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The Shoulder Complex PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "The Shoulder Complex".

This medical PowerPoint presentation is about the shoulder complex, a group of joints, muscles, and other tissues that work together to allow a wide range of motion in the shoulder. It includes the glenohumeral joint, acromioclavicular joint, sternoclavicular joint, and scapulothoracic joint.

The glenohumeral joint is the main joint of the shoulder, where the head of the humerus (upper arm bone) articulates with the glenoid fossa of the scapula (shoulder blade). It allows for a wide range of motion in multiple planes, including flexion, extension, abduction, adduction, internal and external rotation, and circumduction.

The acromioclavicular joint is where the acromion (part of the scapula) meets the clavicle (collarbone). This joint allows for some movement in the shoulder girdle and helps to transmit forces from the upper limb to the rest of the body.

The sternoclavicular joint is where the sternum (breastbone) meets the clavicle. It allows for some movement in the shoulder girdle and helps to transmit forces from the upper limb to the rest of the body.

The scapulothoracic joint is not a true joint, but rather the movement of the scapula on the thoracic (ribcage) wall. It is essential for normal shoulder function and allows for proper positioning of the glenohumeral joint.

In addition to the joints, there are many muscles that attach to and move the shoulder complex, including the rotator cuff muscles, deltoid, pectoralis major, and trapezius. These muscles work together to allow for the wide range of motion and stability needed for everyday activities and athletic performance.

Tags : shoulder complex, motion in the shoulder, glenohumeral joint, acromioclavicular joint, sternoclavicular joint, scapulothoracic joint, Orthopaedic Surgery, Orthopaedic Surgery PowerPoint presentation

Published on : Jun 23, 2023 | Views : 1897 | Downloads : 3

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Slide 1-

The Shoulder Complex Chapter 18
Slide 2-

Shoulder Anatomy The most unstable joint in the body, mostly stabilized by soft tissue structures Because there is not a strong bony articulation, the shoulder is extremely mobile Bones: Scapula Clavicle Humerus Joints: Sternoclavicular Joint Acromioclavicular Joint Glenohumeral Joint Scapulothoracic Joint
Slide 3-

Muscles of the Shoulder complex Originate on the Axial Skeleton & Attach to the Humerus: Lattisumus Dorsi Pectoralis Major
Slide 4-

Muscles of the shoulder complex Originate on the Scapula & attach to the Humerus: Deltoid Teres Major Coracobrachialis Subscapularis Supraspinatus Infraspinatus Teres Minor
Slide 5-

Muscles of the shoulder complex Attach the Axial Skeleton to the Scapula: Levator Scapula Trapezius Pectoralis Minor Rhomboid Major & Minor Serratus Anterior & Posterior
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Glenohumeral Motions Flexion Extension ABDuction ADDuction Internal Rotation External Rotation Scapular Motions Elevation Depression Scapular Protraction Scapular Retraction
Slide 9-

Glenohumeral Joint Motions
Slide 10-

Flexion Pectoralis Major Anterior Deltoid Biceps
Slide 11-

Extension Lattissumis Dorsi Teres Major Posterior Deltoid
Slide 12-

ABDuction Supraspinatus Middle Deltoid
Slide 13-

ADDuction Pectoralis Major Latissimus Dorsi
Slide 14-

Internal Rotation (Medial Rotation) Pectoralis Major Subscapularis Latissimus Dorsi Teres Major
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External Rotation (Lateral Rotation) Infraspinatus Teres Minor
Slide 16-

Scapular MOTIONS
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Scapular Motions Scapular Elevation Trapezius Levator Scapula Rhomboids Scapular Depression Trapezius Pec Minor Pec Major Latissmus Dorsi Scapular ADDuction Trapezius Rhomboids Levator Scapula Scapular ABDuction Serratus Anterior Pec Major & Minor Lattisimus Dorsi Scapular Upward Rotation Serratus Anterior Trapezius Scapular Downward Rotation Rhomboids Pec Minor Levator Scapula
Slide 18-

Phases of the throwing motions
Slide 19-

Throwing Technique Wind-up Phase: Lasts from first movement until ball leaves gloved hand Lead leg strides forward Shoulders ABD, ER, Horizontally ABD
Slide 20-

Throwing Technique Cocking Phase Begins when Hands Separate & ends when maximum ER has occurred Foot contacts ground
Slide 21-

Throwing Technique Acceleration Phase From maximal ER until ball release Humerus ABD, Horizontally ABD, IR Scapula ABD, Elevates, & rotates upward
Slide 22-

Throwing Technique Deceleration Phase Ball release until maximal shoulder IR RC contracts eccentrically to slow down the humerus Rhomboids contract eccentrically to slow down the scapula
Slide 23-

Throwing Technique Follow Through Maximum IR until end of motion when there is a balanced position
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Clavicle Fracture How? Fall on outstretched arm. Fall on tip of shoulder. Direct blow Treat: splint/sling send for x-ray.
Slide 26-

https://www.youtube.com/watch?v=cxklzKlV_qM
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Humerus Fracture How? Direct blow Dislocation Falling on arm Treatment: X-rays Cuff and collar type Sling or sarmiento brace for Immobilization Refer to Physician immediately Look for swelling, discoloration, and point tenderness. Surgery may be required
Slide 28-

Humerus Fracture
Slide 29-

Fracture of Humeral Head
Slide 30-

(sternoclavicular) SC Joint Sprain How? Is uncommon, it can be dangerous because of the subclavian artery 3 grades life threatening, posterior dislocation Treatment: Splint three to five weeks High incidence of reoccurrence
Slide 31-

SC Joint Sprain
Slide 32-

(acromioclavicular) AC Joint Sprain How? Direct impact Falling on outstretched arm Very common in sports 3 Grades (or 5 grade) Treatment: Ice Stabilize Return to play as tolerated Pad or Tape
Slide 33-

AC Joint Sprain
Slide 34-

AC Joint
Slide 35-

Glenohumeral Dislocation How? Most common is anterior Likely to reoccur Pain Treatment: Decrease ROM 4-6 Weeks of immobilization Strength exercise Brace
Slide 36-

Glenohumeral Dislocation https://www.youtube.com/watch?v=jD0eAuctHoo
Slide 37-

Shoulder Impingement How? Soft Tissue Structures are compressed Located under the coracoacromial arch: Supraspinatous Tendon Subacromial Bursa Bicep Tendon Treatment: Decrease Inflammation Ice Exercise: Strengthening & ROM Restrict throwing & gradually return to activity https://www.youtube.com/watch?v=YLdjvpxXgnU
Slide 38-

Shoulder Impingement
Slide 39-

Rotator Cuff Strain How? Supraspinatus is the most commonly injured Mechanism involves dynamic rotation of the arm at a high velocity Most often occur at the humeral head Most common in over head throwing athletes Treatment: Exercise: Strengthening & ROM PRICE Decrease activity
Slide 40-

Rotator Cuff Strain
Slide 41-

Rotator Cuff Strain https://www.youtube.com/watch?v=41GZVz-gt9o
Slide 42-

Biceps Tendonitis How? Overuse injury, tenderness, anterior shoulder pain, swelling, crepitus Treatment Rest Ice Anti-inflammatory Med Ultrasound Strengthen muscle
Slide 43-

Biceps Tendonitis
Slide 44-

Biceps Tendon Rupture
Slide 45-

Shoulder Bursitis How? Subacromial Bursa Chronic inflammation resulting from trauma or overuse Treatment Ice Anti-inflammatories Rest Exercise Proper mechanics Work on ROM
Slide 46-

Shoulder Bursitis
Slide 47-

Upper arm contusion How? Caused by repetitive contact Usually occurs on the lateral aspect Repeated contusions can cause Myositis Ossificans Contusions can cause reduced ROM Treatment PRICE Stretching Pad to return to play
Slide 48-

Upper Arm Contusion
Slide 49-

SLAP LESION Labrum Injury: Superior Labral Anterior to Posterior Labral tear occurs where the biceps tendon meets the labrum 4 Types of SLAP Lesions Typically caused by trauma or repetitive shoulder motions Conservative treatment includes: Rest, Anti-inflammatories, & Physical Therapy for strengthening & ROM Surgical Treatment: Done if conservative measures fail, if the athlete wants to continue sport. Must do Physical Therapy post surgically
Slide 50-

SLAP LESION SLAP (Superior Labral Tear, Anterior to Posterior) Type 1 Fraying of Superior Labrum Biceps Anchor Intact Type 2 Superior Labrum detached Detachment of the Biceps Anchor Type 3 Bucket Handle type tear of Superior Labrum Biceps Anchor INTACT Type 4 Bucket Handle tear of Superior Labrum Extension of tear in Biceps Tendon Part of Biceps Anchor still INTACT
Slide 51-

SLAP Lesion
Slide 52-

Bennet Lesion Calcification of the inferior glenohumeral ligament Caused by a posterior capsule avulsion injury Common in overhead throwing athletes, particularly baseball Posterior shoulder pain with cocking & early acceleration Surgical treatment is still controversial Start treatment with active rest & rehabilitation If the athlete has: positive xray, posterior shoulder pain (especially during follow through), tenderness with palpation of posteroinferior shoulder, relief of symptoms with injection of anesthetics an arthroscopic procedure may be warranted
Slide 53-

Bankhart Lesion Labral injury sustained in shoulder dislocations Tear of the inferior glenohumeral ligament Symptoms include: a sense of instability, repeat dislocations, catching sensations, aching of the shoulder Treat initially with immobilization, rest, anti-inflammatories & physical therapy Surgery has a 90% success rate if performed on young patients who have not had any previous injury
Slide 54-

Bankart Lesion
Slide 55-

Hill-Sachs Lesion A posterolateral humeral head compression fracture A dent in the back of the humeral head which occurs during the dislocation as the humeral head impacts against the front of the glenoid. The depth of the lesion reflects the amount of damage to the opposite side of the joint—the anterior capsule and the labrum. Therefore larger Hill-Sachs lesions are associated with higher risks of recurrent dislocations.
Slide 56-

Shoulder GIRD Glenohumeral Internal Rotation Deficit when compared to the contralateral side Most commonly seen in baseball players Likely accompanied by increased external rotation Causes pain Physical Therapy for stretching the posterior inferior shoulder capsule is usually very effective Arthroscopy may be warranted if physical therapy fails Physician needs to rule out additional injuries
Slide 57-

Shoulder GIRD Rehabilitation
Slide 58-

Shoulder GIRD Rehabilitation
Slide 59-

Winging Scapula Medial Winging Scapula – Serratus Anterior Paralysis caused by damage or a contusion to the long thoracic nerve. If the long thoracic nerve is injured it can cause paralysis of the serratus anterior muscle & winging of the scapular or shoulder blade. Damage to the nerve can be caused by a contusion or blunt trauma of the shoulder, traction of the neck & can also sometimes follow a viral illness. Lateral Winging Scapula – Trapezius & Rhomboid Paralysis Serratus Anterior Palsy Trapezius Palsy
Slide 60-

Winging Scapula Treatment Non-operative treatment: REST from the offending activity Nonsteriodal Anti-inflammatory medications to help reduce inflammation and pain. Applying ice or cold therapy may help reduce the shoulder blade pain Ultrasound (with physician approval) The nerve usually spontaneously recovers, although this may take up to 12-24 months. Performing shoulder range-of-motion exercises while waiting for nerve recovery is of paramount importance. The most important muscle to strengthen is the serratus anterior muscle which holds the shoulder blade in place. Exercises to strengthen the serratus anterior, which is known as the punching muscle, include: scapular protraction punching with resistance bands serratus press. Operative treatment: If this conservative treatment is not successful, surgery may be necessary to replace the lost function of the serratus anterior muscle with the function of another muscle. This surgery is considered a salvage operation; it is not meant to allow the athlete to return to sports, just to allow pain-free activities of daily living. Surgery is used as a last resort if the condition is caused by nerve entrapment
Slide 61-

Thoracic Outlet Syndrome The thoracic outlet is the space between your collarbone (clavicle) & your first rib. This narrow passageway is crowded with blood vessels, muscles, and nerves. If the shoulder muscles in your chest are not strong enough to hold the collarbone in place, it can slip down and forward, putting pressure on the nerves and blood vessels that lie under it Symptoms vary depending on which nerves or blood vessels are compressed. Symptoms from nerve compression are much more common than symptoms from blood vessel compression. Pressure on the nerves (brachial plexus) may cause a vague, aching pain in the neck, shoulder, arm, or hand. It may also cause pain, numbness, or tingling on the inside of the forearm and the fourth and fifth fingers of the hand. Weakness may make your hand clumsy. Pressure on the blood vessels can reduce the flow of blood out of your arm, resulting in swelling and redness of your arm. Less commonly, pressure can reduce the blood flow into your arm and hand, making them feel cool and easily fatigued. Overhead activities are particularly difficult because they worsen both types of compression. depression in your shoulder, or swelling or discoloration in your arm. Your range of motion may be limited
Slide 62-

Thoracic Outlet syndrome Nonsurgical Treatment Physical therapy. Exercises can help strengthen the muscles surrounding the shoulder so that they are better able to support the collarbone. Postural exercises can help you stand and sit straighter, which lessens the pressure on the nerves and blood vessels. Nonsteroidal anti-inflammatory medications. Drugs like naproxen and ibuprofen can ease the pain and reduce swelling. Weight loss. If you are overweight, your doctor may recommend that you begin a weight loss program. Being overweight can stress the shoulder muscles that support your collarbone. Lifestyle changes. You may need to change your workstation layout, avoid strenuous activities, and even modify everyday activities that aggravate your symptoms. Surgical Treatment If nonsurgical treatment does not relieve your symptoms, your doctor may recommend surgery. Surgery for thoracic outlet syndrome may involve removing a portion of an abnormal first rib, releasing a muscle that joins the neck and chest, or sometimes both
Slide 63-

Athletes with thoracic outlet syndrome Kenzie Fowler- Softball, University of Arizona Brittany Rathbun – Softball, University of Wisconsin Taylor Sishc – Gymnastics & Diving, Stanford University Kenny Rogers (2001), Hank Blalock (2007), John Rheinecker (2008), Matt Harrison (2009), Jarrod Saltalamacchia (2009) – Baseball, Texas Rangers Phil Hughes – Baseball, New York Yankees
Slide 64-

Chapter 18, Question 1 What are the bony & soft tissue structures associated with the shoulder complex? Bones: Humerus, Clavicle, Scapula Ligaments: Coracoacromial, Coracoclavicular, Glenohumeral, Coracohumeral, Transverse Humeral and the LABRUM. (pg. 435-436) Muscles/Tendons: (pg. 436-438) Latissumus Dorsi & Pectoralis Major Deltoid, Teres Major, Coracobrachialis, Rotator Cuff Group Levator scapula, Trapezius, Rhomboid Major & Minor, Serratus Anterior Triceps Brachii, Biceps Brachii Bursa: Subacromial, Subdeltoid, Subscapular
Slide 65-

Chapter 18, Question 2 What four major joints make up the shoulder complex? Acromioclavicular Joint Sternoclavicular Joint Glenohumeral Joint (True Shoulder Joint) Scapulothoracic Joint (pg. 435-436)
Slide 66-

Chapter 18, question 4 Discuss the throwing motion & injuries that can occur in each phase. (pg. 438 – 440) Most injuries occur during the Acceleration & Deceleration Phases (infraspinatus, teres minor, supraspinatus, subscapularis, deltoid, pectoralis major, latissimus dorsi, teres major, rhomboids) The Supraspinatus is the most commonly injured Rotator Cuff Muscle Wind-up Phase 1st movement - ball leaves glove or hands separate Cocking Phase Maximum ER Acceleration Phase Maxiumum ER – Ball release The Humerus: ABDucts, Horizontal ABDucts & Internally Rotates Deceleration Phase External Rotators Eccentrically contract to decelerate the Humerus (slow it down) Rhomboids Eccentrically contract to decelerate the Scapula (slow it down) Ball Release - Maximum IR Follow-through Phase Maximum IR - Resting in balanced position