What are the bony structures of the shoulder?
- Sternum
- clavicle
- scapula
- humerus
Sternoclavicular jt. (SC jt)
- sternoclavicular lig.
- costalclavicular lig.
- interclavicular lig.
Acromioclavicular jt (AC jt)
- acrmioclavicular jt
- coracoclavicular jt
a. trapeoid
b. conoid - coracoacromial jt
4 fundamental mov’ts of the shoudler girdle
- Abduction
- Adduction
- Elevation
- Depression
Common mechanisms of injuries to the Sternoclavicular jt
- most common athlete falls on shoulder, and opponent lands on top (distributes force along the clavicle)
- Direct trauma to the joint
- Throwing (not often)
Common injuries to SC jt
- Sprain most common
2. Dislocation (usually ant.)
Fx to shaft of clavicle
- most common when falling on outstretched hand
- less common- direct blow
- most fx’s occur in the middle 1/3
- diagnosis is obvious w. visible and palpable deformity (except greenstick fx)
Common mechanisms of injury to the AC jt.
- Direct trauma- fall on pt. of shoulder forcing acromion and corcoid process downward
- indirect trauma- fall on outstretched hand
S/Sx of 1st degree sprain to AC jt
- mild (AC lig only)
- pain/tender localized
- no deformity
- clavicle stable
- no elevation of clavicle
- min limits on ROM
S/Sx of 2nd degree sprain to AC jt.
- moderate (AC and partial CC lig)
- tender/swell over AC
- shoulder ROM considerably limited
- slight elevation of clavicle
- Piano key shoulder
Piano Key Shoulder
- push down clavicle and it comes back up (+) spring test
S/Sx of 3rd degree sprain to AC jt
- severe/complete tearing of AC and CC lig
- often damage to delt/trap muscles
- usually come off field holding arm
- sev. swell/tender over AC
- obvious elevation of clavicle relative to acromion
- check stability: pull down on wrists to see if clavicle moves up
TX for sprain to AC jt
-ice/immobilization
Rehab:
-exercises of entire shoulder girdle complex
-should be cont until pre injury power/strength/ endurance/ROM are ontained
Gleno-humeral jt (GH jt)
almost totally depends on soft tissue for its stability.
-Rotator cuff determines the stability of the jt
Common injuries to the GH jt
- Strains: RC or surrounding muscles
- Subluxation: more common
- dislocation: NEVER try to reduce a 1st time dislocation b/c there may be a fx
Types of dislocations to GH jt.
1 Anterior
- Posterior
- Inferior
Anterior GH dislocation
- most common
- mechanism: abd/ext rotate
- head of humerus comes under coracoid proc.
Post GH dislocation
- Very rare
- mechanism: int rotate/add
- secure in int. rotate and refer
Inferior GH dislocation
- head of humerus fall below gelnoid f.
- mechanism: extreme abd/ head moves down
Knight Technique
- athletet in abd
- traction on distal humerus
- ask athlete to add and med rotate the shoulder
Bronstein technique
- athlete in add
- traction on distal humerus
- ask athlete to walk finger up midline of the body
Rotator Cuff (RC) 4 muscles
- Supraspinatus
- Infraspinatus
- Subscapularis
- Teres Minor
Fcns of the RC
- deceleration
- eccentric contraction
- stabilize head of humerus
3 General causes of injury to RC
- Overstretch
- Violent Contraction
- Overuse
