Transcript lecture 7 shoulder

Lecture 7
The Shoulder
Anatomy Review
The shoulder is difficult to assess because
of the many structure located in a small
area
There are a number of different joints and
the shoulder may be a site of referred pain
Glenohumeral Joint
Mulit-axial ball and socket synovial joint
Depends on muscle rather than ligaments
for support
Has a labrum – or a ring of fibrocartilage
that surrounds and deepens the glenoid
cavity
Resting position
55 degrees of abduction
30 degrees of cross extension
The humerus sits in the upper part of the
glenoid cavity with contraction of the
rotator cuff muscles it is pulled down into
the lower wider part – allowing for full
abduction
Ligaments of the GH
Superior, middle and inferior glenohumeral
ligaments
Z – shaped band across the front of the
GH joint
Weak and easily stretched
AC Joint
Irregular diarthrodial joint
limited motion in all three planes
Augments the ROM of the humerus
Resting position
arm by side
Ligaments of the AC
- Acromioclavicular
- Coracoclavicular
- Both function to hold clavicle down
Sternoclavicular Joint
Along with the AC joint the SC joint
enables the humerus to move through a
full 180 degrees of abduction
Saddle shaped – synovial joint
Medial end of clavicle and manubrium of
the sternum and cartilage of the first rib
Disc between the two ends of joint
ROM include elevation, depression,
protraction and retraction (rotation)
Scapulothoracic joint
Not a true joint
Functions as an integral part of the
shoulder complex - important in
stabilization of shoulder and facilitates
movement
Body of scapula and muscles covering the
posterior wall of the chest form this
pseudo joint
Scapulohumeral rhythm
the coordination of the scapular and
humeral movements
this enables much greater ROM of the
shoulder
If arm elevated past 30 abduction or 45-60
of flexion the scapula rotates , contributing
1/3 of total rotational movement of the
humerus
Roughly 2-1 rotation of humerus to
scapula
Hiking of the shoulder
- reverse scapulohumeral rhythm –
scapula moves more than the
humerous
Winging of the scapula
- winging of the medial border of the
scapula
- indicative of injury or weakness of the
serratus anterior muscle or the long
thoracic nerve
- have athlete stand at wall and do a
push up to see winging of scapula
ROM end feels
ROM of shoulder
- LR/MR (ER/IR) Ext/Flex, Abd/add, cross
flex/cross ext, ( hor-abd/hor-add)
circumduction
- Muscles ?
Special Tests
AC Distraction / Compression Test
 AC joint
 apply downward traction (distraction) on the
upper extremity , this will lead to downward
movement of acromion away from clavicle if AC
is unstable
 positive test - will produce pain and joint
movement
 AC Compression
 Horizontal adduction of humerus across the
chest compresses the AC joint and will lead to
pain if injured
 positive test - will produce pain
 Load and shift
GH joint instability
 Athlete sitting or supine
 Press humerus into the glenoid cavity (the load)
 Move humeral head Ant/post noting the amount
of translation (shift)
 Positive test – more movement( instability)
 Normal is about 25% of humeral head diameter
http://www.youtube.com/watch?v=uhBWu9
TJsJ8&feature=related
http://www.youtube.com/watch?v=WnlpkE
WXIiU
Apprehension / Crank test ( anterior
instability)
GH joint
 Examiner passively abducts the arm to 90
degrees and LR athletes shoulder slowly
 positive test - is indicated by the feeling or look
of apprehension of the athlete
 Athlete will likely resist further movement
 Do this test very slowly as this is the position of
most dislocations
 http://www.youtube.com/watch?v=qKqJRrms4u8
&feature=channel
Sulcus Sign (Inferior instability)
GH joint
 Examiner grasps athletes forearm below
elbow and pulls down (distally)
 The arm is in a neutral position with no
rotation and slight abduction (10 – 20
degrees)
 Positive test- Presence of a sulcus at the top
of the shoulder is a positive sign of inferior
instability
 If athlete has an inferior instability – usually
multidirectional instability as well
 http://www.youtube.com/watch?v=lsaOqetQZ
Speed’s Test
Biceps tendon
 Athletes arm is straight out in a flexed position
with the palm up (supinated)
 Examiner then pushed down on the forearm
(pushing into extension)
 Positive test - is pain and weakness in the
anterior part of the shoulder (bicepital groove)
 Indicative of biceps tendon injury (long head)
http://www.youtube.com/watch?v=N00gA4
Pvsbw&feature=channel
Empty can
Supraspinatus
 Athlete stands with arm out to side (approx 45
degrees cross extension)
 Thumb is pointed down (arm internally rotated)
 Examiner pushes down on the forearm
 Positive test -is pain and weakness
 Indicative of a supraspinatus tendinitis or strain
 http://www.youtube.com/watch?v=qjHOqydDhxo
Drop Arm
Rotator cuff
 Examiner passively abducts the athletes arm to
90 degrees
 Athlete tries to hold it there and then slowly
lower arm to side
 Positive test -occurs when athlete can not lower
arm slowly and with out pain
 Indicative of a tear in the Rotator cuff complex
 http://www.youtube.com/watch?v=taVMaab9
e8c&feature=related
Hawkin’s Test
 Impinges supraspinatus muscle, Teres Minor muscle, and
Infraspinatus muscle
 Hawk trainers hold their arm in the starting
position of this test
 Shoulder forward flexed to 90 degrees
 Elbow flexed to 90 degrees
 Examiner grasps patients elbow with one hand
and their wrist with the other
 Examiner passively internally rotates the
shoulder
 Positive sign – pain – shoulder impingement
Costoclavicular syndrome test
Test for thoracic outlet syndrome
Examiner palpates the radial pulse then
draws athletes shoulder down and back
while athlete hyperextends their neck
Positive test - is a diminishing or absence
of radial pulse
Subclavian artery is being blocked by
costolclavicular structures of the shoulder
Adson Maneuver
Test for thoracic outlet syndrome
Examiner palpates radial pulse
Athlete rotates head toward affected
shoulder ( keeps head extended) , while
examiner LR and extends shoulder
Athlete takes a deep breath and holds
Positive test - if radial pulse diminishes
or is absent, then subclavian artery is
being blocked by anterior and middle
scalene muscles
Sport Specific Functional Tests
All functional patterns should be fluid and
painfree
throwing
swimming strokes
overhead serves...