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
Rotator Cuff MusclesRotator Cuff Muscles
Subscapularis-Subscapularis-anterior shoulder anterior shoulder Internal rotationInternal rotation
Rotator Cuff MusclesRotator Cuff Muscles
Supraspinatus-Supraspinatus-anterior superior anterior superior shoulder shoulder abductionabduction
Rotator Cuff MusclesRotator Cuff Muscles
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.
Impingement SyndromeImpingement Syndrome
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
Impingement SyndromeImpingement Syndrome
Special TestsSpecial Tests Hawkins TestHawkins Test Neer’s ImpingementNeer’s Impingement Cross over TestCross over Test
Impingement SyndromeImpingement Syndrome
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 Shoulder Anterior Shoulder DislocationDislocation
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.
Anterior Shoulder Anterior Shoulder DislocationDislocation
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.
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.
Glenoid Labrum InjuryGlenoid Labrum Injury
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.
Glenoid Labrum InjuryGlenoid Labrum Injury
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.