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Shoulder

Shoulder. Anatomy Review. 2 bones Scapula Humerus 4 joints Gleno-humeral Acromio-clavicular Sterno-clavicular Scapulo-thoracic. Rotator Cuff Muscles S I T S. Scapular Muscles Move Scapula / Greater ROM Fixate Scapula on thorax Rhomboid Major / Minor Levator Scapula

Jimmy
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Shoulder

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  1. Shoulder

  2. Anatomy Review • 2 bones • Scapula • Humerus • 4 joints • Gleno-humeral • Acromio-clavicular • Sterno-clavicular • Scapulo-thoracic

  3. Rotator Cuff Muscles • S • I • T • S

  4. Scapular Muscles • Move Scapula / Greater ROM • Fixate Scapula on thorax • Rhomboid Major / Minor • Levator Scapula • Serratus Anterior • Pectoralis Minor • Trapezius • Latissimus Dorsi • Pectoralis Major

  5. General Rehab Considerations

  6. Mechanics of Activities • Baseball throw • Windup – Cocking – Acceleration – Follow-through • Tennis Serve • Windup – Cocking – Acceleration – Follow-through • Tennis Backhand / Forehand • Racket prep – Acceleration – Follow-through • Swimming (Freestyle) • Early pull-through – Late pull-through – Early recovery – Late recovery • Golf Swing • Take-away – Forward swing – Acceleration – Follow-through

  7. Stability • Passive stabilizers • Joint capsule, ligaments, labrum • Active stabilizers • Muscles • Damage (Microtrauma / Macrotrauma) to passive stabilizers and weakness / dysfunction of active stabilizers  Functional Instability

  8. Other Factors to Consider • Posture • Cervical Dysfunction • Thoracic Dysfunction • Scapular Plane (Scaption) • Exercise Progression • Stay below 90° until good strength in rotator cuff

  9. Flexibility / Range of Motion

  10. Range of Motion • Pendulum Exercises (Codman’s) • Wand Exercises • Supine • Standing • Pulley Exercises • PROM

  11. Flexibility • Capsular stretches • Inferior (shoulder flexion) • Anterior (horizontal ext / ext rotation) • Posterior (horizontal flex / int rotation)

  12. Active stretches • Internal Rotation • Rhomboid • Supraspinatus

  13. Assistive • Supraspinatus • Infraspinatus • Subscapularis • Teres Minor • Teres Major • Latissimus Dorsi

  14. Strengthening

  15. Isometrics • Rotator Cuff Isotonics • MRE • PRE • Rubber bands • Scapular Stabilizers • Open Chain • Closed Chain

  16. Machines • Deltoid • Pectoralis Major • Latissimus Dorsi • Rhomboids • Trapezius • Isokinetics • Flexion / Extension • Internal / External Rotation

  17. Proprioception

  18. Swiss Ball Stabilization • Distal Segment Stabilization • Rhythmic Stabilization • PNF Patterns (D1 / D2) • MRE • Rubber Tubing

  19. Special Considerations

  20. Shoulder Instability • TUBS • Traumatic, Unilateral, Bankart, Surgery • AMBRI • Atraumatic, Multi-directional, Bilateral, Rehabilitation, Inferior capsular shift

  21. Shoulder Impingement • Narrowing of subacromial space • Primary • Caused by structures within the SA space (RC tendons, biceps tendon, bursa) • Secondary • Caused by shoulder dysfunction due to instability • Capsular laxity / tightness • Postural deformity • Rotator cuff weakness • Muscular imbalance

  22. Treatment options • Pain / Inflammation Control • Secondary – Find the cause!! • Tight capsule – Joint Mobs • Loose capsule – Strengthen active stabilizers • Avoid aggravating activities • Gradual return to full activity

  23. Traumatic RC Conditions • Acute strain • Partial thickness tear vs. full thickness tear • Post-surgical cases • Conservative vs. Surgical Options

  24. Arthroscopic Decompression • Surgical procedure to clean out the subacromial space • Decompression • Primary impingement • May involve acromioplasty • Debridement • Chronic tendinitis / synovitis

  25. Glenoid Labral Tears • Most common in high-velocity overhead activities • SLAP (Superior Labrum Anterior and Posterior) • Usually involves LH of Biceps • Conservative vs. Surgical options • Bankart repair • Capsulolabral reconstruction

  26. Adhesive Capsulitis • “Frozen Shoulder” • Capsular pattern of restriction at GH jt. • Most common in older adults • Female > male • Stage I • Shoulder pain, pain at EROM, sleeping difficulties, diminishing ROM (3-6 weeks of rehab) • Stage II • Very stiff shoulder, pain through available motion, elbow pain, unable to lay on affected shoulder (1-3 months of rehab) • Stage III • Pain at rest, hard-leathery end feel at EROM w/ capsular pattern, loss of scapulo-humeral rhythm (3-6 months of rehab) • No rehab  18 – 24 months to resolve

  27. AC Sprains • Almost always treated conservatively • Grade I • No deformity, sling (1-2 days) • Grade II • AC ligament torn, mild deformity, sling (5-7 days) • Grade III • AC / CC ligaments torn, deformity, sling (7-14 days) • Type IV, V, VI – usually require surgery and involve severe damage to AC and surrounding tissues.

  28. Biceps Tendon Injuries • Bicipital tendinitis • Usually secondary to instability, impingement, RC pathology • Biceps tendon ruptures • More common in middle-aged adults especially with RC pathology • Sudden muscle contraction while muscle on stretch • Complete ruptures exhibit “Popeye” Sign • Younger athletes will usually require surgery, older adults may be fine with out

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