The shoulder complex sp2010

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The shoulder complex sp2010

  1. 1. The Shoulder Complex
  2. 2. Complicated Region of the Body . <ul><li>Bones: </li></ul><ul><ul><li>Clavicle: “S” shaped </li></ul></ul><ul><ul><ul><li>Vulnerable to injury </li></ul></ul></ul><ul><ul><li>Scapula: </li></ul></ul><ul><ul><ul><li>flat and triangular </li></ul></ul></ul><ul><ul><li>Humerus: </li></ul></ul><ul><ul><ul><li>spherical </li></ul></ul></ul>
  3. 3. Scapula and the Humerus
  4. 4. <ul><li>Articulations : </li></ul><ul><ul><li>Sternoclavicular Joint </li></ul></ul><ul><ul><li>Acromoclavicular Joint </li></ul></ul><ul><ul><li>Glenohumeral Joint </li></ul></ul><ul><ul><li>Scapulothoracic Joint </li></ul></ul><ul><li>Ligaments </li></ul><ul><ul><li>Sternoclavicular </li></ul></ul><ul><ul><li>Acromioclavicular </li></ul></ul><ul><ul><ul><li>Anterior, posterior, superior, inferior portions </li></ul></ul></ul><ul><ul><ul><li>Coracoclavicular ligament which is divided into two other ligaments. </li></ul></ul></ul><ul><ul><li>Glenohumeral </li></ul></ul><ul><ul><ul><li>Surrounded by a capsule </li></ul></ul></ul><ul><ul><ul><li>Reinforced by the superior, middle, and inferior GH ligament and a tough coracohumeral ligament </li></ul></ul></ul>
  5. 5. MUSCULATURE <ul><li>Two Groups in GH Joint </li></ul><ul><ul><li>Produce dynamic motion and establish stability to compensate for arrangement of bone and ligaments for a great deal of mobility </li></ul></ul><ul><ul><ul><ul><li>Originate on the axial skeleton – attach to humerus </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Latissiumus dorsi & pectoralis major </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Originate on the scapula – attach to humerus </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Deltoid, teres major, coracobrachialis </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Other Muscles: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>S ubscapularis, </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>I nfraspinatus, </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>T eres Minor, </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>S upraspinatus </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Short rotator muscles </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Triceps and Biceps </li></ul></ul></ul></ul></ul>
  6. 6. Rotator Cuff Muscles
  7. 9. SCAPULAR MUSCLES <ul><li>Third group of muscles </li></ul><ul><ul><li>Attaches axial skeleton to scapula </li></ul></ul><ul><ul><ul><li>Levator scapula </li></ul></ul></ul><ul><ul><ul><li>Trapezius </li></ul></ul></ul><ul><ul><ul><li>Rhomboids </li></ul></ul></ul><ul><ul><ul><li>Serratus anterior and posterior </li></ul></ul></ul><ul><ul><li>Provide dynamic stability to shoulder complex </li></ul></ul>
  8. 10. Scapular Muscles levator scapulae deltoid infraspinatus teres minor teres major levator scapulae infraspinatus teres major supraspinatus teres minor
  9. 11. <ul><li>Bursae </li></ul><ul><ul><li>Subacromial Bursa </li></ul></ul><ul><ul><ul><li>Most important </li></ul></ul></ul><ul><ul><ul><li>Easily subjected to trauma when the humerus is in the overhead position </li></ul></ul></ul><ul><ul><ul><ul><li>compresses </li></ul></ul></ul></ul><ul><li>Nerve Supply </li></ul><ul><ul><li>Cervical Vertebrae (C5 – C6, & T1) </li></ul></ul><ul><li>Blood Supply </li></ul><ul><ul><li>Subclavian artery </li></ul></ul><ul><ul><li>Becomes the Brachial artery just after the 1 st rib </li></ul></ul>
  10. 12. Bursae, and Nerve Supply
  11. 13. BLOOD SUPPLY
  12. 14. FUNCTIONAL ANATOMY <ul><li>Movement of the shoulder is critical to maintain the positioning of the humeral head relative to the glenoid. </li></ul><ul><ul><ul><li>Helps control humeral head movement </li></ul></ul></ul><ul><li>Rotator Cuff contraction, they dynamically tighten the capsule </li></ul><ul><ul><li>Helps center the humeral head relative to the glenoid. </li></ul></ul><ul><ul><ul><li>Crucial with ANY over head activity </li></ul></ul></ul><ul><li>Scapulohumeral Rhythm </li></ul><ul><ul><li>As humerus elevates to 30’ no movement </li></ul></ul><ul><ul><li>30-90’ scapula abducts & upwardly rotates </li></ul></ul><ul><ul><li>180’ humeral abduction & sternoclavicular jt. moves </li></ul></ul>
  13. 15. RECOGNITION OF SPECIFIC INJURIES <ul><li>Fractures: </li></ul><ul><ul><li>Acromioclavicular (common) </li></ul></ul><ul><ul><ul><li>Caused by outstretched arm, fall on the tip of shoulder, direct impact </li></ul></ul></ul><ul><ul><ul><li>Athletes usually supports the fx’d. side, tilts head and chin to opposite side </li></ul></ul></ul><ul><ul><ul><li>Deformity, pain, swelling </li></ul></ul></ul><ul><ul><li>Scapular (infrequent) </li></ul></ul><ul><ul><ul><li>Direct impact, or when force is transmitted through humerus to scapula </li></ul></ul></ul><ul><ul><ul><li>Pain with movement </li></ul></ul></ul><ul><ul><li>Humeral </li></ul></ul><ul><ul><ul><li>Shaft- (occasionally) </li></ul></ul></ul><ul><ul><ul><ul><li>Direct blow, fall on the arm </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Comminuted or transverse with deformity due to muscular pull </li></ul></ul></ul></ul><ul><ul><ul><li>Proximal – dangerous to nerves and blood supply </li></ul></ul></ul><ul><ul><ul><ul><li>Direct blow, dislocation, impact received by falling on an outstretched arm </li></ul></ul></ul></ul><ul><ul><ul><li>Head of humerus (Epiphyseal fx) </li></ul></ul></ul><ul><ul><ul><ul><li>Occur in ages 10 or younger </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Direct blow or indirect blow </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Difficult to recognize </li></ul></ul></ul></ul>
  14. 16. Fracture of Clavicle
  15. 17. Humeral shaft, Proximal & Epiphyseal
  16. 18. Injuries Continued <ul><li>Sprains </li></ul><ul><ul><li>Sternoclavicular (uncommon) </li></ul></ul><ul><ul><ul><li>Initiated by a direct force transmitted through the humerus </li></ul></ul></ul><ul><ul><li>Acromioclavicular </li></ul></ul><ul><ul><ul><li>Extremely vulnerable especially in collision sports </li></ul></ul></ul><ul><ul><ul><li>Direct impact to the TIP of the shoulder that forces the acromion process downward, backward, and inward </li></ul></ul></ul><ul><ul><ul><ul><li>The clavicle is pushed down against the rib cage </li></ul></ul></ul></ul>
  17. 19. Rockwood’s Classification of AC Sprains
  18. 20. Sternoclavicular & Acromioclavicular Sprains
  19. 21. DISLOCATIONS <ul><li>Account for 50% of all dislocations </li></ul><ul><ul><li>Two Types </li></ul></ul><ul><ul><ul><li>Anterior </li></ul></ul></ul><ul><ul><ul><ul><li>Most common </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Direct impact to the posterior aspect of shoulder </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Forced abduction, external rotation, and extension that forces the humeral head out (arm tackle) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Bankart’s Lesion (Labrum tear) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hill Sachs Lesion (creates a divot in humeral head) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Slap Lesion (injury to labrum and long head of biceps) </li></ul></ul></ul></ul><ul><ul><ul><li>Posterior </li></ul></ul></ul><ul><ul><ul><ul><li>Account for 1 – 4.3% </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Extremely Rare </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Forced Adduction and Internal rotation of shoulder or fall on an extended internally rotated arm </li></ul></ul></ul></ul>
  20. 22. Dislocations
  21. 23. <ul><li>Impingements </li></ul><ul><ul><li>Involves mechanical compression of </li></ul></ul><ul><ul><ul><li>Supraspinatus tendon, subacromial bursa, and long head of biceps tendon </li></ul></ul></ul><ul><ul><li>Related to shoulder instability and overhead activities </li></ul></ul><ul><ul><li>Failure of RC muscles to maintain position </li></ul></ul><ul><li>Bursitis </li></ul><ul><ul><li>Overuse </li></ul></ul><ul><ul><li>Chronic Inflammation </li></ul></ul><ul><li>Biceps Brachii Ruptures </li></ul><ul><ul><li>Caused by powerful concentric & eccentric contraction </li></ul></ul><ul><ul><ul><li>Occurs near the origin of muscle </li></ul></ul></ul><ul><ul><ul><li>Athlete will hear a “SNAP”, then feels sudden intense pain </li></ul></ul></ul>
  22. 24. Biceps Tendon Rupture
  23. 25. Throwing Mechanics <ul><li>Consists of 5 Phases </li></ul><ul><ul><li>Windup or Preparation </li></ul></ul><ul><ul><ul><li>1 st movement until ball leaves glove </li></ul></ul></ul><ul><ul><ul><li>Lead leg strides forward </li></ul></ul></ul><ul><ul><ul><li>Both shoulders abduct, externally rotate and horizontally rotate </li></ul></ul></ul><ul><ul><li>Cocking </li></ul></ul><ul><ul><ul><li>Begins when hands separate </li></ul></ul></ul><ul><ul><ul><li>Ends when Maximum external rotation of humerus has ocurred </li></ul></ul></ul><ul><ul><ul><li>Lead foot touches ground </li></ul></ul></ul><ul><ul><li>Acceleration </li></ul></ul><ul><ul><ul><li>Lasts from Maximum external rotation until ball release </li></ul></ul></ul><ul><ul><ul><li>Humerus abducts, horizontally abducts, and internally rotates </li></ul></ul></ul><ul><ul><ul><li>Scapula elevates, abducts, and rotates upward </li></ul></ul></ul><ul><ul><li>Deceleration </li></ul></ul><ul><ul><ul><li>From ball release until Maximum shoulder internal rotation </li></ul></ul></ul><ul><ul><ul><li>External rotators of the RC muscles contract eccentrically (lengthening) to decelerate the humerus </li></ul></ul></ul><ul><ul><ul><li>Rhomboids contract eccentrically to decelerate the scapula </li></ul></ul></ul><ul><ul><li>Follow-through </li></ul></ul><ul><ul><ul><li>From Maximum shoulder internal rotation until the end of motion </li></ul></ul></ul><ul><ul><ul><li>When athlete is in balanced position </li></ul></ul></ul>
  24. 26. Phases of Throwing www.chrisoleary.com/projects/Baseball/Pitchin ...
  25. 27. Nolan Ryan & Jake Peavy
  26. 28. Randy Johnson

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