ANATOMY 4 Characteristic- very moveable joint, shallow joint, unstable, ball and socket 4 Bones of the shoulder: scapula, humerus, clavicle 4 spine of scapula 4 Acromion process tip of shoulder 4 Coracoid process 4 Supraspinatus fossa 4 Infraspinatus fossa 4 Subscapularis fossa 4 Glenoid fossa 4 Medial border of scapula 4 Lateral border of scapula 4 Inferior/superior angle of scapula
Anatomy cont. 4 Bones cont. 4 Humerus: Proximal Head of the humerus 4 Bicipital groove 4 Clavicle: S shape and fracture middle 1/3 most common
Joints/Ligaments 4 Joints of the shoulder 4 1 Acromioclavicular=AC –Attaches acromion process to the distal end of clavicle 4 2 Coracoclavicular=CC –Attaches the coracoid process to dstal end of clavicle 4 3 Glenohumeral=GH –Attaches the rim of the glenoid fossa to the proximal end of the humerus 4 4 Sternoclavicular=SC –Attaches the sternum to the proximal end of the clavicle
Muscles 4 Rotator cuff SITS 4 Attachmentaction 4 Supraspinatus - supraspinatus fossa, goes underneath acromion process, then to lateral head of humerus 4 Initiates abduction, sinks head of the humerus into glenoid fossa 4 Infraspinatus - infraspinatus fossa to the posterior lateral head of humerus 4 External rotation and adduction 4 Teres minor - lateral border of scapula to posterior head of humerus 4 External rotation and adduction 4 Subscapularis - subscapularis fossa to the anterior surface head of humerus 4 Internal rotation and adduction 4 Teres major - lateral border of scapula to anterior head of humerus 4 Internal rotation and adduction
Rotator Cuff: SITS Subscapularis SH Biceps LH biceps
Shoulder Mechanics 4 Cocking phase 4 Shoulder abduction, flexion, and external rotation 4 Stretched- pectoralis, ant. Deltoid, biceps, subscapularis, teres major 4 Acceleration phase 4 Pectoralis, ant. Deltoid, biceps, subscapularis, teres major 4 Internal rotation 4 Follow through phase 4 Humerus adducts, internal rotation 4 lastissimus dorsi, rotator cuff, pectoralis major 4 What muscles in this phase are commonly injured? 4 External rotators-teres minor,infraspinatus
Injuries to the shoulder 4 Fracture to the clavicle: middle 1/3 most common area injured. 4 Mechanism= fall on tip of shoulder 4 Hold their head to the injured side with arm held up
Injuries to the shoulder 4 Dislocations:Anterior glenohumeral 4 Most common- head of the humerus slides in front of the coracoid process. Tearing of the joint capsule. 4 Most unstable position= abduction/ext. rotation 4 posterior glenohumeral uncommon 4 mechanism of injury: arms in front(flexion), direct blow to hands.
Injuries Cont.. 4 Acromioclavicular or AC sprain/separation. 4 Grade 1- minimal deformity. 4 Grade 2- slight deformity. 4 Grade 3- huge deformity. 4 Mechanism of injury. 4 Falling on an outstretched arm or falling on the tip of your shoulder. 4 Functional test for AC injury. –Touch the opposite shoulder-pain over AC= positive findings. –Drop arm test. 4.4.
Injuries Cont.. 4 Contusion of the shoulder. 4 Shoulder pointer- AC and deltoid. Can lead to myositis ossificans. 4 Strains to the shoulder: Grades 1,2,3 4 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 4 Bursitis/tendonitis 4 Bicipital tendonitis, supraspinatus 4 Subacromion, subcoracoid- signs/symptoms= inflammation, pain, burning, redness 4 Impingement : narrowing of the subacromion space where the supraspinatus passes under the acromion process. S/S= pain and aching 4 Tests: empty can- thumb up/thumb down 4 overhead opposite arm.
Treatment of common injuries to the shoulder 4 Dislocations 4 separations/sprains 4 Fractures 4 Chronic injuries 4 Brachial plexus
Special Tests 4 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 4 Neer’s test pg. 391 fig –Impingement Forced flexion of the shoulder towards your ear 4 Hawkin’s Kennedy test pg 391 fig –Impingement Horizontal adduction and forced internal rotation
Special Tests 4 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. 4 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 4 Stage 1: decrease swelling and pain, wear sling, Rest Ice, ROM while in sling for wrist and elbow, squeeze tennis ball, CV 4 Progression to Stage II- minimal swelling and pain 4 Stage 2: Increase ROM, flexibility, and start on strength, PNF 4 Int/ext rotation at neutral position, shoulder shrugs, circumduction (Codman exercises),finger wall walking, tubing, CV 4 Progression to stage III- full ROM, partial strength 4 Stage 3: PNF, wall push-ups, push-up on ground and with a ball, airplanes, Weight room, SAID-sport specific