SHOULDER GIRDLE
REGION
Anatomy
Injuries
Special Tests
Skeletal Anatomy
SHOULDER JOINTS
SHOULDER LIGAMENTS
GLENOID LABRUM
GROSS ANATOMY
ROTATOR CUFF MUSCLES
ROTATOR CUFF INJURY
SHLD MUSCLE MOVEMENTS
MUSCLES
ABDUCTS
Deltoid
XLATERAL
ADDUCTS
EXTENDS
FLEXION
X POST
X ANT &
LAT
Infraspinatu
s
X
Latissimus
Dorsi
X
X
SCAPULA
& BENDS
Levator
Scapula
e
ELEVATES
Rhomboides
Serratus
LATERAL
ROTATE
XANTERIOR
XPOSTERIOR
X
X
NECK
LATERA
XSCAPULA
XSCAPULA
ST
LLY
XSCAPULA
AB
IL
IZ
ES
X
Subscapulari
s
Supraspinat
us
MEDIAL
ROTAT
X
X
Teres Major
X
X
Teres Minor
X
X
X
X
ROTATOR CUFF MUSCLES
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
Muscles
Affecting
Scapula
Levator
Scapulae
Rhomboids
Serratus
DELTOID
LATISMUSS
DORSI
TERES MAJOR
SUPRAPINATUS
Muscles
Moving
Humerus
SUBSCAPULARIS
INFRASPINATUS
TERES MINOR
ROTATORS

MEDIAL




ANTERIOR DELTOID
Latissimus Dorsi
Teres Major
SUBSCAPULARIS

LATERAL




Posterior Deltoid
Supraspinatus
INFRASPINATUS
Teres Minor

ABDUCTORS


DELTOID
SUPRASPINATUS

ADDUCTORS




Infraspinatus
LATISSIMUS DORSI
Teres Major
Teres Minor
EXTENSOR
Teres Major
Teres Minor
Posterior Deltoid
LATISSIMUS DORSI
INJURIES

Adhesive Capulitis






aka Frozen Shoulder
Thick joint capsule
Rotator cuff muscles
affected
Chronic inflammation
Pain & limited
movement
TX: joint mobilization,
stretching muscles
electric modalities

Tendonitis





Repeat stress
Improper technique
Biceps tendon
General soreness
point tenderness
mild swelling
PRICE
restrengthening
INJURIES

A/C Joint Sprain






Fall on outstretched arm
Moved acromion
Displaced clavicle
“piano key sign”
Pain & swelling
Amount of damage
depends on ligament tear
PRICE
immobilization

S/C Joint Sprain





Shoulder pushed back
sternum pushed up
Decreased ROM
pain with breathing
deforminty @ joint
Pain & swelling
Amount of damage
depends on ligament
tear
PRICE
immobilization
INJURIES

Synovitis & Bursitis





Repeated stress or
direct trauma
Crepitation
Pain & swelling
Decreased ROM
Heat before activity
ice after

Dislocations




Extreme ROM
Humeral head moved
forcefully; direct trauma
“slipped out”
popping sound
unable to move
pain
hand hanging awkward
Immobilization
PRICE
INJURIES

SHLD Impingement



Repeated overhead motion
ie swimming, throw sports
Supraspinatus weakness
glenohumeral pain
PRICE
strengthening of Rotator
cuff muscles

SLAP tear





Labrum increases
depth of “socket”
Tear in upper part of
labrum
Separation of labrum
& biceps muscle
Throwing MOI
Exercise to strengthen
Eventual surgery
MOVEMENT
INJURY
DESCRIPTION
TESTS
MUSCLES
ROM ER
Infraspinatus, Post
Delt, Teres Min
ER
STRAIN/
WEAKNES
S
@ 0,45 & 90 Flexion ER shoulder
ROM IR
Subscapularis, Ant
Delt, Teres Min
IR
STRAIN/
WEAKNES
S
@ 0,45 & 90 Flexion IR shoulder
STRENGTH
ER
Infraspinatus, Post
Delt, Teres Min
ER
STRAIN/
WEAKNES
S
@ 0,45 & 90 Flexion ER shoulder with
resistance
STRENGTH
IR
Subscapularis, Ant
Delt, Teres Min
IR
STRAIN/
WEAKNES
S
@ 0,45 & 90 Flexion IR shoulder with
resistance
STRENGTH
EXTENSIO
N
Post Delt Teres Maj
Lats
EXTENSION
STRAIN/
WEAKNES
S
Extension of shoulder with resistance
STRENGTH
FLEXION
Deltoid
Biceps
FLEXION
STRAIN/
WEAKNES
S
Flexion of shoulder with resistance
STRENGTH
ABD/ADD
B-A/L Delt, Supra
D-Ant Delt
ABD/ADD
STRAIN/
WEAKNES
S
Abduction & Adduction @ 0 w/resistance
@ 90 flexion=Horizontal ABD w/ resistance
SPECIAL TESTS
EMPTY CAN
Supraspinatus
Shld Flex w
thumbs down
(full IR)
Supraspinatus
weakness
Shld @ 90 Horiz ABD. Thumbs down on
thighs. Resist thru flexion
PERCUSSION
BONES
Tap involved bone
Fracture
Tap bone in question to assess for a
fracture
COMPRESSIO
N
(O’Briens)
Superior Anterior
Labrum of
SHLD/ AC
Resisted ER
SLAP/ AC
injury
SHLD flex @ 90 & fully IR. Apply
downward pressure @ wrist. ER.
SULCUS
GH ligaments
Downward force
on elbow
GH joint sprain
APPREHENSIO
N
Anterior Capsule of
SHLD
ER of shoulder
Joint laxity/
Ant
Capsule
Sprain
Arm ABD @ 90, stabilize shld, ER shld with
your hand @ their wrist
A/C SPRAIN
Acromioclavicular
Ligament
Downward
distraction of
humerus
Sprain or Joint
stability
Pull on humerus at elbow. Deformity @
clavicle
S/C SPRAIN
Sternoclavicular
Ligament
Posterior force to
clavicle
Sprain or Joint
stability
Thumb on ant proximal clavicle. Look for
movement
DROP ARM
Rotator Cuff
ABD of arm
Rotator Cuff
Sprain/
Supra
tear
Raise arm past 90 of ABD. Athlete resist.
If weakness arm will drop
Subacromial bursa
Shoulder @ 90
Support elbow
resist at wrist
Impingement
of
Thoracic
Nerve
Compress supraspinuts tendon for
impingement
Serratus anterior
Standing push up
Weakness of
SA
Weak muscle will have scapula protrude
out
HAWKINSKENNEDY
WINGED SCAPULA