Shoulder Anatomy and Injuries

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Shoulder Anatomy and Injuries

• PED 477
• Spring 2009

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Shoulder Anatomy - bones

• Scapula
• Clavicle
• Humerus
• greater tubercle

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Scapula
Supraspinous fossa
Infraspinous fossa
Subscapular fossa
Axillary border
Inferior angle
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Humerus
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Shoulder Anatomy - joints

• Acromioclavicular

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Shoulder Anatomy - joints

• Scapulothoracic
• muscular attachments only

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Shoulder Anatomy - joints

• Glenohumeral
• ball and socket
• lacks bony stability (small glenoid, large
  humerus)
• provides motion
• glenoid labrum (fibrocartilage)
• rotator cuff (muscular stability)

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Muscles - Trapezius
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Rotator cuff - Supraspinatus
D greater tubercle A ABD stabilization
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Rotator cuff - Infraspinatus
D greater tubercle A external rotation
stabilization
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Deltoids - Anterior
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Pectoralis major
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Shoulder Pathology

• Rotator cuff injury
• Strain
• forced rotation
• Contusion
• acute
• same mechanism as A/C joint
• need to exercise cuff below 90
• chronic
• pre-existing that never healed
• hooked acromion causing irritation

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Shoulder Pathology

• Fractures
• Humeral
• More likely to dislocate (glenoid shallow)
• Clavicle
• Common injury
• Scapula
• Not as common but difficult to overcome (blood
  supply)

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Shoulder Pathology

• Capsular instability
• Often from subluxation or dislocation
• Extremes of EROT and ABD
• Inferior and anterior are most common
• Often requires surgery
• ROM limited in ABD and EROT

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Shoulder Instabilities

• A-traumatic
• Secondary to dislocation
• Typically Anterior
• Typically Recurrent
• Can cause labral tears

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Shoulder Instabilities

• SLAP
• Superior
• Labrum
• Anterior
• Posterior

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Shoulder Instabilities

• AMBRI
• Atraumatic
• Multidirectional
• Bilateral
• Rehabilitation Effective
• Inferior capsular shift recommended
• capsulorrhaphy

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Capsular Shift
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Shoulder Instabilities

• TUBS
• Traumatic
• Unilateral
• Bankart Lesion
• Surgery required

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Shoulder Pathology

• Acromioclavicular joint sprain
• Force along humerus in superior direction
• Force to acromion or clavicle in inferior
  direction
• Contusion can give the same symptoms
• In separation, humerus and acromion descend
  rather than clavicle elevating

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Shoulder Pathology

• Brachial Plexus injury
• Strain or contusion (Stinger)
• Stretch or force to neck/shoulder
• Radicular symptoms
• Weakness, atrophy, numbness, tingling
• Need to x-ray neck to check for stenosis