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When you finish this chapter you should be able to

  • Point out the critical anatomical features of the four articulations in the shoulder complex.

  • Perform an in-depth evaluation of the shoulder complex.

  • Recognize the steps that can be taken to minimize the chances of injury to the shoulder complex.

  • Explain how shoulder stability is maintained by the joint capsule, ligaments, and muscles.

  • Summarize the anatomical and functional relationship between shoulder stability and shoulder impingement.

  • Identify the etiology and recognize the symptoms and signs of specific injuries that occur around the shoulder joint, and discuss plans for management.

  • Formulate a general plan that may be effectively incorporated into a rehabilitation program for treating a variety of injuries in the shoulder complex.


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external rotation gain (ERG) glenohumeral internal rotation deficit (GIRD)


Visit for further exercises to apply your knowledge:

  • Clinical application scenarios covering assessment and recognition of shoulder injuries, etiology, symptoms and signs, and management of shoulder injuries, and rehabilitation for the shoulder

  • Click-and-drag questions covering structural anatomy of the shoulder, assessment of shoulder injuries, and rehabilitation plan of the shoulder

  • Multiple-choice questions covering anatomy, assessment, etiology, management, and rehabilitation of shoulder injuries

  • Selection questions covering rehabilitation plans for various injuries to the shoulder

  • Video identification of special tests for the shoulder injuries, rehabilitation techniques for the shoulder, and taping and wrapping for shoulder injuries

  • Picture identification of major anatomical components of the shoulder, rehabilitation techniques of the shoulder,


The shoulder complex, as the name implies, is an extremely complicated region of the body. Because of its anatomical structure, the shoulder complex has a great degree of mobility. This mobility requires some compromise in stability, and thus the shoulder is highly susceptible to injury. Many overhead activities—in particular, those that involve repetitive overhead movements—place a great deal of stress on the supporting structures (Figure 22–1). Consequently, injuries related to overuse in the shoulder are commonplace. Some understanding of the anatomy and mechanics of this joint is essential for the athletic trainer.


Vigorous and/or repetitive overhead activities, such as (A) serving in tennis or (B) painting, can result in a variety of shoulder injuries. (a) © moodboard/Corbis; (b) © William E. Prentice



The bones that make up the shoulder complex and shoulder joint are the clavicle, sternum, scapula, and humerus (Figure 22–2).


(A) Skeletal anatomy of the shoulder complex. (B) Anatomy of the scapula.

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