THE SHOULDER COMPLEX
Anatomy - Bones
Anatomy - Ligaments
Anatomy - Muscles Flexors
Pectoralis Major Deltoid Coracobrachialis Biceps Brachii
Extensors Latissimus Dorsi Deltoid Teres Major Triceps Brachii
Anatomy - Muscles
Abduction Deltoid Supraspinatus Biceps Brachii
Adduction Pectoralis Major Latissimus Dorsi Infraspinatus Teres Major Coracobrachialis Trapezius (Scapula) Rhomboideus Major & Minor (Scapula)
Anatomy - Muscles
Internal Rotation Pectoralis Major Latissimus Dorsi Deltoid Subscapularis Teres Major
External Rotation Supraspinatus Infraspinatus Teres Minor Deltoid
Anatomy - Muscles
Horizontal Abduction Deltoid Infraspinatus Teres Minor
Horizontal Adduction Deltoid Pectoralis Major
Anatomy - Muscles Elevators
Trapezius (Scapula) Levator Scapulae (Scapula)
Depressors Latissimus Dorsi (Humerus) Trapezius (Scapula) Pectoralis Minor (Scapula)
Scapular Motion
Elevation Levator scapulae Rhomboid major/minor Serratus Anterior Trapezius (Upper)
Depression Serratus Anterior Trapezius (Lower) Pectoralis Major
Scapular Motion
Protraction Serratus Anterior
Retraction Rhomboid Major/Minor Trapezius (Middle/Lower)
Upward Rotation Serratus Anterior Trapezius (Upper/Lower)
Downward Rotation Rhomboid Major/Minor Levator Scapulae
Brachial Plexus
Winging Scapula
Can occur because of weakness of the periscapula muscles (especially the serratus anterior and middle/lower trapezius) and occurs secondary to long thoracic nerve trauma
Scapula stabilization is necessary for normal arm movement
Forward/Rounded Shoulder Posture Caused by a slouched posture,
shortened anterior chest muscles, elongation of the posterior interscapula muscles (lower/middle trapezius and rhomboids), and abnormal cervical and thoracic spine curvatures
Consequences of FSP: degeneration of AC joint, bicipital or rotator cuff tendinitis or impingment, muscle weakness, myofascial pain and trigger points, posterior capsular tightness, excessive back flexion, and thoracic outlet syndrome
Shoulder Injuries
Sternoclavicular Sprain MOI: Indirect force transmitted through
the humerus by a blow that strikes the poorly padded clavicle by twisting of a posteriorly extended arm.
Shoulder Injuries
Acromioclavicular Sprain MOI:
Direct impact to the tip of the shoulder that forces the acromion process downward, backward, and inward while the clavicle is pushed down against the rib cage
Fall on an outstretched armStep-Off Deformity
Shoulder Injuries
Glenohumeral Joint Sprain MOI:
Anterior: Arm is forced into abduction, external rotation, or direct blow.
Posterior: A forceful movement of the humerus posteriorly when the arm is flexed.
Shoulder Injuries
Anterior Glenohumeral Dislocation MOI:
Direct impact to the posterior or posterolateral aspect of the shoulder.
Forced abduction, external rotation, and extension
Shoulder Injuries
Posterior Glenohumeral Dislocation MOI: Forced adduction and internal
rotation or a fall on an extended and internally rotated arm
Shoulder Injuries
Superior Labrum Anteroposterior (SLAP) Lesion MOI: Compression and inferior traction
Shoulder Injuries
Shoulder Impingement Syndrome MOI:
Mechanical compression of the supraspinatus tendon, the subacromial bursa, and the biceps brachii (long head) tendon causing a decrease in space in the coracoacromial arch
Postural alignments: Forward head, rounded shoulders, increased kyphotic curve
Shoulder Injuries Frozen Shoulder (Adhesive
Capsulitis) Contracted and thickened joint capsule
that is tight around the humeral head with little synovial fluid.
The individual progressively resists any movement to the shoulder making it stiff or “frozen” because of the pain
Shoulder Injuries Thoracic Outlet Compression
Syndrome Compression on the brachial plexus,
subclavian artery, and subclavian vein in the neck and shoulder.
MOI: Compression of the neurovascular
bundle between the first rib and clavicle Compression between the anterior and
middle scalene muscles Compression by pec minor as the
bundle passes beneath the corocoid process or between the clavicle and first rib
Presence of a cervical rib (an abnormal rib originating from a cervical vertebra and the thoracic rib)
Shoulder Injuries
Biceps Brachii Rupture MOI: Powerful concentric or eccentric
contraction
Shoulder Injuries
Bicipital Tenosynovitis MOI: Repeated stretching of the biceps
in highly ballistic activities (pitchers, tennis players, volleyball players, and javelin throwers) may cause an irritation of the tendon and the synovial sheath
Throwing Mechanics
Windup Cocking Acceleration Deceleration Follow-through
Shoulder Pad Fitting
Width of shoulders is measured to determine proper size of pads The inside shoulder pad should cover the tip of the shoulder in a
direct line with the lateral aspect of the shoulder Deltoid should be covered, and all motion required by athlete’s
positions hould be permitted Neck opening must allow athlete to raise their arms overhead but not
allow the pad to slide back and forth Straps underneath the arm must hold pads firmly in place but must
not constrict soft-tissueCantileverNon-
Cantilever
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