The function of the shoulder allows the greatest range of motion of any joint in the body.

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Introduction

• The function of the shoulder allows the greatest
  range of motion of any joint in the body.
• This great range of motion can also lead to
  several common problems affecting the shoulder
  joint.
• In other words, the shoulder is built for motion,
  not stability

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Considerations

• What happens to the ROM during flexion if the arm
  is externally and internally rotated? Why?
• Which arm can you reach furthest up your back
  with?
• Why?

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Bones

• The bones of the shoulder include the humerus,
  the scapula, and the clavicle.
• A roof of the shoulder is formed by a part of
  the scapula called the acromion.

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Joints

• There are actually two joints around the shoulder
  
• The glenohumeral joint or the shoulder joint
• The acromioclavicular (AC) joint where the
  clavicle meets the acromion.

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Joint Capsule

• The joint capsule is made by a group of ligaments
  that connect the humerus to the socket of the
  shoulder joint on the scapula.
• Three ligaments are the main source of stability
  for the shoulder, and help to keep the shoulder
  from dislocating.
• Coracohumeral ligament
• Middle glenohumeral ligament
• Inferior glenohumeral ligament

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Bursa

• Sandwiched between the rotator cuff muscle layer
  and the outer layer of large bulky muscles is a
  structure known as a bursa.
• A bursa is simply a closed space between two
  moving surfaces that has a small amount of
  lubricating fluid inside

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Ligaments

• Ligaments are soft tissue structures that connect
  bones to bones.
• The acromioclavicular ligaments that attach the
  clavicle to the acromion
• The coracoclavicular (2) ligaments connects the
  clavicle to the coracoid process.
• The coracoacromial ligament connects the coracoid
  process and the acromion process

Coracoacromial ligament
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coracoclavicular
coracoacromial
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A Guide to Shoulder Problems

• http//www.castleortho.com/group/shoulder/default.
  htm

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Shoulder Injuries

• Impingement/Bursitis
• Rotator Cuff Tear
• Acromioclavicular(AC) Joint Separation
• Shoulder Instability
• Labral Tear

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Impingement Syndrome
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Impingement Syndrome

• The supraspinatus tendon connects the humerus
  with the scapula (shoulder blade) and helps raise
  and rotate the arm.
• As the arm is raised, the supraspinatus tendon
  also keeps the humerus tightly in the socket
  (glenoid) of the scapula. 

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Impingement Syndrome

• The part of the scapula that makes up the roof of
  the shoulder is called the acromion process. 
• Between the acromion process and the
  supraspinatus tendon there is a bursa. 
• The bursa is a lubricated sac of tissue that
  protects the muscles and tendons as they move
  against one another. 
• The bursa simply allows the moving parts to slide
  against one another without too much friction.

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Impingement Syndrome
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Impingement Syndrome

• If any condition decreases the amount of space
  between the acromion and the supraspinatus
  tendon,  the impingement process may get worse.
• Swelling
• Bone spurs
• Anatomical structure 

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Impingement Syndrome
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Rotator Cuff Tears
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Rotator cuff

• Subscapularis
• Supraspinatus
• Infraspinatus
• Teres minor

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Movement of RC Muscles

• Subscapularis is an internal rotator of the arm.
• Supraspinatus assists the deltoid in abducting
  the arm, with its greatest contribution being the
  initiation of abduction.
• Infraspinatus and teres minor muscles both
  externally rotate the arm.

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Rotator Cuff Injury

• The throwing motion has been divided into five
  phases wind-up, cocking, acceleration, and
  follow-through.
• Cocking phase
• Supraspinatus, infraspinatus, and teres minor
  muscles begin to fire at the end of early cocking
  phase
• Subscapularis subsequently fires in late cocking
  to decelerate the shoulder's external rotation.
  Also, it is stretching during the cocking phase.

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Rotator Cuff Injury

• Follow-through (muscles fire most intensely)
• Subscapularis internally rotates the shoulder,
• Remaining rotator cuff muscles are contracting
  eccentrically to decelerate the arm and are
  stretched.
• During this repetitive eccentric loading, the
  rotator cuff is prone to overload, fatigue,
  tendinitis, and even a partial undersurface tear.

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Note Surgery needs to be performed within 3
months or the supraspinatus muscle will atrophy
and be too short to reattach
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Shoulder Separation
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Shoulder Separation

• A shoulder separation is a fairly common injury,
  especially in an athletic population. 
• A shoulder separation is actually a dislocation
  of the acromioclavicular (AC) joint. 
• Some people mistake this for a shoulder
  dislocation, and vice versa. 
• This is a very different injury than a shoulder
  dislocation. 

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Grades of Shoulder Separation
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Shoulder Separation

• The most common cause of an acromicoclavicular
  (AC) joint separation is a fall on the shoulder. 
  
• As the shoulder strikes the ground, the force
  from the fall pushes the scapula down. 
• The clavicle, because it is attached to the rib
  cage, cannot move down enough to follow the
  motion of the scapula. 
• Something has to give, and the ligaments around
  the acromioclavicular (AC) joint begin to tear -
  separating, or dislocating, the joint.   

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Shoulder Dislocation Instability
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Shoulder Dislocation

• If the shoulder slips completely out of the
  socket, it has become dislocated.  
• 97 out of 100 dislocations are anterior.
• 3 out of 100 dislocate posteriorly.
• Repeated dislocations are not only a nuisance,
  but can cause further injury to the shoulder and
  can lead to arthritis of the shoulder if not
  treated.

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Shoulder Subluxation

• The ligaments that make up the joint capsule have
  a considerable amount of slack, or looseness, so
  that the shoulder is unrestricted as it moves
  through its rather large range of motion. 

• Sometimes the shoulder does not come completely
  out of the socket but slips partially out and
  then returns to its normal position. This is
  called subluxation. 

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Shoulder Instability

• Instability means that the shoulder is too loose
  and has a tendency to slip out of the socket, (or
  glenoid fossa). 
• This initial injury is usually fairly significant
  and the shoulder must be reduced, or put back
  into the socket, by a physician. 
• After that first violent injury that causes the
  shoulder to dislocate, the joint may remain
  unstable.  
• The ligaments that are supposed to hold the
  shoulder in the socket may not heal back
  properly, or they may remain stretched and too
  loose to keep the shoulder in the socket in
  certain positions. 

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Glenoid Labrum
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Labral Tear

• A part of the scapula, called the glenoid cavity,
  makes up the socket of the shoulder. 
• This socket is very shallow and flat. 
• To make the socket more like a cup, there is a
  rim of soft tissue called the labrum.  

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Labral Tear

• The labrum acts sort of like a gasket, turning
  the flat surface of the glenoid into a deeper
  socket that molds to the head of the humerus for
  a better fit.
• A tear of labrum can cause a very difficult to
  diagnose problem of pain and a catching sensation
  with movement of the shoulder. 

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Labral Tear

• This tissue can be caught between the socket and
  the humerus and be torn.
• This flap of tissue can move in and out of the
  joint, getting caught between the humeral head
  and glenoid socket, and cause pain and catching. 
  
• The labrum is also the area for attachment of
  several of the tendons and ligaments of the
  shoulder. 
• The ligaments that attach to the labrum help with
  maintaining the stability of the shoulder. 

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Labral Tear

• Most labral tears are probably the result of an
  injury to the shoulder, such as falling on an
  outstretched hand. 
• There is reason to believe that the excess motion
  of the humerus moving around on the glenoid may
  cause damage to the labrum over time.  
• An unstable shoulder may also cause injury to the
  labrum, if it repeatedly dislocates out of the
  glenoid.

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Exercises

• www.bodybuilding.com/fun/shoulders
• www.bestpersonaltraining.com/aze.htm

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Shoulder action ? Shoulder muscle(s) ?
Scapula action ? Scapula muscle(s) ?
Upward Rotation
Abduction
Deltoid
Ser. Ant., Trap (lower)
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Shoulder action ? Shoulder muscle(s) ?
Flexion
Ant Deltoid Upper Pect Major Coracobrach
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Shoulder action ? Shoulder muscle(s) ?
Scapula action ? Scapula muscle(s) ?
Horz. Add.
Ant. Deltoid Pect. Major Coracobrach.
Abduction
Pect. Minor Ser. Ant.
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Scapula action ? Scapula muscle(s) ?
Elevation
Lev. Scap. Rhomboids Up. Mid. Trap
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Shoulder action ? Shoulder muscle(s) ?
Scapula action ? Scapula muscle(s) ?
Hor. Abd
Adduction
Rhomboid Upper and Mid. Trap.
Lat. Post. Deltoid Teres Minor Infraspinatus
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Shoulder action ? Shoulder muscle(s) ?
Scapula action ? Scapula muscle(s) ?
Downward Rotation
Adduction
Pect. Major Coracobrach. Lat. Teres Major
Pect. Minor Rhomboid
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Shoulder action ? Shoulder muscle(s) ?
Scapula action ? Scapula muscle(s) ?
Adduction
Horizontal Add
Ant. Deltoid Pect. Major Coracobrach.
Rhomboid Upper and Mid. Trap.
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Shoulder action ? Shoulder muscle(s) ?
Scapula action ? Scapula muscle(s) ?
Adduction
Extension
Rhomboid Upper and Mid. Trap.
Lats Teres Minor Post. Deltoid
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Shoulder action ? Shoulder muscle(s) ?
External Rotation
Infrspinatus Teres Minor
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Rotator Cuff Exercises
External Rotation
Internal Rotation
Internal Rotation
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Rotator Cuff Exercises
External Rotation
Internal Rotation
External Rotation
Abduction (to work the supraspinatus)
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What position are her shoulders in?
Flexion
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What rotation action is his shoulder performing
as he continues to through the ball?
Internal Rotation
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What position is his right shoulder in?
Horizontal Abduction and External Rotation
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What position are her shoulders in?
Flexion
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What position are his shoulders in?
Horizontal abduction or Extension
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Position of their shoulders?
2.
1.
Extension
Flexion
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Position of his scapula?
Upward Rotation
Position of his shoulder?
Abduction
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What is the position of scapula?
What is the position of shoulder?
Adduction
Extension