Anatomy of the Shoulder Joint

The type of joint formed between the head of the humerus and the glenoid fossa of the scapula.

The rounded end of the humerus that articulates with the glenoid fossa.

A pear-shaped depression on the scapula that receives the head of the humerus.

The capsule surrounding the glenohumeral joint is relatively weak and loose, especially inferiorly, allowing for a wide range of motion but making it prone to instability.

The inferior part of the joint capsule that is particularly weak, contributing to the vulnerability of the shoulder to inferior dislocations.

The primary ligaments stabilizing the glenohumeral joint, including the coracohumeral ligament, transverse humeral ligament, and the acromioclavicular and coracoclavicular complexes.

A ligament that connects the coracoid process to the humerus, helping to stabilize the humeral head.

A ligament that spans the humerus, helping to stabilize the biceps tendon.

A complex of ligaments that connect the acromion to the clavicle, helping to stabilize the shoulder joint.

Composed of the conoid and trapezoid ligaments, they connect the coracoid process to the clavicle and provide important stabilization to the shoulder.

The Costoclavicular Ligament helps to control upward movement of the shoulder, both towards the body (medial movement) and away from the body (lateral movement).

The Glenohumeral Joint is the main joint of the shoulder, allowing for movement in three planes: flexion/extension, abduction/adduction, and external/internal rotation.

A 'Concave on Convex' joint movement describes how one joint surface glides in the opposite direction of the rolling motion.

A 'Convex on Concave' joint movement describes how one joint surface glides in the same direction as the rolling motion.

The Glenohumeral Joint's resting position is achieved with the arm slightly abducted (away from the body) and rotated inward (horizontally adducted).

The Glenohumeral Joint is most stable (closed packed) when the arm is fully raised outward (abducted) and rotated outward (externally rotated).

The Acromioclavicular Joint allows for movement in three planes: elevation/depression, protraction/retraction, and anterior/posterior rotation.

A condition where the tendons in the rotator cuff become inflamed, irritated, or torn. This can happen due to overuse, aging, or injuries.

Reduced blood supply to the rotator cuff muscles, particularly the supraspinatus and infraspinatus. This can lead to poor healing and degeneration.

A condition where the biceps tendon becomes inflamed, usually due to overuse or compression. This can cause pain and limited movement in the shoulder.

A condition where calcium deposits form in the tendons of the rotator cuff, usually the supraspinatus. This can cause pain, stiffness, and limited movement.

A test used to evaluate the biceps tendon for bicipital tendonitis. It involves resisting the patient's attempt to flex their elbow while the arm is in a specific position.

A test used to evaluate the supraspinatus muscle for tendonitis or impingement. It involves lifting the arm to a specific angle and then resisting the movement.

A test used to evaluate the supraspinatus muscle for strain. It involves raising the arm, then asking the patient to slowly lower it. This is watched to see if the arm drops.

A test used to evaluate the subscapularis muscle for strain. It involves asking the patient to lift their arm away from their back.

Inflammation of a bursa, which is a fluid-filled sac that reduces friction between tendons and bones.

The most commonly affected bursa in the shoulder, located above the supraspinatus tendon and beneath the acromion and deltoid muscle.

A bursa located anterior to the shoulder joint capsule, under the subscapularis tendon.

Rest and ice treatment for pain.

A gradual approach to restoring strength, flexibility, and function. It includes breaking down adhesions, improving muscle tone, and progressive strengthening exercises.

A condition where the biceps tendon is inflamed and may become trapped in the bicipital groove.

A condition where the tendon is stuck to the groove, limiting its ability to glide smoothly.

The inflammation and healing process in frozen shoulder initially affects the subsynovial layer, then the synovial layer, leading to the easy tearing observed with abduction and external rotation.

Adhesive capsulitis or frozen shoulder starts with adhesions in the triangular space between the subscapularis and biceps tendons and then spreads to surrounding structures including the rotator cuff muscles, glenoid rim, and coracohumeral ligament.

This type of frozen shoulder is characterized by an unknown cause and appears spontaneously.

This type of frozen shoulder is caused by a preceding injury or underlying condition.

This phase is characterized by a gradual onset of pain, often severe at night, making it difficult to lie on the affected side.

This phase is marked by a decrease in pain, but a significant increase in stiffness. Activities of daily living become difficult due to the limited range of motion.

This phase features a gradual decrease in pain and a return of motion and function. Although full range of motion might not be fully restored, the shoulder begins to thaw out.

A condition where there is a decrease in range of motion with a deviation from the normal scapulohumeral rhythm during shoulder movements.

This refers to the characteristic pattern of limited motion in the shoulder joint, commonly seen in frozen shoulder.

Strong and painless movement of the shoulder indicates no significant lesions, while strong and painful movements suggest a minor lesion. Weak and painful movements may indicate a partial rupture or inhibition due to a more serious lesion. Weak and painless movements could indicate a complete rupture or nerve compromise.

A condition involving partial or complete separation of the humerus from the glenoid fossa, often occurring anteriorly.

Commonly occurs due to excessive abduction and external rotation of the humerus, often caused by direct trauma (football) or indirect trauma (FOOSH - falling on an outstretched hand).

Caused by flexion, adduction, and internal rotation of the shoulder, often triggered by a fall onto an outstretched hand or elbow.

Usually caused by forced abduction with a fixed hand, and is less common than anterior or posterior dislocations.

This test evaluates for anterior shoulder instability by placing the patient's shoulder in a position mimicking the mechanism of injury (abduction, external rotation, and extension). A positive sign is apprehension shown by the patient due to the unstable joint.

A visible depression or hollow beneath the acromion, indicating a shoulder subluxation or dislocation. This is often accompanied by a loss of the typical rounded deltoid shape.

Occurs when the acromioclavicular joint is sprained. This involves damage to the AC joint capsule and ligaments, as well as the coracoclavicular complex.

A mild AC joint sprain with damage to the AC joint ligaments and capsule, but no clavicle displacement.

A moderate AC joint sprain with disruption to the AC joint ligaments and capsule, resulting in subluxation of the clavicle (partial dislocation). It involves some damage to the coracoclavicular complex.

A severe AC joint sprain, involving rupture of the AC and coracoclavicular ligaments. This leads to a prominent step deformity, where the clavicle rides superiorly to the acromion.

This test examines the integrity of the AC joint by applying a shearing force along the AC joint, aiming to determine joint stability.

A technique used to evaluate the integrity of the AC joint by applying horizontal adduction force to the shoulder. It is more relevant for assessing inflammation or mild sprains, rather than significant separation.

The treatment approach for instability conditions, such as hypermobility, fractures, dislocations, AC separations, post-immobilization, and disuse atrophy.

This stage of treatment involves immobilization for comfort and stability, reducing pain, SNS firing, and edema, maintaining local circulation, and addressing compensatory structures with techniques like GSM, petrissage, and MLD.

This stage emphasizes maintaining available ROM through PROM exercises, preventing disuse atrophy with isometric contractions, and gradually reducing protective muscle spasms without completely eliminating them.

Programs designed to improve shoulder health should aim to avoid causing pain or inflammation, be gradually increased in challenge, begin as early as possible (once inflammation has subsided), and prioritize stability and endurance.

Exercises that aim to improve range of motion should be performed without added weight, while exercises that focus on strength and stability should incorporate appropriate resistance.

In general, exercises should be progressed from easier to more challenging variations. This progression includes starting with submaximal effort, non-weight-bearing activities, single-plane movements, single-joint exercises, simple movements, slow speeds, and closed activities before moving towards maximal effort, weight-bearing activities, multi-plane movements, multi-joint exercises, complex movements, faster speeds, and open activities.

Exercises should mimic the desired functional movements you are aiming to improve. For example, if you're rehabilitating from shoulder impingement, exercises should focus on overhead movements.

Eccentric contractions are emphasized early in rehabilitation because they have a more powerful neural output, contribute significantly to stability, and are particularly effective in tendon strengthening. Additionally, starting with eccentric contractions allows you to introduce load to the muscle in its safest position.

Concentric contractions produce less tension in the muscle than eccentric contractions for the same weight. Therefore, concentric contractions should precede eccentric contractions in isokinetic exercises.

Muscle setting exercises are gentle, submaximal isometric contractions used in the acute stage of rehabilitation following a shoulder injury.

Isometric exercises are used in the sub-acute stage to strengthen the shoulder muscles in the mid-range of motion.

Progressive exercises incorporating both eccentric and concentric contractions are incorporated in the late sub-acute and chronic stages to further strengthen the shoulder and return it to function.

Self-distraction or self-mobilization exercises are used in the early stages of managing conditions such as adhesive capsulitis and impingement to gently move the shoulder.

Manual PROM or AAROM exercises are performed in the early stages of conditions such as adhesive capsulitis, impingement, dislocations, and AC separations, where another person helps to move the shoulder through its range of motion.

Pendulum swings are a gentle exercise used in the early stages of adhesive capsulitis to improve shoulder range of motion.

Finger walking exercises involve tracing patterns on a wall with your finger to improve shoulder range of motion, often used in the early stages of adhesive capsulitis.

Eccentric strengthening exercises are used in the later stages of rehabilitation to further strengthen the shoulder muscles, particularly the tendons, often for conditions like tendonitis.

Co-contraction exercises involve contracting multiple muscles around the shoulder joint simultaneously to improve stability and control, often used in the later stages of impingement, dislocations, and AC separations.