Objectives:Understand: The anatomy of the shoulder complex and upper arm The anatomy of the shoulder complex and upper arm The principles of rehabilitation for the shoulder and upper arm The principles of rehabilitation for the shoulder and upper arm The preventive/supportive techniques and protective devices The preventive/supportive techniques and protective devicesIdentify: The components of an evaluation format The components of an evaluation formatRecognize: The common injuries associated with the shoulder and upper arm. The common injuries associated with the shoulder and upper arm. Chapter 11: Shoulder & Upper Arm

 Moves in multiple directions  Made up of 4 bones 1. Sternum- located on the anterior portion of the body and provides attachment to the clavicle at the SC joint. 2. Clavicle- supports the shoulder complex on the front of the body, S-Shaped, does not articulate with the humerus 3. Humerus- long bone in the upper arm 4. Scapula-(coracoid process, is the bony projection on the anterior aspect of the scapula) floats on the back of the rib cage, also known as the thorax. Gleniod fossa (depression) articulates with the head of the humerus to form the glenohumeral joint Anatomy of Shoulder One of the most mobile and vulnerable anatomical structures in the body.

 5 shoulder joints 1. Sternoblavicular (SC)-attaches the upper extremity to the torso 2. Acromioclavicular (AC)- join the clavicle & scapula 3. Coracoclavicular (CC)-join the clavicle & scapula 4. Glenohumeral (GH)-humerus & scapula (shallow socket, allowing for greater movement) very weak, but very mobile. 5. Scapulothoracic- critical movement to the shoulder Coracoid Process- the bony projection on the anterior aspect of the scapula where articulates with the clavicle Joints of Shoulder

 Coracoclavicular- joins the clavicle with the scapula  Sternoclavicular  Acromioclavicular  Glenohumeral Ligaments

 Deltoid- anterior fibers (flexion, horizontal adduction, internal rotation) & posterior fibers (extention, horizontal adduction, external rotation)  Pectoralis Major- flexes upper arm; adducts upper arm anteriorly, internal roatation  Pectoralis Minor- raises ribs for inspiration, draws scapula forward and downward  Rhomboids- retraction and rotation of the scapula  Serratus Anterior- rotates scapula for abduction & flexion of upper arm, protracts scapula  Biceps- flexion and supination of upper arm  Triceps- extends forearm and upper arm Muscles & Functions Muscles of the shoulder assist with the stability, movement, and strength to the complex structure.

 Latissimus dorsi- extends arm; adducts arm posteriorly, internal rotation, downward rotation of scapula  Levator Scapula- elevates scapula, extends and lateral flexion of neck, assists with downward rotation of scapula.  Coracobrachialis- adduction; assists in flexion & pronation of the arm  Rotator cuff Muscles: (SITS) Supraspinatus (abducting arm), Infraspinatus (external rotation), teres minor (external rotation), subscapularis (internal rotation of shoulder)  Teres Major- extension, adduction, and internal rotation of upper arm  Trapezius- retraction, upward rotation, elevates scapula, and downward rotation of scapula  Bursae- are closed, fluid-filled sacs that serve as cushions against friction over a prominent bone, or where a tendon moves over a bone. Muscles & Function

HOPSHistoryObservationPalpation Special Tests EVALUATION FORMAT

Glenohumeral Joint Stability Tests  Apprehension: detects anterior shoulder subluxation or dislocation  Relocation: detects chronic anterior dislocation of the glenohumeral joint  Anterior Instability: detects anterior instability of the glenohumeral joint  Anterior/Posterior Translation: assesses anterior/posterior joint laxity  Posterior Glenohumeral Instability: assesses humeral head posterior subluxation  Inferior Drawer or Feagin: assesses humeral head inferior subluxation  Sulcus: assesses humeral head for inferior subluxation Assessment Tests

Rotator Cuff Impingement Tests  Full flexion: assesses the presence of rotator cuff inflammation or impingement  Flexion-Internal Rotation (Hawkins’s Kennedy): assesses the presence of rotator cuff inflammation or impingement Rotator Cuff Muscular Strength Tests  Supraspinatus Strength (empty can test): assesses the strength  Internal Rotation Strength: assesses the strength of subscapularis  External Rotation Strength: assesses the strength of infraspinatus & teres minor Assessment Tests

Internal Derangement Test  Glenoid Labrum Clunk: assesses the glenoid labrum’s integrity & stability Acromioclavicular Joint Test  Acromioclavicular joint stability: assesses the integrity of the AC & costoclavicular ligaments  Cross Chest or Horizontal Adduction: assesses the sternoclavicuar joint impingement Sternoclavicular Joint Test  Joint Integrity: assesses the sternoclavicular & costoclavicular ligaments Assessment Tests