Part of a larger applied anatomy training module, contains thoughts on injuries to the clavicle and rotator cuff.

1. John M. Cissik
Human Performance Services, LLC

2. Injuries and Modifications
 AC Joint Injuries
 Impingement

3. AC Joint Injuries
 Dislocation
 Distal clavicle fractures
 Osteoarthritis

4. AC Separation
 From Johnson,R.J. (2001).
 Usually caused by falling on the adducted shoulder
 Type 1 & 2 can be treated by exercise
 Type 3 treated by immobilization
 Type 4, 5, 6 treated by surgery

5. Treating AC Separation with
Exercise
From Johnson, R.J. (2001b).

6. Distal Clavicle Fractures
 10-20% of all clavicle fractures
(Johnson, R.J. 2001)
 Usually caused by lateral force directed
against shoulder

7. Types of Distal Clavicular
Fractures
 Type 1: fracture is lateral to
the coraclavicular ligaments.
Treatment is use of a sling
then rotator cuff and scapular
exercises.
 Type 2a: Occur medially to
the coraclavicular ligaments.
Displacement.
 Type 2b: Occurs between the
conoid and trapezoid
ligaments, displacement.
 Surgery for type 2 fractures.

8. Osteoarthritis
 Caused by age, repetitive upper body
exercises, previous injuries, etc.
 Lateral shoulder pain, pain aggravated
by horizontal adduction, worse at night
 Treated with physical therapy, NSAIDs,
corticosteroids, and surgery (removal of
distal clavicle)

9. Rotator Cuff Injuries
 Causes
 Types
 Primary Impingement
 Secondary Impingement
 Internal or posterior superior glenoid
impingement

10. Predisposition to Rotator Cuff
Injuries?
 From Wolin & Tarbet (1997).
 Shape of acromion may predispose to injury.
 Type II & III correlated with full tears
 Type II tears correlated with partial tears

11. Primary Impingement
 Repetitive overhead
activity leads to
impingement of
supraspinatus
against the inferior
acromion and/or
coracromial ligament

12. Shoulder Secondary Impingement,
Scapulothoracic Causes
 Excessive anterior tilt
of the scapula
 Fatigue of muscles
stabilizing scapula
(trapezius, serratus
anterior)
From DePalma & Johnson (2003).

13. Diagnosing Scapulothoracic Rhythm
Deficiencies
 Medial “winging”
 Indicates
weaknesses or
difficulties with the
serratus anterior
From DePalma & Johnson (2003).

14. Diagnosing Scapulothoracic Rhythm
Deficiencies
 Lateral “winging”
 Indicates trapezius
weakness
From DePalma & Johnson (2003).

15. Rehabbing Scapulothoracic
Rhythm
Isometric Stabilization
Exercises
“Simple” Closed
Chain
“Complex” Closed
Chain
Rotator Cuff
Exercises

16. Scapulothoracic Isometric
Exercises
 Protraction
 Retraction
 Elevation
 Depression

17. “Simple” Closed Chain
Exercises
 On all fours, elbows extended:
 Elevation
 Depression
 Protraction
 Retraction

18. “Complex” Closed Chain
Exercises
 From retraction:
 Rowing
 Push-Ups
 Press-Ups

19. Internal/Posterior Superior
Glenoid Impingement
 Overhead activities
where arm abducted
to 90 degrees and
maximally externally
rotated.
 Supraspinatus
caught between
humerus and glenoid
labrum.
From Wolin & Tarbet (1997).

20. Rotator Cuff Injury Therapy
ROM Exercises
Very light weight,
isotonic exercises
Weight-bearing,
closed chain
exercises

21. Rotator Cuff Rehab Guidelines
 Initially performed with light weights or
elastic bands
 Performed with arm below shoulder
level or at the side
 Exercises that isolate specific cuff
muscles should not be done at greater
than 90 degrees of abduction

22. Modifying Exercises for RC
Injuries
 Bench Press
 Dumbbell Press
 Seated Row
 Lat Pulldown

23. Bench Press
 Towel Bench Press
 Floor Press
 Close Grip Bench Press

24. Dumbbell Press
 Using a neutral grip
 Elbows at side

25. Seated Row 1
 Higher Seat (arm
less than 90 degrees
of flexion)
From Lantz & McNamara
(2003a).

26. Seated Row 2
 Initiate movement
with retraction
From Lantz & McNamara
(2003a).

27. Seated Row 3
 Arms travel to side of
body only
From Lantz & McNamara
(2003a).

28. Lat Pulldown 1
 Depress and retract
the scapula at
beginning.
 Maintain this position
From Lantz & McNamara (2003b).

29. Lat Pulldown 2
 Don’t let elbows
travel past the body.
From Lantz & McNamara
(2003b).