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The Shoulder Complex PowerPoint Presentation

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Description : Check out this medical presentation on Orthopaedics, which is titled "The Shoulder Complex", to know about the Shoulder Complex, General Structure and Function, Structure and Function of Specific Joints, Muscular Considerations, Specific Functional Considerations, and Common Injuries.

Tags : Orthopaedics, Shoulder Complex, Structure, Function, Muscular Considerations, Injuries

Published on : Aug 10, 2021 | Views : 2056 | Downloads : 6

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Slide 1-

The Shoulder Complex
Slide 2-

The Shoulder Complex General Structure & Function Structure & Function of Specific Joints Muscular Considerations Specific Functional Considerations Common Injuries
Slide 3-

The Shoulder Complex General Structure & Function Structure & Function of Specific Joints Muscular Considerations Specific Functional Considerations Common Injuries
Slide 4-

General Structure
Slide 5-

General Function Provides very mobile, yet strong base for hand to perform its intricate gross and skilled functions Transmits loads from upper extremity to axial skeleton
Slide 6-

Shoulder Girdle
Slide 7-

Shoulder Complex Movements Shoulder Girdle Elevation & depression Protraction & retraction Upward & downward rotation Upward tilt Shoulder (glenohumeral) FL, EXT, HyperEXT ABD, ADD, HyperADD, HyperABD MR, LR, HorizontalABD, HorizontalADD
Slide 8-

Abduction/Lateral Tilt (Protraction) Adduction/Reduced Lateral Tilt (Retraction) Linear Movement Frontal Plane Angular movement Transverse Plane
Slide 9-

Depression Elevation Linear Movement Frontal Plane
Slide 10-

Downward rotation Upward rotation
Slide 11-

Shoulder Complex Movements Upward tilt Reduction of Upward Tilt Angular movement Sagittal plane
Slide 12-

Limited by capsular torsion Limited by bony impingement of greater tubercle on acromion
Slide 13-

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Slide 14-

Large ROM Due To: Poor bony structure Poor ligamentous restraint Scapulohumeral cooperative action
Slide 15-

The Shoulder Complex General Structure & Function Structure & Function of Specific Joints Muscular Considerations Specific Functional Considerations Common Injuries
Slide 16-

Structure & Function of Specific Joints Sternoclavicular Joint Acromioclavicular Joint Scapulothoracic Joint Glenolhumeral Joint Coracoacromial Arch
Slide 17-

Sternoclavicular Joint: Bony Structure Poor Diarthrodial Biaxial
Slide 18-

Sternoclavicular Joint: Capsule Very strong
Slide 19-

Sternoclavicular Joint: Interclavicular Ligament Resists superior & anterior (posterior portion) motion
Slide 20-

Sternoclavicular Joint: Sternoclavicular Ligament Resists anterior (PSL), posterior (ASL), & superior motion
Slide 21-

Sternoclavicular Joint: Costoclavicular Ligament Resists upward and posterior motion
Slide 22-

Sternoclavicular Joint: Accessory Structures Resists medial & inferior displacement via articular contact
Slide 23-

Sternoclavicular Joint: Articular Surfaces Medial end of clavice is convex Clavicular facet is reciprocally shaped
Slide 24-

Sternoclavicular Joint: Motions Axial Rotation: 50° EL/DEP: 35° PROT/RET: 35°
Slide 25-

Sternoclavicular Joint: Motions Frontal plane Elev/Dep Sagittal plane Post Rot Horizontal plane ProT/ReT Ant/Post axis Vertical axis
Slide 26-

Acromioclavicular Joint Bony Structure Poor Diarthrodial Nonaxial
Slide 27-

Acromioclavicular Joint: Joint Capsule Very weak
Slide 28-

Acromioclavicular Joint Acromioclavicular Ligament Resists axial rotation & posterior motion
Slide 29-

Acromioclavicular Joint Coracoclavicular Ligament Resists superior motion
Slide 30-

Acromioclavicular Joint Accessory Structures Articular disc
Slide 31-

Acromioclavicular Joint: Motion Little relative motion at AC joint UR/DR: 60° EL/DEP: 30° PROT/RET: 30-50°
Slide 32-

Acromioclavicular Joint: Osteokinematics Horizontal plane adjustments during scapulothoracic protraction Sagittal plane adjustment during scapulothoracic elevation
Slide 33-

Clavicle Acts a strut connecting upper extremity to thorax Protects brachial plexus & vascular structures Serves as attachment site for many shoulder muscles
Slide 34-

Scapula
Slide 35-

Scapular Plane
Slide 36-

Scapulothoracic Joint No osseous connection SUBSCAP & SA
Slide 37-

Glenohumeral Joint: Humerus Retroversion angle: 30°
Slide 38-

Glenohumeral Joint: Humerus Inclination angle: 45°
Slide 39-

Glenohumeral Joint: Glenoid Fossa Inclination angle: 5° Retroversion angle: 7°
Slide 40-

Glenohumeral Joint: Glenoid Fossa Articular cartilage thicker on periphery Shallow fossa 1/3 diameter of humeral head
Slide 41-

Glenohumeral Joint: Bony Structure Pure rotation Bony restraint poor Head 4-5X larger than fossa Close-packed position ABD with LR
Slide 42-

Glenohumeral Joint: Joint Capsule Inherently lax Surface area 2X head Provides restraint for ABD, ADD, LR, MR
Slide 43-

Glenohumeral Joint: Superior GH Ligament Resists inferior translation in rest or adducted arm Well-developed in 50%
Slide 44-

Glenohumeral Joint: Coracohumeral Ligament Resists inferior translation in shoulders with less-developed SGH
Slide 45-

Glenohumeral Joint: Middle GH Ligament Great variability in proximal attachment & morphology Absent in 30% Resists inferior translation in ABD & ER Restrains anterior translation (45° ABD)
Slide 46-

Glenohumeral Joint: Inferior GH Ligament 3 components (A,P,Ax) Resists inferior, anterior, & posterior translation
Slide 47-

Glenohumeral Joint: Bursae Subcoracoid Subacromial Subscapular
Slide 48-

Glenohumeral Joint: Accessory Structures 50% of depth Increases tangential stability 20% Labrum
Slide 49-

Glenohumeral Joint: Intra-articular Pressure Synovial fluid causes adhesion Provides ~50% restraint
Slide 50-

Coracoacromial Arch
Slide 51-

Glenohumeral Joint: ROM Flexion (167° W; 171° M) 30° in max LR Extension (60°) Abduction (180°) 60° in max IR Hyperadduction (75°)
Slide 52-

Glenohumeral Joint: ROM Medial rotation (90°) Lateral rotation (90°) Horizontal abduction (45°) Horizontal adduction (135°) Total rotation 180° Total ROT 90° in 90° ABD Role of multiarticular muscles???
Slide 53-

Glenohumeral Joint: ROM Medial rotation (90°) Lateral rotation (90°) Horizontal abduction (45°) Horizontal adduction (135°)
Slide 54-

Soft Tissue Restraint Summary Anterior Capsule Labrum Glenohumeral lig Coracohumeral lig Subscapularis Pectoralis major Inferior Capsule Triceps brachii (L) Posterior Capsule Labrum Teres minor Infraspinatus Superior Labrum Coracohumeral lig Suprapinatus Biceps brachii (L) Coracoacromial arch Subacromial bursa
Slide 55-

The Shoulder Complex General Structure & Function Structure & Function of Specific Joints Muscular Considerations Specific Functional Considerations Common Injuries
Slide 56-

Shoulder girdle has its own set of muscles.
Slide 57-

Retraction of the Scapulothoracic Joint Levator scapula
Slide 58-

Protraction of the Scapulothoracic Joint Pectoralis minor
Slide 59-

Pathomechanics of a weak serratus anterior muscle Deltoid force causes scapula to downwardly rotate. Unstable and cannot resist deltoid force
Slide 60-

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Slide 61-

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Slide 62-

GH Flexion Prime flexors: Anterior deltoid Pectoralis major: clavicular portion Assistant flexors: Coracobrachialis Biceps brachii: short head
Slide 63-

GH Flexion Anterior deltoid Coracobrachialis Biceps brachii
Slide 64-

GH Extension Gravitational force Posterior deltoid Latissimus dorsi Pectoralis major (sternal) Teres major (with resistance)
Slide 65-

Abduction at Glenohumeral Joint Major abductors of humerus: Supraspinatus Initiates abduction Active for first 110 degrees of abduction Middle deltoid Active 90-180 degrees of abduction Superior dislocating component neutralized by infraspinatus, subscapularis, and teres minor
Slide 66-

Abduction at Glenohumeral Joint Initiates abduction Active for first 110 degrees of abduction Active 90-180 degrees of abduction Superior dislocating componentneutralized by infraspinatus, subscapularis, and teres minor
Slide 67-

Abduction at Glenohumeral Joint: The “Kinetic Arc”
Slide 68-

Adduction of Glenohumeral Joint Primary adductors: Latissimus dorsi Teres major Sternocostal pectoralis Minor assistance: Biceps brachii: short head Triceps brachii: long head Above 90 degrees- coracobrachialis and subscapularis
Slide 69-

GH Medial Rotation Subscapularis Latissimus dorsi Pectoralis major Teres major (with resistance) Decreased activity with ABD
Slide 70-

GH Lateral Rotation Primary Infraspinatus Assistant: Teres minor Posterior deltoid
Slide 71-

Horizontal Adduction and Abduction Anterior to joint: Pectoralis major (both heads), anterior deltoid, coracobrachialis Assisted by short head of biceps brachi Posterior to joint: Middle and posterior deltoid, infraspinatus, teres minor Assisted by teres major, latissimus dorsi
Slide 72-

Muscle Strength Adduction (2X ABD) Extension Flexion Abduction Internal rotation (max in neutral) External rotation (max at 90° FL) Role of multiarticular muscles???
Slide 73-

The Shoulder Complex General Structure & Function Structure & Function of Specific Joints Muscular Considerations Specific Functional Considerations Common Injuries
Slide 74-

Specific Functional Considerations Stability Functions of Shoulder Girdle Mobility Functions of Shoulder Girdle Rotator Cuff Function
Slide 75-

Stability Functions of Shoulder Girdle Provides stable base from which shoulder muscles can generate force Shoulder girdle muscles as stabilizers Maintain appropriate force-length relationship Maintain maximum congruence of shoulder joint
Slide 76-

Specific Functional Considerations Stability Functions of Shoulder Girdle Mobility Functions of Shoulder Girdle Rotator Cuff Function
Slide 77-

Mobility Functions of Shoulder Girdle Permits largest ROM of any complex in the body Shoulder girdle increases ROM with less compromise of stability (scapulohumeral rhythm) (4 joints vs. 1 joint) Facilitate movements of the upper extremity by positioning GH favorably
Slide 78-

Dynamic Stabilization Mechanisms Passive muscle tension Compressive forces from muscle contraction Joint motion that results in tightening of passive structures Redirection of joint force toward center of GH joint
Slide 79-

Muscular Considerations Force-length relationships quite variable due to multiple joints Tension development in agonist frequently requires tension development in antagonist to prevent dislocation of the humeral head Force couple – 2 forces equal in magnitude but opposite in direction
Slide 80-

Movements in the Frontal Plane GH Joint - Abduction Shoulder Girdle: UR Totals Upward rotation - 60° GH Abduction - 120° 2:1 (.66) ratio 1.25:1 after 30° 0.5-0.75 across individuals ABD 30° ABD - 30° UR - 40° ABD - 60° UR - 20°
Slide 81-

Movements in the Frontal Plane GH Joint - Adduction Shoulder Girdle: DR Fig 5.17
Slide 82-

Movements in the Sagittal Plane GH Joint – Flexion & Extension Shoulder Girdle: UR ELEV (>90°) PROT ( to 90°) RET (>90°) Fig 5.18
Slide 83-

Movements in the Sagittal Plane GH Joint - Hyperextension Shoulder Girdle: Upward tilt of scapula Fig 5.20
Slide 84-

Movements in the Transverse Plane GH Joint – MR & LR Fig 5.22a
Slide 85-

Spinal Contribution to GH Motion
Slide 86-

Movements in the Transverse Plane GH HAdd & HAbd
Slide 87-

Influences on GH ROM Humeral position in other planes FL limited by ER (30 FL in max ER) ABD limited by IR (60-90 ABD in max IR) ABD with ER = 90-120 Rotation limited by ABD (total ROT only 90 in 90 ABD) Scapular position Elbow position
Slide 88-

Large ROM Due To: Poor bony structure Poor ligamentous restraint Scapulohumeral coordination Normal movement dependent on interrelationships of 4 joints Restriction in any of these four can impair normal function
Slide 89-

Specific Functional Considerations Stability Functions of Shoulder Girdle Mobility Functions of Shoulder Girdle Rotator Cuff Function
Slide 90-

Subscapularis Teres minor Supraspinatus Infraspinatus
Slide 91-

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Slide 92-

Function of Rotator Cuff Large external muscles (e.g., lats, delts) create shear forces Rotator cuff provides Joint compression Tangential restraint (Ant, Post, Sup)
Slide 93-

Destabilizing Action of Deltoid
Slide 94-

Deltoid produces superior shear force at GH joint.
Slide 95-

Subscapularis Resists superior shear Produces simultaneous internal rotation
Slide 96-

Infraspinatus & Teres Minor Resists superior shear Neutralizes SUBSCAP internal rotation
Slide 97-

Supraspinatus
Slide 98-

Summary of Active Arthrokinematics Resisting Shear
Slide 99-

Destabilizing Action of Latissimus Dorsi LD pulls humerus INF SSP resists INF force INF & SUBSCAP create compressive force
Slide 100-

The Shoulder Complex General Structure & Function Structure & Function of Specific Joints Muscular Considerations Specific Functional Considerations Common Injuries
Slide 101-

Common Shoulder Injuries Joint dislocations Clavicular fracture Rotator cuff injuries Other rotational injuries Subscapular neuropathy
Slide 102-

Evaluation of Injuries Mechanism of Injury (MOI): How did the injury occur? Pathology (PATH): What tissues are damaged? Sign & Symptoms (S&S): What does the patient tell you? What can be determined from an evaluation of the injury?
Slide 103-

Joint Dislocations: Acromioclavicular Sprain AKA Shoulder Separation MOI: Downward blow to outer end of shoulder Fall on outstretched hand, Punching PATH: Sprain of AC ligaments S&S: Pain over AC joint Laxity of AC joint???
Slide 104-

Joint Dislocations: Shoulder Dislocation MOI: Arm forcefully ABD & LR May occur by a blow to top of shoulder PATH: Head of humerus is forced out of the glenoid fossa S&S: Arm held out from side in slight ABD & LR Loss of normal rounded contour of deltoid muscle
Slide 105-

Chronic Dislocation of the Shoulder MOI: Congenital abnormality Repeated acute dislocations PATH: Head of humerus relatively easily come out of the glenoid fossa Tissue damage due to repeated dislocations S&S: Usually not very painful
Slide 106-

Clavicular Fracture MOI: Downward blow to outer end of shoulder Fall on outstretched hand PATH: Fracture to middle 1/3 S&S: Patient supports injured arm Head may be tilted toward injured side with face turned to opposite side
Slide 107-

Rotator Cuff Injuries MOI: Overuse Falling on an outstretched hand PATH: Strains or tearing of rotator cuff muscles Supraspinatus most often injured S&S: Pain, Inflammation, Weakness
Slide 108-

Impingement Possible mechanisms Weak or inflexible rotator cuff Small anatomical space Hyperabduction of GH joint GH ABD + ROT
Slide 109-

Impingement: Roll-Slide Kinematics “Roll” created by abduction not countered with “Slide” action
Slide 110-

Rotator Cuff Injury Anatomical cause of rotator cuff injury Kinesiological cause of injury
Slide 111-

Impingement Narrow space Inextensibility of capsule, ligaments, muscles – esp. rotator cuff Abduction and internal/external rotations
Slide 112-

During ABD SSP tendon pushed into acromion process & CA ligament During ROT SSP tendon dragged along the inferior surface of the acromion process
Slide 113-

Rotator Cuff Injury Anatomical cause of rotator cuff injury Kinesiological cause of injury
Slide 114-

Wind-Up Phase Kinesiological breakdown of overhand throwing No excessive movements (safe) First Motion Maximum knee lift of leg
Slide 115-

Shoulder ABD (DELT & SSP) RC maintain proper humeral head position Abduction and no rotation (Safe) Kinesiological breakdown of overhand throwing Stride Lead leg begins to move Arms separate Lead foot contacts the ground
Slide 116-

ER in ABD position; ER 150-180° ECC action of SUBSCAP (decelerates ER humerus) RC stabilization Kinesiological breakdown of overhand throwing Arm Cocking Lead foot contact Maximum shoulder external rotation External rotation in abducted position Possible cuff damage
Slide 117-

Concentric IR (PMJR & LD ) IR velocity (> 1000 °/s) RC stabilization Kinesiological breakdown of overhand throwing Arm Acceleration Maximum shoulder ER Ball release Internal rotation in abducted position Possible cuff damage
Slide 118-

Decelerating IR & ADD ECC action of TMin RC stabilization Kinesiological breakdown of overhand throwing Arm Deceleration Ball release Maximum shoulder IR Internal rotation Abduction reduced Safer
Slide 119-

Decelerating IR ECC action of TMin RC stabilization Kinesiological breakdown of overhand throwing Follow Through Maximum shoulder IR Ends in balanced position Reduced internal rotation Safe
Slide 120-

Rotator Cuff Injuries: Solution Alter technique during problem phases to avoid impingement Arm cocking Arm acceleration Strengthen rotator cuff Surgical repair Video techniques
Slide 121-

Risk Factors Risk factor – a characteristic that influences the loading on the musculoskeletal system Movement risk factors – characteristics of a movement Intrinsic risk factors – the personal, physical, and psychological characteristics of an individual Extrinsic risk factors – the environmental and administrative procedures
Slide 122-

Intrinsic Risk Factors Age and gender Physical fitness Overtraining Skeletal abnormalities Technique Warm-up Psychological factors
Slide 123-

Technique Technique refers to the movement pattern of an individual during a particular movement or sequence of movements. Good technique is a movement pattern not only effective in performance, but also one that minimizes risk of injury by appropriately distributing the overall load throughout the kinetic chain. Poor technique is characterized by inappropriate utilization and summation of muscular effort and abnormal joint movements, both of which result in localized overload and, therefore, increased risk of injury.
Slide 124-

Swimming Mechanism: ABD + IR Solutions: Lead with hand to ↓ IR Increase body roll to ↓ ABD
Slide 125-

Supraspinatus Tear
Slide 126-

Other Rotational Injuries Tears of labrum Mostly in anterior-superior region Tears of biceps brachii tendon Due to forceful rotational movements Also: calcification of soft tissues, degenerative changes in articular surfaces, bursitis
Slide 127-

Biceps Tendon Tear
Slide 128-

Subscapular Neuropathy Denervation of INF with ↓ strength GH ER Mechanism: Repeated stretching of nerve
Slide 129-

Loads on the Shoulder Arm segment moment arm: Perpendicular distance between weight vector and shoulder. With elbow flexion, upper arm and forearm/hand segments must be analyzed separately. Large torques from extended moment arms countered by shoulder muscles. Load reduced by half with maximal elbow flexion
Slide 130-

Injury Potential in the Shoulder Complex - Impacts Sternoclavicular Joint not commonly injured may sprain anteriorly if fall on top of shoulder or middle delt - pain in horizontal abd children may dislocate anteriorly during throwing because of increased joint mobility as compared to adults posterior dislocation may occur when force is applied to sternal end of clavicle; serious because of trachea, esophagus, and blood vessels located posteriorly Clavicular Injuries fx to any part due to direct trauma fx to middle 1/3 can occur by falling on shoulder, outstretched arm, or direct trauma to shoulder that transmits force down shaft of clavicle AC Injuries dislocation from fall on shoulder, fall on elbow or outstretched arm overuse injuries from overhand pattern (throwing, tennis, swimming) or sports that repeatedly load in the overhead position (wrestling, wt lifting)
Slide 131-

Glenohumeral Injuries Most common dislocation in anterior (anterior-inferior 95%) most commonly dislocated when abducted and ER overhead recurrence rate 33-50% (66-90% <20 yrs)