 4 directions to determine stability

    • •Will bounce depending on grade of sprain – 
    • sits on top of joint
  9. Test for GH instability
    •Glenohumeral Translation - anterior and posterior stability

    •Does it move?

    • •Apprehension test used for anterior glenohumeral
    • instability (1)

    •Posterior instability apprehension test (2)

    • •Relocation test uses external rotation and posteriorly directed pressure to allow for
    • increased external rotation (3)
  10. O'Brien's Test
    Empty Can test

    • –If pain with internal rotation but decreases with external rotation and there is
    • clicking = SLAP lesion

    –Pain in AC joint may indicate AC joint pathology
  11. Test for impingement
    Hawkins-Kennedy Test
  12. Fractured Clavicle
    Can't protect themselves when falling

    • Pain
    • deformity
    • decr ROM

    • Sling
    • Refer for x-rays
  13. Test for serratus anterior weakness
    • wall push up
    • look for winging scapula
  14. –Tests for Thoracic Outlet Compression Syndrome
    •Anterior scalene syndrome (Adson’s test)

    –Compression of subclavian artery by scalenes is assessed

    –Disappearance of pulse while athlete turns toward extended arm and takes a breath indicates a positive test

    •Costoclavicular syndrome test (Roo’s test)

    –Compression of artery between clavicle and first rib

    –Test is positive if after opening and closing hands for 3 minutes, strength or circulation decreases

    –Test is also positive if while in military brace position, head is turned in opposite direction and pulse disappears

    •Hyperabduction syndrome test (Allen test)

    • »Used to assess if pressure from pectoralis
    • minor is compressing brachial plexus and subclavian artery

    •Sensation Testing
  15. Humeral Fracture
    • S+S
    • Pain, deformity, swelling, decr ROM

    • Treatment
    • Splint and place in sling and refer for xrays
    • Break arm at proximal end, needs sling not cast
  16. Scapular Fracture
    • Treatment:
    • Place in sling, refer
    • Need to continue ROM exercises, if lose ROM can only move shoulder first 30 degrees
  17. Shoulder Sprain
    • Treatment 
    • Sling
    • •Compromised glenohumeral joint
    • •Damaged ligaments and labrum

    • First aid
    • •RICE
    • •Immobilization
    • •Refer
  18. Sternoclavicular Sprain

    •Indirect force, blunt trauma (may cause displacement)

    • •Grade 3 can be life threating if dislocates anteriorly – pressure on lungs, heart,
    • etc.

    –Signs and Symptoms 

    •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


    •RICE, reduction if necessary

    •Immobilize for 3-5 weeks followed by graded reconditioning
  19. Shoulder Dislocation Etiology
    •Accounts for up to 50% of all joint dislocations in the body

    •After initial injury-- more likely to suffer re-injury.

    •85 to 90% of traumatic dislocations recur.

    •The most frequent type of dislocation is an anterior displacement.
  20. Acromioclavicular Sprain

    •Result of direct blow (from any direction), upward force from humerus,

    •Can be graded from 1-6 depending on severity

    •Grade 1 - point tenderness and pain w/ movement; no disruption of AC joint

    • •Grade 2 - tear or rupture of AC ligament, partial displacement of lateral end of
    • clavicle; pain, point tenderness and decreased ROM (abduction/adduction)

    •Grade 3 - Rupture of AC and CC ligaments

    •Grade 4 - posterior dislocation of clavicle
  21. Shoulder Dislocation
    • S+S
    • •Moderate to severe pain

    •Athlete will clutch the arm to the side

    •Obvious deformity (can see sulcus - dimple)

    •Decreased or no ROM (maybe b/c too sore)

    •Swelling in joint

    • Tr.
    • •Initially, needs to be put back in
    • •Place in a sling and refer to a physician for reduction.

    •Pain decreases post-reduction

    •Begin ROM and strengthening program as soon as symptoms allow.

    •More recovery time for upper-body sports
  22. Shoulder Dislocation Special Tests
    •Apprehension Test

    •Relocation Test

    •Anterior Drawer Test

    •Posterior Drawer Test

    •Sulcus Sign
  23. Possible complications of shoulder dislocation
    •Bankart lesion - permanent anterior defect of labrum(tear)

    • •Hill Sachs lesion - caused by compression of cancellous bone against anterior glenoid rim
    • creating a divot in the humeral head

    • •SLAP lesion - defect in superior labrum that begins posteriorly and extends
    • anteriorly impacting attachment of long head of biceps on labrum

    •Brachial nerves and vessels may be compromised

    •Rotator cuff injuries


    •Bicipital tendon subluxation and transverse ligament rupture
  24. AC Joint Sprain

    •AC Shear Test

    •AC Spring Test


    •Place in an arm sling and refer to a physician

    •X-rays will help to rule out a fracture

    •RTP once pain-free with full strength, ROM, and good joint stability
  25. Labrum
    •The labrum is the cartilaginous structure attached to the glenoid fossa

    •Allows a smooth surface for motion, and provides a cushion for any impacts at the shoulder
  26. Labrum Tears
    • S+S
    • •Pain in shoulder with motion

    •Clicking or popping with motion

    •Previous history of dislocations

    •Loss of ROM

    •Tests: Clunk Test


    •Must be repaired surgically
  27. Labrum Tears (2)
    • •The labrum is often injured or torn at the same time as other shoulder injuries,
    • especially shoulder dislocations.

    •Hill-Sachs-posterior lateral aspect of the humeral head

    •Bankart -anterior portion of the labrum

    •SLAP lesion- superior aspect of the labrum
  28. Brachial Plexus Injury

    •Numbness or tingling throughout the arm

    •Loss of ROM or strength

    •Possible swelling or discoloration


    •Athlete moves fingers & elbow continuously

    •Strength, sensation, and ROM should return over time (time varies)

    •Athlete with previous history is more prone to injury

    •Possible trapezius muscle spasm and pain next day

    •Speak to a physician when frequent injury
  29. Rotator cuff strain

    •Empty Can Test

    •Drop Arm Test

    • Treatment
    • •RICE therapy

    •If significant loss of ROM or strength, refer to physician

    •Jobe Exercises

    •Recovery time is depends on sport.
  30. Muscle Tendinitis
    When does it hurt?

    • •When haven’t done anything for some time then starting motion hurts (i.e. first
    • thing in the morning, muscle is shortened)

    •Pain after practice


    •RICE therapy, electric modalities, and ultrasound

    • •Anti-inflammatory
    • medicine
    • – increase blood flow
  31. Impingement Syndrome
    • S+S
    • •Pain in shoulder around the acromion

    •Pain and decreased ROM with overhead activities

    •Tests: Hawkins-Kennedy Test


    •RICE therapy, electric modalities, and ultrasound

    •Correct improper mechanics

    •Therapeutic tubing programs
  32. Frozen Shoulder

    •Contracted and thickened joint capsule w/ little synovial fluid

    •Chronic inflammation w/ contracted inelastic rotator cuff muscles

    • •Generalized
    • pain w/ motions (active and passive) resulting in resistance of movement

    –Signs and Symptoms

    •Pain in all directions both w/ active and passive motion


    • •Aggressive
    • joint mobilizations and stretching of tight musculature

    •Electricvstim for pain and ultrasound for deep heating
  33. Bicipital Tenosynovitis
    •Inflammation and thickening of tendon capsule (lining around tendon)


    • –Repetitive overhead athlete - ballistic activity that involves repeated stretching of
    • biceps tendon causing irritation to the tendon and sheath

    –Signsand Symptoms

    • •Tenderness over bicipital
    • groove, swelling, crepitus due to inflammation

    •Pain when performing overhead activities


    •Rest, ice and ultrasound to treat inflammation


    •Gradual program of strengthening and stretching
  34. Throwing Mechanics
    • •Windup
    • Phase

    • –First
    • movement until ball leaves gloved hand

    • –Lead
    • leg strides forward while both shoulders abduct, externally rotate and
    • horizontally abduct

    • •Cocking
    • Phase

    • –Hands
    • separate (achieve max. external rotation) while lead foot comes in contact w/
    • ground


    • –Max
    • external rotation until ball release (humerus
    • adducts, horizontally adducts and internally rotates)

    • –Scapula
    • elevates, abducts and rotates upward

    • •Deceleration
    • Phase

    • –Point
    • from ball release until max shoulder internal rotation

    • –Eccentric
    • contraction of ext. rotators to decelerate humerus
    • while rhomboids decelerate scapula

    • •Follow-Through
    • Phase

    • –End
    • of motion when athlete is in a balanced position
  35. Flexibility
    –Codman’s pendulum exercises and sawing motions should begin early

    –Progress to active assisted ROM in pain free range (cardinal planes)

    –Should be performed in conjunction w/ rotator cuff and scapula strengthening exercises
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