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Shoulder Complex The shoulder is susceptible to injury because there is more mobility compromising the stability __________________________ place great stress on the complex. EX: MOI: ANATOMY Bones: S shaped 6 in. long Flat, triangular Prone to fx because of shape and not protected purpose is an articulating surface for the humerus Bicipital groove Glenohumeral joint Clavicular Fx Humeral shaft Fx Proximal Fx MOI: Proximal Humerus: great danger to nerve and vessels MOI: MOI: S/S: athlete supports arm, swelling, deformity, point tenderness. tilts head to the injured side w/ chin toward opposite side. TX: S/S: x –ray, pain, inability to move arm, swelling, point tenderness, discoloration TX: Epiphyseal FX MOI: young athlete 10 years and younger Test: Account for 50% of all dislocations Shoulder instability increases chances Subluxation MOI brief translation of the humeral head without separation of the joint surfaces. 85-90% re-occurrence Anterior Dislocation Most common MOI Posterior Dislocation MOI S/S S/S - TX: flat deltoid Feel humeral head Athlete carries the affected arm in slight abduction and ER Unable to touch opposite shoulder TX: - immediate immobilization PRICE Refer Articulations: Sternoclavicular Joint (SC) - Clavicle + Manubrium of sternum - Only direct connection between the upper extremity and trunk - Acromioclavicular Joint (AC) Glenohumeral joint (shoulder joint) - Scapulothoracic Joint - Lateral end of clavicle + acromion process - -Head of humerus + glenoid cavity of scapula -Held together by the glenoid labrum, capsular ligamentous structures & rotator cuff - -Not a true joint - Ligaments Sternoclavicular joint ligaments - AC jt Sprain MOI: S/S: Grade 1 - point tenderness - Discomfort during movement - TX: Grade 2 - tearing or rupture of AC lig - Stretching or tearing of coracoclavicular lig - Displacement of distal end of clavicle - Grade 3 Test: Piano key, compression Special Test: Piano sign/key Special Test: Compression/Squeeze - Athlete sitting or standing + test = + test = Glenohumeral (GH) joint Sprain MOI: S/S: TX: Tests: load and shift, Sulcus, Apprehension Crank Special Test: GH Glide/Load and shift Special Tests: Sulcus Special Test: Apprehension Crank + test= laxity compared bilaterally + test= observable gap + test = apprehension/resistance Musculature: Glenohumeral Joint movements/muscles Scapulothoracic Joint movements/muscles - Flexion - Protraction - Extension - Retraction - Abduction - Depression - Adduction - Elevation - External rotation - Internal rotation -Horizontal Adduction -Horizontal Abduction Special Tests: Shoulder MMT +MUSCLE Bicipital Tenosynovitis: MOI: S/S: TX: Tests: Yergasons, Speeds Special Test: Yergason’s Test Special Test: Speeds + test = pain in bicipital groove + test = pain in the bicipital groove Rotator Cuff Muscles: Special Test: Empty Can Special Test: Drop Arm + test = weakness or pain in shoulder + test = athlete cannot hold 90 degree position Supraspinatus Subscapularis Shoulder Impingement MOI: S/S: TX: Special tests: Neer, Hawkins Kennedy empty can test, drop arm Special Test: Neer Special test: Hawkins Kennedy + test = pain at AC joint + test = pn at the AC joint Bursae: Subacromial (subdeltoid) bursa: - Most important - Shoulder Bursitis MOI: build up of fluid - chronic inflammation - Direct impact * Subacromial bursa is most inflamed. S/S: Nerve Supply: Blood Supply: - Subclavian artery - Brachial artery TX: Tests: Neer, Hawkins-Kennedy Thoracic Outlet Compression Syndrome (TOCS) “stingers” MOI: S/S: Winging Scapula - Serratus anterior weakness, 2 scapula - Special Test: Scapulohumeral Rhythm: Describes the movement of the scapula relative to the movement of the humerus through a full ROM of abduction Preventing Shoulder Injuries: 1. proper total physical training through full ROM 2. proper warm up 3. instruction on how to properly fall. 4. appropriate techniques must be taught. Shoulder Complex Assessment History: A. 1. pins and needles = 2. sharp pain = 3. dull, aching, sense of heaviness = 4. deep, aching pain in the neck/shoulder region = 5. night pain = 6. burning pain = 7. weakness, numbness = B. Normal activities 1. neck = Ability to talk/swallow = SCJ 2. shoulder ER = 3. above 90 degrees = What movements hurt most ____________________________________________________________________________________ Observation B. Anteriorly A. 1. Step deformity at the ACJ = 1. 2. Flat deltoid = - 2. muscle wasting v. hypertrophy C. Laterally 3. 1. kyphosis: 4. 2. 5. D. Posteriorly 6. 1. muscle definition 2. scapulohumeral rhythm 3. scapular winging during flexion and abduction __________________________________________________________________________________________ Palpation Anterior bony palpation clavicle acromioclavicular joint Humeral head Bicipital groove Posterior Bony Palpation medial border of the scapula lateral border Anterior Soft tissue palpation SC, AC joint ligaments • with thumb on subscapularis, second, third and fourth fingers will be over the insertion of other three rotator cuff muscles: supraspinatus, infraspinatus, teres minor Sternocleidomastoid Posterior soft tissue palpation Rhomboids Trapezius Infraspinatus Rehab Exercises for the Shoulder Form is EVERYTHING!!! Phase 1 Wall Walks Tubing ER, IR, Flexion, Extension, Abd., Add. Strengthening (p. 586) I’s, Y’s and T’s Wall pushups Pendulum Phase 2 Stabilization Fist: lying supine, arm at 30,90, and 120 degrees of flexion, push fist in all directions Balancing Dot drill Pushups Tubing Stretching Sleeper (posterior capsule) Triceps (inferior capsule) Strengthening Ceiling Punch with weight Phase 3 Plyometrics Trampoline side Strengthening I’s, Y’s and T’s on ball w/weight Pushups Tubing Balancing theraball Shoulder PNF Ceiling Punch Pitching Flex fingers, wrist, elbow and horizontal adduction (punch) across the chest. Shrugs Shiver Athlete is supine with elbow in 90 degrees of flexion and moves their arm in flexion and extension Throwing Analysis Sequential pattern of movements each part of the body must perform a number of carefully timed and executed acts. 1. Windup 2. Cocking 3. Acceleration 4. Release - Deceleration 5. Follow Through