1. The Shoulder

2. Shoulder Girdle Complex There are three primary articulations Glenohumeral joint Glenohumeral joint Aromioclavicular joint Aromioclavicular joint Sternoclavicular joint Sternoclavicular joint

3. Shoulder Girdle Dynamic Stability- mobility with stability. Dynamic Stability- mobility with stability. as in it can move around and be stable. Glenoid Fossa- concave part of the scapula that the humeral head articulates with. Glenoid Fossa- concave part of the scapula that the humeral head articulates with. Glenohumeral joint- multi directional ball and socket joint that is held together by the ligments and muscles of the shoulder. Less stable than the hip ball and socket. Glenohumeral joint- multi directional ball and socket joint that is held together by the ligments and muscles of the shoulder. Less stable than the hip ball and socket.

4. The Joints of the Shoulder Acromion Process- Acromion Process- The superior part of The superior part of the scapula that you can palpate. the scapula that you can palpate. Acromioclavicular joint (AC)- where the acromion and clavicle come together. Acromioclavicular joint (AC)- where the acromion and clavicle come together.

5. The Joints of the Shoulder Sternoclavicular joint (SC)- where the clavicle and the sternum come together. Sternoclavicular joint (SC)- where the clavicle and the sternum come together.

6. The joints of the Shoulder Scapulothoracic Joint- the scapula slides over the back of the thorax (ribcage). Scapulothoracic Joint- the scapula slides over the back of the thorax (ribcage). Synergistically- muscle groups working together to move one joint and maintain dynamic stability. Synergistically- muscle groups working together to move one joint and maintain dynamic stability.

7. Rotator Cuff Muscles Infraspinatus- posterior inferior shoulder External rotation

8. Rotator Cuff Muscles Subscapularis-anterior shoulder Subscapularis-anterior shoulder Internal rotation Internal rotation

9. Rotator Cuff Muscles Supraspinatus-anterior superior shoulder Supraspinatus-anterior superior shoulder abduction abduction

10. Rotator Cuff Muscles Teres Minor- posterior shoulder Adduction

11. Muscle Force Couple Force Couple-two equal forces acting in opposite direction to rotate a part around an axis. Force Couple-two equal forces acting in opposite direction to rotate a part around an axis.deltoid Rotator Cuff Rotator Cuff

12. Scapulothoracic Mechanics Scapular Movers-upper, lower, middle trapezius, rhomboids, serratus anterior and pectoralis minor. Scapular Movers-upper, lower, middle trapezius, rhomboids, serratus anterior and pectoralis minor. They work with rotator cuff muscles to; They work with rotator cuff muscles to; Flex and extend shoulder Flex and extend shoulder Internal and externally rotate shoulder Internal and externally rotate shoulder Abduct and adduct shoulder Abduct and adduct shoulder Hoizontally abduct and adduct shoulder Hoizontally abduct and adduct shoulder

13. Shoulder Injuries They can be one of two varieties: They can be one of two varieties: Overuse-chronic – typically limited to the soft tissue of the shoulder. Overuse-chronic – typically limited to the soft tissue of the shoulder. Traumatic-acute Traumatic-acute

14. Impingement Syndrome A condition that occurs when the space between the humeral head and the acromion above becomes narrowed. A 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: The three things that can get pinched are the: joint capsule, tendons of rotator cuff, and bursa.

15. Impingement Syndrome Impingement can create either bursitis, or tendonitis depending on what structure is being squeezed. Impingement can create either bursitis, or tendonitis depending on what structure is being squeezed. Overhead athletes are more likely to have problems with this injury. Overhead athletes are more likely to have problems with this injury. 1/3 of shoulder problems are due to impingement. 1/3 of shoulder problems are due to impingement.

16. Impingement Syndrome Signs and Sx Signs and Sx Pain and tender GH joint Pain and tender GH joint Pain and weak active abd in mid range Pain and weak active abd in mid range Limited internal rotation Limited internal rotation + Hawkins Test + Hawkins Test Tender subacromial area possibly into the deltoid Tender subacromial area possibly into the deltoid Treatment Correct technique Strengthen inferior muscles Strengthen weak rotator cuff muscles

17. Impingement Syndrome Special Tests Special Tests Hawkins Test Hawkins Test Neer’s Impingement Neer’s Impingement Cross over Test Cross over Test

18. Impingement Syndrome Stretches- Stretches- 3 way door stretch 3 way door stretch Posterior shoulder Posterior shoulder Internal Rotation with Internal Rotation with Exercises Exercises Internal Rotation Internal Rotation External Rotation External Rotation Adduction Adduction

19. Rotator Cuff Tears In the young person it is In the young person it is more of a traumatic injury, more of a traumatic injury, fall on outstretched arm, fall on outstretched arm, arm yanked back. arm yanked back. Young person can have Young person can have chronic injury that ultimately tears a tendon. chronic 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. 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.

20. Rotator Cuff Tears Signs and Sx Signs and Sx With a parcial tear the athlete will feel pain but still be able to move with normal ROM. 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. With a complete tear the athlete will not have normal ROM. Overhead motions are hardest. Overhead motions are hardest. A shrug motion will result. A shrug motion will result. Pain sleeping on injured side. Pain sleeping on injured side.

21. Rotator Cuff Tears Special Tests Special Tests Active Abdcution-look for hiking shoulder Active Abdcution-look for hiking shoulder Drop Arm sign- athlete abduct above head then lowers slow, look for loss of muscle control. Drop Arm sign- athlete abduct above head then lowers slow, look for loss of muscle control. Supraspinatus muscle test- looking for weakness Supraspinatus muscle test- looking for weakness MRI is final diagnostic tool MRI is final diagnostic tool

22. Biceps Tendonitis Discomfort in the front of the shoulder. Discomfort in the front of the shoulder. Can be caused by impingement. Can be caused by impingement. Special Tests- Special Tests- Speed’s Test Speed’s Test Yergeson’s Test Yergeson’s Test

23. Traumatic Shoulder Injuries Shoulder Dislocation Shoulder Dislocation Glenoid Labrum Injuries Glenoid Labrum Injuries Multidirectional Instabilites Multidirectional Instabilites Acromioclavicular Separation Acromioclavicular Separation Brachial Plexus Injury Brachial Plexus Injury Fractures Fractures

24. Anterior Shoulder Dislocation A humerus can dislocate A humerus can dislocate Anteroinferiorly-front and down (most common) Anteroinferiorly-front and down (most common) Inferiorly – down Inferiorly – down Posteriorly -back Posteriorly -back

25. Anterior Shoulder Dislocation Anterior dislocation happens when the arm is abducted to the side and a forceful external rotation happens. 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. 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. Even if it goes back a Hill- Sach’s Lesion can occur.

26. Anterior Shoulder Dislocation Rehabilitation is very important to this injury. Rehabilitation is very important to this injury. Reinjury will likely happen if a first time injury happens before the age of 20. Reinjury will likely happen if a first time injury happens before the age of 20. Surgery may be necessary if repeated dislocation occurs. Surgery may be necessary if repeated dislocation occurs.

27. Special Test-Dislocation Apprehension test Apprehension test

28. Glenoid Labrum Injury Glenoid Labrum-a ring of cartilage attached to the margin of the glenoid cavity of the scapula. Glenoid 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. The labrum acts to keep the humeral head positioned on the glenoid by blocking unwanted movement.

29. Glenoid Labrum Injury A labral tear can occur with a shoulder dislocation, more likely to occur with numerus dislocations. A 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. 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.

30. Glenoid Labrum Injury Signs and Sx Signs and Sx Pain with catching and popping Pain with catching and popping Possible weakness Possible weakness Possible limited ROM Possible limited ROM Special Tests Special Tests Clunk Test Clunk Test Cross Over Test Cross Over Test Treatment Rotator Cuff strengthening Surgery

31. Multidirectional Instabilities Typically an anatomical problem. Typically an anatomical problem. Multiple dislocations will make it worse. Multiple dislocations will make it worse. Exercise may help with the problem, surgery sometimes, but not always Exercise may help with the problem, surgery sometimes, but not always Weight bearing exercise are helpful. Like what? Weight bearing exercise are helpful. Like what?

32. Acromicavicular Separation Also known as an AC sprain. 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 Occurs due to fall on outstretched arm or tip of shoulder. May be due to blow to tip of shoulder

33. AC separation Signs and Sx Signs and Sx deformity deformity Pain in vicinity of AC Pain in vicinity of AC Special Test Special Test Shear Test Shear Test Sulcus Sign Sulcus Sign Treatment Three grades –the grade determines treatment Grade one is exercise and ice Grade two immobilize 3 weeks and then exercise Grade three immobilize 5 weeks and then exerccise

34. Brachial Plexus Injury Brachial Plexus-group of nerves that leave the spinal cord and extend into the shoulder giving arm function. Brachial Plexus-group of nerves that leave the spinal cord and extend into the shoulder giving arm function. AKA-stinger or burner AKA-stinger or burner A result of stretching or compression of the nerves. A result of stretching or compression of the nerves.

35. Dermatones When looking at nerves you need to know level off spine injury relative to sensation and movement. When looking at nerves you need to know level off spine injury relative to sensation and movement. Dermatomes is sensation areas corresponding to nerve. Dermatomes is sensation areas corresponding to nerve.

36. Myotomes Each of the spinal nerves controls certain muscles. The muscles (or muscles) controlled by a particular nerve root are called its myotome. Each of the spinal nerves controls certain muscles. The muscles (or muscles) controlled by a particular nerve root are called its myotome. C4-Trapezius-shrug C4-Trapezius-shrug C5-deltoid-abduction C5-deltoid-abduction C6-biceps- elbow flex C6-biceps- elbow flex C7-triceps- elbow ext C7-triceps- elbow ext C8-thumb ext C8-thumb ext T1- finger abduct/adduct. T1- finger abduct/adduct.

37. Brachial Plexus Injury Signs and Sx Signs and Sx Pain in neck and arm Pain in neck and arm Weakness in neck and arm Weakness in neck and arm Numb or pins and needles down arm Numb or pins and needles down arm Treatment Rest till Sx go away Ice after activity Anti-inflammatory Possible dr visit

38. Fractures Typically caused by a direct blow. Typically caused by a direct blow. Clavicle and humerus, very rarely the scapula. Clavicle and humerus, very rarely the scapula. Typically you will see deformity Typically you will see deformity Xray necessary, immobilization 4-6 weeks minimum. Xray necessary, immobilization 4-6 weeks minimum.

39. We have strong shoulders ‘cause we stay athletic as we age