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The Shoulder

The Shoulder. Sternoclavicular Joint. Only attachment of upper extremity to trunk. Acromioclavicular Joint. AC ligament Anterior Posterior Superior Inferior Coracoclavicular Ligament. Glenohumeral Joint. Humeral head is larger than glenoid

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The Shoulder

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  1. The Shoulder

  2. Sternoclavicular Joint • Only attachment of upper extremity to trunk

  3. Acromioclavicular Joint • AC ligament • Anterior • Posterior • Superior • Inferior • Coracoclavicular Ligament

  4. Glenohumeral Joint • Humeral head is larger than glenoid • Static stabilizers- Labrum and glenohumeral ligaments • Dynamic Stabilizers- Rotator cuff and Deltoid • Long head of biceps tendon passes superiorly to the head of the humerus

  5. Scapulothoracic Joint • Movement of the scapula on the thoracic wall is critical to shoulder joint motion • Muscles that attach to scapula must stabilize scapula providing a base for the head of humerus to rotate on.

  6. Scapulohumeral Rhythm • Movement of the scapula relative to the movement of the humerus in abduction • First 30 degrees of abduction- no scapular movement • 30-90 degrees of abduction- 1:2 ratio of scapula:humerus • Above 90 degrees of abduction- 1:1 ratio of scapula:humerus

  7. Stretching Exercises • Static Hang from chin up bar • Codman’s Pendulums- Early in Rehab below 90 • Sawing- Early in Rehab below 90 • Wall Climb- Flexion and Abduction • Corner Stretch- Anterior Structures • Wand Stretches • Sleeper Stretch

  8. Strengthening Exercises • Free Weights • Weight Machines • Exercise Tubing

  9. Strengthening Exercises • Bench Press • Horizontal Flys • Military Press • Front Raises • Side Raises • Reverse Flys • I’s • Y’s • T’s • Push-up with a plus • Push ups • Rows • Upright Rows • Ball push ups

  10. Plyometric Exercises • Need rebouder or partner • Single-arm toss • Double-arm toss with trunk rotation • Double-arm toss overhead • Push ups with a clap • Push ups on a box

  11. Reestablishing Neuromuscular Control • Weight Shifting • Table • Swiss Ball • Fitter Board • Wobble Board • Weighted Ball • Slide Board • Rhythmic Stabilization • Body Blade

  12. AC Sprain • MOI- Fall on tip of shoulder • Rehab Concerns-Focus on Deltoid, Trapezius, and Pectoralis Major muscles. Also focus on scapular stabilizers • Grade I- Sling for a couple of Days. Begin AROM exercises immediately • Grade II- 7-14 days in sling. Full RTP for contact sports 8-12 weeks.

  13. Clavicle Fx • MOI- FOOSHA, Direct Blow • Immobilization for 6-8 weeks • Regain ROM • Regain Strength • Deltoid • Pectoralis Major • RC • Scapular Stabilizers

  14. Glenohumeral Dislocation • MOI- 90 degree abduction, 90 degree elbow flexion and external rotation is most common • 85-90% will dislocate again • Likely to tear labrum also • Avoid Following Postions • Anterior- Combined ER and Abduction. Fly, Pull Down, Bench, Military Press • Posterior- Combined IR, Horizontal Adduction, and Flexion. Fly, Bench, Weight bearing exercises • Inferior- Full Elevation. Shrugs, elbow curls, military press

  15. GH Dislocation Cont. • Up to 3 weeks in sling • Passive ROM • Isometrics • Scapular exercises without elevation • Weeks 3-8 • Restore full AROM • Begin neuromuscular control exercises • Weeks 6-12 • Begin scapular and rotator cuff exercises • Add motion neuromuscular control exercises • Begin Plyometrics • Begin Body Blade • Weeks 12-20 • Begin sport specific drills

  16. Shoulder Impingement • Mechanical compression of supraspinatus tendon, subacromial bursa, and biceps tendon • MOI-Dynamic and static stabilizers fail to maintain subacromial space. Acute and Chronic • Rehabilitation Concerns • Avoid activities above 90 degrees of flexion and abduction early. • Focus on RC strength • Strengthen scapular stabilizers • Strengthen LE and Core to reduce stress on throwing shoulder

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