SHOULDER UNIT Chapter 18

Objectives:anatomy Ligaments Muscles Shoulder mechanics Injuries Treatments Rehabilitation

VocabularyVocabulary 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 Glenoid fossa Medial border of scapula Lateral border of scapula Inferior/superior angle of scapula

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

SH Biceps

LH 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