Transcript Chapter 11: Shoulder & Upper Arm
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