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Out there in the real world, one athletic trainer experienced the following:

During a surprisingly warm Saturday morning in early October I was covering a junior varsity football game. One of the running backs was sprinting down the sideline when he was tackled. He landed on the tip of his shoulder, briefly paused, and then slowly rose to his feet. He was cradling his right arm as he walked toward the sideline. As I began evaluating him, I considered possible involvement of the acromioclavicular joint or a fractured clavicle. With the help of a couple of varsity players milling on the sideline, we removed the injured athlete's shoulder pads and immediately saw an anterior dislocation of the sternoclavicular joint. I placed his arm in a sling, applied ice, and sent him to the emergency room with his parents. It was a quick reminder that you cannot assume that a typical injury has occurred based on an initial assessment. I was thankful the athlete did not experience a posterior dislocation.

Kari Terrell, MSEd, AT, ATC

Highland District Hospital

East Clinton High School

Hillsboro, Ohio


learning outcomes

After working through this chapter, you will be able to:

  1. Verbalize the questions to use when obtaining a thorough medical history for an assessment.

  2. Describe the principles of body movement at the shoulder and the various mechanisms of injury that affect the shoulder.

  3. Compare and contrast the findings of various special tests and the role of diagnostic tests used during a shoulder evaluation.

  4. Explain the medical terminology associated with the assessment of musculoskeletal injuries.

  5. Verbalize the standard procedures used for a clinical evaluation of the shoulder and interpret the findings for differential diagnoses.


JoAnn Hartman is playing soccer in a weekend tournament in her hometown. She is an aggressive forward who is one of the top scorers on her team. Ms. Hartman receives the ball from a teammate and is on a fast breakaway to the goal. As she gets inside the goal box, a defender slide tackles her just before the goalkeeper gets the ball, and Ms. Hartman collides with the defender and the goalie. She hears a cracking sound and experiences immediate pain. As she leaves the field in a panic, she supports her left arm with her right hand, keeps her left arm next to her body, and rotates her head to the right side. Upon evaluation, there is a visible deformity (Fig. 8-1), no apparent edema, no ecchymosis, and mild paraesthesia in her upper left arm. Ms. Hartman has normal capillary refill on the affected side. Ms. Hartman has pain with palpation to the shoulder and clavicle and has pain with any shoulder range of motion.

Figure 8-1:

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