Shoulder Complex

Chapter 22
 Shoulder Anatomy
 http://  Ligaments
www.sportsknee.com/sho • AC
ulderanatomy.htm
• Glenohumeral lig
 Clavicle
 Scapula
 Musculature
 Humerus • Scapular muscles
 Articulations: • RC (4)
• Sternoclavicular joint • Bursae
• Acromioclavicular joint
• Glenohumeral joint
Ligaments
 Nerve Supply
• Brachial plexus (C5-T1)
 Blood Supply
• Subclavian artery
 Bursae
• Subacromial (subdeltoid): often becomes compressed
through motion by coracoacomila arch
• Subcoracoid
 Preventing/Assessing Shoulder
Injuries
 Proper Conditioning
 Muscle Testing
 History
 Observation
 Palpation
Special Tests
• Muscle testing
• Those which act in scapula and those which act on GH joint
• Instability
• Sternoclavicular: pressure on clavicle
• Acromioclavicular: distal clavicle all 4 directions
• GH
– Sulcus test
– Anterior/Posterior Drawer (supine, scapula stabilized;
ant/post force)
– Load and shift (sitting; ant/post force)
• Impingement
• Neer (overhead)
• Hawkins-Kennedy (IR with horizontal adduction
• Apprehension test
• Supraspinatus
• Drop Arm test (at 90 degrees abduction, unable to
control the adduction)
• Empty Can Test (thumbs down, apply downward
pressure)
• Biceps Tendon Irritation
• Yergason (elbow flexed to 90; evaluator distracts
humerus while pt attempts to supinate)
• Speed’s (elbow extended, forearm supinated,
resistance to elbow flexion)
• Circulatory Assessment
• Axillary, brachial, radial
• Thoracic Outlet Syndrome test
• Adson’s (monitor radial pulse from arm at neutral to
extended with athlete elevating chin, turning toward
extended arm, and holding breath) looking to
occlude subclavian artery between scalene muscles
and cervical ribs
 Shoulder Injuries
 Clavicle Fracture  Epiphyseal Fracture
• Etiology • Etiology
• Signs and Symptoms • Signs and Symptoms
• Management • Management
 Scapular Fracture  Sternoclavicular Sprain
• Etiology • Etiology
• Signs and Symptoms • Signs and Symptoms
• Management • Management
 Humeral Shaft Fracture  Acromioclavicular Sprain
• Etiology • Etiology
• Signs and Symptoms • Signs and Symptoms
• Management • Management
 Shoulder Injuries
 Contusion to the distal end of  Acute subluxation and
clavicle Dislocatoin
• Etiology • Etiology
• Signs and Symptoms • Signs and Symptoms
• Management • Management
 Glenohumeral Joint  Anterior Glenohumeral
• Etiology Dislocation
• Signs and Symptoms • Etiology
• Management • Signs and Symptoms
• Management
 Shoulder Injuries
 Posterior Glenohumeral  Shoulder Impingement
dislocation • Etiology
• Etiology • Signs and Symptoms
• Management
• Signs and Symptoms
• Management
 Rotator Cuff Tears
• Etiology
 Chronic Instabilities • Signs and Symptoms
(anterior, posterior, and • Management
multidirectional)  Frozen Shoulder
• Etiology • Etiology
• Signs and Symptoms • Signs and Symptoms
• Management • Management
 Shoulder Injuries
 Thoracic Outlet  Bicipital Tenosynovitis
Compression Syndrome • Etiology
• Signs and Symptoms
• Etiology
• Management
• Signs and Symptoms
 Contusion of the Upper Arm
• Management
• Etiology
 Biceps Brachii Rupture • Signs and Symptoms
• Etiology • Management
• Signs and Symptoms  Peripheral Nerve Injury
• Management • Etiology
• Signs and Symptoms
• Management
 Rehabilitation of Shoulder
 Therapy:
• RICE
Injuries
• EXERCISE
• ISOMETRIC EXERCISE DURING IMMOBILIZATION
– CODMANS EXERCISE
• THERAPY: ICE WITH ELECTRICAL
STIMULATION
• ULTRASOUND
 Basic Shoulder Biomechanics:
• Scapulohumeral rhythm
• How scapula moves in relation to humerus through
abduction
• Humerus at 30 degrees, scapula has not moved
• 30-90: humerus elevates 2 degree, scapula rotates 1
• 90-full ABD: 1:1 ration
• Great mobility at the joint sacrifices stability
Biomechanics of Throwing
 Wind Up Phase
• 1st movement til ball leaves glove
• Lead leg forward; shoulder ABD, ER, horizontal ABD
 Cocking Phase
• Hand separation til max. ER of humerus
• Lead foot hits ground
 Acceleration phase
• Max ER of humerus til ball release
• Shoulder ABD, horizontal ABD and IR, velocity approaches 7000 degrees
per second
 Deceleration phase
• Ball release to max IR
• ER rotators of cuff eccentrically decelerate humerus
 Follow up phase
• Max IR to end position where player is balanced from release
 Rehabilitation of The Shoulder
Complex
 Immobilization After Injury
 General Body Conditioning
 Shoulder Joint Mobilization
 Flexibility
 Muscular Strength
 Regaining Neuromuscular Control
 Functional Progression
 Return to Activity