Transcript A Guide to Shoulder Problems

Introduction
 The function of the
shoulder allows the
greatest range of motion
of any joint in the body.
 This great range of
motion can also lead to
several common
problems affecting the
shoulder joint.
 In other words, the
shoulder is built for
motion, not stability
Considerations
 What happens to the ROM during flexion if
the arm is externally and internally rotated?
Why?
 Which arm can you reach furthest up your
back with?
 Why?
Bones
 The bones of the
shoulder include the
humerus, the scapula,
and the clavicle.
 A “roof” of the shoulder
is formed by a part of
the scapula called the
acromion.
Joints
 There are actually two
joints around the
shoulder
 The glenohumeral joint
or the shoulder joint
 The acromioclavicular
(AC) joint where the
clavicle meets the
acromion.
Joint Capsule
 The joint capsule is made by
a group of ligaments that
connect the humerus to the
socket of the shoulder joint
on the scapula.
 Three ligaments are the main
source of stability for the
shoulder, and help to keep
the shoulder from dislocating.
 Coracohumeral ligament
 Middle glenohumeral
ligament
 Inferior glenohumeral
ligament
Bursa
 Sandwiched between
the rotator cuff muscle
layer and the outer
layer of large bulky
muscles is a structure
known as a bursa.
 A bursa is simply a
closed space between
two moving surfaces
that has a small amount
of lubricating fluid inside
Ligaments
 Ligaments are soft tissue
structures that connect
bones to bones.
 The acromioclavicular
ligaments that attach the
Coracoacromia
l ligament
clavicle to the acromion
 The coracoclavicular (2)
ligaments connects the
clavicle to the coracoid
process.
 The coracoacromial ligament
connects the coracoid
process and the acromion
process
coracoclavicular
coracoacromial
A Guide to Shoulder
Problems
http://www.castleortho.com/group/shoulder/default.h
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Shoulder Injuries
1.
2.
3.
4.
5.
Impingement/Bursitis
Rotator Cuff Tear
Acromioclavicular(AC) Joint Separation
Shoulder Instability
Labral Tear
Impingement Syndrome
Impingement Syndrome
 The supraspinatus tendon
connects the humerus with
the scapula (shoulder
blade) and helps raise and
rotate the arm.
 As the arm is raised, the
supraspinatus tendon also
keeps the humerus tightly
in the socket (glenoid) of
the scapula.
Impingement Syndrome
 The part of the scapula that
makes up the roof of the shoulder
is called the acromion process.
 Between the acromion process
and the supraspinatus tendon
there is a bursa.
 The bursa is a lubricated sac of
tissue that protects the muscles
and tendons as they move
against one another.
 The bursa simply allows the
moving parts to slide against one
another without too much friction.
Impingement Syndrome
Impingement Syndrome
 If any condition decreases
the amount of space
between the acromion
and the supraspinatus
tendon, the impingement
process may get worse.
 Swelling
 Bone spurs
 Anatomical structure
Impingement Syndrome
Rotator Cuff Tears
Rotator cuff
 Subscapularis
 Supraspinatus
 Infraspinatus
 Teres minor
Movement of RC Muscles
 Subscapularis is an
internal rotator of the arm.
 Supraspinatus assists the
deltoid in abducting the
arm, with its greatest
contribution being the
initiation of abduction.
 Infraspinatus and teres
minor muscles both
externally rotate the arm.
Rotator Cuff Injury
 The throwing motion has been divided into
five phases: wind-up, cocking, acceleration,
and follow-through.
 Cocking phase
 Supraspinatus, infraspinatus, and teres minor
muscles begin to fire at the end of early cocking
phase
 Subscapularis subsequently fires in late cocking to
decelerate the shoulder's external rotation. Also, it
is stretching during the cocking phase.
Rotator Cuff Injury
 Follow-through (muscles fire most intensely)
 Subscapularis internally rotates the shoulder,
 Remaining rotator cuff muscles are contracting
eccentrically to decelerate the arm and are
stretched.
 During this repetitive eccentric loading, the
rotator cuff is prone to overload, fatigue,
tendinitis, and even a partial undersurface
tear.
Note: Surgery needs
to be performed
within 3 months or
the supraspinatus
muscle will atrophy
and be too short to
reattach
Shoulder Separation
Shoulder Separation
 A shoulder separation is a fairly
common injury, especially in an
athletic population.
 A shoulder separation is actually
a dislocation of the
acromioclavicular (AC) joint.
 Some people mistake this for a
shoulder dislocation, and vice
versa.
 This is a very different injury than
a shoulder dislocation.
Grades of Shoulder
Separation
Shoulder Separation
 The most common cause of an
acromicoclavicular (AC) joint separation is a fall
on the shoulder.
 As the shoulder strikes the ground, the force
from the fall pushes the scapula down.
 The clavicle, because it is attached to the rib
cage, cannot move down enough to follow the
motion of the scapula.
 Something has to give, and the ligaments
around the acromioclavicular (AC) joint begin to
tear - separating, or dislocating, the joint.
Shoulder Dislocation &
Instability
Shoulder Dislocation
 If the shoulder slips
completely out of the
socket, it has become
dislocated.
 97 out of 100 dislocations
are anterior.
 3 out of 100 dislocate
posteriorly.
 Repeated dislocations are
not only a nuisance, but
can cause further injury to
the shoulder and can lead
to arthritis of the shoulder if
not treated.
Shoulder Subluxation
 The ligaments that make up the joint capsule have a
considerable amount of slack, or looseness, so that the
shoulder is unrestricted as it moves through its rather
large range of motion.
 Sometimes the
shoulder does not
come completely out
of the socket but
slips partially out and
then returns to its
normal position. This
is called subluxation.
Shoulder Instability
 Instability means that the shoulder is too loose and has a tendency to
slip out of the socket, (or glenoid fossa).
 This initial injury is usually fairly significant and the shoulder must be
reduced, or put back into the socket, by a physician.
 After that first violent injury that causes the shoulder to dislocate, the
joint may remain unstable.
 The ligaments that are supposed to hold the shoulder in the socket may
not heal back properly, or they may remain stretched and too loose to
keep the shoulder in the socket in certain positions.
Glenoid Labrum
Labral Tear
 A part of the scapula, called the
glenoid cavity, makes up the
socket of the shoulder.
 This socket is very shallow and
flat.
 To make the socket more like a
cup, there is a rim of soft tissue
called the labrum.
Labral Tear
 The labrum acts sort of
like a gasket, turning the
flat surface of the glenoid
into a deeper socket that
molds to the head of the
humerus for a better fit.
 A tear of labrum can
cause a very difficult to
diagnose problem of pain
and a catching sensation
with movement of the
shoulder.
Labral Tear
 This tissue can be caught between
the socket and the humerus and be
torn.
 This flap of tissue can move in and
out of the joint, getting caught
between the humeral head and
glenoid socket, and cause pain and
catching.
 The labrum is also the area for
attachment of several of the tendons
and ligaments of the shoulder.
 The ligaments that attach to the
labrum help with maintaining the
stability of the shoulder.
Labral Tear
 Most labral tears are probably the
result of an injury to the shoulder,
such as falling on an outstretched
hand.
 There is reason to believe that the
excess motion of the humerus
moving around on the glenoid may
cause damage to the labrum over
time.
 An unstable shoulder may also
cause injury to the labrum, if it
repeatedly dislocates out of the
glenoid.
Exercises
 www.bodybuilding.com/fun/shoulders
 www.bestpersonaltraining.com/aze.htm
Shoulder action = ?
Shoulder muscle(s) = ?
Scapula action = ?
Scapula muscle(s) = ?
Upward Rotation
Abduction
Deltoid
Ser. Ant.,
Trap (lower)
Shoulder action = ?
Shoulder muscle(s) = ?
Flexion
Ant Deltoid
Upper Pect Major
Coracobrach
Shoulder action = ?
Shoulder muscle(s) = ?
Scapula action = ?
Scapula muscle(s) = ?
Horz. Add.
Ant. Deltoid
Pect. Major
Coracobrach.
Abduction
Pect. Minor
Ser. Ant.
Scapula action = ?
Scapula muscle(s) = ?
Elevation
Lev. Scap.
Rhomboids
Up. & Mid. Trap
Shoulder action = ?
Shoulder muscle(s) = ?
Hor. Abd
Lat.
Post. Deltoid
Teres Minor
Infraspinatus
Scapula action = ?
Scapula muscle(s) = ?
Adduction
Rhomboid
Upper and Mid. Trap.
Shoulder action = ?
Shoulder muscle(s) = ?
Adduction
Pect. Major
Coracobrach.
Lat.
Teres Major
Scapula action = ?
Scapula muscle(s) = ?
Downward
Rotation
Pect. Minor
Rhomboid
Shoulder action = ?
Shoulder muscle(s) = ?
Scapula action = ?
Scapula muscle(s) = ?
Adduction
Horizontal Add
Ant. Deltoid
Pect. Major
Coracobrach.
Rhomboid
Upper and
Mid. Trap.
Shoulder action = ?
Shoulder muscle(s) = ?
Extension
Lats
Teres Minor
Post. Deltoid
Scapula action = ?
Scapula muscle(s) = ?
Adduction
Rhomboid
Upper and Mid. Trap.
Shoulder action = ?
Shoulder muscle(s) = ?
External Rotation
Infrspinatus
Teres Minor
Rotator Cuff Exercises
External Rotation
Internal Rotation
Internal Rotation
Rotator Cuff Exercises
External Rotation
Internal Rotation
External Rotation
Abduction (to work the supraspinatus)
What position are her shoulders in?
Flexion
What rotation action is his shoulder performing as he
continues to through the ball?
Internal Rotation
What position is his right shoulder in?
Horizontal Abduction and
External Rotation
What position are her shoulders in?
Flexion
What position are his shoulders in?
Horizontal abduction or Extension
Position of their shoulders?
1.
Flexion
2.
Extension
Position of his scapula?
Upward Rotation
Position of his shoulder?
Abduction
What is the position of
scapula?
Adduction
What is the position of shoulder?
Extension