Objectives:Objectives:

Understand:Understand:• The anatomy of the shoulder complex and upper armThe anatomy of the shoulder complex and upper arm• The principles of rehabilitation for the shoulder and The principles of rehabilitation for the shoulder and

upper armupper arm• The preventive/supportive techniques and protective The preventive/supportive techniques and protective

devices devices

Identify:Identify:• The components of an evaluation formatThe components of an evaluation format

Recognize:Recognize:• The common injuries associated with the shoulder The common injuries associated with the shoulder

and upper arm.and upper arm.

Chapter 11: Chapter 11: Shoulder & Upper ArmShoulder & Upper Arm

Moves in multiple directionsMoves in multiple directions Made up of 4 bonesMade up of 4 bones

1.1. Sternum-Sternum- located on the anterior portion located on the anterior portion of the body and provides attachment to the of the body and provides attachment to the clavicle at the SC joint.clavicle at the SC joint.

2.2. Clavicle- Clavicle- supports the shoulder complex supports the shoulder complex on the front of the body, S-Shaped, does on the front of the body, S-Shaped, does not articulate with the humerusnot articulate with the humerus

3.3. Humerus-Humerus- long bone in the upper armlong bone in the upper arm4.4. Scapula-Scapula-(coracoid process, is the bony (coracoid process, is the bony

projection on the anterior aspect of the projection on the anterior aspect of the scapula) floats on the back of the rib cage, scapula) floats on the back of the rib cage, also known as the thorax. Gleniod fossa also known as the thorax. Gleniod fossa (depression) articulates with the head of (depression) articulates with the head of the humerus to form the glenohumeral the humerus to form the glenohumeral jointjoint

Anatomy of ShoulderAnatomy of ShoulderOne of the most mobile and vulnerable One of the most mobile and vulnerable anatomical structures in the body.anatomical structures in the body.

5 shoulder joints5 shoulder joints

1.1. Sternoblavicular Sternoblavicular (SC)-attaches the upper (SC)-attaches the upper extremity to the torsoextremity to the torso

2.2. Acromioclavicular Acromioclavicular (AC)- join the clavicle & (AC)- join the clavicle & scapulascapula

3.3. CoracoclavicularCoracoclavicular (CC)-join the clavicle & (CC)-join the clavicle & scapulascapula

4.4. GlenohumeralGlenohumeral (GH)-humerus & scapula (GH)-humerus & scapula (shallow socket, allowing for greater movement) (shallow socket, allowing for greater movement) very weak, but very mobile.very weak, but very mobile.

5.5. ScapulothoracicScapulothoracic- critical movement to the - critical movement to the shouldershoulder

Coracoid Process- Coracoid Process- the bony projection on the the bony projection on the anterior aspect of the scapula where articulates anterior aspect of the scapula where articulates with the claviclewith the clavicle

Joints of ShoulderJoints of Shoulder

CoracoclavicularCoracoclavicular- joins the clavicle with - joins the clavicle with the scapulathe scapula

SternoclavicularSternoclavicular AcromioclavicularAcromioclavicular GlenohumeralGlenohumeral

LigamentsLigaments

DeltoidDeltoid-- anterior fibers (flexion, horizontal adduction, anterior fibers (flexion, horizontal adduction, internal rotation) & posterior fibers (extention, horizontal internal rotation) & posterior fibers (extention, horizontal adduction, external rotation)adduction, external rotation)

Pectoralis Major-Pectoralis Major- flexes upper arm; adducts upper arm flexes upper arm; adducts upper arm anteriorly, internal roatationanteriorly, internal roatation

Pectoralis Minor-Pectoralis Minor- raises ribs for inspiration, draws raises ribs for inspiration, draws scapula forward and downwardscapula forward and downward

RhomboidsRhomboids- - retraction and rotation of the scapularetraction and rotation of the scapula Serratus Anterior-Serratus Anterior- rotates scapula for abduction & flexion rotates scapula for abduction & flexion

of upper arm, protracts scapulaof upper arm, protracts scapula BicepsBiceps-- flexion and supination of upper arm flexion and supination of upper arm Triceps-Triceps- extends forearm and upper arm extends forearm and upper arm

Muscles & FunctionsMuscles & FunctionsMuscles of the shoulder assist with the stability, Muscles of the shoulder assist with the stability, movement, and strength to the complex structure.movement, and strength to the complex structure.

Latissimus dorsi- Latissimus dorsi- extends arm; adducts arm extends arm; adducts arm posteriorly, internal rotation, downward posteriorly, internal rotation, downward rotation of scapularotation of scapula

Levator Scapula- Levator Scapula- elevates scapula, extends elevates scapula, extends and lateral flexion of neck, assists with and lateral flexion of neck, assists with downward rotation of scapula.downward rotation of scapula.

Coracobrachialis- Coracobrachialis- adduction; assists in adduction; assists in flexion & pronation of the armflexion & pronation of the arm

Rotator cuff Muscles: Rotator cuff Muscles: (SITS) (SITS) SupraspinatusSupraspinatus (abducting arm), (abducting arm), Infraspinatus Infraspinatus (external (external rotation), teres minor (external rotation), rotation), teres minor (external rotation), subscapularis subscapularis (internal rotation of shoulder)(internal rotation of shoulder)

Teres Major- Teres Major- extension, adduction, and extension, adduction, and internal rotation of upper arminternal rotation of upper arm

Trapezius- Trapezius- retraction, upward rotation, retraction, upward rotation, elevates scapula, and downward rotation of elevates scapula, and downward rotation of scapulascapula

Bursae- Bursae- are closed, fluid-filled sacs that are closed, fluid-filled sacs that serve as cushions against friction over a serve as cushions against friction over a prominent bone, or where a tendon moves prominent bone, or where a tendon moves over a bone.over a bone.

Muscles & Function Muscles & Function

HOPSHOPS

HistoryHistory

ObservationObservation

PalpationPalpation

Special TestsSpecial Tests

EVALUATION EVALUATION FORMATFORMAT

Glenohumeral Joint Stability Glenohumeral Joint Stability TestsTests

Apprehension: Apprehension: detects anterior shoulder detects anterior shoulder subluxation or dislocationsubluxation or dislocation

Relocation: Relocation: detects chronic anterior detects chronic anterior dislocation of the glenohumeral jointdislocation of the glenohumeral joint

Anterior Instability: Anterior Instability: detects anterior detects anterior instability of the glenohumeral jointinstability of the glenohumeral joint

Anterior/Posterior Translation: Anterior/Posterior Translation: assesses assesses anterior/posterior joint laxityanterior/posterior joint laxity

Posterior Glenohumeral Instability: Posterior Glenohumeral Instability: assesses humeral head posterior assesses humeral head posterior subluxation subluxation

Inferior Drawer or Feagin: Inferior Drawer or Feagin: assesses assesses humeral head inferior subluxationhumeral head inferior subluxation

Sulcus: Sulcus: assesses humeral head for inferior assesses humeral head for inferior subluxationsubluxation

Assessment TestsAssessment Tests

Rotator Cuff Impingement TestsRotator Cuff Impingement TestsFull flexion: Full flexion: assesses the presence of assesses the presence of rotator cuff inflammation or impingementrotator cuff inflammation or impingementFlexion-Internal Rotation (Hawkins’s Flexion-Internal Rotation (Hawkins’s Kennedy): Kennedy): assesses the presence of rotator assesses the presence of rotator cuff inflammation or impingementcuff inflammation or impingement

Rotator Cuff Muscular Strength Rotator Cuff Muscular Strength TestsTestsSupraspinatus Strength (empty can test): Supraspinatus Strength (empty can test): assesses the strengthassesses the strengthInternal Rotation Strength: Internal Rotation Strength: assesses the assesses the strength of subscapularisstrength of subscapularisExternal Rotation Strength: External Rotation Strength: assesses the assesses the strength of infraspinatus & teres minorstrength of infraspinatus & teres minor

Assessment TestsAssessment Tests

Internal Derangement TestInternal Derangement Test Glenoid Labrum Clunk: Glenoid Labrum Clunk: assesses the assesses the

glenoid labrum’s integrity & stabilityglenoid labrum’s integrity & stability

Acromioclavicular Joint TestAcromioclavicular Joint Test Acromioclavicular joint stability: Acromioclavicular joint stability: assesses assesses

the integrity of the AC & costoclavicular the integrity of the AC & costoclavicular ligamentsligaments

Cross Chest or Horizontal Adduction: Cross Chest or Horizontal Adduction: assesses the sternoclavicuar joint assesses the sternoclavicuar joint impingementimpingement

Sternoclavicular Joint TestSternoclavicular Joint Test Joint Integrity: Joint Integrity: assesses the assesses the

sternoclavicular & costoclavicular sternoclavicular & costoclavicular ligamentsligaments

Assessment TestsAssessment Tests