1. Shoulder Anatomy

2. Shoulder
It is a ball and socket joint that moves in all three planes and has.
Most mobile and least stable joint.

3. Shoulder joint motions
Flexion- is raising the arm in the lateral plane from degrees.
Extension- return to anatomical position.
Hyperextension degrees back through the lateral plane.

4. Shoulder joint motions
Abduction- arm moving in the frontal plane away from the body, with a degrees of motion.
Adduction- arm moving back to midline, with degrees of motion.

5. Shoulder joint motions
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.

6. Shoulder joint motions
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.

7. Shoulder joint motions
Scaption- flexion in the scapular plane, vs the lateral or frontal plane degree of motion can occur.

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

9. Shoulder Landmarks 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.

10. Shoulder Landmarks Surgical Neck- where the head meets the body.
Anatomical neck- where the head meets the tubercles.

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

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

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

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

15. 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.

16. 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.

17. Impingement Syndrome Signs and Sx Treatment 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

18. Impingement Syndrome Special Tests Hawkins Test Neer’s Impingement
Cross over Test

19. Impingement Syndrome Stretches- Exercises 3 way door stretch
Posterior shoulder
Internal Rotation with
Exercises
Internal Rotation
External Rotation
Adduction

20. 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.

21. 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.

22. 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

23. Biceps Tendonitis Discomfort in the front of the shoulder.
Can be caused by impingement.
Special Tests-
Speed’s Test
Yergeson’s Test

24. Traumatic Shoulder Injuries
Shoulder Dislocation
Glenoid Labrum Injuries
Multidirectional Instabilites
Acromioclavicular Separation
Brachial Plexus Injury
Fractures

25. Anterior Shoulder Dislocation
A humerus can dislocate
Anteroinferiorly-front and down (most common)
Inferiorly – down
Posteriorly -back

26. 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.

27. 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.

28. Special Test-Dislocation
Apprehension test

29. 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.

30. 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.

31. Glenoid Labrum Injury Signs and Sx Special Tests Treatment
Pain with catching and popping
Possible weakness
Possible limited ROM
Special Tests
Clunk Test
Cross Over Test
Treatment
Rotator Cuff strengthening
Surgery

32. 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?

33. 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

34. AC separation Signs and Sx Special Test Treatment 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

35. Muscles of the Shoulder Joint
Deltoid is superficial muscle. All three parts of it attach to the deltoid tuberosity.
Axillary Nerve

36. Rotator Cuff Muscles
Supraspinatus-anterior superior shoulder. It is superior to the spine of the scapula.
abduction

37. Muscles of the Shoulder Joint
Pectoralis Major-
Clavicular portion-most effective during flexion from 0-90
Sternal portion- most effective in extension degrees of shoulder extension
Both of them adduct, internally rotate and horizontally adduct the shoulder.

38. Muscles of the Shoulder Joint
Latissimus Dorsi- means widest, back, so the widest back muscle. It is mostly superficial and is involved with shoulder extension , adduction and internal rotation

39. Muscles of the Shoulder Joint
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.

40. Rotator Cuff Muscles Infraspinatus- posterior inferior shoulder
Inferior to the spine of the scapula
External rotation

41. Rotator Cuff Muscles
Teres Minor- posterior shoulder
Adduction

42. Rotator Cuff Muscles
Subscapularis-anterior shoulder
Internal rotation

43. Muscles of the shoulder joint
Coracobrachialis- attaches to the coracoid process and the arm or Brachium. Stabalizes the humerus in the fossa.

44. Muscles of the Shoulder Joint
The four rotator cuff muscles cover the humeral head and hold the head against the glenoid fossa.

45. Rotator Cuff Muscles Know these muscles if you remember nothing else.
Infraspinatus
Supraspinatus
Subscapularis
Teres Minor