Shoulder Anatomy Shoulder It is a ball and

Shoulder Anatomy

Shoulder It is a ball and socket joint that moves in all three planes and has. p Most mobile and least stable joint. p

SHOULDER JOINT MOTIONS

Shoulder joint motions Flexion- is raising the arm in the lateral plane from 0 -180 degrees. p Extension- return to anatomical position. p Hyperextension- 0 -45 degrees back through the lateral plane. p

Shoulder joint motions Abduction- arm moving in the frontal plane away from the body, with a 0 -180 degrees of motion. p Adduction- arm moving back to midline, with 0 -180 degrees of motion. p

Shoulder joint motions p p 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 p 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 p Scaption- flexion in the scapular plane, vs the lateral or frontal plane. 180 degree of motion can occur.

SHOULDER LANDMARKS

Shoulder Landmarks Scapula Glenoid labrum-fibrocartilage ring attached to the rim of the glenoid fossa, which deepens the cavity.

Shoulder Landmarks p Humerusn n 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 p p Surgical Neck- where the head meets the body. Anatomical neckwhere the head meets the tubercles.

Shoulder Landmarks p Greater Tubercle/Tuberosity- large projection lateral to the head. Supraspinatus, infraspinatus and teres minor attach here.

Shoulder Landmarks p Lesser Tubercle/Tuberosity- smaller projection on the anterior surface, subscapularis attaches here.

Shoulder Landmarks p Deltoid tuberosity- lateral side, near the midpoint, deltoid attaches here.

Shoulder Landmarks p Bicipital Groove- groove between the tubercles containing the long head of the biceps tendon.

MUSCLES OF THE SHOULDER JOINT

Muscles of the Shoulder Joint Deltoid is superficial muscle. All 3 musclesof it attach to the deltoid tuberosity. p 3 muscles: anterior, middle, posterior p Axillary Nerve p

Deltoid Injuries Avulsion fractures of the clavical, acromion, and the spinous process of the scapula p Fractures of the clavical, acromion, and the scapula p Axillary nerve damage p Hyperextension p Strain p

Anterior Deltoid Exercises Arnold press p Military press p Front raise p

Middle Deltoid Exercises Lateral raises p Upright rows p

Posterior Deltoid Exercises Reverse fly p Rear delt/lateral row p

Muscles of the Shoulder Joint p Pectoralis Majorn n n 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.

Pectoralis Injuries Peripheral Nerve Damage: medial and lateral pectoral p Contusions p Strains from throwing p Strains from exercise (ie push ups/bench press) p

Pectoralis Major, Sternal Exercises Bench press p Fly p Push up p

Pectoralis Major, Clavicular Exercises Incline Bench press p Incline fly p Decline push up p

Pectoralis Minor Exercises Dips p Standing fly p

Muscles of the Shoulder Joint p 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 p Coracobrachialis- attaches to the coracoid process and the arm or Brachium. Stabalizes the humerus in the fossa.

Muscles of the Shoulder Joint p 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 p Supraspinatus-anterior superior shoulder. It is superior to the spine of the scapula. n abduction

Rotator Cuff Muscles p Infraspinatusn n n posterior inferior shoulder Inferior to the spine of the scapula External rotation

Rotator Cuff Muscles p Teres Minor- posterior shoulder n Adduction

Rotator Cuff Muscles p Subscapularis-anterior shoulder n Internal rotation

Muscles of the Shoulder Joint p The four rotator cuff muscles cover the humeral head and hold the head against the glenoid fossa.

Rotator Cuff Muscles p Know these muscles if you remember nothing else. n n Infraspinatus Supraspinatus Subscapularis Teres Minor

Throwing Mechanics p Five Phases n n n Windup: shoulders – abduct, ext rot, horz abd Cocking: humerus – max ext rot Acceleration: humerus – abducts, horz abd, int rot; scapula – elevates, abducts, rotates up Deceleration: humerus – external rotators of the rotator cuff contract eccentrically to decel; scapula – rhomboids contract eccentrically to decel Follow-through: balanced position

Windup Begins with the first movement and ends when the ball leaves the gloved opposite hand p Humeral movement p p Scapular movement

Cocking Begins when hand separates and ends when maximum external rotation of the humerus has occurred p Humeral movement p p Scapular movement

Acceleration Begins when maximum external rotation of the humerus occurs and ends when the ball is released p Humeral movement p p Scapular movement

Deceleration Begins when the ball is released and ends with maximum shoulder internal rotation p Humeral movement p p Scapular movement

Follow-through Begins with maximum shoulder internal rotation and end with the athlete is in a balanced position p Humeral movement p p Scapular movement

SHOULDER JOINT INJURIES

Impingement Syndrome p p 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. p Overhead athletes are more likely to have problems with this injury. p 1/3 of shoulder problems are due to impingement. p

Impingement Syndrome p Signs and Sx n n n 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 p Treatment n n n Correct technique Strengthen inferior muscles Strengthen weak rotator cuff muscles

Impingement Syndrome p Special Tests n n n Hawkins Test Neer’s Impingement Cross over Test

Impingement Syndrome p Stretchesn n n p 3 way door stretch Posterior shoulder Internal Rotation with Exercises n n n Internal Rotation External Rotation Adduction

Rotator Cuff Tears p p p 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 p Signs and Sx n n n 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 p Special Tests n n n 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 p p p Discomfort in the front of the shoulder. Can be caused by impingement. Special Testsn n Speed’s Test Yergeson’s Test

Traumatic Shoulder Injuries Shoulder Dislocation p Glenoid Labrum Injuries p Multidirectional Instabilites p Acromioclavicular Separation p Brachial Plexus Injury p Fractures p

Anterior Shoulder Dislocation p A humerus can dislocate n n n Anteroinferiorly-front and down (most common) Inferiorly – down Posteriorly -back

Anterior Shoulder Dislocation p p p 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 p p p 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 p Apprehension test

Glenoid Labrum Injury Glenoid Labrum-a ring of cartilage attached to the margin of the glenoid cavity of the scapula. p The labrum acts to keep the humeral head positioned on the glenoid by blocking unwanted movement. p

Glenoid Labrum Injury A labral tear can occur with a shoulder dislocation, more likely to occur with numerus dislocations. p 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. p

Glenoid Labrum Injury p Signs and Sx n n n p Pain with catching and popping Possible weakness Possible limited ROM Special Tests n n Clunk Test Cross Over Test p Treatment n n Rotator Cuff strengthening Surgery

Multidirectional Instabilities p p 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 p p 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 p Signs and Sx n n p deformity Pain in vicinity of AC Special Test n n Shear Test Sulcus Sign p Treatment n n 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

Rehabilitation Immobilization p General body conditioning p Shoulder joint mobilization p Flexibility p Muscular strength p Neuromuscular control p Functional progression p Return to activity p