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Shoulder

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by

Douglas Willmott

on 18 March 2016

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Transcript of Shoulder

Shoulder
History
Symptoms
Have you dislocated?
Pitching motion
Sleeping pattern
Describe the pain
Prior injuries
Observation
Anatomy
Humerus
Sternum
Clavicle
Scapula
Latissimus Dorsi
A: Extend the shoulder,
adduct the shoulder, medially rotate the shoulder.


Levator Scapula
A: Unilaterally- elevate the scapula, downwardly rotate the scapula, laterally flex the head and neck, rotate the head and neck to the same side.
Bilaterally- extend the head and neck.

Rhomboid Major
A: Adduct the scapula, elevate the scapula, downwardly rotate the scapula.
Rhomboid Minor
A: Adduct the scapula, elevate the scapula, downwardly rotate the scapula.
Serratus Anterior
A: Origin fixed- abduct the scapula, upwardly rotate the scapula, depress the scapula, hold the medial border of the scapula against the rib cage. When scapula is fixed-elevate the thorax during forced inhalation
Trapezius
A: Upper fibers: bilaterally- extend the head and neck. Unilaterally- laterally flex the head and neck to the same side, rotate the head and neck to the opposite side, elevate the scapula, upwardly rotate the scapula. Middle fibers- Adduct the scapula, stabilize the scapula. Lower fibers- depress the scapula, upwardly rotate the scapula
Pectoralis Major
A: All fibers- adduct the shoulder, medially rotate the shoulder, assist to elevate the thorax during forced inhalation. Upper fibers- flex the shoulder, horizontally adduct the shoulder. Lower fibers- extend the shoulder.

Pectoralis Minor
A: depress the scapula, abduct the scapula, downwardly rotate the scapula. Scapula fixed- assist to elevate the thorax during forced inhalation.
Bicep Brachii
A: flex the elbow, supinate the forearm, Flex the shoulder.
Coracobrachialis
A: Flex the shoulder, adduct the shoulder.
Deltoid
A: All fibers- abduct the shoulder. Anterior fibers- flex the shoulder, medially rotate the shoulder, horizontally adduct the shoulder. Posterior fibers- extend the shoulder, laterally rotate the shoulder, horizontally abduct the shoulder.
SITS Group
Supraspinatus
A: Abduct the shoulder, stabilize the head of the humerus in the glenoid cavity.
Infraspinatus
A: Laterally rotate the shoulder, adduct the shoulder, stabilize the head of humerus in glenoid cavity
Teres Minor
A: Laterally rotate the shoulder, adduct the shoulder, stabilize the head of humerus in glenoid cavity.
Subscapularis
A: Medially rotate the shoulder, stabilize the head of humerus in glenoid cavity.
Triceps brachii
A: All heads- extend the elbow. Long head- extend the shoulder, adduct the shoulder.
Labrum
Special Test
Apley's Scratch Test
1. Touch opposite shoulder from the front. Motions- GH adduction, horizontal flexion, and internal rotation; scapular protraction.
2. Reach behind the head and touch the opposite shoulder from behind. Motions- GH abduction and external rotation; scapular protraction, elevation, and upward rotation.
3. Reach behind the back and touch the opposite shoulder blade. Motions- GH adduction and internal rotation; scapular retraction and downward rotation.
Winging Scapula "push-up"

Glenohumeral Glide Tests
PA: Lying supine with the glenohumeral joint over the edge of the table.
PE: Standing lateral to the side being tested. One hand stabilizes the scapula and the other grasps the humerus just below the surgical neck.
Eval: The examiner applies a gentle, yet firm, force that moves the humeral head anteriorly relative to the glenoid fossa while applying a slight distraction to the joint to seperate the humeral head from the fossa. This procedure is then repeated in the posterior and inferior direction.
+: Pain or increased motion compared with the same direction on the opposite shoulder.
Implications: Laxity of the static stabilizers of the glenohumeral joint:
Anterior: Coracohumeral ligament, superior, middle and inferior glenohumeral ligamnets, posterior joint capsule.
Posterior: Anterior joint capsule.
Inferior-anterior: Inferior glenohumeral ligament, superior joint capsule.
Acromioclavicular Traction Test
PA: Sitting or standing. The arm is hanging naturally from the side with the elbow flexed to 90'
PE: Standing lateral to the involved side. The clinician grasps the athlete's humerus above the elbow. The opposite hand gently palpates the acromioclavicular joint.
Eval: The examiner applies a downward traction on the humerus.
+: the humerus and scapula move inferior to the clavicle, causing a step deformity.
Implications: The integrity of the acromioclavicular and costoclavicular ligaments has been compromised.

Apprehension Test for Anterior Glenohumeral Laxity
PA: Standing, sitting, or supine. The glenohumeral joint is abducted to 90'; the elbow flexed to 90'.
PE: Positioned behind or beside the athlete on the involved side. The examiner supports the humerus at midshaft. Supports the forearm proximal to the wrist.
Eval: While supporting the humerus at 90' abduction, the examiner passively externally rotates the glenohumeral joint by slowly applying pressure to the forearm.
+: Pain is centered in the anterior capsule of the glenohumeral joint. The athlete displays apprehension that the shoulder may dislocate, and further movement is resisted.
Implications: The anterior capsule and/or glenoid labrum have been compromised, allowing for the humeral head to dislocate or subluxate anteriorly on the glenoid fossa.
Relocation Test for Anterior Glenohumeral Laxity
PA: Supine. The glenohumeral joint is abducted to 90'. The elbowed is flexed to 90'.
PE: Standing beside the athlete, inferior to the humerus on the involved side. the forearm is grasped distal to the elbow to provide leverage during external rotation of the humerus. the opposite hand is placed over the anterior portion of the glenohumeral capsule. A downward pressure is applied to prevent anterior displacement of the humeral head.
Eval: While maintaining pressure on the anterior inferior portion of the glenohumeral joint, the examiner externally rotates the humerus until apprehension is experienced by the atlete or the normal range of motion is met.
+: An increased amount of external rotation is obtained when compared with the apprehension test.
Implication: A positive test result suppports the conclusion of increased laxity in the anterior capsule owing to capsular damage or labrum tears.



Sulcus Sign for Inferior Glenohumeral Laxity
PA: Sitting. Arm hanging at the side.
PE: Standing lateral to the involved side. The athlete's arm is gripped at the elbow and midforearm.
Eval: A downward traction is applied to the athlete's arm.
+: An indentation appears beneath the acromion process.
Implications: The humeral head slides inferiorly on the glenoid fossa, indicating laxity in the superior glenohumeral ligament or a tear of the inferior portion of the glenoid labrum.
Hawkins-Kennedy Impingement Test
PA: Sitting or standing, the shoulder, elbow and wrist are in anatomical position.
PE: Standing lateral or forward of the involved side. The athlete's shoulder is stabilized on the posterior aspect. The examiner;s other hand grips the athlete's arm at the elbow joint.
Eval: With the elbow flexed, the glenohumeral joint is forward flexed to 90'. At this point the humerus is passively internally rotated. Then the shoulder is abducted to 90' and the glenohumeral joint is passively internally rotated.
+: Pain with motion, especially near the end of the range motion.
Implications: Pathology is present in the rotator cuff group or the long head of the biceps brachii tendon.


Neer Impingement Test
PA: Sitting or standing, with the shoulder, elbow and wrist are in the anatomical position.
PE: Standing lateral or forward of the involved side, the athlete's shoulder is stabilized on the posterior aspect. The examiner's other hand gips the athlete's arm at the elbow joint.
Eval: with the elbow extended, the glenohumeral joint is passively moved through forward flexion.
+: Pain with motion, especially near the end of the range of motion.
Implication: Pathology is present in the rotator cuff group or the long head of the bicep brachii tendon.
Drop Arm Test
PA: Standing or sitting, with the arm fully abducted with the elbow straight.
PE: Standing lateral to, or behind, the involved extremity.
Eval: The athlete slowly lowers the arm to the side.
+: the arm falls uncontrollably rom a position of 90' to the side.
Implications: The inability to control adduction of the glenohumeral joint is indicative of lesions to the rotator cuff, especially the supraspinatus.

Empty Can Test
PA: Sitting, the glenohumeral joint is abducted to 90' while the elbow is extended and the palm face upward.
PE: Standing facing the athlete. one hand is placed on the superior portion of the midforearm to resist the motion of abduction.
Eval: The evaluator resists abduction while the athlete internally rotates the glenohumeral joint and horizontally flexes the shoulder to 30'.
+: Weakness or pain accompanying the movement.
Implications: The supraspinatus tendon is being impinged between the humeral head and the coracoacromial arch, or it is inflamed, or it contains a lesion.
Yergason's Test
PA: Seated of standing, the glenohumeral joint is in the anatomical position. The elbow is flexed to 90". The forearm is supinated 90' so that the lateral border of the radius faces upward.
PE: Positioned lateral to the athlete on the involved side. The olecranon is stabilized inferiorly and maintained close to the thorax. The forearm is stabilized proximal to the wrist.
Eval: The athlete flexes the forearm against resistance while the examiner concurrently moves the glenohumeral joint into external rotation.
+: Pain and/or snapping in the bicipital groove.
Implications: 1': snapping or popping in the bicipitla groove indicates a tear or laxity of the transverse humeral ligament. 2": Pain with no associated popping in the bicipital groove may be indicative of bicipital tendinitis.

Special Considerations
SC joint sprain
Clavicular Fracture
AC Joint Sprains
Rotator Cuff Impingement/ Tendinopathy
Superior Labrum Anterior and Posterior Lesions
Rotator Cuff Tears
Biceps Tendinopathy
Shoulder Dislocation
Full transcript