Shoulder Anatomy

Shoulder It is a ball and socket joint that moves in

all three planes and has. Most mobile and least stable joint.

Shoulder joint motions Flexion- is raising the arm in the lateral

plane from 0-180 degrees. Extension- return to anatomical position. Hyperextension- 0-45 degrees back

through the lateral plane.

Shoulder joint motions Abduction- arm moving in the frontal plane

away from the body, with a 0-180 degrees of motion.

Adduction- arm moving back to midline, with 0-180 degrees of motion.

Shoulder joint motions Internal Rotation-

occur in the transverse plane. This can go to 90 degrees into body

External Rotation- occurs in the transverse plane, 90 degrees out from neutral.

Shoulder joint motions Horizontal

abduction/adduction- occurs in the transverse plane. Neutral is 90 degrees of shoulder abduction, so horiz abduction is 30 degrees and adduction is 120 degree.

Shoulder joint motions Scaption- flexion in

the scapular plane, vs the lateral or frontal plane. 180 degree of motion can occur.

Shoulder Landmarks

ScapulaGlenoid labrum-fibrocartilage ring attached to the rim of the glenoid fossa, which deepens the cavity.

Shoulder Landmarks Humerus-

Head- is the semi round proximal end, articulates with the scapula.

Shaft- body of the humerus is the area between the neck and the epicondyles.

Shoulder Landmarks Surgical Neck- where

the head meets the body.

Anatomical neck- where the head meets the tubercles.

Shoulder Landmarks

Greater Tubercle/Tuberosity- large projection lateral to the head. Supraspinatus, infraspinatus and teres minor attach here.

Shoulder Landmarks

Lesser Tubercle/Tuberosity- smaller projection on the anterior surface, subscapularis attaches here.

Shoulder Landmarks

Deltoid tuberosity- lateral side, near the midpoint, deltoid attaches here.

Shoulder Landmarks

Bicipital Groove- groove between the tubercles containing the long head of the biceps tendon.

Impingement Syndrome A condition that occurs when the space between

the humeral head and the acromion above becomes narrowed.

The three things that can get pinched are the:joint capsule, tendons of rotator cuff, and bursa.

Impingement Syndrome Impingement can create either bursitis, or

tendonitis depending on what structure is being squeezed.

Overhead athletes are more likely to have problems with this injury.

1/3 of shoulder problems are due to impingement.

Impingement Syndrome Signs and Sx

Pain and tender GH joint

Pain and weak active abd in mid range

Limited internal rotation + Hawkins Test Tender subacromial

area possibly into the deltoid

Treatment Correct technique Strengthen inferior

muscles Strengthen weak

rotator cuff muscles

Impingement Syndrome Special Tests

Hawkins Test Neer’s Impingement Cross over Test

Impingement Syndrome Stretches-

3 way door stretch Posterior shoulder Internal Rotation with

Exercises Internal Rotation External Rotation Adduction

Rotator Cuff Tears In the young person it is more of a traumatic injury, fall on outstretched arm, arm yanked back. Young person can have chronic injury that ultimately

tears a tendon. In the older person it is a

result of lose of elasticity in the muscle and tendon and can tear with everyday activities or a bone spur.

Rotator Cuff Tears Signs and Sx

With a parcial tear the athlete will feel pain but still be able to move with normal ROM.

With a complete tear the athlete will not have normal ROM.

Overhead motions are hardest. A shrug motion will result. Pain sleeping on injured side.

Rotator Cuff Tears Special Tests

Active Abduction-look for hiking shoulder Drop Arm sign- athlete abduct above head

then lowers slow, look for loss of muscle control.

Supraspinatus muscle test- looking for weakness

Empty Can Test- supraspinatus/subscap motion MRI is final diagnostic tool

Biceps Tendonitis Discomfort in the front

of the shoulder. Can be caused by

impingement. Special Tests-

Speed’s Test Yergeson’s Test

Traumatic Shoulder Injuries Shoulder Dislocation Glenoid Labrum Injuries Multidirectional Instabilites Acromioclavicular Separation Brachial Plexus Injury Fractures

Anterior Shoulder Dislocation A humerus can

dislocate Anteroinferiorly-front

and down (most common)

Inferiorly – down Posteriorly -back

Anterior Shoulder Dislocation Anterior dislocation

happens when the arm is abducted to the side and a forceful external rotation happens.

A doctor visit is necessary, immediately if the humerus does not relocate on it’s own.

Even if it goes back a Hill-Sach’s Lesion can occur.

Anterior Shoulder Dislocation Rehabilitation is very

important to this injury.

Reinjury will likely happen if a first time injury happens before the age of 20.

Surgery may be necessary if repeated dislocation occurs.

Special Test-Dislocation Apprehension test

Glenoid Labrum Injury Glenoid Labrum-a ring of cartilage

attached to the margin of the glenoid cavity of the scapula.

The labrum acts to keep the humeral head positioned on the glenoid by blocking unwanted movement.

Glenoid Labrum Injury A labral tear can occur with a shoulder

dislocation, more likely to occur with numerus dislocations.

A degenerative tear can occur when a shoulder becomes loose, letting the humeral head slip over the labrum numerus times and eventually the labrum will fail/tear.

Glenoid Labrum Injury Signs and Sx

Pain with catching and popping

Possible weakness Possible limited ROM

Special Tests Clunk Test Cross Over Test

Treatment Rotator Cuff

strengthening Surgery

Multidirectional Instabilities Typically an anatomical problem. Multiple dislocations will make it worse. Exercise may help with the problem, surgery

sometimes, but not always Weight bearing exercise are helpful. Like what?

Acromicavicular Separation Also known as an AC sprain. Occurs due to fall on outstretched arm or tip of

shoulder. May be due to blow to tip of shoulder

AC separation Signs and Sx

deformity Pain in vicinity of AC

Special Test Shear Test Sulcus Sign

Treatment Three grades –the

grade determines treatment

Grade one is exercise and ice

Grade two immobilize 3 weeks and then exercise

Grade three immobilize 5 weeks and then exerccise

Muscles of the Shoulder Joint Deltoid is superficial muscle. All three

parts of it attach to the deltoid tuberosity. Axillary Nerve

Rotator Cuff Muscles Supraspinatus-anterior superior shoulder. It is

superior to the spine of the scapula. abduction

Muscles of the Shoulder Joint Pectoralis Major-

Clavicular portion-most effective during flexion from 0-90

Sternal portion- most effective in extension 180-120 degrees of shoulder extension

Both of them adduct, internally rotate and horizontally adduct the shoulder.

Muscles of the Shoulder Joint Latissimus Dorsi-

means widest, back, so the widest back muscle. It is mostly superficial and is involved with shoulder extension , adduction and internal rotation

Muscles of the Shoulder Joint Teres Major- it is the

little helper of the lats. It runs from the axillary boarder of the scapula to the lesser tubercle of the humerus.

Rotator Cuff Muscles Infraspinatus-

posterior inferior shoulder

Inferior to the spine of the scapula

External rotation

Rotator Cuff Muscles

Teres Minor- posterior shoulder Adduction

Rotator Cuff Muscles Subscapularis-anterior

shoulder Internal rotation

Muscles of the shoulder joint Coracobrachialis- attaches to the coracoid

process and the arm or Brachium. Stabalizes the humerus in the fossa.

Muscles of the Shoulder Joint The four rotator cuff

muscles cover the humeral head and hold the head against the glenoid fossa.

Rotator Cuff Muscles Know these muscles if you remember

nothing else. Infraspinatus Supraspinatus Subscapularis Teres Minor