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The Shoulder

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  1. The Shoulder

  2. Sternoclavicular Joint • Only attachment of upper extremity to trunk

  3. Acromioclavicular Joint • AC ligament • Anterior • Posterior • Superior • Inferior • Coracoclavicular Ligament

  4. Glenohumeral Joint • Humeral head is larger than glenoid • Static stabilizers- Labrum and glenohumeral ligaments • Dynamic Stabilizers- Rotator cuff and Deltoid • Long head of biceps tendon passes superiorly to the head of the humerus

  5. Scapulothoracic Joint • Movement of the scapula on the thoracic wall is critical to shoulder joint motion • Muscles that attach to scapula must stabilize scapula providing a base for the head of humerus to rotate on.

  6. Scapulohumeral Rhythm • Movement of the scapula relative to the movement of the humerus in abduction • First 30 degrees of abduction- no scapular movement • 30-90 degrees of abduction- 1:2 ratio of scapula:humerus • Above 90 degrees of abduction- 1:1 ratio of scapula:humerus

  7. Stretching Exercises • Static Hang from chin up bar • Codman’s Pendulums- Early in Rehab below 90 • Sawing- Early in Rehab below 90 • Wall Climb- Flexion and Abduction • Corner Stretch- Anterior Structures • Wand Stretches • Sleeper Stretch

  8. Strengthening Exercises • Free Weights • Weight Machines • Exercise Tubing

  9. Strengthening Exercises • Bench Press • Horizontal Flys • Military Press • Front Raises • Side Raises • Reverse Flys • I’s • Y’s • T’s • Push-up with a plus • Push ups • Rows • Upright Rows • Ball push ups

  10. Plyometric Exercises • Need rebouder or partner • Single-arm toss • Double-arm toss with trunk rotation • Double-arm toss overhead • Push ups with a clap • Push ups on a box

  11. Reestablishing Neuromuscular Control • Weight Shifting • Table • Swiss Ball • Fitter Board • Wobble Board • Weighted Ball • Slide Board • Rhythmic Stabilization • Body Blade

  12. AC Sprain • MOI- Fall on tip of shoulder • Rehab Concerns-Focus on Deltoid, Trapezius, and Pectoralis Major muscles. Also focus on scapular stabilizers • Grade I- Sling for a couple of Days. Begin AROM exercises immediately • Grade II- 7-14 days in sling. Full RTP for contact sports 8-12 weeks.

  13. Clavicle Fx • MOI- FOOSHA, Direct Blow • Immobilization for 6-8 weeks • Regain ROM • Regain Strength • Deltoid • Pectoralis Major • RC • Scapular Stabilizers

  14. Glenohumeral Dislocation • MOI- 90 degree abduction, 90 degree elbow flexion and external rotation is most common • 85-90% will dislocate again • Likely to tear labrum also • Avoid Following Postions • Anterior- Combined ER and Abduction. Fly, Pull Down, Bench, Military Press • Posterior- Combined IR, Horizontal Adduction, and Flexion. Fly, Bench, Weight bearing exercises • Inferior- Full Elevation. Shrugs, elbow curls, military press

  15. GH Dislocation Cont. • Up to 3 weeks in sling • Passive ROM • Isometrics • Scapular exercises without elevation • Weeks 3-8 • Restore full AROM • Begin neuromuscular control exercises • Weeks 6-12 • Begin scapular and rotator cuff exercises • Add motion neuromuscular control exercises • Begin Plyometrics • Begin Body Blade • Weeks 12-20 • Begin sport specific drills

  16. Shoulder Impingement • Mechanical compression of supraspinatus tendon, subacromial bursa, and biceps tendon • MOI-Dynamic and static stabilizers fail to maintain subacromial space. Acute and Chronic • Rehabilitation Concerns • Avoid activities above 90 degrees of flexion and abduction early. • Focus on RC strength • Strengthen scapular stabilizers • Strengthen LE and Core to reduce stress on throwing shoulder