basic anatomy of the shoulder

1. The ShoulderThe Shoulder

2. Shoulder Girdle ComplexShoulder Girdle Complex
There are three primaryThere are three primary
articulationsarticulations
 Glenohumeral jointGlenohumeral joint
 Aromioclavicular jointAromioclavicular joint
 Sternoclavicular jointSternoclavicular joint

3. Shoulder GirdleShoulder Girdle
 Dynamic Stability- mobility with stability.Dynamic Stability- mobility with stability.
as in it can move around and be stable.as in it can move around and be stable.
 Glenoid Fossa- concave part of the scapula thatGlenoid Fossa- concave part of the scapula that
the humeral head articulates with.the humeral head articulates with.
 Glenohumeral joint- multi directional ball andGlenohumeral joint- multi directional ball and
socket joint that is held together by the ligmentssocket joint that is held together by the ligments
and muscles of the shoulder. Less stable thanand muscles of the shoulder. Less stable than
the hip ball and socket.the hip ball and socket.

4. The Joints of the ShoulderThe Joints of the Shoulder
 Acromion Process-Acromion Process-
The superior part ofThe superior part of
the scapula that youthe scapula that you
can palpate.can palpate.
 AcromioclavicularAcromioclavicular
joint (AC)-joint (AC)- where thewhere the
acromion and clavicleacromion and clavicle
come together.come together.

5. The Joints of the ShoulderThe Joints of the Shoulder
 Sternoclavicular jointSternoclavicular joint
(SC)- where the clavicle(SC)- where the clavicle
and the sternum comeand the sternum come
together.together.

6. The joints of the ShoulderThe joints of the Shoulder
 Scapulothoracic Joint-Scapulothoracic Joint-
the scapula slides overthe scapula slides over
the back of the thoraxthe back of the thorax
(ribcage).(ribcage).
 Synergistically- muscleSynergistically- muscle
groups working togethergroups working together
to move one joint andto move one joint and
maintain dynamicmaintain dynamic
stability.stability.

7. Rotator Cuff MusclesRotator Cuff Muscles
 Infraspinatus- posteriorInfraspinatus- posterior
inferior shoulderinferior shoulder
 External rotationExternal rotation

8. Rotator Cuff MusclesRotator Cuff Muscles
 Subscapularis-anteriorSubscapularis-anterior
shouldershoulder
 Internal rotationInternal rotation

9. Rotator Cuff MusclesRotator Cuff Muscles
 Supraspinatus-anteriorSupraspinatus-anterior
superior shouldersuperior shoulder
 abductionabduction

10. Rotator Cuff MusclesRotator Cuff Muscles
 Teres Minor- posteriorTeres Minor- posterior
shouldershoulder
 AdductionAdduction

11. Muscle Force CoupleMuscle Force Couple
 Force Couple-two equal forces acting inForce Couple-two equal forces acting in
opposite direction to rotate a part around anopposite direction to rotate a part around an
axis.axis.
deltoiddeltoid
Rotator CuffRotator Cuff

12. Scapulothoracic MechanicsScapulothoracic Mechanics
 Scapular Movers-upper, lower, middle trapezius,Scapular Movers-upper, lower, middle trapezius,
rhomboids, serratus anterior and pectoralisrhomboids, serratus anterior and pectoralis
minor.minor.
 They work with rotator cuff muscles to;They work with rotator cuff muscles to;
 Flex and extend shoulderFlex and extend shoulder
 Internal and externally rotate shoulderInternal and externally rotate shoulder
 Abduct and adduct shoulderAbduct and adduct shoulder
 Hoizontally abduct and adduct shoulderHoizontally abduct and adduct shoulder

13. Shoulder InjuriesShoulder Injuries
 They can be one of twoThey can be one of two
varieties:varieties:
 Overuse-chronic –Overuse-chronic –
typically limited to thetypically limited to the
soft tissue of thesoft tissue of the
shoulder.shoulder.
 Traumatic-acuteTraumatic-acute

14. Impingement SyndromeImpingement Syndrome
 A condition that occurs when the space between theA condition that occurs when the space between the
humeral head and the acromion above becomeshumeral head and the acromion above becomes
narrowed.narrowed.
 The three things that can get pinched are the:The three things that can get pinched are the:
joint capsule, tendons of rotator cuff, and bursa.joint capsule, tendons of rotator cuff, and bursa.

15. Impingement SyndromeImpingement Syndrome
 Impingement can create either bursitis, orImpingement can create either bursitis, or
tendonitis depending on what structure is beingtendonitis depending on what structure is being
squeezed.squeezed.
 Overhead athletes are more likely to haveOverhead athletes are more likely to have
problems with this injury.problems with this injury.
 1/3 of shoulder problems are due to1/3 of shoulder problems are due to
impingement.impingement.

16. Impingement SyndromeImpingement Syndrome
 Signs and SxSigns and Sx
 Pain and tender GH jointPain and tender GH joint
 Pain and weak active abdPain and weak active abd
in mid rangein mid range
 Limited internal rotationLimited internal rotation
 + Hawkins Test+ Hawkins Test
 Tender subacromial areaTender subacromial area
possibly into the deltoidpossibly into the deltoid
 TreatmentTreatment
 Correct techniqueCorrect technique
 Strengthen inferiorStrengthen inferior
musclesmuscles
 Strengthen weak rotatorStrengthen weak rotator
cuff musclescuff muscles

17. Impingement SyndromeImpingement Syndrome
 Special TestsSpecial Tests
 Hawkins TestHawkins Test
 Neer’s ImpingementNeer’s Impingement
 Cross over TestCross over Test

18. Impingement SyndromeImpingement Syndrome
 Stretches-Stretches-
 3 way door stretch3 way door stretch
 Posterior shoulderPosterior shoulder
 Internal Rotation withInternal Rotation with
 ExercisesExercises
 Internal RotationInternal Rotation
 External RotationExternal Rotation
 AdductionAdduction

19. Rotator Cuff TearsRotator Cuff Tears
 In the young person it isIn the young person it is
more of a traumatic injury,more of a traumatic injury,
fall on outstretched arm,fall on outstretched arm,
arm yanked back.arm yanked back.
 Young person can haveYoung person can have
chronic injury that ultimatelychronic injury that ultimately
tears a tendon.tears a tendon.
 In the older person it is a resultIn the older person it is a result
of lose of elasticity in the muscleof lose of elasticity in the muscle
and tendon and can tear withand tendon and can tear with
everyday activities or a bone spur.everyday activities or a bone spur.

20. Rotator Cuff TearsRotator Cuff Tears
 Signs and SxSigns and Sx
 With a parcial tear the athlete willWith a parcial tear the athlete will
feel pain but still be able to movefeel pain but still be able to move
with normal ROM.with normal ROM.
 With a complete tear the athleteWith a complete tear the athlete
will not have normal ROM.will not have normal ROM.
 Overhead motions are hardest.Overhead motions are hardest.
 A shrug motion will result.A shrug motion will result.
 Pain sleeping on injured side.Pain sleeping on injured side.

21. Rotator Cuff TearsRotator Cuff Tears
 Special TestsSpecial Tests
 Active Abdcution-look for hiking shoulderActive Abdcution-look for hiking shoulder
 Drop Arm sign- athlete abduct above head thenDrop Arm sign- athlete abduct above head then
lowers slow, look for loss of muscle control.lowers slow, look for loss of muscle control.
 Supraspinatus muscle test- looking for weaknessSupraspinatus muscle test- looking for weakness
 MRI is final diagnostic toolMRI is final diagnostic tool

22. Biceps TendonitisBiceps Tendonitis
 Discomfort in the frontDiscomfort in the front
of the shoulder.of the shoulder.
 Can be caused byCan be caused by
impingement.impingement.
 Special Tests-Special Tests-
 Speed’s TestSpeed’s Test
 Yergeson’s TestYergeson’s Test

23. Traumatic Shoulder InjuriesTraumatic Shoulder Injuries
 Shoulder DislocationShoulder Dislocation
 Glenoid Labrum InjuriesGlenoid Labrum Injuries
 Multidirectional InstabilitesMultidirectional Instabilites
 Acromioclavicular SeparationAcromioclavicular Separation
 Brachial Plexus InjuryBrachial Plexus Injury
 FracturesFractures

24. Anterior Shoulder DislocationAnterior Shoulder Dislocation
 A humerus can dislocateA humerus can dislocate
 Anteroinferiorly-front andAnteroinferiorly-front and
down (most common)down (most common)
 Inferiorly – downInferiorly – down
 Posteriorly -backPosteriorly -back

25. Anterior Shoulder DislocationAnterior Shoulder Dislocation
 Anterior dislocationAnterior dislocation
happens when the arm ishappens when the arm is
abducted to the side and aabducted to the side and a
forceful external rotationforceful external rotation
happens.happens.
 A doctor visit is necessary,A doctor visit is necessary,
immediately if theimmediately if the
humerus does not relocatehumerus does not relocate
on it’s own.on it’s own.
 Even if it goes back a Hill-Even if it goes back a Hill-
Sach’s Lesion can occur.Sach’s Lesion can occur.

26. Anterior Shoulder DislocationAnterior Shoulder Dislocation
 Rehabilitation is veryRehabilitation is very
important to this injury.important to this injury.
 Reinjury will likelyReinjury will likely
happen if a first timehappen if a first time
injury happens beforeinjury happens before
the age of 20.the age of 20.
 Surgery may be necessarySurgery may be necessary
if repeated dislocationif repeated dislocation
occurs.occurs.

27. Special Test-DislocationSpecial Test-Dislocation
 Apprehension testApprehension test

28. Glenoid Labrum InjuryGlenoid Labrum Injury
 Glenoid Labrum-a ring of cartilage attached toGlenoid Labrum-a ring of cartilage attached to
the margin of the glenoid cavity of the scapula.the margin of the glenoid cavity of the scapula.
 The labrum acts to keep the humeral headThe labrum acts to keep the humeral head
positioned on the glenoid by blocking unwantedpositioned on the glenoid by blocking unwanted
movement.movement.

29. Glenoid Labrum InjuryGlenoid Labrum Injury
 A labral tear can occur with a shoulderA labral tear can occur with a shoulder
dislocation, more likely to occur with numerusdislocation, more likely to occur with numerus
dislocations.dislocations.
 A degenerative tear can occur when a shoulderA degenerative tear can occur when a shoulder
becomes loose, letting the humeral head slipbecomes loose, letting the humeral head slip
over the labrum numerusover the labrum numerus
times and eventually thetimes and eventually the
labrum will fail/tear.labrum will fail/tear.

30. Glenoid Labrum InjuryGlenoid Labrum Injury
 Signs and SxSigns and Sx
 Pain with catching andPain with catching and
poppingpopping
 Possible weaknessPossible weakness
 Possible limited ROMPossible limited ROM
 Special TestsSpecial Tests
 Clunk TestClunk Test
 Cross Over TestCross Over Test
 TreatmentTreatment
 Rotator CuffRotator Cuff
strengtheningstrengthening
 SurgerySurgery

31. Multidirectional InstabilitiesMultidirectional Instabilities
 Typically an anatomical problem.Typically an anatomical problem.
 Multiple dislocations will make it worse.Multiple dislocations will make it worse.
 Exercise may help with the problem, surgeryExercise may help with the problem, surgery
sometimes, but not alwayssometimes, but not always
 Weight bearing exercise are helpful. Like what?Weight bearing exercise are helpful. Like what?

32. Acromicavicular SeparationAcromicavicular Separation
 Also known as an AC sprain.Also known as an AC sprain.
 Occurs due to fall on outstretched arm or tip ofOccurs due to fall on outstretched arm or tip of
shoulder. May be due to blow to tip of shouldershoulder. May be due to blow to tip of shoulder

33. AC separationAC separation
 Signs and SxSigns and Sx
 deformitydeformity
 Pain in vicinity of ACPain in vicinity of AC
 Special TestSpecial Test
 Shear TestShear Test
 Sulcus SignSulcus Sign
 TreatmentTreatment
 Three grades –the gradeThree grades –the grade
determines treatmentdetermines treatment
 Grade one is exercise andGrade one is exercise and
iceice
 Grade two immobilize 3Grade two immobilize 3
weeks and then exerciseweeks and then exercise
 Grade three immobilize 5Grade three immobilize 5
weeks and then exercciseweeks and then exerccise

34. Brachial Plexus InjuryBrachial Plexus Injury
 Brachial Plexus-group ofBrachial Plexus-group of
nerves that leave thenerves that leave the
spinal cord and extendspinal cord and extend
into the shoulder givinginto the shoulder giving
arm function.arm function.
 AKA-stinger or burnerAKA-stinger or burner
 A result of stretching orA result of stretching or
compression of thecompression of the
nerves.nerves.

35. DermatonesDermatones
 When looking at nervesWhen looking at nerves
you need to know levelyou need to know level
off spine injury relativeoff spine injury relative
to sensation andto sensation and
movement.movement.
 Dermatomes isDermatomes is
sensation areassensation areas
corresponding to nerve.corresponding to nerve.

36. MyotomesMyotomes
 Each of the spinal nervesEach of the spinal nerves
controls certain muscles. Thecontrols certain muscles. The
muscles (or muscles) controlledmuscles (or muscles) controlled
by a particular nerve root areby a particular nerve root are
called its myotome.called its myotome.
 C4-Trapezius-shrugC4-Trapezius-shrug
 C5-deltoid-abductionC5-deltoid-abduction
 C6-biceps- elbow flexC6-biceps- elbow flex
 C7-triceps- elbow extC7-triceps- elbow ext
 C8-thumb extC8-thumb ext
 T1- finger abduct/adduct.T1- finger abduct/adduct.

37. Brachial Plexus InjuryBrachial Plexus Injury
 Signs and SxSigns and Sx
 Pain in neck and armPain in neck and arm
 Weakness in neck andWeakness in neck and
armarm
 Numb or pins andNumb or pins and
needles down armneedles down arm
 TreatmentTreatment
 Rest till Sx go awayRest till Sx go away
 Ice after activityIce after activity
 Anti-inflammatoryAnti-inflammatory
 Possible dr visitPossible dr visit

38. FracturesFractures
 Typically caused by a direct blow.Typically caused by a direct blow.
 Clavicle and humerus, very rarely the scapula.Clavicle and humerus, very rarely the scapula.
 Typically you will see deformityTypically you will see deformity
 Xray necessary, immobilization 4-6 weeksXray necessary, immobilization 4-6 weeks
minimum.minimum.

39. We have strong shouldersWe have strong shoulders
‘‘cause we stay athletic as we agecause we stay athletic as we age