The document summarizes the anatomy of the shoulder complex, including bones, articulations, ligaments, musculature, nerves, and blood supply. It then discusses functional anatomy, common injuries such as fractures, sprains, dislocations, and impingements. It also covers the phases of throwing mechanics and notable pitchers.

1. The Shoulder Complex

2. Complicated Region of the Body . Bones: Clavicle: “S” shaped Vulnerable to injury Scapula: flat and triangular Humerus: spherical

3. Scapula and the Humerus

4. Articulations : Sternoclavicular Joint Acromoclavicular Joint Glenohumeral Joint Scapulothoracic Joint Ligaments Sternoclavicular Acromioclavicular Anterior, posterior, superior, inferior portions Coracoclavicular ligament which is divided into two other ligaments. Glenohumeral Surrounded by a capsule Reinforced by the superior, middle, and inferior GH ligament and a tough coracohumeral ligament

5. MUSCULATURE Two Groups in GH Joint Produce dynamic motion and establish stability to compensate for arrangement of bone and ligaments for a great deal of mobility Originate on the axial skeleton – attach to humerus Latissiumus dorsi & pectoralis major Originate on the scapula – attach to humerus Deltoid, teres major, coracobrachialis Other Muscles: S ubscapularis, I nfraspinatus, T eres Minor, S upraspinatus Short rotator muscles Triceps and Biceps

6. Rotator Cuff Muscles

9. SCAPULAR MUSCLES Third group of muscles Attaches axial skeleton to scapula Levator scapula Trapezius Rhomboids Serratus anterior and posterior Provide dynamic stability to shoulder complex

10. Scapular Muscles levator scapulae deltoid infraspinatus teres minor teres major levator scapulae infraspinatus teres major supraspinatus teres minor

11. Bursae Subacromial Bursa Most important Easily subjected to trauma when the humerus is in the overhead position compresses Nerve Supply Cervical Vertebrae (C5 – C6, & T1) Blood Supply Subclavian artery Becomes the Brachial artery just after the 1 st rib

12. Bursae, and Nerve Supply

13. BLOOD SUPPLY

14. FUNCTIONAL ANATOMY Movement of the shoulder is critical to maintain the positioning of the humeral head relative to the glenoid. Helps control humeral head movement Rotator Cuff contraction, they dynamically tighten the capsule Helps center the humeral head relative to the glenoid. Crucial with ANY over head activity Scapulohumeral Rhythm As humerus elevates to 30’ no movement 30-90’ scapula abducts & upwardly rotates 180’ humeral abduction & sternoclavicular jt. moves

15. RECOGNITION OF SPECIFIC INJURIES Fractures: Acromioclavicular (common) Caused by outstretched arm, fall on the tip of shoulder, direct impact Athletes usually supports the fx’d. side, tilts head and chin to opposite side Deformity, pain, swelling Scapular (infrequent) Direct impact, or when force is transmitted through humerus to scapula Pain with movement Humeral Shaft- (occasionally) Direct blow, fall on the arm Comminuted or transverse with deformity due to muscular pull Proximal – dangerous to nerves and blood supply Direct blow, dislocation, impact received by falling on an outstretched arm Head of humerus (Epiphyseal fx) Occur in ages 10 or younger Direct blow or indirect blow Difficult to recognize

16. Fracture of Clavicle

17. Humeral shaft, Proximal & Epiphyseal

18. Injuries Continued Sprains Sternoclavicular (uncommon) Initiated by a direct force transmitted through the humerus Acromioclavicular Extremely vulnerable especially in collision sports Direct impact to the TIP of the shoulder that forces the acromion process downward, backward, and inward The clavicle is pushed down against the rib cage

19. Rockwood’s Classification of AC Sprains

20. Sternoclavicular & Acromioclavicular Sprains

21. DISLOCATIONS Account for 50% of all dislocations Two Types Anterior Most common Direct impact to the posterior aspect of shoulder Forced abduction, external rotation, and extension that forces the humeral head out (arm tackle) Bankart’s Lesion (Labrum tear) Hill Sachs Lesion (creates a divot in humeral head) Slap Lesion (injury to labrum and long head of biceps) Posterior Account for 1 – 4.3% Extremely Rare Forced Adduction and Internal rotation of shoulder or fall on an extended internally rotated arm

22. Dislocations

23. Impingements Involves mechanical compression of Supraspinatus tendon, subacromial bursa, and long head of biceps tendon Related to shoulder instability and overhead activities Failure of RC muscles to maintain position Bursitis Overuse Chronic Inflammation Biceps Brachii Ruptures Caused by powerful concentric & eccentric contraction Occurs near the origin of muscle Athlete will hear a “SNAP”, then feels sudden intense pain

24. Biceps Tendon Rupture

25. Throwing Mechanics Consists of 5 Phases Windup or Preparation 1 st movement until ball leaves glove Lead leg strides forward Both shoulders abduct, externally rotate and horizontally rotate Cocking Begins when hands separate Ends when Maximum external rotation of humerus has ocurred Lead foot touches ground Acceleration Lasts from Maximum external rotation until ball release Humerus abducts, horizontally abducts, and internally rotates Scapula elevates, abducts, and rotates upward Deceleration From ball release until Maximum shoulder internal rotation External rotators of the RC muscles contract eccentrically (lengthening) to decelerate the humerus Rhomboids contract eccentrically to decelerate the scapula Follow-through From Maximum shoulder internal rotation until the end of motion When athlete is in balanced position

26. Phases of Throwing www.chrisoleary.com/projects/Baseball/Pitchin ...

27. Nolan Ryan & Jake Peavy

28. Randy Johnson