Shoulder Lab Handout PDF

PT 8361 Shoulder Clinical Conference I Upper Extremity: The Shoulder Complex INTRODUCTION (Review on your own): identify each joint in terms of shape, number of articular surfa...

PT 8361 Shoulder Clinical Conference I Upper Extremity: The Shoulder Complex INTRODUCTION (Review on your own): identify each joint in terms of shape, number of articular surfaces, degrees of freedom and movements available: Glenohumeral Joint Review the Glenohumeral Joint: Classification according to shape:  Ball & socket joint: articulation between the shallow glenoid fossa of the scapula and the convex ball shaped proximal end of the humerus Classification according to degrees of freedom: 3 Degrees of Freedom (DOF); hence it is triaxial  Sagittal plane movements include: flexion, extension  Frontal plane movements include: abduction, adduction  Horizontal plane movements included: internal rotation, external rotation # of movements available at the glenohumeral joint= 6  Movements available include: flexion, extensions, abduction, adduction, internal rotation, external rotation (demonstrate to a partner): Acromioclavicular Joint Classification according to shape:  Planar joint between the lateral end of clavicle and medial border of the acromial process Classification according to degrees of freedom: 3 DOF; hence it is triaxial  6 Movements available at the AC joint : vertical movement of the acromial process, anterior & posterior movement of the acromial process, rotation of the scapula anteriorly and posteriorly Identify and palpate the following bony landmarks on the skeleton:  Acromial process of the scapula  Lateral end of the clavicle Sternoclavicular Joint Classification according to shape:  Has been described as a modified ball & socket/or saddle joint (depending on the reference) between the medial end of the clavicle and manubrium of the sternum & first costal cartilage Version_8.15.23 PT 8361 Shoulder Classification according to degrees of freedom: 3 DOF; hence it is triaxial Number of Movements available = 6  Movements include: elevation, depression, protraction, retraction, anterior rotation of clavicle, posterior rotation of clavicle Identify and palpate the following bony landmarks on the skeleton.  Clavicle  Medial end of clavicle  Jugular notch of the sternum  Clavicular notch of the sternum Scapulothoracic Complex Not a true anatomical joint, but a crucial relationship between the scapula and thorax Movements of the scapula are intimately linked to movements of the sternoclavicular, acromioclavicular, and glenohumeral joints Demonstrate the motions available to the scapula along the bony thorax Elevation of scapula Depression of scapula Protraction of scapula Retraction of scapula Upward rotation of scapula Downward rotation of scapula Version_8.15.23 PT 8361 Shoulder Shoulder Girdle & Superficial Back Muscles: Surface Anatomy Bony Reference Points: (Seated) SCAPULA This is a triangular bone that rests upon the thoracic cage, in the resting position covers ribs two to seven.  Medial border: o lies approximately 2 inches from the spinous processes. o palpate inferiorly to the inferior angle o palpate superiorly to the superior medial angle  not as distinct as the inferior angle  important clinically as a site of referred pain in cervical spine dysfunctions.  Lateral border: o From the inferior angle of the scapula o move laterally to palpate the lateral border of the scapula. o Note: that this border of the scapula disappears as move superiorly  Covered by latissimus dorsi and teres major (Reichert 2011)  Spine of the Scapula: Version_8.15.23 PT 8361 Shoulder o Lies across from T3 (Thoracic Spinous Process of 3rd vertebrae). o Should feel a smooth triangular area at the start of the spine of the scapula. o Trace the spine of the scapula (pinch top and bottom w/fingers) until it terminates laterallythe acromion process. o Palpate scapular spine from underneath (inferior edge)  Follow it to the posterior corner of the acromion.  Palpate the lateral edge of the acromion (don’t go too lateral to the greater tubercle)  It runs ventrally and cranially  Pull on the humerus  space between the humeral head and acromion increases, and makes the lateral and particularly the anterior aspect of the acromion more obvious.  Follow the acromion ventrally to the ventral corner where it meets the clavicle….this makes a palpable “V” anteriorly o From the lateral edge, this meeting point lies about 1.0- 1.5cm medially o Confirm it by pulling back on patient…body will move (if you are in the right spot) vs finger will slide  Then palpate the scapular spine from above o follow it laterally to where it meets the clavicle o it will turn inwards ….towards the clavicle o The two bones come together and form another “V”.  Connect the two “V’s” with a slightly LATERAL CONVEX line (this will be your “helper’s line”). o Is where clavicle meets acromion  Palpate from dorsal to ventral perpendicular to this “helper’s line.” o Along the dorsal half of the “helper’s line” one palpates a bony step from acromion to clavicle o As approach the ventral part of the “helper’s line” the bony step becomes a smoother inclination.  This area is the acromioclavicular joint.  Is about 1 cm long  lies in the area of the ventral half of the “helper’s line.”  gives an appreciation of the direction of the ACJ importance when assessing joint mobility. Version_8.15.23 PT 8361 Shoulder Reichert 2011 Clavicle palpation  Start on inferior aspect of clavicle medially….follow it laterally until start to lose it o Don’t get lost in anterior V notch  Come on superior aspect of clavicle and palpate laterally and posteriorly o Note…. clavicle goes more posterior and widens in this direction  Will meet the line drew before on superior edge of spine of scapula…goes to post V notch Soft Tissue Structures- Muscles and tendons You must be able to palpate and know the origins, insertions, and actions of the following UE muscles and tendons that are bolded. Deltoid muscle  shoulder muscle  comprised of the anterior, middle and posterior bundles  inserts on the deltoid tuberosity of the humerus o anterior deltoid  activated during flexion to 90 degrees o middle deltoid  activated during abduction to 90 degrees o posterior deltoid  activated during horizontal abduction. Supraspinatus:  Rotator cuff muscle  Above spine of the scapula  palpate in the supraspinatus fossa during abduction Infraspinatus:  Rotator cuff muscle  Below the spine of the scapula Version_8.15.23 PT 8361 Shoulder  Find medial and lateral scapular borders  Palpate in the infraspinatous fossa during external rotation with the arm in 90 degrees of abduction. Trapezius muscle  is composed of three parts: Upper, Middle, and Lower.  upper trapezius o easily palpated when subject shrugs the shoulders. o can be activated unilaterally by resisting lateral flexion of the neck.  middle trapezius o activated by asking your subject to horizontally abduct the shoulder when in prone. (T’s) o fibers run transversely to insert on the acromion and the crest of the spine of the scapula.  lower trapezius o subject in prone, and the arms elevated to approximately 120 degrees, ask your subject to lift the arm up. (Y’S) o fibers run obliquely, upward and outward attaching to the scapular spine. Teres Major:  In prone with arm off side of table ask your subject to internally rotate arm  Fibers of both the Teres Major and Latissimus dorsi will contract-muscle fibers closest to the lateral board of the scapula are the Teres Major Rhomboid Major and Minor muscle:  Prone with arm behind back and dorsum of the hand resting lightly on the sacrum.  Ask your subject to lift the hand. Pectoralis Major  muscle has 2 heads  Clavicular Head: o in supine, abduct the arm to 90 degrees with the elbow flexed to 90 o Ask the subject to ADDUCT the arm horizontally. o Palpate the clavicular head under the clavicle.  Sternal Head: o place the shoulder in FULL flexion o ask the subject to reach over to the opposite hip (adduction and internal rotation). o Palpate in the axilla fold. Subscapularis  in supine  forearm on forehead to protract scapula Version_8.15.23 PT 8361 Shoulder  Slide your fingers on the anterior surface of the scapula between the latissimus dorsi and rib cage  To activate muscle, ask subject to internally rotate the shoulder. Reichert B. Palpation Techniques Surface Anatomy for Physical Therapists. Stuttgart, Germany: Thieme; 2011. Sizer P., et al. International Academy of Orthopedic Medicine-US Presents Diagnosis- Specific Orthopedic Management of the Shoulder Complex. OPTP. Version_8.15.23