Download SHOULDER UNIT Chapter 18

SHOULDER UNIT Chapter 18
 Objectives:anatomy
 Ligaments
 Muscles
 Shoulder mechanics
 Injuries
 Treatments
 Rehabilitation
Vocabulary
 Brachial plexus
 Impingement
 Labrum
 Thoracic outlet compression syndrome
 Trigger point
 Axilla
 Shoulder pointer
 Shoulder articulations
ANATOMY
 Characteristic- very moveable joint, shallow joint,
unstable, ball and socket
 Bones of the shoulder: scapula, humerus, clavicle
 spine of scapula
 Acromion process tip of shoulder
 Coracoid process
 Supraspinatus fossa
 Infraspinatus fossa
 Subscapularis fossa
Scapula
 Glenoid fossa
 Medial border of scapula
 Lateral border of scapula
 Inferior/superior angle of scapula
Anatomy cont.
 Bones cont.
 Humerus: Proximal Head of the humerus
 Bicipital groove
 Clavicle: S shape and fracture middle 1/3
most common
Joints/Ligaments
 Joints of the shoulder
 1 Acromioclavicular=AC
– Attaches acromion process to the distal end of clavicle
 2 Coracoclavicular=CC
– Attaches the coracoid process to dstal end of clavicle
 3 Glenohumeral=GH
– Attaches the rim of the glenoid fossa to the proximal
end of the humerus
 4 Sternoclavicular=SC
– Attaches the sternum to the proximal end of the clavicle
Muscles
 Rotator cuff
SITS
 Attachment action
 Supraspinatus- supraspinatus fossa, goes underneath acromion
process, then to lateral head of humerus
 Initiates abduction, sinks head of the humerus into glenoid fossa
 Infraspinatus- infraspinatus fossa to the posterior lateral head
of humerus
 External rotation and adduction
 Teres minor- lateral border of scapula to posterior head of
humerus
 External rotation and adduction
 Subscapularis- subscapularis fossa to the anterior surface head
of humerus
 Internal rotation and adduction
 Teres major- lateral border of scapula to anterior head of
humerus
 Internal rotation and adduction
Muscles cont.
 Deltoid- Anterior, middle (median), posterior
 Abduction
 Pectoralis maj/min.- attaches to chest wall and to
anterior surface of humerus
 horizontal flexion and internal rotation
 Trapezius- shrug shoulders/abduction
 Latissimus Dorsi- wings, adduction
 Rhomboid maj/min- scapular retraction
 Serratus anterior- sawtooth looks likes ribs, pushup
motion
 Levator Scapula- elevates scapula
 Triceps- elbow extension
 Biceps- elbow flexion
Rotator Cuff: SITS
Subscapularis
LH biceps
SH Biceps
Shoulder Mechanics
 Cocking phase
 Shoulder abduction, flexion, and external rotation
 Stretched- pectoralis, ant. Deltoid, biceps,
subscapularis, teres major
 Acceleration phase
 Pectoralis, ant. Deltoid, biceps, subscapularis,
teres major
 Internal rotation
 Follow through phase
 Humerus adducts, internal rotation
 lastissimus dorsi, rotator cuff, pectoralis major
 What muscles in this phase are commonly injured?
 External rotators-teres minor,infraspinatus
Injuries to the shoulder
 Fracture to the clavicle:middle
1/3 most common area injured.
 Mechanism= fall on tip of shoulder
 Hold their head to the injured side
with arm held up
Injuries to the shoulder
 Dislocations:Anterior
glenohumeral
 Most common- head of the
humerus slides in front of
the coracoid process.
Tearing of the joint capsule.
 Most unstable position=
abduction/ext. rotation
 posterior glenohumeral
uncommon
 mechanism of injury: arms
in front(flexion), direct blow
to hands.
Injuries Cont..
 Acromioclavicular or AC sprain/separation.
 Grade 1- minimal deformity.
 Grade 2- slight deformity.
 Grade 3- huge deformity.
 Mechanism of injury.
 Falling on an outstretched arm or falling on the tip of your
shoulder.
 Functional test for AC injury.
– Touch the opposite shoulder-pain over AC= positive
findings.
– Drop arm test.
.
Injuries Cont..
 Contusion of the shoulder.
 Shoulder pointer- AC and deltoid. Can lead to myositis
ossificans.
 Strains to the shoulder:Grades 1,2,3
 causes of strains: overuse, improper mechanics, lack
of flexibility, going past the normal ROM, lack of strength,
unexpected acceleration/deceleration, improper warm-up,
poor conditioning
Injuries
 Bursitis/tendonitis
 Bicipital tendonitis, supraspinatus
 Subacromion, subcoracoid- signs/symptoms=
inflammation, pain, burning, redness
 Impingement : narrowing of the subacromion space
where the supraspinatus passes under the acromion
process. S/S= pain and aching
 Tests: empty can- thumb up/thumb down
 overhead opposite arm.
Treatment of common injuries to
the shoulder
 Dislocations
 separations/sprains
 Fractures
 Chronic injuries
 Brachial plexus
Special Tests
 Gleno humeral Instability
– Load and shift
• Move the head of the humerus anterior/posterior
– Anterior /Posterior drawer test
• Move the humerus anterior while laying down
– Sulcus test
• Pull down on the elbow and look for a depression
– Apprehension Test (Crank test)
• Shoulder dislocation
• Arm is 90 degrees abducted and externally rotated. Look for
apprehension or pain
Special Tests
 Neer’s test pg. 391 fig. 18-7
– Impingement
• Forced flexion of the shoulder towards your ear
 Hawkin’s Kennedy test pg 391 fig. 18-7
– Impingement
• Horizontal adduction and forced internal rotation
Special Tests
 Drop arm test
– Supraspinatus weakness
• Abduct the arm as far as possible and slowly lower
it to 90 degrees. If there is weakness they won’t be
able to hold that position.
 Empty Can test
– Supraspinatus weakness
• The athlete brings both shoulder into 90 degrees of
forward flexion and 30 degrees of horizontal
abduction. The thumbs are pointing downward.
Force is applied to the arm in a downward motion.
Rehab
 Stage 1: decrease swelling and pain, wear sling, Rest
Ice, ROM while in sling for wrist and elbow, squeeze
tennis ball, CV
 Progression to Stage II- minimal swelling and pain
 Stage 2: Increase ROM, flexibility, and start on strength,
PNF
 Int/ext rotation at neutral position, shoulder shrugs,
circumduction (Codman exercises),finger wall walking,
tubing, CV
 Progression to stage III- full ROM, partial strength
 Stage 3: PNF, wall push-ups, push-up on ground and
with a ball, airplanes, Weight room, SAID-sport specific