Chapter 11: Shoulder & Upper Arm

Objectives: • • • Understand: The anatomy of the shoulder complex and upper arm The principles of rehabilitation for the shoulder and upper arm The preventive/supportive techniques and protective devices Identify: • • The components of an evaluation format Recognize: The common injuries associated with the shoulder and upper arm.

Anatomy of Shoulder

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

  Moves in multiple directions Made up of 4 bones

1.

2.

3.

4.

Sternum-

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

Clavicle-

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

Humerus-

long bone in the upper arm

Scapula-

joint (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

Joints of Shoulder

 5 shoulder joints

1.

2.

3.

4.

5.

Sternoblavicular

(SC)-attaches the upper extremity to the torso

Acromioclavicular

scapula (AC)- join the clavicle &

Coracoclavicular

(CC)-join the clavicle & scapula

Glenohumeral

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

Scapulothoracic

- critical movement to the shoulder

Coracoid Process-

the bony projection on the anterior aspect of the scapula where articulates with the clavicle

Ligaments

 Coracoclavicular- joins the clavicle with the scapula 

Sternoclavicular



Acromioclavicular



Glenohumeral

Muscles & Functions

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

       Deltoid rotation) & posterior fibers (extention, horizontal adduction, external rotation) anterior fibers (flexion, horizontal adduction, internal

Pectoralis Major-

internal roatation flexes upper arm; adducts upper arm anteriorly,

Pectoralis Minor-

and downward raises ribs for inspiration, draws scapula forward Rhomboids retraction and rotation of the scapula

Serratus Anterior-

rotates scapula for abduction & flexion of upper arm, protracts scapula Biceps-

Triceps-

flexion and supination of upper arm extends forearm and upper arm

Muscles & Function

      

Latissimus dorsi-

posteriorly, internal rotation, downward rotation of scapula extends arm; adducts arm

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.

HOPS

History Observation Palpation Special Tests

EVALUATION FORMAT

Assessment Tests 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