Transcript shoulder-chp_21

The Shoulder
Shoulder Girdle Complex
There are three primary
articulations
 Glenohumeral joint
 Aromioclavicular joint
 Sternoclavicular joint
Shoulder Girdle
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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.
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.
The Joints of the Shoulder
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Acromion ProcessThe superior part of
the scapula that you
can palpate.
Acromioclavicular
joint (AC)- where the
acromion and clavicle
come together.
The Joints of the Shoulder
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Sternoclavicular joint
(SC)- where the clavicle
and the sternum come
together.
The joints of the Shoulder
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Scapulothoracic Jointthe scapula slides over
the back of the thorax
(ribcage).
Synergistically- muscle
groups working together
to move one joint and
maintain dynamic
stability.
Rotator Cuff Muscles
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Infraspinatus- posterior
inferior shoulder
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External rotation
Rotator Cuff Muscles
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Subscapularis-anterior
shoulder
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Internal rotation
Rotator Cuff Muscles
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Supraspinatus-anterior
superior shoulder
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abduction
Rotator Cuff Muscles
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Teres Minor- posterior
shoulder
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Adduction
Muscle Force Couple
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Force Couple-two equal forces acting in
opposite direction to rotate a part around an
axis.
deltoid
Rotator Cuff
Scapulothoracic Mechanics
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Scapular Movers-upper, lower, middle trapezius,
rhomboids, serratus anterior and pectoralis
minor.
They work with rotator cuff muscles to;
Flex and extend shoulder
 Internal and externally rotate shoulder
 Abduct and adduct shoulder
 Hoizontally abduct and adduct shoulder
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Shoulder Injuries
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They can be one of two
varieties:
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Overuse-chronic –
typically limited to the
soft tissue of the
shoulder.
Traumatic-acute
Impingement Syndrome
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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:
joint capsule, tendons of rotator cuff, and bursa.
Impingement Syndrome
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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.
1/3 of shoulder problems are due to
impingement.
Impingement Syndrome
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Signs and Sx
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Pain and tender GH joint
Pain and weak active abd
in mid range
Limited internal rotation
+ Hawkins Test
Tender subacromial area
possibly into the deltoid
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Treatment
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Correct technique
Strengthen inferior
muscles
Strengthen weak rotator
cuff muscles
Impingement Syndrome
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Special Tests
Hawkins Test
 Neer’s Impingement
 Cross over Test
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Impingement Syndrome
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Stretches3 way door stretch
 Posterior shoulder
 Internal Rotation with
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Exercises
Internal Rotation
 External Rotation
 Adduction
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Rotator Cuff Tears
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In the young person it is
more of a traumatic injury,
fall on outstretched arm,
arm yanked back.
Young person can have
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.
Rotator Cuff Tears
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Signs and Sx
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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.
Rotator Cuff Tears
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Special Tests
Active Abdcution-look for hiking shoulder
 Drop Arm sign- athlete abduct above head then
lowers slow, look for loss of muscle control.
 Supraspinatus muscle test- looking for weakness
 MRI is final diagnostic tool
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Biceps Tendonitis
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Discomfort in the front
of the shoulder.
Can be caused by
impingement.
Special Tests
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Speed’s Test
Yergeson’s Test
Traumatic Shoulder Injuries
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Shoulder Dislocation
Glenoid Labrum Injuries
Multidirectional Instabilites
Acromioclavicular Separation
Brachial Plexus Injury
Fractures
Anterior Shoulder Dislocation
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A humerus can dislocate
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Anteroinferiorly-front
and down (most
common)
Inferiorly – down
Posteriorly -back
Anterior Shoulder Dislocation
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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 HillSach’s Lesion can occur.
Anterior Shoulder Dislocation
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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.
Special Test-Dislocation
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Apprehension test
Glenoid Labrum Injury
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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.
Glenoid Labrum Injury
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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.
Glenoid Labrum Injury
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Signs and Sx
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Pain with catching and
popping
Possible weakness
Possible limited ROM
Special Tests
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Clunk Test
Cross Over Test
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Treatment
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Rotator Cuff
strengthening
Surgery
Multidirectional Instabilities
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Typically an anatomical problem.
Multiple dislocations will make it worse.
Exercise may help with the problem, surgery
sometimes, but not always
Weight bearing exercise are helpful. Like what?
Acromicavicular Separation
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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
AC separation
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Signs and Sx
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deformity
Pain in vicinity of AC
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Treatment
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Special Test
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Shear Test
Sulcus Sign
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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
Brachial Plexus Injury
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Brachial Plexus-group of
nerves that leave the
spinal cord and extend
into the shoulder giving
arm function.
AKA-stinger or burner
A result of stretching or
compression of the
nerves.
Dermatones
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When looking at nerves
you need to know level
off spine injury relative
to sensation and
movement.
Dermatomes is
sensation areas
corresponding to nerve.
Myotomes
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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
C5-deltoid-abduction
C6-biceps- elbow flex
C7-triceps- elbow ext
C8-thumb ext
T1- finger abduct/adduct.
Brachial Plexus Injury
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Signs and Sx
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Pain in neck and arm
Weakness in neck and
arm
Numb or pins and
needles down arm
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Treatment
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Rest till Sx go away
Ice after activity
Anti-inflammatory
Possible dr visit
Fractures
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Typically caused by a direct blow.
Clavicle and humerus, very rarely the scapula.
Typically you will see deformity
Xray necessary, immobilization 4-6 weeks
minimum.
We have strong shoulders
‘cause we stay athletic as we age