Pathomechanics of the Shoulder

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Pathomechanics of the Shoulder

• Edward B. Farrell, MS, PT, CSCS

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Factors of Normal Mechanics

• Scapular Stability
• Glenohumeral Stability
• Rotator cuff
• Neuromuscular Timing
• Muscular Endurance

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Shoulder Anatomy
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Bony Anatomy

• Scapulothoracic
• Glenohumeral
• Acromioclavicular
• Sternoclavicular

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Scapulothoracic Joint
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Glenohumeral Joint

• Passive Restraints
• Bony
• Labrum
• Ligaments

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Glenohumeral Joint

• Active Restraints
• Rotator cuff
• Deltoid
• Others

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Glenohumeral Joint

• Active Restraints

• Strength
• Neuromuscular Timing
• Endurance

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Accessory Joints

• Sternoclavicular Joint
• Acromioclavicular Joint

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Factors of Pathomechanics

• Scapular Tightness
• Capsular Tightness
• Poor Mechanics

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Sequelae of Pathomechanics

• Instability
• Impingement
• Rotator Cuff Tears
• Adhesive Capsulitis
• The Overhead Athlete

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Shoulder Instability

• Where does instability come from?

• What does instability lead to?

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Shoulder Instabiltiy Causes

• Congenital
• Traumatic
• Overuse

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Shoulder Instability Effects

• Labral Tears (SLAP, BANKART)
• Hill-Sachs
• Throwers Exostosis
• Subluxation/Dislocation
• Internal Impingement

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Impingement

• Causes
• Primary impingement
• Acromial Shape
• Decreased subacromial space
• Secondary impingement
• Mechanics

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Impingement

• Stages

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Rotator Cuff Tears

• Acute vs. Chronic
• Further Deterioration of Shoulder Mechanics

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Stiff Shoulder

• Adhesive Capsulitis
• Result of poor mechanics?
• Effects of a tight capsule

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Overhead Athlete

• Extremes of External Rotation
• Overuse Injuries
• Effects of Mechanics
• Proper Training

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General Rehabilitation Guidelines

• Phase One / Immediate Phase

• Protect Healing tissue
• Prevent negative effects of Immobility
• Re-establish Stability
• Diminish post-operative pain

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General Rehabilitation Guidelines

• Phase Two / Intermediate Phase

• Re-establish Full Range of Motion
• Normalize arthrokinematics
• Enhance Neuromuscular Control
• Improve Strength

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General Rehabilitation Guidelines

• Phase Three / Advanced Strengthening Phase

• Enhance Strength, Power, and Endurance
• Improve Muscular Endurance
• Monitor Functional Motion

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General Rehabilitation Guidelines

• Phase Four / Return to activity Phase

• Return Gradually
• Maintain Strength and Flexibility

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Implementing an Exercise Protocol

• Rotator Cuff
• Scapular Stabilizers
• Prime Movers

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Key Points

• Avoid causing overuse syndrome
• Emphasis on ROM and proprioception
• Error on conservative side for strength
• Patient education

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Thank You

• Edward B. Farrell, MS, PT, CSCS
• Peak Performance
• 516-746-6350