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