Você está na página 1de 6

Chapter 18 The Shoulder Complex

CHAPTER 18
The Shoulder Complex
OVERVIEW

The shoulder complex, as the name implies, is an extremely complicated region


of the body. Sports using the shoulder in repetitive activities such as throwing,
blocking, tackling, serving, and hitting overhead may produce a serious injury.
Injuries to the shoulder joint usually result from its structural vulnerability coupled
with its extensive freedom of movement, the relatively poor correlation between the
articular surfaces, and the great strength of some of the surrounding musculature.
Subjected to both acute and chronic problems, the shoulder complex is one of
the most difficult regions of the body to evaluate. Those individuals that work with
athletes should become familiar with the various conditions associated with the
shoulder complex and should also become familiar with the various treatment plans
used to treat these conditions.

LEARNING OBJECTIVES
After studying Chapter 18, the student should be able to:

Identify the bones associated with the shoulder complex.


Identify the four articulations of the shoulder complex.
Identify the rotator cuff muscles and describe each muscle's function.
Explain how shoulder injuries may be prevented.
Describe the different phases of the throwing motion.
Describe the process for assessing injuries to the shoulder.
Identify both acute and chronic injuries that can occur to the shoulder complex,
and discuss signs and symptoms as well as treatment.

KEY TERMINOLOGY

Apprehension test - A test for anterior glenohumeral instability


Bicipital groove - Groove on the humerus which lies between the greater and
lesser tuberosities where the long head of the biceps brachii passes
Empty can test - Test for supraspinatus strength
Frozen shoulder - Chronic irritation of the shoulder joint causing extreme
limitation of movement in the area
Rotator cuf - Includes the supraspinatus, infraspinatus, teres minor, and
subscapularis muscles
Rotator cuf impingement syndrome Mechanical compression of the
supraspinatus tendon, the subacromial bursa, and the long head of the biceps
tendon under the coracoacromial arch

DISCUSSION QUESTIONS
1. What are the bony and soft tissue structures associated with the shoulder
IM-18 | 1
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 18 The Shoulder Complex

complex? Which ones are palpable?


2. What four joints comprise the shoulder complex?
3. What movements occur at the shoulder joint and the scapula? How do they work
together to produce movement?
4. What steps are taken to evaluate the shoulder joint and the associated
structures?
5. What measures can be used to prevent shoulder injuries?
6. What are some common injuries seen in the shoulder area? What mechanisms
would cause them? How are they managed?
7. What are the phases of throwing? Why is the proper throwing technique
important to the integrity of the shoulder joint?
8. What are some of the injuries often seen in the upper arm? How are they
managed?
CLASS ACTIVITIES
1. After proper instruction, each student should pair up with a partner and practice
injury evaluations of the shoulder complex. Each student should dress
accordingly so that visual observation can be done as much as possible.
Particular attention should be paid to the details needed to perform each stress
test correctly.
2. The students may wish to mimic an injury or syndrome and have their partners
evaluate the injury and determine what it is.
3. Invite an orthopedic surgeon to discuss injuries associated with the shoulder
complex and the various types of surgical procedures used to repair the different
joints. He /she may have access to slides or tapes on specific surgical procedures
to show to the class.
4. Visit an athletic training room and demonstrate the different types of exercises
that can be included in a rehabilitation program and the various methods that
can be used to increase range of motion and strength for the shoulder complex.
5. Have students analyze a sport in which the arm propels an object or the body
through space (e.g., swimming) and determine what possible injuries may occur
during each of the phases of that motion.

WORKSHEET ANSWERS
Matching
1.
2.
3.
4.

f
g
b
e

5. a
6. d
7. c

Short Answer
8. Apprehension test
9. Dynamic rotation of the arm at a high velocity as occurs during overhead
throwing or any other activity in which there is rotation of the humerus
10.Fall on an outstretched arm
IM-18 | 2
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 18 The Shoulder Complex

11.Impingement happens when the supraspinatus tendon, subacromial bursa, and


long head of the biceps are compressed between the anterior edge of the
acromion and coracoacromial ligament
12.An anterior dislocation that results from forced abduction, external rotation, and
extension
13.Restoration of normal biomechanics to the shoulder joint in an effort to maintain
the space under the coracoacromial arch during overhead activities. Strengthen
the rotator cuff muscles, strengthen the muscles of the scapula, stretch the
posterior and inferior joint capsule, and PRICE
14.The humerus, scapula, and clavicle
15.Flattened deltoid contour. Palpation of the axilla will reveal prominence of the
humeral head; the athlete carries the affected arm in slight abduction and
external rotation and is unable to touch the opposite shoulder with the hand of
the affected arm; moderate pain and disability
16.The athlete will support the arm on the injured side and tilt his/her head to the
injured side with the chin turned to the opposite side. Observation may reveal
that the injured clavicle is lower than the unaffected side. Palpation may also
reveal swelling, point tenderness, and mild deformity.
17.Care includes application of ice and pressure to control local hemorrhage,
stabilization of the joint with the use of a shoulder immobilizer, and referral to
MD for definitive diagnosis and treatment.
Listing
18.Supraspinatus: shoulder abduction
19.Infraspinatus: external rotation
20.Teres minor: external rotation
21.Subscapularis: internal rotation
22.Glenohumeral joint
23.Scapulothoracic joint
24.Sternoclavicular joint
25.Acromioclavicular joint
26.Pain with abduction or with flexion, adduction, and internal rotation
27.Tenderness to palpation in the area just under the acromion
28.Impingement tests are positive
29.Wind-up
30.Cocking
31.Acceleration
32.Deceleration
33.Follow-through
Essay
34-39.Grade 1: Point tenderness and discomfort during movement at the junction
between the acromion process and the outer end of the clavicle. There is no
deformity present.
Grade 2: There is definite displacement and prominence of the lateral end of
the clavicle when compared to the unaffected side. There is point tenderness
during palpation and the athlete is unable to fully abduct through a full ROM
or bring the arm completely across the chest.
IM-18 | 3
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 18 The Shoulder Complex

Grade 3: Rupture of the acromioclavicular and coracoclavicular ligaments


with dislocation of the clavicle. Gross deformity and prominence of the distal
clavicle, severe pain, loss of movement, and instability of the shoulder
complex.
40-43.All the muscles involved in movement of the shoulder complex should be
strengthened through a full range of motion. Emphasis should be given to
the muscles of the rotator cuff and the scapular stabilizers. Proper warm-up
must be performed gradually before dynamic arm movements are attempted.
All athletes in collision and contact sports should be instructed and drilled to
fall properly. Wearing of specialized protective equipment such as shoulder
pads.

IM-18 | 4
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 18 The Shoulder Complex

NAME ______________________________
SECTION__________

CHAPTER 18 WORKSHEET
The Shoulder Complex
MATCHING: Match each structure with the appropriate name.
_____
_____
_____
_____
_____
_____

1. Acromion
2. Acromioclavicular joint
3. Clavicle
4. Humerus
5. Scapula
6. Scapulothoracic
articulation
_____ 7. Sternoclavicular joint

SHORT ANSWER: Answer the following questions with a brief response.


8. Which test is used for glenohumeral joint instability?
9. What mechanism of injury is associated with rotator cuff strain?
10.What is the common mechanism for an acute injury to the upper extremity?
11.What is the cause of shoulder impingement syndrome?
12.What is the most common glenohumeral joint dislocation? How does this occur?
13.How is impingement managed conservatively?
14.Which three bones comprise the shoulder joint?
15.What signs and symptoms will be present in an anterior glenohumeral
dislocation?
16.What are the signs and symptoms of a fractured clavicle?
17.What is the immediate care for an acromioclavicular sprain?

IM-18 | 5
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 18 The Shoulder Complex

LISTING: List the four muscles of the rotator cuff and their functions.
18.
19.
20.
21.
List the four main articulations of the shoulder complex.
22.
23.
24.
25.
List the signs and symptoms of shoulder bursitis.
26.
27.
28.
What are the phases of throwing?
29.
30.
31.
32.
33.
ESSAY:
34-39.Describe the signs associated with grade 1, grade 2, and grade 3 AC joint
sprains.
40-43.How can you prevent shoulder injuries?

IM-18 | 6
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.