SHOULDER UNIT Chapter 18

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SHOULDER UNIT Chapter 18

• Objectivesanatomy
• Ligaments
• Muscles
• Shoulder mechanics
• Injuries
• Treatments
• Rehabilitation

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Vocabulary

• Brachial plexus
• Impingement
• Labrum
• Thoracic outlet compression syndrome
• Trigger point
• Axilla
• Shoulder pointer
• Shoulder articulations

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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

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Anatomy cont.

• Bones cont.
• Humerus Proximal Head of the humerus
• Bicipital groove
• Clavicle S shape and fracture middle 1/3 most
  common

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Joints/Ligaments

• Joints of the shoulder
• 1 AcromioclavicularAC
• Attaches acromion process to the distal end of
  clavicle
• 2 CoracoclavicularCC
• Attaches the coracoid process to dstal end of
  clavicle
• 3 GlenohumeralGH
• Attaches the rim of the glenoid fossa to the
  proximal end of the humerus
• 4 SternoclavicularSC
• Attaches the sternum to the proximal end of the
  clavicle

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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

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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

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Rotator Cuff SITS
Subscapularis
LH biceps
SH Biceps
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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

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Injuries to the shoulder

• Fracture to the claviclemiddle 1/3 most common
  area injured.
• Mechanism fall on tip of shoulder
• Hold their head to the injured side with arm held
  up

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Injuries to the shoulder

• DislocationsAnterior 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.

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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.
• .

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Injuries Cont..

• Contusion of the shoulder.
• Shoulder pointer- AC and deltoid. Can lead to
  myositis ossificans.
• Strains to the shoulderGrades 1,2,3
• causes of strains overuse, improper mechanics,
  lack of flexibility, going past the normal ROM,
  lack of strength, unexpected acceleration/decelera
  tion, improper warm-up, poor conditioning

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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.

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Treatment of common injuries to the shoulder

• Dislocations
• separations/sprains
• Fractures
• Chronic injuries
• Brachial plexus

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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

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Special Tests

• Neers test pg. 391 fig. 18-7
• Impingement
• Forced flexion of the shoulder towards your ear
• Hawkins Kennedy test pg 391 fig. 18-7
• Impingement
• Horizontal adduction and forced internal rotation

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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 wont 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.

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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