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s.h.o.u.l.d.e.r.

***MOTIONS***
ABduction
Deltoid, (Supraspinatus partially does it but it mainly starts the motion)

ADduction
Pectoralis Major, Teres Major, Latissimus Dorsi

Flexion
Anterior Deltoid, Pectoralis Major (clavicular portion)

Extension/Hyperextension
Posterior Deltoid, Teres Major, Latissimus Dorsi

External Rotation
Infraspinatus, Teres Minor, Posterior Deltoid

Internal Rotation
Latissumus Dorsi, Teres Major, Anterior Deltoid, Subscapularis

Horizontal ABduction (Extension)
Posterior Deltoid, Latissimus Dorsi, Teres Major

Horizontal ADduction (flexion)
Pectoralis Major, Anterior Deltoid

Injuries of the SHOULDER!!!!!


I. Shoulder Dislocations-highest dislocated joint.
-gleno-humeral joint
-anterior dislocations are the most common
A. Mechanism
1. ABducted and externally rotated. (horizontal abduction)
B. S+S
1. deformity--palpat the acromion process and then feel a drop off laterally
2. Pain
3. Decrease Movement
C. Treatment
1. Immobilize
2. sling and swath
3. Ice
4. Dr. Referral-E.R. to Reduce it (put it back into place) 5. immobilize (sling and swath) again for torn tissue to heal so another dislocation is less likely to occur. 2-3 weeks give or take
6. Rehab
-Strengthening adduction and internal rotation to pull away from abduction and externally rotating.
7. bracing if needed
**If Chronic-(3 reoccurences) surgery is needed-(to tighten muscles and capsule
II. Subluxations
A. Mechanism
1. Abduction and external rotation
B. S+S
1. Pt. Tender on the anterior shoulder
2. Positive Apprehension Test (try to externally rotate and abduct their arm and if they don't like it, the test is positive.
3. Sulcus Sign--Hold acromion process, pull with the other hand on the humerus. Laxity is what to look for.
B. RX(treatment)
1. 1st time--immobilize
2. RI
C. Rehabilitation
1. Strengthen adduction/internal rotators
***If chronic, surgery is necessary
III. Shoulder Separations
A. Mechanism
1. This is the sprain of the Acromio clavicular joint
2. Falls on the tip of the shoulder
3. Falls on outstretched arm
B. S+S
1. Pt. tender over AC joint
2. Pain (duh)
3. Decreased ROM
4. Stiffness
5. 2nd/3rd degree sprain you will see a slightly raised clavicle
6. Positive Spring Test- Pushing down the clavicle to see if it raises back up
C. RX
1. 1st degree, Ice, Pad it, Play as able (treat it like a bruise)
2. 2nd Degree, Rest, Immobilize, Ice, 2-3 weeks out with a gradual return to play
3. Surgery
IV. Clavicle Fractures
A. Mechanism
1. direct blow
2. Fall with arm pinned to side
B. S+S
1. Pain (which will be left off from S+S from now on because that is a given)
2. Deformity
3. Swelling
C. RX
1. R.I.
2. Sling or figure 8 wrap
3. Dr. Referral
4. Rest for 4 weeks
5. Rehab-return to play
D. Complications*
1. Careful of damaged artery, nerve, lungs!!
V. Rotator Cuff Problems
A. What they could be-
1. Tendonitis
2. Strain
3. Bursitis
4. Impingement Syndrome
B. Mechanism
1. Overhead throwing motion
**Ex. Tennis serve, Volley ball serve, baseball pitch, football throw, swimming, javalyn, ect.
2. Post Cuff gets pinched in between the scapular spine and the acromion process
C. S+S
1. Pain w/ overhand throwing motion
2. Pt. tenderness in sub acromial space
3. Decrease in strength
4. "Empty Can" test. Hold arm like emptying a can in the sink, Flex arm and horizontally abduct
This tests the supraspinatus.
D. RX
1. Rest, avoid overhead motion
2. R.I.
3. Anti-inflamatories
4. stretching poterior cuff muscles
5. Strengthening Posterior Cuff Muscles
6. Surgery-if chronic
VI Biceps Tendonitis
A. Biceps Bronchi has two tendons, one at the acromion process and the other at the coracoid process
B. Mechanism
1. Overuse for tendonitis and rotation for a subluxed tendon
C. S+S
1. Pt tenderness to the Anterior Proximal Humerus (inferior to the gleno-humeral joint)
2. Feel "popping"
3. Positive Yergenson's Test-Athlete flexes bicep and trainer internally and externally rotates arm
D. RX
1. Anti-inflamatories
2. R.I.
3. If problem-surgery
4. Shoulder Spica is good for this, subluxations and dislocations
REHAB. 1. ROM Exercises
2. Codman's Pendullum Exercise. Have athlet lean on table with unaffected arm and with the other arm, swing in circles or back and forth.
3. Wall walking-fingers walk up wall
4. Shoulder Wheel
5. Strength Exercises
6. Tubing exercises-elastic band
7. Dumbells


On to the Elbow/wrist/hand