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THE SHOULDER COMPLEX

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Originates in axial skeleton and inserts on the humerus ... Is there an indentation in the upper biceps region? LATERAL OBSERVATON ... – PowerPoint PPT presentation

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Title: THE SHOULDER COMPLEX


1
THE SHOULDER COMPLEX
2
SHOULDER COMPLEX
  • Anatomy of shoulder complex allows for a great
    degree of mobility.
  • Because of the great degree of mobility,
    stability is sacrificed.
  • Overuse injuries are common

3
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4
BONES OF SHOULDER COMPLEX
  • CLAVICLE
  • SCAPULA
  • HUMERUS

5
SHOULDER COMPLEX ARTICULATIONS
  • Sternoclavicular
  • Acromioclavicula
  • Glenohumeral
  • Scapulothoracic

6
Glenohumeral Joint Movements
  • Flexion
  • Extension
  • Abduction
  • Adduction
  • External Rotation
  • Internal Rotation
  • Circumduction

7
Movements Cont.
  • Horizontal Abduction
  • Horizontal Adduction
  • Elevation
  • Depression
  • Protraction
  • Retraction

8
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9
Glenohumeral Joint Muscles
  • Originates in axial skeleton and inserts on the
    humerus
  • Latissmus dorsi- internal rotation, extension.
  • Pectoralis major- horizontal adduction, flexion.

10
Glenohumeral Joint Muscles
  • Originates on Scapula and attach to Humerus
  • Anterior Deltoid
  • Abduction
  • Flexion
  • Lateral Deltoid
  • Abduction
  • Posterior Deltoid
  • Abduction
  • Extension

11
Glenohumeral Joint Muscles
  • Teres Major
  • Internal Rotation
  • Extension
  • Coracobrachialis
  • Flexion
  • Horizontal Adduction

12
Glenohumeral Joint Muscles
  • Rotator Cuff
  • Supraspinatus
  • Abduction
  • External Rotation
  • Infraspinatus
  • External Rotation
  • Extension
  • Teres minor
  • External Rotation
  • Extension
  • Subscapularis
  • Flexion
  • Internal Rotation

13
Glenohumeral Joint Muscles
  • Originates on Axial Skeleton Insertion point on
    Scapula
  • Levator Scapula
  • Elevation
  • Trapezius
  • Part 1 Elevation
  • Part 2 Elevation, Adduction of Scapula
  • Part 3 Adduction of Scapula
  • Part 4 Depression, Adduction of Scapula

14
Glenohumeral Joint Muscles
  • Rhomboids
  • Adduction of Scapula
  • Elevation
  • Serratus anterior
  • Abduction of Scapula

15
Acromioclavicular Ligaments
  • Coracoacromial ligament
  • Acromioclavicular ligament
  • Coracoclavicular ligament

16
Prevention of Shoulder Injuries
  • Proper physical conditioning
  • Strengthen shoulder muscles through the full
    Range of Motion.
  • Proper warm-up and Stretch
  • Falling properly (ie shoulder roll)
  • Properly fitted protective equipment
  • Proper technique

17
Correct Throwing Technique
  • Wind-up Phase
  • Cocking Phase
  • Acceleration
  • Deceleration
  • Follow Through

18
Wind-up Phase
  • First movement until ball leaves gloved hand
  • Lead leg strides forward
  • Both shoulders abduct, externally rotate, and
    horizontally abduct.

19
Cocking Phase
  • Hands separate until maximal external rotation of
    the humerus
  • Foot comes in contact with ground

20
Acceleration
  • Maximum external rotation until ball is released
  • Humerus abducts, horizontally abducts and
    internally rotates.
  • Scapula elevates, abducts, and upward rotates.

21
Deceleration
  • Ball release until maximal shoulder internal
    rotation.
  • External rotators act as decelerators by
    eccentrically contracting

22
Follow Through
  • Last phase of throwing
  • Maximum internal rotation until the end of the
    motion.
  • Balanced position
  • Important phase to avoid throwing injuries.

23
Assessing the Shoulder
  • One of the most difficult regions of the body to
    evaluate.

24
HISTORY
  • What happened to cause this pain?
  • Have you ever had this problem?
  • What is the duration and intensity of pain?
  • Where is pain located?
  • Is there crepitus during movement or numbness or
    distortion in temperature such as a cold or warm
    feeling?

25
HISTORY
  • Is there a feeling of weakness or a sense of
    fatigue?
  • What shoulder movements or positions seem to
    aggravate or relieve the pain?
  • If therapy has been given before, what, if
    anything offered pain relief?

26
ANTERIOR OBSERVATION
  • Are both shoulder tips even with one another?
  • Is one shoulder held higher because of muscle
    spasm or guarding?
  • Is the lateral end of the clavicle prominent?
  • Is one lateral acromion process more prominent
    that the other?

27
ANTERIOR OBSERVATION
  • Does the clavicular shaft appear deformed?
  • Is there loss of the normal lateral deltoid
    muscle contour?
  • Is there an indentation in the upper biceps
    region?

28
LATERAL OBSERVATON
  • Is there thoracic kyphosis or are the shoulders
    slumped forward?
  • Is there forward or backward arm hang?

29
POSTERIOR OBSERVATION
  • Is there asymmetry such as a low shoulder, uneven
    scapulae, or winging of one scapular wing and not
    the other?
  • Is the scapula protracted because of constricted
    pectoral muscles?
  • Is there a distracted or winged scapula on one or
    both sides?

30
PALPATION
  • Done anteriorly and posteriorly
  • Both shoulder are palpated at same time for pain
    sites and deformities.
  • Detects point tenderness, abnormal swelling or
    lumps, muscle spasm or guarding, and trigger
    points.

31
SPECIAL TESTS
  • Active and passive range of motion should be
    noted and compared to opposite side.
  • Strength of the of the shoulder musculature
    should be assessed by resisted manual muscle
    testing.

32
APPREHENSION TEST (crank test)
  • With arm abducted 90 degrees.
  • Shoulder is slowly and gently externally rotated
    as far as the athlete will allow.
  • Athlete with anterior glenohumeral instability
    will show apprehension before end point can be
    reached.

33
Test for Shoulder Impingement
  • Forced flexion of the humerus in the overhead
    position may cause impingement of soft tissue
    structures.
  • Horizontal adduction with forced internal
    rotation of the humerus.

34
Test for Supraspinatus Muscle Weakness
  • Empty Can Test
  • Bring both arms in to 90 degrees of forward
    flexion
  • 30 degrees of horizontal abduction
  • Arms are internally rotated as far as possible,
    thumbs pointing down.
  • Downward pressure applied.
  • Arms should be the same strength.
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