Shoulder Joint Glenohumeral joint

Shoulder joint  Most movable joint in the body  Most unstable joint  most injuried  Made up of two separate joints - the glenohumeral and acromioclavicular joints. These two joints work together to allow greater movement

Shoulder Joint  Shallow socket- allows for greater mobility but less stability  Stability comes from the muscles (rotator cuff)

Shoulder Blade (scapula)  1/3 of your ability to raise your arm actually comes not from the shoulder joint but from the movement of your shoulder blade across the rib-cage (scapulo- thoracic movement).

Attachment  The arm is attached to the rest of the body by only one, relatively small joint  the acromioclavicular joint (AC joint)  where the collar-bone attaches to the shoulder blade at the top/front of the shoulder  the rest are muscle attachments

The Axilla

Nerves of the axilla

Muscles

Rotator Cuff muscles

SITS: S upraspinatus*** I nfraspinatus T eres Minor S ubscapularis

Ligaments of the shoulder

Bursa of the shoulder

Most common injuries of the shoulder  Sprains  Strains  dislocations  separations  tendinitis  bursitis  torn rotator cuffs  frozen shoulder  fractures  arthritis

Tendonitis -repeated microtrauma to the tendons rather than a specific one-off trauma

-Most tears are the result of a wearing down of the tendon that occurs slowly over time. -repetitive stress -lack of blood supply -bone spurs

Most common

Healthy Bursa

Bursitis -repetitive activities include: gardening, raking, carpentry, shoveling, painting, scrubbing, tennis, golf, skiing, throwing, and pitching. -incorrect posture at work or home and -poor stretching or conditioning before exercise can also lead to bursitis.

Impingement

Tear in rotator cuff

Rotator Cuff tear repair

AC Joint (acromioclavicular joint)

AC joint sprains

Arthritic changes in shoulder

Shoulder Replacement

Movements

Bony Landmarks of shoulder

Shoulder Lab  Measure the shoulder movements and manual muscle testing

Modalites  Heat  Cold  Ultrasound  Electrical stimulation  Paraffin wax

Modalities  Ultrasound

Modalities  Transcutaneous Electrical Nerve Stimulation (TENS)- low voltage electrical current used for:  Pain relief  Muscle re-education HOW DOES IT WORK: the electricity from the electrodes stimulates the nerves in an affected area and sends signals to the brain that block or "scramble" normal pain signals and help the body to produce natural painkillers called endorphins, which block the perception of pain.

Modalities  TENS

Precautions/contraindications  Patients who do not comprehend the instructions or who are unable to co- operate  Patients with a Pacemaker  Patients who have an allergic response to the electrodes  Electrode placement over dermatological lesions e.g. dermatitis, eczema  Application over the anterior aspect of the neck or carotid sinus  Electrodes should not be placed over the eyes  Patients who have epilepsy

Modalities  Paraffin Bath