The Shoulder!!

Anatomy Bones Shoulder Girdle Scapula-with acromion and coracoid processes Glenoid labrum and Glenoid fossa 2) Humerus- head of humerus 3) Clavicle 4) Sternum

Acromion process  Acromion Process  Coracoid Process  Glenoid Fossa Coracoid Process Glenoid Fossa Glenoid Labrum is green

Joints

Anatomy Ligaments 1) Acromioclavicular ligament- AC 2) Sternoclavicular ligament- SC 3) Coracoclavicular ligament- CC 4) Glenohumeral ligament

5) Gleniod Labrum

GlenOId Fossa and Glenoid Labrum

Anatomy Muscles Rotator Cuff-SITS

Large Anterior Muscles Pectoralis Major Horizontal add Pectoralis Minor Move scapular Biceps Brachii elbow flexion

Large Posterior Muscles Lattissimus dorsi adduction humerus Triceps brachii Elbow ext Trapezius shoulder elevation Rhomboidus Scapular retraction Lateral View Deltoideus Abduction of humerus

Common Injuries AC Sprain (1st, 2nd, 3rd) also called separated Shoulder mech- Fall on tip of shoulder symp- PT above acromion, pain with AB and horizontal ADD tx- PRICE- sling, ROM and exercise as tolerated (small possibility for surgery)

Xray for diagnosis

2) Rotator Cuff- Strain of SITS, usually Supra Mech- overuse from throwing Symp- Dull ache deep in shoulder, can not sleep on that side, pain and weakness in ER/IR and ABD loss of ROM (read frozen shoulder article) Tx- rest- stop activity, strength training (I will show during rehab topic) Possible Surgery

Rotator Cuff Video http://www.mayoclinic.org/diseases-conditions/rotator-cuff- injury/basics/definition/con-20031421

Rotator Cuff Surgery 1) Tendon Repair or replacement (blood supply)- will reattach Supraspinatus tendon to humerus, or replace with another tendon 2) Bone Spur removal- arthoscopic, smooth out under acromion 3) Acromioplasty- make acromion Thinner to widen 4) Shoulder replacement

http://www. mayoclinic http://www.mayoclinic.org/diseases-conditions/rotator-cuff- injury/basics/treatment/con-20031421

3) Shoulder Subluxation/dislocation Mech-Forceful fall, clothesline, susceptible when in ER and ABD Symp- obv def, intense pain, loss of ROM, possible numbness Tx- Reduction (pain relief and muscle relaxer) immobilize and rehab strengthen whole area to stop recurrent ones Subluxation- comes out and goes back in OR only partially out of socket

4) Fractured Clavicle Mech- direct hit Symp- obv def TX- sling or figure 8 brace

Assessment HOPS History Observation Palpation Special tests

Special Tests Drop Arm test- Check supraspinatus Ask athlete to ABD and hold at 90 degrees Have patient lower or, push arm into ADD- if torn or weak supraspinatus the arm will drop

Special Tests 2) Empty Can- Check Supraspinatus Ask athlete to ABD arm with IR the pulls into 45 degrees of horizontal ADD (looks like emptying a can) Try to press arm into ADD- if drops torn or weak supraspintus

Special Tests 3) AC sprain- A) ask athlete to keep arms at their side-Trainers pulls down and both arms and looks for pain or movement at AC joint B) trainer horizontally ADD arm and looks for pain.

Special Tests 4) Apprehension test- tests for shoulder subluxation (dislocation) Trainer ABD and ER arm and athlete gets nervous

Special tests 5) Apley’s Scratch test- Used to check ROM in shoulder: touch opposite shoulder, touch opposite shoulder behind head, then touch opposite scapular with back of hand

Phase 1 Usually ways to control inflammation (except CWP hard to do)

Phase II- ROM First PROM (therapist moves shoulder- can be painful) AROM http://orthoinfo.aaos.org/topic.cfm?topic=A00067

Phase 3 Isometric P

Phase III- strength\Isotonic for Rotator Cuff http://www.bassett.org/sportsmedicine/rehabshoulder.cfm

Rotator Cuff External/internal Rotations http://www.youtube.com/watch?v=BJbkZ5RBIM8&feature=related

Phase 4

http://beginners http://therotater.com/blog/shoulder-exercise-for-explosive-throwing-power/ www.youtube.com/watch?v=vzOdrE7Ps8w&feature=related blody blade