Download Shoulder Complex

Shoulder Complex
The shoulder is susceptible to injury because there is more mobility compromising the stability
__________________________ place great stress on the complex. EX:
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MOI:
ANATOMY
Bones:
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 S shaped 6 in. long
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 Flat, triangular
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Prone to fx because of shape and not
protected
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purpose is an articulating surface for the
humerus
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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:
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Account for 50% of all dislocations
Shoulder instability increases chances
Subluxation
MOI
brief translation of the
humeral head without
separation of the joint
surfaces.
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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 =
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3. above 90 degrees =
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 What movements hurt most
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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
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Palpation
Anterior bony palpation
 clavicle
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 acromioclavicular joint
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 Humeral head
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 Bicipital groove
Posterior Bony Palpation
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 medial border of the scapula
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 lateral border
Anterior Soft tissue palpation
 SC, AC joint ligaments
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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
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Posterior soft tissue palpation
 Rhomboids
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 Trapezius
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 Infraspinatus
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Rehab Exercises for the Shoulder
Form is EVERYTHING!!!
Phase 1
 Wall Walks
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 Tubing
 ER, IR, Flexion, Extension, Abd., Add.
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 Strengthening (p. 586)
 I’s, Y’s and T’s
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 Wall pushups
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 Pendulum
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Phase 2
 Stabilization
 Fist: lying supine, arm at 30,90, and 120 degrees of flexion, push fist in all directions
 Balancing
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 Dot drill
 Pushups
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 Tubing
 Stretching
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 Sleeper (posterior capsule)
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 Triceps (inferior capsule)
 Strengthening
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 Ceiling Punch with weight
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Phase 3
 Plyometrics
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 Trampoline
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 side
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 Strengthening
 I’s, Y’s and T’s on ball w/weight
 Pushups
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 Tubing
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 Balancing
 theraball
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Shoulder PNF
 Ceiling Punch
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 Pitching
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 Flex fingers, wrist, elbow and horizontal adduction (punch) across the chest.
 Shrugs
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 Shiver
 Athlete is supine with elbow in 90 degrees of flexion and moves their arm in flexion and extension
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Throwing Analysis
Sequential pattern of movements each part of the body must perform a number of carefully timed and executed acts.
1. Windup
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2. Cocking
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3. Acceleration
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4. Release - Deceleration
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5. Follow Through
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