the shoulder. shoulder girdle complex there are three primary articulations glenohumeral joint...

The Shoulder The Shoulder

Shoulder Girdle ComplexShoulder Girdle Complex

There are three There are three primary primary articulationsarticulations

Glenohumeral jointGlenohumeral joint Aromioclavicular Aromioclavicular

jointjoint Sternoclavicular Sternoclavicular

jointjoint

Shoulder GirdleShoulder Girdle

Dynamic Stability- mobility with stability.Dynamic Stability- mobility with stability.

as in it can move around and be stable.as in it can move around and be stable. Glenoid Fossa- concave part of the scapula Glenoid Fossa- concave part of the scapula

that the humeral head articulates with.that the humeral head articulates with. Glenohumeral joint- multi directional ball Glenohumeral joint- multi directional ball

and socket joint that is held together by and socket joint that is held together by the ligments and muscles of the shoulder. the ligments and muscles of the shoulder. Less stable than the hip ball and socket.Less stable than the hip ball and socket.

The Joints of the The Joints of the ShoulderShoulder

Acromion Process-Acromion Process-

The superior part of The superior part of

the scapula that you the scapula that you can palpate. can palpate.

Acromioclavicular Acromioclavicular joint (AC)- joint (AC)- where where the acromion and the acromion and clavicle come clavicle come together.together.

The Joints of the The Joints of the ShoulderShoulder

Sternoclavicular Sternoclavicular joint (SC)- where joint (SC)- where the clavicle and the clavicle and the sternum come the sternum come together.together.

The joints of the The joints of the ShoulderShoulder

Scapulothoracic Scapulothoracic Joint- the scapula Joint- the scapula slides over the back slides over the back of the thorax of the thorax (ribcage).(ribcage).

Synergistically- Synergistically- muscle groups muscle groups working together to working together to move one joint and move one joint and maintain dynamic maintain dynamic stability.stability.

Rotator Cuff MusclesRotator Cuff Muscles

Infraspinatus- Infraspinatus- posterior inferior posterior inferior shouldershoulder External rotationExternal rotation


Subscapularis-Subscapularis-anterior shoulder anterior shoulder Internal rotationInternal rotation


Supraspinatus-Supraspinatus-anterior superior anterior superior shoulder shoulder abductionabduction


Teres Minor- Teres Minor- posterior shoulderposterior shoulder Adduction Adduction

Muscle Force CoupleMuscle Force Couple

Force Couple-two equal forces Force Couple-two equal forces acting in opposite direction to rotate acting in opposite direction to rotate a part around an axis.a part around an axis.

deltoiddeltoid

Rotator CuffRotator Cuff

Scapulothoracic Scapulothoracic MechanicsMechanics

Scapular Movers-upper, lower, middle Scapular Movers-upper, lower, middle trapezius, rhomboids, serratus anterior trapezius, rhomboids, serratus anterior and pectoralis minor.and pectoralis minor.

They work with rotator cuff muscles to;They work with rotator cuff muscles to; Flex and extend shoulderFlex and extend shoulder Internal and externally rotate shoulderInternal and externally rotate shoulder Abduct and adduct shoulderAbduct and adduct shoulder Hoizontally abduct and adduct shoulderHoizontally abduct and adduct shoulder

Shoulder InjuriesShoulder Injuries

They can be one of They can be one of two varieties:two varieties: Overuse-chronic –Overuse-chronic –

typically limited to typically limited to the soft tissue of the soft tissue of the shoulder.the shoulder.

Traumatic-acuteTraumatic-acute

Impingement SyndromeImpingement Syndrome A condition that occurs when the space between A condition that occurs when the space between

the humeral head and the acromion above the humeral head and the acromion above becomes narrowed.becomes narrowed.

The three things that can get pinched are the:The three things that can get pinched are the:joint capsule, tendons of rotator cuff, and bursa.joint capsule, tendons of rotator cuff, and bursa.

Impingement SyndromeImpingement Syndrome

Impingement can create either Impingement can create either bursitis, or tendonitis depending on bursitis, or tendonitis depending on what structure is being squeezed.what structure is being squeezed.

Overhead athletes are more likely to Overhead athletes are more likely to have problems with this injury.have problems with this injury.

1/3 of shoulder problems are due to 1/3 of shoulder problems are due to impingement.impingement.


Signs and SxSigns and Sx Pain and tender GH Pain and tender GH

jointjoint Pain and weak active Pain and weak active

abd in mid rangeabd in mid range Limited internal Limited internal

rotationrotation + Hawkins Test+ Hawkins Test Tender subacromial Tender subacromial

area possibly into area possibly into the deltoidthe deltoid

TreatmentTreatment Correct techniqueCorrect technique Strengthen inferior Strengthen inferior

musclesmuscles Strengthen weak Strengthen weak

rotator cuff musclesrotator cuff muscles


Special TestsSpecial Tests Hawkins TestHawkins Test Neer’s ImpingementNeer’s Impingement Cross over TestCross over Test


Stretches-Stretches- 3 way door stretch3 way door stretch Posterior shoulderPosterior shoulder Internal Rotation withInternal Rotation with

ExercisesExercises Internal RotationInternal Rotation External RotationExternal Rotation AdductionAdduction

Rotator Cuff TearsRotator Cuff Tears In the young person it is In the young person it is more of a traumatic injury, more of a traumatic injury, fall on outstretched arm, fall on outstretched arm, arm yanked back.arm yanked back. Young person can have Young person can have chronic injury that chronic injury that

ultimately tears a tendon. ultimately tears a tendon. In the older person it is a In the older person it is a

result of lose of elasticity in result of lose of elasticity in the muscle and tendon and the muscle and tendon and can tear with everyday can tear with everyday activities or a bone spur.activities or a bone spur.

Rotator Cuff TearsRotator Cuff Tears

Signs and SxSigns and Sx With a parcial tear the With a parcial tear the

athlete will feel pain but still athlete will feel pain but still be able to move with normal be able to move with normal ROM.ROM.

With a complete tear the With a complete tear the athlete will not have normal athlete will not have normal ROM.ROM.

Overhead motions are Overhead motions are hardest.hardest.

A shrug motion will result.A shrug motion will result. Pain sleeping on injured side.Pain sleeping on injured side.

Rotator Cuff TearsRotator Cuff Tears

Special TestsSpecial Tests Active Abdcution-look for hiking Active Abdcution-look for hiking

shouldershoulder Drop Arm sign- athlete abduct above Drop Arm sign- athlete abduct above

head then lowers slow, look for loss of head then lowers slow, look for loss of muscle control.muscle control.

Supraspinatus muscle test- looking for Supraspinatus muscle test- looking for weaknessweakness

MRI is final diagnostic toolMRI is final diagnostic tool

Biceps TendonitisBiceps Tendonitis

Discomfort in the Discomfort in the front of the front of the shoulder.shoulder.

Can be caused by Can be caused by impingement.impingement.

Special Tests-Special Tests- Speed’s TestSpeed’s Test Yergeson’s TestYergeson’s Test

Traumatic Shoulder Traumatic Shoulder InjuriesInjuries

Shoulder DislocationShoulder Dislocation Glenoid Labrum InjuriesGlenoid Labrum Injuries Multidirectional InstabilitesMultidirectional Instabilites Acromioclavicular SeparationAcromioclavicular Separation Brachial Plexus InjuryBrachial Plexus Injury FracturesFractures

Anterior Shoulder Anterior Shoulder DislocationDislocation

A humerus can A humerus can dislocate dislocate Anteroinferiorly-Anteroinferiorly-

front and down front and down (most common) (most common)

Inferiorly – downInferiorly – down Posteriorly -backPosteriorly -back


Anterior dislocation Anterior dislocation happens when the happens when the arm is abducted to arm is abducted to the side and a the side and a forceful external forceful external rotation happens.rotation happens.

A doctor visit is A doctor visit is necessary, necessary, immediately if the immediately if the humerus does not humerus does not relocate on it’s own.relocate on it’s own.

Even if it goes back Even if it goes back a Hill-Sach’s Lesion a Hill-Sach’s Lesion can occur.can occur.


Rehabilitation is very Rehabilitation is very important to this important to this injury.injury.

Reinjury will likely Reinjury will likely happen if a first time happen if a first time injury happens injury happens before the age of 20.before the age of 20.

Surgery may be Surgery may be necessary if repeated necessary if repeated dislocation occurs.dislocation occurs.

Special Test-DislocationSpecial Test-Dislocation

Apprehension testApprehension test

Glenoid Labrum InjuryGlenoid Labrum Injury

Glenoid Labrum-a ring of cartilage Glenoid Labrum-a ring of cartilage attached to the margin of the attached to the margin of the glenoid cavity of the scapula.glenoid cavity of the scapula.

The labrum acts to keep the humeral The labrum acts to keep the humeral head positioned on the glenoid by head positioned on the glenoid by blocking unwanted movement.blocking unwanted movement.


A labral tear can occur with a A labral tear can occur with a shoulder dislocation, more likely to shoulder dislocation, more likely to occur with numerus dislocations. occur with numerus dislocations.

A degenerative tear can occur when A degenerative tear can occur when a shoulder becomes loose, letting a shoulder becomes loose, letting the humeral head slip over the the humeral head slip over the labrum numerus labrum numerus times and eventually the times and eventually the labrum will fail/tear. labrum will fail/tear.


Signs and SxSigns and Sx Pain with catching Pain with catching

and poppingand popping Possible weakness Possible weakness Possible limited Possible limited

ROMROM Special TestsSpecial Tests

Clunk TestClunk Test Cross Over TestCross Over Test

TreatmentTreatment Rotator Cuff Rotator Cuff

strengtheningstrengthening SurgerySurgery

Multidirectional Multidirectional InstabilitiesInstabilities

Typically an anatomical problem.Typically an anatomical problem. Multiple dislocations will make it worse.Multiple dislocations will make it worse. Exercise may help with the problem, surgery Exercise may help with the problem, surgery

sometimes, but not alwayssometimes, but not always Weight bearing exercise are helpful. Like what?Weight bearing exercise are helpful. Like what?

Acromicavicular Acromicavicular SeparationSeparation

Also known as an AC sprain.Also known as an AC sprain. Occurs due to fall on outstretched arm Occurs due to fall on outstretched arm

or tip of shoulder. May be due to blow or tip of shoulder. May be due to blow to tip of shoulderto tip of shoulder

AC separationAC separation

Signs and SxSigns and Sx deformitydeformity Pain in vicinity of Pain in vicinity of

ACAC

Special TestSpecial Test Shear TestShear Test Sulcus SignSulcus Sign

TreatmentTreatment Three grades –the Three grades –the

grade determines grade determines treatmenttreatment

Grade one is Grade one is exercise and iceexercise and ice

Grade two Grade two immobilize 3 weeks immobilize 3 weeks and then exerciseand then exercise

Grade three Grade three immobilize 5 weeks immobilize 5 weeks and then exercciseand then exerccise

Brachial Plexus InjuryBrachial Plexus Injury

Brachial Plexus-Brachial Plexus-group of nerves that group of nerves that leave the spinal cord leave the spinal cord and extend into the and extend into the shoulder giving arm shoulder giving arm function.function.

AKA-stinger or AKA-stinger or burnerburner

A result of stretching A result of stretching or compression of or compression of the nerves.the nerves.

DermatonesDermatones

When looking at When looking at nerves you need to nerves you need to know level off spine know level off spine injury relative to injury relative to sensation and sensation and movement. movement.

Dermatomes is Dermatomes is sensation areas sensation areas corresponding to corresponding to nerve.nerve.

MyotomesMyotomes Each of the spinal nerves Each of the spinal nerves

controls certain muscles. controls certain muscles. The muscles (or muscles) The muscles (or muscles) controlled by a particular controlled by a particular nerve root are called its nerve root are called its myotome.myotome.

C4-Trapezius-shrugC4-Trapezius-shrug C5-deltoid-abductionC5-deltoid-abduction C6-biceps- elbow flexC6-biceps- elbow flex C7-triceps- elbow extC7-triceps- elbow ext C8-thumb extC8-thumb ext T1- finger abduct/adduct.T1- finger abduct/adduct.

Brachial Plexus InjuryBrachial Plexus Injury

Signs and SxSigns and Sx Pain in neck and Pain in neck and

armarm Weakness in neck Weakness in neck

and armand arm Numb or pins and Numb or pins and

needles down armneedles down arm

TreatmentTreatment Rest till Sx go awayRest till Sx go away Ice after activityIce after activity Anti-inflammatoryAnti-inflammatory Possible dr visitPossible dr visit

FracturesFractures

Typically caused by a direct blow.Typically caused by a direct blow. Clavicle and humerus, very rarely Clavicle and humerus, very rarely

the scapula.the scapula. Typically you will see deformityTypically you will see deformity Xray necessary, immobilization 4-6 Xray necessary, immobilization 4-6

weeks minimum.weeks minimum.

We have strong We have strong shouldersshoulders

‘‘cause we stay athletic as we agecause we stay athletic as we age

the shoulder. shoulder girdle complex there are three primary articulations glenohumeral joint...

Documents