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Sports Medicine

Sports Medicine. The Shoulder. Reading Assignment. Read pages 450-451 and answer the following questions: What three bones make up the shoulder girdle? What three articulations make up the shoulder complex? What bones make up each articulation?. Anatomy Review.

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Sports Medicine

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  1. Sports Medicine The Shoulder

  2. Reading Assignment • Read pages 450-451 and answer the following questions: • What three bones make up the shoulder girdle? • What three articulations make up the shoulder complex? • What bones make up each articulation?

  3. Anatomy Review • Bones of the Shoulder Girdle: • _____________ • _____________ • _____________ • The shoulder complex is made up of four different articulations. • __________________:(____) Formed by the head of the humerus and the glenoid fossa of the scapula. • ___________________: (____) Formed by the distal end of the clavicle and the acromion process of the scapula • ___________________: (____) Formed by the scapula and the thoracic cage. • ____________________: (____________) Formed by the proximal end of the clavicle and the manubrium of the sternum.

  4. Scapular Anatomy Review Glenoid Fossa Acromion Process Coracoid Process Spine Scapula

  5. HumerusAnatomy Review Greater Tubercle Lesser Tubercle Bicipital Groove Head of Humerus Humerus

  6. Movements of the Glenohumeral Joint • Flexion • Extension • Adduction • Abduction • Internal Rotation • External Rotation • Horizontal Flexion • Horizontal Extension

  7. Movement of The Scapulothoracic Joint • Scapular Retraction • Scapular Protraction • Scapular Upward Rotation • Scapular Downward Rotation • Elevation • Depression

  8. Ligamentous Stability (Static) • Glenohumeral Joint • ____________ Ligament • _____________ Ligament • AC Joint • _______________ Ligament • _______________ Ligament • __________ Ligament • __________ Ligament • ________________ Ligament

  9. Ligament Anatomy Review

  10. Bony Shoulder Anatomy Review

  11. Pace Lap • What are the four muscles that make up the rotator cuff? • 5 minutes

  12. Reading Assignment • Please read pages 452 – 455 and answer the following questions: • What is the main function of the rotator cuff? • What four muscles make up the rotator cuff? • What movement do each produce? (Chart: Pg. 454) • Which superficial muscle act to elevate the arm? • What is a force couple?

  13. Rotator Cuff • Group of four muscles of the G-H joint . • Subscapularis • IR and ADD • Supraspinatus • ABD • Infraspinatus • ER • Teres Minor • ER • Functions • Stabilization of the head of the humerus in the glenoid fossa.

  14. Anterior Rotator Cuff Anatomy

  15. Posterior Rotator Cuff Anatomy

  16. Glenohumeral Joint • _______________ • Add, IR, Flex/Ext. • _________________ • Ext, Add, IR • ________________ • Abd, IR, Ext/ER, Flex/IR • _________________ • Add, IR • ___________________ • Flex, Add.

  17. Scapulothoracic Joint • ________________ • Scapular Elevation • ______________ • Scapular Retraction • Downward Rotation • _________________ • Elevation • Retraction • Upward Rotation • Depression • _________________ • Depression • _________________ • Protraction • Upward Rotation • ________________ • Depression • Stabilization of the SC joint

  18. Posterior Muscular Anatomy Review

  19. Anterior Muscular Anatomy Review

  20. Brachial Plexus

  21. Common Sports Injuries • Injuries are common due to the wide range of motion in the _________________ joint. • A lot of the injuries to the shoulder complex are sport specific • Types of Injuries • Fractures • Subluxation / Dislocations • Sprains • Strains

  22. Soft-Tissue Injuries • Ligament Injuries • A-C Injuries • G-H Injuries • S-C Injuries • Muscular Injuries • Rotator Cuff Injuries • Biceps Tendon Injuries • Impingement Syndrome • Contusions

  23. Fractures • Clavicle Fracture • Scapular Fractures

  24. Pace Lap • What is the main function of the rotator cuff muscles? • 5 minutes

  25. Anterior View

  26. Posterior View

  27. Assignment • Read pages 464 and 466 and answer the following questions: • What are the two types of Rotator Cuff Tears? • Which one requires surgery and which one can be treated non-operatively? • What are some signs and symptoms of a full thickness rotator cuff tear?

  28. Rotator Cuff Injury • Two Types • _______________ Thickness • Partial tear of the rotator cuff tendon. • ________________ • __________ Thickness • Complete tear of the rotator cuff tendon. • Requires ______________

  29. Mechanism of Rotator Cuff Injuries • Commonly occur as overuse injuries in the throwing athlete. • Throwing can be broken down into five phases: • ________________ • ________________ • ________________ • ________________ • ________________

  30. Phases of a Baseball Pitch http://www.pbats.com

  31. Signs and Symptoms • Pain within the shoulder especially during the ___________ phase of throwing or swinging. • Pain and difficulty with ___________ and external rotation (90/90) of the arm. • Pain and stiffness __________ hours post practice or competition that involved throwing or swinging. • Point tenderness around the _________ head deep within the deltoid muscle.

  32. Prevention is the Key • _____________ _________________ • A well designed ______________ ___________ strengthening program is essential. • Focus on training each individual rotator cuff muscle. • ___________________ • ___________________ • _____________________ • Combination of these movements • ______________ training is a must.

  33. Assignment • With a partner • Design a 5 step warm-up program for an overhead athlete. • Include the parameters (how long, how often, etc) • You have access to: • UBE upper body ergometer • Therabands/Theratubes • Manual Therapy

  34. Treatment of Rotator Cuff Injury • Application of ice to relieve pain and swelling. • Discontinue activity. • Refer to physician for further evaluation. • Some rotator cuff injuries can be treated non-operatively (Partial-Thickness Tear) • Some must be surgically repaired. (Full-Thickness Tear) • Why??? (Think Stabilization)

  35. Assignment • Read pages 458-461 and answer the following questions: • What is impingement syndrome? • What three structures are found in the subacromial space? • What are the signs and symptoms of impingement syndrome?

  36. Glenohumeral Joint-Related Impingement Syndrome Anatomy • ______________ Space • Acromion Process and the Coracoacromial ligament. (Coracoacromial _______ or ___________) • The Glenohumeral joint capsule. (________)

  37. The Subacromial Space • When the arm is ______________ this space ______________ in size. • Contents • Long head of the ___________ tendon and joint capsule. • ______________ bursa • ________________ tendon (most common) • Anything that causes a decrease in the size of the subacromial space can cause an _______________ of one or more of these structures.

  38. Common Causes • Rotator Cuff Patholgy • Congenital defects of the coracoacromial arch. • Odd shaped acromion. • Biceps Tendonitis • Supraspinatus Tendonitis • Bone Spurs on the inferior part of the acromion. • Subacromial Bursitis

  39. Subacromial Space

  40. Why is this a problem? • Athletes that place the arm _____________ during their sport can often suffer from impingement syndrome. • The signs and symptoms often mimic those of a _______________ _______ tear.

  41. Signs and Symptoms • G-H pain • Pain when the G-H joint is actively ____________ and __________ ___________. • Point tenderness in the Subacromial Space. • Limited ____________ • Confirmation with special test. • ________________________

  42. Treatment • Rest • Anti-inflammatory drugs • Rehabilitation • Strengthen RC and Surrounding Shoulder Muscles. • When all else fails surgery may be required to open up the subacromial space. (_______________)

  43. Pace Lap • What structures are found in the subacromial space? • 5 minutes

  44. Assignment • Read page 466 and 469 and answer the following questions: • What is DOMS? • What does PRICE stand for? • What is Biceps Tendonitis? • Get with a partner and palpate the Biceps tendon in the bicipital groove.

  45. Biceps Tendon Injuries • Long Head of the Biceps Tendon • Runs through the __________ groove of the humerus. • Originates from the supraglenoid tubercle. • Lies within the __________ capsule and subacromial space just beneath the acromion process. (Subacromial Space). • This puts the tendon at risk for impingement when the arm is __________.

  46. Biceps Tendon Anatomy

  47. Biceps Tendonitis • Will develop ___________ over time. • As it become inflamed, it no longer fits in the ___________ groove and becomes prone to ______________. • It is usually held in place by the ______________________. • This subluxation can also occur acutely with an extreme force commonly generated in throwing.

  48. Signs and Symptoms of a Biceps Tendon Injury • Painful abduction of the shoulder. • Pain in the shoulder when the forearm is ____________against resistance. • Subluxation of the biceps tendon when the forearm is _______ and __________ against resistance. • Pain with shoulder ________ with the elbow _____________.

  49. Treatment • Ice and compression if a subluxation occurs. • Rest • Anti-inflammatory drugs • Progressive rehabilitation. • Surgery may be required if chronic subluxation occurs.

  50. Pace Lap • What are three signs and symptoms of impingement syndrome? • What are three methods of treatment? • 5 minutes

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