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Shoulder Joint-Anatomy (1). Sternum Clavicle Scapula- acromion process and coracoid process, glenoid fossa and glenoid labrium, spine of scapula Humerus- Greater tubercle, Lesser tubercle, head of humerus, http://www.readingshoulderunit.com/shoulder_anatomy.htm. Shoulder Anatomy (2). - PowerPoint PPT Presentation
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Shoulder Joint-Anatomy (1) Sternum Clavicle Scapula- acromion process and
coracoid process, glenoid fossa and glenoid labrium, spine of scapula
Humerus- Greater tubercle, Lesser tubercle, head of humerus,
http://www.readingshoulderunit.com/shoulder_anatomy.htm
Shoulder Anatomy (2) The shoulder encompasses 5
separate articulations Sternoclavicular (SC) joint Acromioclavicular (AC) joint Coracoclavicular joint Glenohumeral (GH) joint Scapulothoracic (ST) joint
Sternoclavicular (SC) Joint ** Joint between the sternum and clavicle Allows for rotation during movements
like shrugging the shoulders and reaching above the head.
Supported by 4 ligaments- Fig 8-1 anterior and posterior SC ligament Costoclavicular ligament Interclavicular ligament
Acromioclavicular (AC) Joint** Lies between the acromion process
and the clavicle Has limited motion Primary ligament: AC ligament Secondary ligaments
Coracoacromial ligament Coracoclavicular ligaments
Glenohumeral (GH) Joint**(1)
Fig 8-2 “true” shoulder joint Glenoid fossa of the scapula
VERY shallow Head of the humerus (3-4 x larger
than glenoid)-plunger/volleyball example
lacking in bony stability
GH joint** (2) Joint is deepened by a meniscus like
structure called the glenoid labrum functions to add stability to the joint
Stabilized by two types of stabilizers Static stabilizers
joint capsule several glenohumeral ligaments
GH joint** (3) Dynamic stabilizers
rotator cuff muscles (SITS) Supraspinatus Infraspinatus Teres minor Subscapularis
Scapulathoracic Joint** Gliding joint Scapula rotates to allow full
abduction and adduction Called Scapulothoracic rhythm
Several important muscles are stabilzers including the: levator scapula, rhomboids, trapezius,
and serratus anterior
Other shoulder anatomy (3) Bursa
Subacromial (clinically most important)
Nerve supply brachial plexus (C5-T1)
Blood supply subclavian, axillary artery
Shoulder movements Flexion (180) and Extension (80-90) Abduction (180) and Adduction Horizontal Adduction/Flexion (130) Horizontal Abduction/Extension (60) External rotation (90) Internal rotation (90)
Throwing Motion Activity Cocking, Acceleration, Deceleration Flexion, Extension, Hyperextension Abduction, Adduction Horizontal Adduction/Flexion Horizontal Abduction/Extension External rotation, Internal rotation Elbow Extended, Elbow Flexed
Anatomy of throwing Three phases of over arm
throwing- Fig 8-10 and Box 8-1 Preparatory or cocking phase Acceleration or delivery phase Deceleration or follow-through phase
Shoulder goes thru over ???°/sec-knee ???°/sec when walking
Common injuries during the throwing motions Box 8-2
Cocking phase Arm in horizontal abduction,
hyperextension and external rotation eccentrically loaded:
horizontal adductors internal rotators
scapular muscles rhomboids pull scapula back serratus anterior stabilizes the scapula
Acceleration or delivery phase Ball brought forward and released humeral horizontal add, elbow
extension, rapid internal rotation romboids relax Large stresses placed on
ligaments,
Arm deceleration/ follow through After ball release, until maximum
shoulder internal rotation, horizontal adduction are reached
Eccentric loads placed on: infraspinatus, supraspinatus, teres
major and minor, lats, posterior deltoid
Preventing shoulder problems
General muscle strengthening Try and avoid exercises above 90 degrees
Stretching for shoulder capsule, but be careful
Strengthening rotator cuff muscles including eccentric work http://www.asmi.org/SportsMed/throwing/throw
er10.html Throwing Program
Strengthen scapular stabilizers push-ups press-ups
SC joint Sprain MOI: direct blow to clavicle or transition
forces from a blow to the shoulder driving the clavicle out of place
HOPS point tenderness over SC joint bruising, swelling and pain over SC joint deformity increases with degree; posterior
is serious Motion decreases with degree
TX-See Field Strategy 8.4
AC joint sprain “Separated Shoulder” MOI: fall on tip of shoulder, direct blow to the
tip of the shoulder, falling on outstretched hand (FOOSH)
HOPS point tenderness over AC joint bruising, swelling and pain over AC joint deformity increases with degree; or step
deformity Piano key test positive in 3 degree
TX: place in sling, x-ray; Field Strategy 8.5
GH joint sprains Two forms:
Acute Dislocations Recurrent subluxations/ dislocations
Acute Dislocations MOI: external rotation, abduction,
extension Most are anterior dislocations may cause a avulsion of the anterior
portion of the glenoid = Bankart lesion
Acute Dislocations (con’t) HOPS
Intense pain Tingling and numbness down arm into the hand arm held at slight abduction, external rotation,
and stabilized against the body Flattened appearance to the shoulder; acromion
process becomes prominent (Fig 8-14) inability to move shoulder
Tx-check neurovascular status, sling and ice if able; referral; DO NOT REDUCE
Chronic dislocations/ subluxation MOI: same as acute, force required is
less HOPS:
less symptoms than acute “dead arm syndrome”
TX: conservative: therapy surgery if needed
Rotator Cuff impingement (1) Involves several structures:
supraspinatus tendon micro-tears subacromial bursa coracoacromial ligament Glenoid labrum long head of bicep
May lead to rotator cuff rupture if unchecked
Rotator Cuff impingement MOI: repetitive microtrauma (overuse) HOPS:
pain with activity pain with overhand motions painful arch (between 70 and 120 degrees of
AB) Inability to sleep on involved side + supraspinatus tests, impingement test
TX: TX: cryotherapy, NSAID’s, rest, gradual strengthening, retraining of muscles
Bicipital Tendonitis MOI- overuse during rapid overhead
movements with excessive elbow flexion and supination;
Bicep tendon gets irritated in the bicipital groove and may partially sublux
HOPS-pain in anterior aspect of shoulder over the bicipital groove; athlete may say something is “popping”; pain with resistive elbow flex and supination and passive stretch of bicep
Tx- rest from motions that aggravate, ice, NSAID’s, strengthening and stretching
ROM/Muscle Testing Shoulder flexion-Ant Delt/Pec Major Shoulder extension-Post Delt Shoulder abduction-Middle Delt Shoulder adduction-Pec Major/Lats Shoulder internal rotation-Ant Delt/
Subscapularis Shoulder external rotation-Infraspinatus/ Teres
Major Horizontal ADD/Flex-Ant Delt Horizontal ABD/Ext- Post Delt Scapula elevation, depression, protraction, and
retraction
Special Tests Apprehension test (shoulder
dislocation) Empty Can and Drop Arm Tests
(supraspinatus) Impingement (impingement) Yergerson’s (biceps tendinitis)
HOPS History Observation Palpation
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