Transcript Shoulder Anatomy

Shoulder Anatomy
Shoulder
It is a ball and socket joint that moves in
all three planes and has.
 Most mobile and least stable joint.

Shoulder joint motions
Flexion- is raising the arm in the lateral
plane from 0-180 degrees.
 Extension- return to anatomical position.
 Hyperextension- 0-45 degrees back
through the lateral plane.

Shoulder joint motions
Abduction- arm moving in the frontal
plane away from the body, with a 0-180
degrees of motion.
 Adduction- arm moving back to midline,
with 0-180 degrees of motion.

Shoulder joint motions


Internal Rotationoccur in the
transverse plane. This
can go to 90 degrees
into body
External Rotationoccurs in the
transverse plane, 90
degrees out from
neutral.
Shoulder joint motions

Horizontal
abduction/adductionoccurs in the
transverse plane.
Neutral is 90 degrees
of shoulder abduction,
so horiz abduction is
30 degrees and
adduction is 120
degree.
Shoulder joint motions

Scaption- flexion in
the scapular plane, vs
the lateral or frontal
plane. 180 degree of
motion can occur.
Shoulder Landmarks
Scapula
Glenoid labrum-fibrocartilage ring
attached to the rim of the glenoid fossa,
which deepens the cavity.
Shoulder Landmarks

Humerus

Head- is the semi round
proximal end,
articulates with the
scapula.
Shaft- body of the
humerus is the area
between the neck and
the epicondyles.
Shoulder Landmarks


Surgical Neck- where
the head meets the
body.
Anatomical neckwhere the head meets
the tubercles.
Shoulder Landmarks

Greater Tubercle/Tuberosity- large
projection lateral to the head.
Supraspinatus, infraspinatus and teres
minor attach here.
Shoulder Landmarks

Lesser Tubercle/Tuberosity- smaller
projection on the anterior surface,
subscapularis attaches here.
Shoulder Landmarks

Deltoid tuberosity- lateral side, near the
midpoint, deltoid attaches here.
Shoulder Landmarks

Bicipital Groove- groove between the
tubercles containing the long head of the
biceps tendon.
Impingement Syndrome


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
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

Signs and Sx





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

Treatment



Correct technique
Strengthen inferior
muscles
Strengthen weak
rotator cuff muscles
Impingement Syndrome

Special Tests



Hawkins Test
Neer’s Impingement
Cross over Test
Impingement Syndrome

Stretches



3 way door stretch
Posterior shoulder
Internal Rotation with
Exercises



Internal Rotation
External Rotation
Adduction
Rotator Cuff Tears



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

Signs and Sx





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

Special Tests





Active Abduction-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
Empty Can Test- supraspinatus/subscap
motion
MRI is final diagnostic tool
Biceps Tendonitis



Discomfort in the front
of the shoulder.
Can be caused by
impingement.
Special Tests

Speed’s Test
Yergeson’s Test
Traumatic Shoulder Injuries
Shoulder Dislocation
 Glenoid Labrum Injuries
 Multidirectional Instabilites
 Acromioclavicular Separation
 Brachial Plexus Injury
 Fractures

Anterior Shoulder Dislocation

A humerus can
dislocate



Anteroinferiorly-front
and down (most
common)
Inferiorly – down
Posteriorly -back
Anterior Shoulder Dislocation



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
Hill-Sach’s Lesion can
occur.
Anterior Shoulder Dislocation



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

Apprehension test
Glenoid Labrum Injury
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
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

Signs and Sx




Pain with catching and
popping
Possible weakness
Possible limited ROM
Special Tests


Clunk Test
Cross Over Test

Treatment


Rotator Cuff
strengthening
Surgery
Multidirectional Instabilities




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


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

Signs and Sx



deformity
Pain in vicinity of AC
Special Test


Shear Test
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
Muscles of the Shoulder Joint
Deltoid is superficial muscle. All three
parts of it attach to the deltoid tuberosity.
 Axillary Nerve

Rotator Cuff Muscles

Supraspinatus-anterior superior shoulder. It is
superior to the spine of the scapula.

abduction
Muscles of the Shoulder Joint

Pectoralis Major


Clavicular portion-most effective during flexion
from 0-90
Sternal portion- most effective in extension
180-120 degrees of shoulder extension
Both of them adduct, internally rotate and
horizontally adduct the shoulder.
Muscles of the Shoulder Joint

Latissimus Dorsimeans widest, back,
so the widest back
muscle. It is mostly
superficial and is
involved with shoulder
extension , adduction
and internal rotation
Muscles of the Shoulder Joint

Teres Major- it is the
little helper of the
lats. It runs from the
axillary boarder of the
scapula to the lesser
tubercle of the
humerus.
Rotator Cuff Muscles

Infraspinatus


posterior inferior
shoulder
Inferior to the spine of
the scapula
External rotation
Rotator Cuff Muscles

Teres Minor- posterior
shoulder

Adduction
Rotator Cuff Muscles

Subscapularis-anterior
shoulder

Internal rotation
Muscles of the shoulder joint

Coracobrachialis- attaches to the coracoid
process and the arm or Brachium.
Stabalizes the humerus in the fossa.
Muscles of the Shoulder Joint

The four rotator cuff
muscles cover the
humeral head and
hold the head against
the glenoid fossa.
Rotator Cuff Muscles

Know these muscles if you remember
nothing else.




Infraspinatus
Supraspinatus
Subscapularis
Teres Minor