Shoulder

Pearls/How this relates to treatment throughout the text

Functional Anatomy and Mechanics

The components of the shoulder joint complex

1. Glenohumeral
2. Subdeltoid
3. Acromioclavicular
4. Scapulothorax
5. Sternoclavicular
6. Costosternal
7. Costovertebral

Bony Structures:

1. Humeral Head centralization- non centralization will reduce compressive forces of rotator cuff
muscles decreasing dynamic stability by altering length/tension of mm. Results in destabilization
forces and poor joint arthrokinematics

Activity: Evaluation of Humeral Head Central Position (ref 21 PT of Shld 5th ed)

1. Evaluate scapular posture

2. Assessment of GH capsular extensibility by testing int/ext rotation in various positions
3. Assess strength of Rotator cuff mm
4. Asses strength of scapular rotators
Ligaments (static stabilizers)

1. Glenohumeral ligament (14 PT of Shld 5th ed)

 Coracohumeral ligament strongest supporting ligament blends into the
supraspinatus and subscapularis mm. This ligament also forms a tunnel for
biceps tendon.
 Superior GHL and CH ligament limit ext rotation and abduction of humerus.
Acts as stabilizers in inferior direction at 0-50 abduction.
 Middle GHL taut at 45 abduction 10 extension and ER. Anterior stability at 45-
60 abduction
 Inferior GHL attaches at ant and post sides of glenoid. Taut at 0 abduction and
30 horizontal extension. Stabilize against inferior anterior dislocation

Pearl-with shoulder instability more Long head of biceps and SHB function as anterior stabilizers of the
GHJ with arm in abduction and ER. Increases with shoulder instablity

2. Capsular ligaments

Cartilage

1. Labrum

Active Stabilizers

Passive Stabilizers muscle bulk acts as a passive muscle tension. Contraction of the rotator cuff muscles
primarily cause compression of the articular surfaces, joint motion that secondarily tightens the
ligamentous constraints, barrier or restraint effects of the contracted muscle, and redirection of the
joint force to the center of the glenoid surface by coordination of muscle forces

The subscapularis is the strongest activity stabilizers

Pearl: travell and simons believed trigger points within the SS may cause other trigger points could lead
to major restrictions in GH motion and cause frozen shoulder
21 Fxn Ant of Shld

The deltoid muscles are activated during initial elevation (90). This results in a shearing force on the GH
joint. The Supra, Sub, Infra and Teres counteract that force allowing for pain free movement.

Pearl: if the supporting muscles are not functioning properly you end up with impingment in the
shoulder due to the humerus rising up ( approx 3mm) during elevation.

During the second phase of elevation you have increased scapulothoracic movement. Mvmt assisted by
lower and upper trap along with lower anterior serratus (humerus inf/sup 1.5mm)

Final elevation using extension of lat, pec major, teres major/minor and subscap to allow unconstrained
mvmt of humerus away from scap.

Pearl: with tight mm you lose the motion necessary for complete shoulder mvmt
Demonstration: Subscapularis and pec major with foam roll lat to help shoulder pain during exercise
compression to increase mobility.

Examination: (71)
Common Causes of Shoulder Pain

Rotator Cuff Tendinitis/Tear

Frozen Shoulder

Thoracic Outlet Syndrome

Brachial Plexus

AC strain

SC strain

GH Instability

Various Contributors to knee pain include

Activities

Rehabilitation Technique

Treatment Techniques