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The Shoulder
Anatomy and Injuries
PSK 4U Unit 3, Day 4
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Shoulder Girdle
Shoulder Complex is the most mobile joint in the body.
Scapula
Clavicle
Sternum
Humerus
Rib cage/Thorax
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Shoulder Girdle
It also includes
Sternoclavicular joint
Acromicoclaviulcar joint
Glenohumeral joint
Scapulothoracic articulation
Shoulder joint is attached to axial skeleton
via the clavicle at sternoclavicular joint
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The Shoulder Joint
Wide range of motion of the shoulder joint in
many different planes requires a significant
amount of laxity
Common to have instability problems
Rotator cuff impingement
Subluxations & dislocations
The price of mobility is reduced stability
The more mobile a joint is, the less stable it
is & the more stable it is, the less mobile
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5-4
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Shoulder Girdle Ligaments
Sternoclaviular Joint-Joint connecting the sternum to the clavicle on each side of the body.
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Shoulder Girdle Ligaments
Acromioclavicular Joint- joint connecting the acromion process to the clavicle at the distal end of the clavicle.
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Shoulder Girdle Joints
Glenohumeral joint- joint where the humerus fits into the glenoid fossa of the scapula.
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Shoulder Girdle Ligaments
Scapulothoracic joint- joint where the scapula slides over the thorax or rib cage.
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Bones
Scapula, clavicle, & humerus serve as attachments for shoulder joint muscles Scapular landmarks
supraspinatus fossa
infraspinatus fossa
subscapular fossa
spine of the scapula
glenoid cavity
coracoid process
acromion process
inferior angle
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5-9 From Seeley RR, Stephens TD, Tate P: Anatomy and physiology, ed 7, New York, 2006, McGraw-Hill
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Bones
Scapula, clavicle, & humerus serve as
attachments for shoulder joint muscles
Humeral landmarks
Head
Greater tubercle
Lesser tubercle
Intertubercular groove
Deltoid tuberosity
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5-10
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Glenohumeral Joint
multiaxial ball-&-socket
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5-11
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Bones of Shoulder Joint
Acromion Process
Clavicle
Posterior Anterior
Glenoid
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Glenohumeral Joint
Glenoid labrum slightly enhances stability
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5-14
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GLENOID LABRUM
Cartilage ring around the glenoid fossa. Deepens the socket of the G-H Joint.
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Glenohumeral Joint
Glenohumeral ligaments provide stability
especially anteriorly & inferiorly
inferior glenohumeral ligament
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5-16
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Superior, Middle and Inferior Glenohumeral Ligament
Coracoclavicular Acromioclavicular
Coraco-acromial Lig.
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Glenohumeral Joint
Ligaments are quite lax until extreme ranges of motion reached due to wide range of motion involved
Stability is sacrificed to gain mobility
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5-18
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Glenohumeral Joint
Frequently injured due to anatomical design
shallowness of glenoid fossa
laxity of ligamentous structures
lack of strength & endurance in muscles
anterior or anteroinferior glenohumeral subluxations & dislocations common
posterior dislocations rare
posterior instability problems somewhat common
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5-19
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Glenohumeral Joint
Rotator cuff is frequently injured Subscapularis, supraspinatus, infraspinatus, & teres minor
muscles
attach to the front, top, & rear of humeral head
point of insertion enables humeral rotation
vital in maintaining humeral head in correct approximation within glenoid fossa while more powerful muscles move humerus through its wide range of motion
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5-20
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Movements
Abduction upward lateral
movement of humerus out to the side, away from body
Adduction downward movement of
humerus medially toward body from abduction
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5-21
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Movements
Flexion movement of
humerus straight anteriorly
Extension movement of
humerus straight posteriorly
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5-22
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Movements
Horizontal adduction (transverse flexion) movement of humerus in a
horizontal or transverse plane toward & across chest
Horizontal abduction (transverse extension) movement of humerus in a
horizontal or transverse plane away from chest
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5-23
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Movements
External rotation movement of humerus
laterally around its long axis away from midline
Internal rotation movement of humerus
medially around its long axis toward midline
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5-24
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Movements
Diagonal abduction
movement of humerus in a diagonal plane away from midline of body
Diagonal adduction
movement of humerus in a diagonal plane toward midline of body
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5-25
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Glenohumeral Joint Scapula movement
usually occurs with movement of humerus: Humeral flexion & abduction
require scapula elevation, rotation upward, & abduction
Humeral adduction & extension results in scapula depression, rotation downward, & adduction
Scapula abduction occurs with humeral internal rotation & horizontal adduction
Scapula adduction occurs with humeral external rotation & horizontal abduction
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5-26
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Glenohumeral Joint
Determining exact range of each movement at the glenohumeral joint is difficult due to accompanying shoulder girdle movement (movement at the scapula)
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5-27
Shoulder
Flexion
Extension
Hyperextension
Adduction
Abduction
Medial rotation
Lateral rotation
Shoulder girdle
Up rotation
Down rotation
Scapular tilt
Down rotation
Up rotation
Protraction
Retraction
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Scapulohumeral rhythm
The first 30 degrees of motion is shoulder.
After that the for every 2 degrees the humerus moves the scapula upwardly rotates 1 degree.
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Lets try it
Stand next to a partner that you are comfortable touching on their back.
Person in anatomical position, place your hand on the axillary border of the scapula. Ask them to abduction and see what happens when they get above 30 degrees.
The scapula will start rotating upward
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Shoulder Injuries
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Shoulder Separation
Separation: occurs when bones held together by fibrous ligaments tear and separate from each other.
There are several grades of separation depen-ding on the severity of the torn ligaments
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Grades of Shoulder Separation
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Healthy Shoulder Separated Shoulder
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Shoulder Dislocation
Dislocation occurs when a bone is displaced from its original location
Usually involves damage to the joint capsule and the ligaments that hold the joint together
Signs and symptoms include:
Joint looks awkward or deformed
Joint is painful
Joint is not useable
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Healthy Shoulder Dislocated Shoulder
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Shoulder bursitis Occurs from trauma or overuse or direct impact
Signs and symptoms are: pain with movement; tenderness to palpation in area just under acromion
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Shoulder Impingement
Cause: mechanical compression of supraspinatus tendon, the subacromial
bursa, and long head of biceps tendon; most common in overhead activities
Signs and symptoms: diffuse pain around the acromion in overhead position; external rotators weaker than internal; tightness in posterior and inferior capsules;
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First Aid Care
The first aid care for the majority of these shoulder injuries is PIER.
After PIER and further monitoring, further medical attention may be required.