The Shoulder Unit 9 Shoulder Anatomy Shoulder flashcards: Please get scissors and 1 color We will label 1 structure per card Scapula Humerus Superior Angle Greater Tubercle Spine of Scapula Lesser Tubercle Acromion Process Head of Humerus Acromioclavicular Joint Neck of Humerus Clavicle Infraspinatus Fossa Coracoid Process Lateral Border Sternoclavicular Joint Inferior Angle Subscapularis Medial Fossa Border Bicipital groove Superior angle Spine of the Scapula Medial border of the Scapula Inferior angle REFERENCE SLIDE Head of the Humerus Greater tuberosity Infraspinatus Posterior view fossa Lateral border of the Scapula Supraspinatus Neck of the fossa Humerus Humerus Acromioclavicular Ligament Coracoclavicular Ligaments Sternoclavicular Ligament FEEL FREE TO USE THIS EXTRA FLASHCARD TO LABEL BONY LANDMARKS FROM PREVIOUS SLIDES. JUST A REFERENCE Levator Scapulae Trapezius Rhomboid Minor Rhomboid Major Sternocleidomastoid Pectoralis Minor Serratus Anterior Middle Posterior Deltoid Deltoid Teres Major Triceps Latissimus Brachii Dorsi Anterior Deltoid Pectoralis Major Biceps Brachii Middle Deltoid Pectoralis Major Biceps Brachii Anterior Deltoid Triceps Brachii Supraspinatus Teres Minor Infraspinatus S.I.T.S. (rotator Subscapularis cuff) Triceps Brachii Shiny Desk PRACTICE Quiz: Movement & muscle. 5 6 Practice Quiz: Movement & muscle. KEY Shoulder abduction Shoulder extension Scapular elevation Supraspinatus, Deltoids Latissimus dorsi, teres Trapezius, levator scapulae major, posterior deltoid 5 6 Shoulder internal rotation Shoulder flexion Shoulder external rotation Pectoralis major, subscapularis, Pectoralis major, anterior Infraspinatus, supraspinatus, latissimus dorsi, teres major deltoid, biceps brachii teres minor • With a partner, run through the 6 MMT’s for the shoulder Manual • Start with a 3 score • Full ROM Muscle • Against gravity • No resistance Test (MMT) • If they can do a 3, move onto a 4 or 5 Practice • Stationary hand proximal to joint/side being tested • Resistance hand distal to joint being test (I would go to the distal joint) • Full ROM • Against gravity • Compare bilaterally • If they cannot do a 3, move onto a 2, 1 or 0 • 2 • Full ROM • With gravity • 1 • With gravity • Some ROM or muscle contraction • 0 • Nothing happening Shoulder Outline Shoulder Complex • susceptible to injury = mobility compromising the stability • Repetitive movements place stress on the complex. • Throwing • Swimming • Serving in tennis or volleyball MOI: For many shoulder injuries • FOOSHA: Falling On Out Stretched Hand / Arm Anatomy • Bones • Clavicle • S shaped 6 in. long • Supports the anterior shoulder • Prone to fx because of shape and not protected • Scapula • Flat, triangular • purpose is an articulating surface for the humerus • Humerus structures • Head, neck • Bicipital groove • Greater and Lesser tubercles • Glenohumeral joint Shoulder palpation video #1. Follow along with video click here for url: shoulder palps #1 Clavicular Fracture - Most frequent fx. INJURY MOI: FOOSHA, direct impact, occurs in middle 3rd S/S: athlete supports arm, swelling, deformity, point tenderness. tilts head to the injured side w/ chin toward opposite side. Clavicle Fracture TX: sling and swathe, refer for x-ray. INJURY Special tests: piano key Fracture of the Humerus •Humeral Shaft: INJURY comminuted or transverse. MOI: direct blow or fall on arm Fracture of the Humerus • Proximal Humerus: great INJURY danger to nerve and vessels MOI: direct blow, dislocation • Most likely at the neck • Can be mistaken for dislocation Fracture of the Humerus INJURY • Epiphyseal fx: young athlete 10 years and younger MOI: direct blow, or indirect force applied to the length of the axis. Fractures to the Humerus INJURY S/S: x –ray, pain, inability to move arm, swelling, point tenderness, discoloration TX: splint, treat for shock, refer Shoulder sling elastic wrap Click here for url: shoulder sling video Acute Subluxation/Dislocation • Account for 50% of all dislocations • Shoulder instability increases chances • 85-90% re-occurrence Subluxations INJURY MOI: brief translation of the humeral head without separation of the joint surfaces. Can occur: anteriorly, posteriorly, or inferiorly. Anterior Glenohumeral Dislocation INJURY MOI: Forced abduction, external rotation and extension. direct impact to the posterior or posterorlateral aspect Arm is held in abduction & ER Acute Anterior Subluxations/Dislocations INJURY S/S: Anterior TX: - flat deltoid - immediate immobilization - Feel humeral head - PRICE - Athlete carries the affected arm - Refer in slight abduction and ER - Unable to touch opposite shoulder Shoulder Spica elastic wrap click here for url: shoulder spica Posterior Glenohumeral Dislocation INJURY MOI: - forced adduction and IR, - or fall on an extended and internally rotated arm - Labrum damage Acute Posterior Subluxations/Dislocations INJURY S/S: posterior TX: - severe pain and disablitity - immediate immobilization - Held in adduction and IR - PRICE - Flat anterior deltoid - Refer - Acromion and coracoid processes - Limited ER & elevation Bone Palpations: Get up and review • Anterior • Clavicle • Sternoclavicular joint • Acromioclavicular joint • Coracoid process • Sternum • Humeral head • Bicipital groove • Posterior • Scapula • Spine of scapula • Medial and lateral borders • Inferior angle Articulations • Sternoclavicular Joint (SC) • Clavicle + Manubrium of sternum • Only direct connection between the upper extremity and trunk • articulation disk = shock absorption, allows movement • Acromioclavicular Joint (AC) • Lateral end of clavicle + acromion process • Weak junction Articulations • Glenohumeral joint (shoulder joint) • Ball and socket joint • Head of humerus + glenoid cavity of scapula • Held by the glenoid labrum, capsular ligamentous structures, rotator cuff • cushioned by labrum • Scapulothoracic Joint • Not a true joint • Scapula + thoracic cage Ligaments • Sternoclavicular joint ligaments • Pull clavicle downward and toward the sternum • Acromioclavicular joint ligaments • Coracoclavicular ligament • Glenohumeral joint ligaments • Superior, middles, and inferior Shoulder Palpation #2 click here: shoulder palpation #2 Grade 1 AC Joint Sprain INJURY • Grade 1: - point tenderness - Discomfort during movement - No deformity - Mild stretching of AC lig. Grade 2 AC joint Sprain INJURY • Grade 2: - tearing or rupture of AC lig - Stretching or tearing of coracoclavicular lig - Displacement of distal end of clavicle - Moderate pain - Unable to abduct arm through full ROM Grade 3 AC joint Sprain INJURY • Grade 3: - rupture of the AC &coracoclavicular lig - Dislx of the clavicle - Gross deformity - LOF - instability AC joint Sprain INJURY TX: tape down, sling, refer for x-rays Special tests: Piano Key, Compression Piano Positive/Procedure Diagnosis Key -Push down on clavicle with -AC sprain fingers to find pain & Test movement of lateral clavicle Compression/ Positive/Procedure Diagnosis Squeeze -Squeeze clavicle & spine of -AC sprain scapula with heels of both Test hands to find pain & movement of lateral clavicle Glenohumeral Joint Sprain MOI: forced abduction, external INJURY rotation, direct blow S/S: pain w/ movement and palpation, decreased ROM TX: ROM, PREs Special tests: load and shift, Sulcus, Apprehension Crank GH Glide/ Positive/Procedure Diagnosis Load and Shift -Stabilize as you move the -GH joint sprain humeral head inferiorly, Test anteriorly, and posteriorly to find laxity compared bilaterally Sulcus Sign Positive/Procedure Diagnosis -Stabilize as you pull -GH joint sprain Test humerus inferiorly, eyes on the deltoid to see an observable gap Apprehension/Crank Test Positive/Procedure Diagnosis -passive put athlete into ER -GH joint sprain and look for athlete to be apprehensive or try to resistant movement Review Shoulder Muscle PRACTICE quiz Shiny desk review 1 6 2 5 3 7 4 10 9 8 11 12 Posterior deltoid Pectoralis minor Middle Pectoralis deltoid major Triceps Serratus brachii anterior Latissimus dorsi KEY Pectoralis major Trapezius Biceps Sternocleidomastoid brachii Rhomboid major Movements Review PRACTICE quiz • Shiny desk or scrap paper 1 6 2 5 3 7 4 10 9 8 11 12 Abduction, extension Stabilize, breathing Abduction Flex., Add., IR, H. add. Extension Protraction Ext., Add., IR, H. abd. KEY Flex., Add., IR, H. add. Ele., Ret., Dep. Flexion Flexion, rotation Retraction Musculature write the muscles for each • Glenohumeral joint • Scapulothoracic joint movements movements • Flexion • Protraction • Extension • Retraction • Abduction • Depression • Adduction • elevation • External rotation • Internal rotation • Horizontal abduction • Horizontal adduction Shoulder Palpation: Click here: shoulder palpation #3 Bicipital Tenosynovitis • MOI INJURY • Overuse in overhead activity • S/S • Pain in the anterior upper arm over bicipital groove while performing overhead activity • Some swelling, crepitus • TX • Complete rest for a few days, NSAIDS, gradual PRE program • Special Tests: Yergasons, Speeds Yergason’s Test Positive/Procedure Diagnosis -resist supination from full -Biceps pronation to see if pain in tendinitis/Tenosynovitis distal biceps tendon Speed’s Test Positive/Procedure Diagnosis -resist shoulder flexion to -Biceps see if pain in proximal tendinitis/Tenosynovitis biceps tendon or bicipital groove Rotator Cuff Muscles • Supraspinatus • Infraspinatus • Teres minor • Subscapularis Drop arm Test Positive/Procedure Diagnosis -actively go into full -Supraspinatus weakness abduction, then lower to 90 and hold to see if athlete