2 ShoulderIt is a ball and socket joint that moves in all three planes and has.Most mobile and least stable joint.
3 Shoulder joint motions Flexion- is raising the arm in the lateral plane from degrees.Extension- return to anatomical position.Hyperextension degrees back through the lateral plane.
4 Shoulder joint motions Abduction- arm moving in the frontal plane away from the body, with a degrees of motion.Adduction- arm moving back to midline, with degrees of motion.
5 Shoulder joint motions Internal Rotation- occur in the transverse plane. This can go to 90 degrees into bodyExternal Rotation- occurs in the transverse plane, 90 degrees out from neutral.
6 Shoulder joint motions Horizontal abduction/adduction- occurs in the transverse plane. Neutral is 90 degrees of shoulder abduction, so horiz abduction is 30 degrees and adduction is 120 degree.
7 Shoulder joint motions Scaption- flexion in the scapular plane, vs the lateral or frontal plane degree of motion can occur.
8 Shoulder LandmarksScapula Glenoid labrum-fibrocartilage ring attached to the rim of the glenoid fossa, which deepens the cavity.
9 Shoulder Landmarks Humerus- Head- is the semi round proximal end, articulates with the scapula.Shaft- body of the humerus is the area between the neck and the epicondyles.
10 Shoulder Landmarks Surgical Neck- where the head meets the body. Anatomical neck- where the head meets the tubercles.
11 Shoulder LandmarksGreater Tubercle/Tuberosity- large projection lateral to the head. Supraspinatus, infraspinatus and teres minor attach here.
12 Shoulder LandmarksLesser Tubercle/Tuberosity- smaller projection on the anterior surface, subscapularis attaches here.
13 Shoulder LandmarksDeltoid tuberosity- lateral side, near the midpoint, deltoid attaches here.
14 Shoulder LandmarksBicipital Groove- groove between the tubercles containing the long head of the biceps tendon.
15 Impingement SyndromeA condition that occurs when the space between the humeral head and the acromion above becomes narrowed.The three things that can get pinched are the:joint capsule, tendons of rotator cuff, and bursa.
16 Impingement SyndromeImpingement can create either bursitis, or tendonitis depending on what structure is being squeezed.Overhead athletes are more likely to have problems with this injury.1/3 of shoulder problems are due to impingement.
17 Impingement Syndrome Signs and Sx Treatment Pain and tender GH joint Pain and weak active abd in mid rangeLimited internal rotation+ Hawkins TestTender subacromial area possibly into the deltoidTreatmentCorrect techniqueStrengthen inferior musclesStrengthen weak rotator cuff muscles
18 Impingement Syndrome Special Tests Hawkins Test Neer’s Impingement Cross over Test
19 Impingement Syndrome Stretches- Exercises 3 way door stretch Posterior shoulderInternal Rotation withExercisesInternal RotationExternal RotationAdduction
20 Rotator Cuff Tears In the young person it is more of a traumatic injury,fall on outstretched arm,arm yanked back.Young person can havechronic injury that ultimately tears a tendon.In the older person it is a result of lose of elasticity in the muscle and tendon and can tear with everyday activities or a bone spur.
21 Rotator Cuff Tears Signs and Sx With a parcial tear the athlete will feel pain but still be able to move with normal ROM.With a complete tear the athlete will not have normal ROM.Overhead motions are hardest.A shrug motion will result.Pain sleeping on injured side.
22 Rotator Cuff Tears Special Tests Active Abduction-look for hiking shoulderDrop Arm sign- athlete abduct above head then lowers slow, look for loss of muscle control.Supraspinatus muscle test- looking for weaknessEmpty Can Test- supraspinatus/subscap motionMRI is final diagnostic tool
23 Biceps Tendonitis Discomfort in the front of the shoulder. Can be caused by impingement.Special Tests-Speed’s TestYergeson’s Test
25 Anterior Shoulder Dislocation A humerus can dislocateAnteroinferiorly-front and down (most common)Inferiorly – downPosteriorly -back
26 Anterior Shoulder Dislocation Anterior dislocation happens when the arm is abducted to the side and a forceful external rotation happens.A doctor visit is necessary, immediately if the humerus does not relocate on it’s own.Even if it goes back a Hill-Sach’s Lesion can occur.
27 Anterior Shoulder Dislocation Rehabilitation is very important to this injury.Reinjury will likely happen if a first time injury happens before the age of 20.Surgery may be necessary if repeated dislocation occurs.
29 Glenoid Labrum InjuryGlenoid Labrum-a ring of cartilage attached to the margin of the glenoid cavity of the scapula.The labrum acts to keep the humeral head positioned on the glenoid by blocking unwanted movement.
30 Glenoid Labrum InjuryA labral tear can occur with a shoulder dislocation, more likely to occur with numerus dislocations.A degenerative tear can occur when a shoulder becomes loose, letting the humeral head slip over the labrum numerus times and eventually the labrum will fail/tear.
31 Glenoid Labrum Injury Signs and Sx Special Tests Treatment Pain with catching and poppingPossible weaknessPossible limited ROMSpecial TestsClunk TestCross Over TestTreatmentRotator Cuff strengtheningSurgery
32 Multidirectional Instabilities Typically an anatomical problem.Multiple dislocations will make it worse.Exercise may help with the problem, surgery sometimes, but not alwaysWeight bearing exercise are helpful. Like what?
33 Acromicavicular Separation Also known as an AC sprain.Occurs due to fall on outstretched arm or tip of shoulder. May be due to blow to tip of shoulder
34 AC separation Signs and Sx Special Test Treatment deformity Pain in vicinity of ACSpecial TestShear TestSulcus SignTreatmentThree grades –the grade determines treatmentGrade one is exercise and iceGrade two immobilize 3 weeks and then exerciseGrade three immobilize 5 weeks and then exerccise
35 Muscles of the Shoulder Joint Deltoid is superficial muscle. All three parts of it attach to the deltoid tuberosity.Axillary Nerve
36 Rotator Cuff MusclesSupraspinatus-anterior superior shoulder. It is superior to the spine of the scapula.abduction
37 Muscles of the Shoulder Joint Pectoralis Major-Clavicular portion-most effective during flexion from 0-90Sternal portion- most effective in extension degrees of shoulder extensionBoth of them adduct, internally rotate and horizontally adduct the shoulder.
38 Muscles of the Shoulder Joint Latissimus Dorsi- means widest, back, so the widest back muscle. It is mostly superficial and is involved with shoulder extension , adduction and internal rotation
39 Muscles of the Shoulder Joint Teres Major- it is the little helper of the lats. It runs from the axillary boarder of the scapula to the lesser tubercle of the humerus.
40 Rotator Cuff Muscles Infraspinatus- posterior inferior shoulder Inferior to the spine of the scapulaExternal rotation