THE SHOULDER COMPLEX

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THE SHOULDER COMPLEX
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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

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BONES OF SHOULDER COMPLEX

• CLAVICLE
• SCAPULA
• HUMERUS

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SHOULDER COMPLEX ARTICULATIONS

• Sternoclavicular
• Acromioclavicula
• Glenohumeral
• Scapulothoracic

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Glenohumeral Joint Movements

• Flexion
• Extension
• Abduction
• Adduction
• External Rotation
• Internal Rotation
• Circumduction

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Movements Cont.

• Horizontal Abduction
• Horizontal Adduction
• Elevation
• Depression
• Protraction
• Retraction

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Glenohumeral Joint Muscles

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

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Glenohumeral Joint Muscles

• Originates on Scapula and attach to Humerus
• Anterior Deltoid
• Abduction
• Flexion
• Lateral Deltoid
• Abduction
• Posterior Deltoid
• Abduction
• Extension

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Glenohumeral Joint Muscles

• Teres Major
• Internal Rotation
• Extension
• Coracobrachialis
• Flexion
• Horizontal Adduction

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Glenohumeral Joint Muscles

• Rotator Cuff
• Supraspinatus
• Abduction
• External Rotation
• Infraspinatus
• External Rotation
• Extension
• Teres minor
• External Rotation
• Extension
• Subscapularis
• Flexion
• Internal Rotation

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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

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Glenohumeral Joint Muscles

• Rhomboids
• Adduction of Scapula
• Elevation
• Serratus anterior
• Abduction of Scapula

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Acromioclavicular Ligaments

• Coracoacromial ligament
• Acromioclavicular ligament
• Coracoclavicular ligament

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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

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Correct Throwing Technique

• Wind-up Phase
• Cocking Phase
• Acceleration
• Deceleration
• Follow Through

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Wind-up Phase

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

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Cocking Phase

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

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Acceleration

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

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Deceleration

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

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Follow Through

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

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Assessing the Shoulder

• One of the most difficult regions of the body to
  evaluate.

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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?

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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?

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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?

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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?

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LATERAL OBSERVATON

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

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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?

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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.

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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.

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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.

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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.

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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.