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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.

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Presentation Transcript
shoulder
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
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 motions1
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 motions2
Internal Rotation- occur in the transverse plane. This can go to 90 degrees into body

External Rotation- occurs in the transverse plane, 90 degrees out from neutral.

Shoulder joint motions
shoulder joint motions3
Horizontal abduction/adduction- occurs 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
shoulder landmarks
Shoulder Landmarks

Scapula

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

shoulder landmarks1
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
shoulder landmarks2
Surgical Neck- where the head meets the body.

Anatomical neck- where the head meets the tubercles.

Shoulder Landmarks
shoulder landmarks3
Shoulder Landmarks

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

shoulder landmarks4
Shoulder Landmarks

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

shoulder landmarks5
Shoulder Landmarks

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

shoulder landmarks6
Shoulder Landmarks

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

impingement syndrome
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 syndrome1
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 syndrome2
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
impingement syndrome3
Impingement Syndrome
  • Special Tests
    • Hawkins Test
    • Neer’s Impingement
    • Cross over Test
impingement syndrome4
Impingement Syndrome
  • Stretches-
    • 3 way door stretch
    • Posterior shoulder
    • Internal Rotation with
  • Exercises
    • Internal Rotation
    • External Rotation
    • Adduction
rotator cuff tears
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 tears1
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 tears2
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
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
Traumatic Shoulder Injuries
  • Shoulder Dislocation
  • Glenoid Labrum Injuries
  • Multidirectional Instabilites
  • Acromioclavicular Separation
  • Brachial Plexus Injury
  • Fractures
anterior shoulder dislocation
Anterior Shoulder Dislocation
  • A humerus can dislocate
    • Anteroinferiorly-front and down (most common)
    • Inferiorly – down
    • Posteriorly -back
anterior shoulder dislocation1
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 dislocation2
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
Special Test-Dislocation
  • Apprehension test
glenoid labrum injury
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 injury1
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 injury2
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

Glenoid Labrum Injury
multidirectional instabilities
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
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

AC separation
muscles of the shoulder joint
Muscles of the Shoulder Joint
  • Deltoid is superficial muscle. All three parts of it attach to the deltoid tuberosity.
  • Axillary Nerve
rotator cuff muscles
Rotator Cuff Muscles
  • Supraspinatus-anterior superior shoulder. It is superior to the spine of the scapula.
    • abduction
muscles of the shoulder joint1
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 joint2
Latissimus Dorsi- means widest, back, so the widest back muscle. It is mostly superficial and is involved with shoulder extension , adduction and internal rotationMuscles of the Shoulder Joint
muscles of the shoulder joint3
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.Muscles of the Shoulder Joint
rotator cuff muscles1
Rotator Cuff Muscles
  • Infraspinatus-
    • posterior inferior shoulder
    • Inferior to the spine of the scapula
    • External rotation
rotator cuff muscles2
Rotator Cuff Muscles
  • Teres Minor- posterior shoulder
    • Adduction
rotator cuff muscles3
Rotator Cuff Muscles
  • Subscapularis-anterior shoulder
    • Internal rotation
muscles of the shoulder joint4
Muscles of the shoulder joint
  • Coracobrachialis- attaches to the coracoid process and the arm or Brachium. Stabalizes the humerus in the fossa.
rotator cuff muscles4
Rotator Cuff Muscles
  • Know these muscles if you remember nothing else.
    • Infraspinatus
    • Supraspinatus
    • Subscapularis
    • Teres Minor