Chapter 11:
Shoulder & Upper Arm
Objectives:
Understand:
•
The anatomy of the shoulder complex and upper
arm
•
The principles of rehabilitation for the shoulder
and upper arm
•
The preventive/supportive techniques and
protective devices
Identify:
•
The components of an evaluation format
Recognize:
•
The common injuries associated with the
shoulder and upper arm.
Anatomy of Shoulder
One of the most mobile and vulnerable anatomical
structures in the body.
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1.
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4.
Moves in multiple directions
Made up of 4 bones
Sternum- located on the anterior portion of the
body and provides attachment to the clavicle at
the SC joint.
Clavicle- supports the shoulder complex on the
front of the body, S-Shaped, does not articulate
with the humerus
Humerus- long bone in the upper arm
Scapula-(coracoid process, is the bony projection
on the anterior aspect of the scapula) floats on the
back of the rib cage, also known as the thorax.
Gleniod fossa (depression) articulates with the
head of the humerus to form the glenohumeral
joint
Joints of Shoulder
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5 shoulder joints
1.
Sternoblavicular (SC)-attaches the upper
extremity to the torso
Acromioclavicular (AC)- join the clavicle &
scapula
Coracoclavicular (CC)-join the clavicle & scapula
Glenohumeral (GH)-humerus & scapula (shallow
socket, allowing for greater movement) very
weak, but very mobile.
Scapulothoracic- critical movement to the
shoulder
2.
3.
4.
5.
Coracoid Process- the bony projection on the
anterior aspect of the scapula where articulates
with the clavicle
Ligaments
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Coracoclavicular- joins the clavicle with the
scapula
Sternoclavicular
Acromioclavicular
Glenohumeral
Muscles & Functions
Muscles of the shoulder assist with the stability, movement, and
strength to the complex structure.
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Deltoid- anterior fibers (flexion, horizontal adduction, internal
rotation) & posterior fibers (extention, horizontal adduction, external
rotation)
Pectoralis Major- flexes upper arm; adducts upper arm anteriorly,
internal roatation
Pectoralis Minor- raises ribs for inspiration, draws scapula forward
and downward
Rhomboids- retraction and rotation of the scapula
Serratus Anterior- rotates scapula for abduction & flexion of upper
arm, protracts scapula
Biceps- flexion and supination of upper arm
Triceps- extends forearm and upper arm
Muscles & Function
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Latissimus dorsi- extends arm; adducts arm
posteriorly, internal rotation, downward rotation
of scapula
Levator Scapula- elevates scapula, extends and
lateral flexion of neck, assists with downward
rotation of scapula.
Coracobrachialis- adduction; assists in flexion &
pronation of the arm
Rotator cuff Muscles: (SITS) Supraspinatus
(abducting arm), Infraspinatus (external rotation),
teres minor (external rotation), subscapularis
(internal rotation of shoulder)
Teres Major- extension, adduction, and internal
rotation of upper arm
Trapezius- retraction, upward rotation, elevates
scapula, and downward rotation of scapula
Bursae- are closed, fluid-filled sacs that serve as
cushions against friction over a prominent bone,
or where a tendon moves over a bone.
HOPS
History
Observation
Palpation
Special Tests
EVALUATION FORMAT
Assessment Tests
Glenohumeral Joint Stability Tests
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Apprehension: detects anterior shoulder
subluxation or dislocation
Relocation: detects chronic anterior dislocation of
the glenohumeral joint
Anterior Instability: detects anterior instability of
the glenohumeral joint
Anterior/Posterior Translation: assesses
anterior/posterior joint laxity
Posterior Glenohumeral Instability: assesses
humeral head posterior subluxation
Inferior Drawer or Feagin: assesses humeral head
inferior subluxation
Sulcus: assesses humeral head for inferior
subluxation
Assessment Tests
Rotator Cuff Impingement Tests
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Full flexion: assesses the presence of rotator cuff
inflammation or impingement
Flexion-Internal Rotation (Hawkins’s Kennedy):
assesses the presence of rotator cuff inflammation
or impingement
Rotator Cuff Muscular Strength Tests
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Supraspinatus Strength (empty can test): assesses
the strength
Internal Rotation Strength: assesses the strength
of subscapularis
External Rotation Strength: assesses the strength
of infraspinatus & teres minor
Assessment Tests
Internal Derangement Test
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Glenoid Labrum Clunk: assesses the glenoid
labrum’s integrity & stability
Acromioclavicular Joint Test
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Acromioclavicular joint stability: assesses the
integrity of the AC & costoclavicular ligaments
Cross Chest or Horizontal Adduction: assesses
the sternoclavicuar joint impingement
Sternoclavicular Joint Test
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Joint Integrity: assesses the sternoclavicular &
costoclavicular ligaments