Examination of the Shoulder PDF

Shoulder and Scapula Discuss shoulder joint(s) range of motion and anatomical structures Discuss study strategies using your resources  Shoulder Motion 3 degrees of freedom  Flexion – Extension  ABDuction – ADDuction  Internal (medial) – External (lateral) rota...

Shoulder and Scapula Discuss shoulder joint(s) range of motion and anatomical structures Discuss study strategies using your resources  Shoulder Motion 3 degrees of freedom  Flexion – Extension  ABDuction – ADDuction  Internal (medial) – External (lateral) rotation Additional movements  Horizontal abduction  Horizontal adduction The shoulder sacrifices stability for mobility  ROM Full ROM of the shoulder complex requires motion at: – Bones that move: Humerus Scapula clavicular – Joints of movement Glenohumueral Sternoclavicular Acromioclavicular *scapulothoracic  Glenohumeral Joint (GHJ) Synovial ball-and-socket joint Humeral head: convex Glenoid fossa: concave Relies heavily on soft tissue for stability  Glenoid labrum  Joint Capsule  Ligaments  Musculature Shoulder Musculature  Glenoid Labrum Helps to provide stability to the shoulder  Increases glenoid depth 30-50% (Lippitt 1993) Injury can contribute to c/o:  Limited function  Pain  Instability http://www.houstonmethodist.org/ orthopedics/where-does-it-hurt/shoulder/ labral-tears/  ‘Glenohumeral Clock’ Helpful in understanding the components of stability in the shoulder Describes structures injured and/or repaired during a surgical procedure Great visual of the many components to stability of the GHJ https://www.shoulderdoc.co.uk/article/1399 Capsular Pattern of limitation (GHJ) (from greatest to smallest loss of motion) External Rotation Abduction Internal Rotation  Scapulothoracic Joint Not a real joint – a “functional joint” Motions are caused by the independent or combined motions of the sternoclavicular and acromioclavicular joints  Sternoclavicular Joint (SCJ) Clavicle  sternum and cartilage of 1st rib Synovial joint, saddle shaped Strong joint capsule: – Anterior and posterior SC ligament – Costoclavicular ligament (inferior clavicle) – Interclavicular ligament http://link.springer.com/ referenceworkentry/10.1007%2F978-3- 642-34746-7_50#page-1  SC Joint Motion occurs at the clavicle on a fixed sternum 3 degrees of freedom – Elevation – Depression – Protraction – Retraction – Anterior – Posterior Rotation  Acromioclavicular Joint (ACJ) Scapula  clavicle Fibrocartilagenous disc and surrounded by a weak joint capsule – Superior and inferior AC ligament – Coracoclavicular ligament  AC Joint 3 degrees of freedom – Upward – Downward Rotation – Horizontal Plane Adjustments (ie rotation) – Sagittal Plane Adjustments (aka tipping/tilting) Ludewig, 2009 JBJS  Tests and Measures Start with Observation! Palpation Gross ROM (systems review)  ROM (Tests & Measures) Gross Strength (systems review)  MMT (Tests & Measures) Flexibility (systems review)  Muscle Length Testing (Tests & Measures) Gross sensation (systems review)  Sensory examination (Tests & Measures) Bilateral? How does this relate back to their primary complaint? Functional limitations? Activity Limitations?  Palpation Superficial  deep – Not the other way around. Pain response? Palpate with a purpose! – Don’t just dig around. Understand the anatomy and what you’re feeling for  ROM/Goniometry Observe Posture/Starting position First, perform on the CONTRALATERAL side Observe AROM Palpate landmarks for goniometery Measure AROM using an appropriate device (re- palpating if need be!) Measure PROM using an appropriate device (re- palpating if need be!) Assess end feel Document objective measure, end feel, any subjective report Don’t forget - quality in addition to quantity Now perform all steps on the affected side  Shoulder Strength Scapular muscles ‘Shoulder’ muscles Make sure you are isolating and stabilizing as necessary Trunk/spine position can alter your testing http://www.bodybuilding.com/fun/arnold- schwarzenegger-blueprint-trainer-mass- training.html