Chapter 22: The Shoulder Complex

The shoulder is an extremely complicated region of the body

Joint which has a high degree of mobility but not without compromising stability

Involved in a variety of overhead activities relative to sport making it susceptible to a number of repetitive and overused type injuries

Rotator Cuff Muscles

Supraspinatus

Infraspinatus

Teres Minor

Subscapularis

Nerves Running Through the Shoulder to Limbs

Functional Anatomy

Great degree of mobility w/ limited stability

Integration of the capsule and rotator cuff

Scapula stabilizing muscles and the relationship with the other joints of the shoulder complex and the glenohumeral joint

Scapulohumeral Rhythm

Prevention of Shoulder Injuries

Observation

Special Tests

Tests for Glenohumeral Instability

Glenohumeral Translation - anterior and posterior stability

Anterior and Posterior Drawer tests

Sulcus test Clunk Test

Apprehension test and Relocation test

Apprehension test used for anterior glenohumeral instability (1)

Test for Shoulder Impingement

Tests for Supraspinatus Muscle Weakness

Drop Arm Test

Empty Can Test

Recognition and Management of Specific Injuries

Clavicular Fractures

Scapular Fractures

Fractures of the Humerus

Sternoclavicular Sprain: this joint holds the shoulder complex to the thorax.

Acromioclavicular Sprain

Acute Subluxations and Dislocations

Subluxation involves excessive translation of humeral head w/out complete separation from joint

Anterior dislocation is the result of an anterior force on the shoulder, forced abduction and external rotation

Posterior dislocation occurs due to forced adduction and internal rotation or falling on an extended and internally rotated shoulder

Signs and Symptoms

Anterior dislocation - flattened deltoid, prominent humeral head in axilla; arm carried in slight abduction and external rotation; moderate pain and disability

Possible Complications of Shoulder Dislocations

Bankart lesion - permanent anterior defect of labrum

Hill Sachs lesion - caused by compression of cancellous bone against anterior glenoid rim creating a divot in the humeral head

SLAP lesion - defect in superior labrum that begins posteriorly and extends anteriorly impacting attachment of long head of biceps on labrum

Brachial nerves and vessels may be compromised

Rotator cuff injuries

Bicipital tendon subluxation and transverse ligament rupture

Shoulder Impingement Syndrome

Rotator cuff tear

Biceps Brachii Rupture

Contusion of Upper Arm

Blockerπs disease

Throwing Mechanics

Windup Phase

Cocking Phase

Acceleration

Deceleration Phase

Follow-Through Phase

Rehabilitation of the Shoulder Complex

Immobilization

General Body Conditioning

Shoulder Joint Mobilization

Flexibility

Strengthening Exercises

Functional Progressions