The Shoulder

Sternoclavicular Joint Only attachment of upper extremity to trunk

Acromioclavicular Joint AC ligament – Anterior – Posterior – Superior – Inferior Coracoclavicular Ligament

Glenohumeral Joint Humeral head is larger than glenoid Static stabilizers- Labrum and glenohumeral ligaments Dynamic Stabilizers- Rotator cuff and Deltoid Long head of biceps tendon passes superiorly to the head of the humerus

Scapulothoracic Joint Movement of the scapula on the thoracic wall is critical to shoulder joint motion Muscles that attach to scapula must stabilize scapula providing a base for the head of humerus to rotate on.

Scapulohumeral Rhythm Movement of the scapula relative to the movement of the humerus in abduction First 30 degrees of abduction- no scapular movement degrees of abduction- 1:2 ratio of scapula:humerus Above 90 degrees of abduction- 1:1 ratio of scapula:humerus

Stretching Exercises Static Hang from chin up bar Codman’s Pendulums- Early in Rehab below 90 Sawing- Early in Rehab below 90 Wall Climb- Flexion and Abduction Corner Stretch- Anterior Structures Wand Stretches Sleeper Stretch

Strengthening Exercises Free Weights Weight Machines Exercise Tubing

Strengthening Exercises Bench Press Horizontal Flys Military Press Front Raises Side Raises Reverse Flys I’s Y’s T’s Push-up with a plus Push ups Rows Upright Rows Ball push ups

Plyometric Exercises Need rebouder or partner Single-arm toss Double-arm toss with trunk rotation Double-arm toss overhead Push ups with a clap Push ups on a box

Reestablishing Neuromuscular Control Weight Shifting – Table – Swiss Ball – Fitter Board – Wobble Board – Weighted Ball Slide Board Rhythmic Stabilization Body Blade

AC Sprain MOI- Fall on tip of shoulder Rehab Concerns-Focus on Deltoid, Trapezius, and Pectoralis Major muscles. Also focus on scapular stabilizers Grade I- Sling for a couple of Days. Begin AROM exercises immediately Grade II days in sling. Full RTP for contact sports 8-12 weeks.

Clavicle Fx MOI- FOOSHA, Direct Blow Immobilization for 6-8 weeks Regain ROM Regain Strength – Deltoid – Pectoralis Major – RC – Scapular Stabilizers

Glenohumeral Dislocation MOI- 90 degree abduction, 90 degree elbow flexion and external rotation is most common 85-90% will dislocate again Likely to tear labrum also Avoid Following Postions – Anterior- Combined ER and Abduction. Fly, Pull Down, Bench, Military Press – Posterior- Combined IR, Horizontal Adduction, and Flexion. Fly, Bench, Weight bearing exercises – Inferior- Full Elevation. Shrugs, elbow curls, military press

GH Dislocation Cont. Up to 3 weeks in sling – Passive ROM – Isometrics – Scapular exercises without elevation Weeks 3-8 – Restore full AROM – Begin neuromuscular control exercises Weeks 6-12 – Begin scapular and rotator cuff exercises – Add motion neuromuscular control exercises – Begin Plyometrics – Begin Body Blade Weeks – Begin sport specific drills

Shoulder Impingement Mechanical compression of supraspinatus tendon, subacromial bursa, and biceps tendon MOI-Dynamic and static stabilizers fail to maintain subacromial space. Acute and Chronic Rehabilitation Concerns – Avoid activities above 90 degrees of flexion and abduction early. – Focus on RC strength – Strengthen scapular stabilizers – Strengthen LE and Core to reduce stress on throwing shoulder