1. Glenohumeral (shoulder) Joint By: Cameron, Debbie, Laura and Wendy

2. Humerus Greater tubercle Lesser Tubercle Intertubercular Sulcus Head Anatomical Neck Surgical Neck Detloid tuberosity

3. Anterior Scapula Acromion process Coracoid process Borders: Superior Vertebral Axillary Angles: Superior Inferior Fossae: Subscapular Glenoid cavity Coracoid process Acromion process Superior border Superior angle Inferior angle Glenoid cavity Axillary border Vertebral border Subscapular fossa

4. Posterior Scapula Fossae: Infraspinatous Supraspinatous Spine Glenoid cavity Angles: Superior Inferior Borders: Superior Vertebral Axillary Acromion process Supraspinatous fossa Infraspinatous fossa spine Glenoid cavity Superior angle Inferior angle Vertebral border Superior border Acromion process Axillary border

5. Clavicle Acromial End Conoid Tubercle

7. Cartilage Articular CartilageGlenoid Labruim

8. Ligaments Coracohumeral Glenohumeral Transverse humeral Coracoclavicular Conoid Superior transverse scapular Acromioclavicular Glenohumeral ligament

9. Bursae Subscapular, SubacromialSubdeltoid, Subcoracoid

10. Articular Capsule Articular Cavity is filled with Synovial fluid, which is secreted by the synovial membrane. Synovial membrane is the inner layer, Fibrous layer is the outer layer. Bursae also have synovial fluid inside them.

11. Articular Capsule Synovial MembraneFibrous Layer

13. Red = origin Blue = insertion

16. Innervation

17. Innervation and Vascular Supply

18. Vascular supply and Innervation

19. Vascular Supply

20. Anterior Surface Anatomy

21. Posterior Surface Anatomy

22. Torn Rotator Cuff Physical Therapy Protocol

23. Ruptured Supraspinatus Tendon

24. The Muscles of the Rotator Cuff S. I. T. S. Suprasinatous Infraspinatous Teres Minor Subscapularis

25. Rotator Cuff Repair Rehab Protocol General Considerations:  Quality of tissue and integrity of repair  Acute vs. chronic tear  Chronic repairs typically harder to achieve ROM  Extent of repair  Early PROM of glenohumeral joint is important to prevent capsular adhesions and fibrosis. This is done in a range that SHORTENS involved mm  PT will start immediately following surgery, focus on ROM

26. 0-2 Weeks Post-Op Protection, Dressing, PROM AROM, Pain control, Other Activities  Keep shoulder in a sling unless showering or during exercise.  Okay to shower after 2 days.  Stitches removed 8-10 days.  PROM=flexion, pendulums, pulleys.  Biceps curls, putty grip, neck stretches as tolerated.  STM, modalities for pain control.  Walking, bike.

27. 2-4 Weeks Post-Op Protection, PROM, AROMIsometrics, Other Activities  Still in sling unless showering, meals, or exercise.  PROM for repaired tendons, only in direction that SHORTENS tendon.  AROM for Uninvolved tendons. AVOID STRESSING REPAIRED TENDONS!!  ISO. For Uninvolved tendons as tolerated.  LE conditioning, aquatic therapy.

28. 4-8 Weeks Post-Op Protection, PROM, MobsAROM, Other Activities  No sling needed.  GENTLE PROM into previously protected ranges.  Most plane motions should be 75% of normal.  Make sure and check glenohumeral joint for excessive loss of mobility.  Grade 1-2 w/o restrictions.  Pure ABD. and ER.  Slowly introduce against gravity ROM exercises into extension.

29. 8-12 Weeks Post-Op PROM, Mobs,AROM, Other Activities  Cont. w/ Passive stretching to pain tolerance.  Grade 1-4 mobs. As tolerated.  Progress to high repetitions and then increase resistance.  MONITOR SHOULDER AND POSTURAL MECHANICS AS WELL AS PAIN WITH ALL EXERCISES.  Jogging, UBE for ROM.

30. 3-6 Months Post-Op ROM Other Activities  If ROM is still limited, focus on achieving full ROM.  If ROM is not limited, focus on strengthing.  Motion in most planes should be almost normal.  More aggressive stretching and resistive exercises.  Rowing, UBE for strengthening, weightlifting with extreme caution NOT to stress repair!!!

31. 6 Months(M.D. Visit) ROMOther Activities  Hard resistive exercises, aggressive stretching.  Swimming, weightlifting, throwing progression.

32. Exercise Program