Shoulder

superior angle of scapula

at T2, 2nd rib level

inferior angle of scapula

at T7, 7th rib level

scapular spine

at T4, 4th rib level

clavicle shape

s shape

clavicle

sternum to scapula above 1st rib

spinal cord location

distal brain to superior border of 2nd lumbar vertebra

what motions are osteokinematics

flexion, extension, abduction, adduction

what motions are arthrokinematics

roll, glide, spin

how many degrees of freedom does the glenohumeral joint have and what are they

3 flexion/extension, abduction/adduction, IR/ER

what 2 mechanisms provide stability to shoulder

glenoid fossa and humeral head contact

glenoid labrum roles

deepen articulation, prevent humeral translation, transmission of forces across joint, capsular attachment

primary shoulder stabilizers

rotator cuff

secondary shoulder stabilizers

teres major, lats, pec major, long head of biceps, deltoid

what contributes to instability most of the time

weak stabilizers and overactive movers

roles of scapula

base support between UE and trunk, high degree of movement, point of attachment for rotator cuff, humeral movers, scapular stabilizers

force couples for upward rotation

upper trap, levator, serratus anterior

force couples for downward rotation

lower trap, rhomboids

scapulohumeral rhythm

2 degrees humeral elevation to every 1 degree scapular motion

setting phase of scapulohumeral rhythm

0-30, no scapular motion, can upward rotate

30-90 range of scapulohumeral rhythm

1 degree scapula upward rotation and abduction for every 2 degrees humeral elevation

90-180 range of scapulohumeral rhythm

1 degree scapula upward rotation and abduction for every 1 degree humeral elevation

supraspinatus nerve

suprascapular

supraspinatus action

abduction, humeral head stabilization

infraspinatus action

ER, humeral head stabilization

infraspinatus nerve

suprascapular

teres minor action

ER, humeral head stabilization

teres minor nerve

axillary

subscapularis action

IR

subscapularis nerve

subscapular

serratus anterior action

protraction, upward rotation, scapular stabilization

serratus anterior nerve

long thoracic

upper trap action

neck extension, lateral flexion/rotation, scap elevation, retraction, upward rotation

upper trap nerve

spinal accessory

middle trap action

scap retraction

middle trap nerve

spinal accessory

lower trap action

scap depression, retraction, upward rotation

lower trap nerve

spinal accessory

rhomboid major action

elevation, retraction, downward rotation

rhomboid major nerve

dorsal scapular

rhomboid minor action

elevation, retraction, downward rotation

rhomboid minor nerve

dorsal scapular

lats action

extension, adduction, IR

lats nerve

thoracodorsal

handcuff muscle

lats

teres major action

extension, adduction, IR

teres major nerve

lower subscapular

lats helper

teres major

levator scapulae action

scap elevation, downward rotation, lateral neck flexion, neck extension

levator scapulae nerve

dorsal scapular

pec major action

adduction, horizontal adduction, IR

pec major nerve

medial and lateral pectoral nerve

pec minor action

scap protraction, downward rotation, rib elevation

pec minor nerve

medial pectoral nerve

anterior deltoid action

flexion, IR

middle deltoid action

abduction

posterior deltoid action

extension, ER

deltoid nerve

axillary

biceps brachii action

elbow flexion, shoulder flexion, supination

biceps brachii nerve

musculocutaneous

coracobrachialis action

flexion, adduction

coracobrachialis nerve

musculocutaneous

triceps brachii action

elbow extension, shoulder extension

triceps brachii nerve

radial

TUBS instability

traumatic, unilateral, bankart lesion, surgery

AMBRI instability

atraumatic, multidirectional, bilateral, rehab, rarely inferior capsular shift

anterior instability symptoms

pain/clicking with overhead activity, dead arm syndrome in cocking phase, excessive anterior translation

what motion might be limited with anterior instability

ER

posterior instability symptoms

pain with overhead, crepitus during overhead, excessive posterior translation

what motion might be limited with posterior instability

IR

special tests for instability

anterior/posterior drawer, apprehension, sulcus sign

multidirectional instability symptoms

pain/clicking with arm at side

GH joint sprain MOI

forced abduction/ER, direct blow

what is a dislocation of the GH joint

grade 3 sprain

anterior GH dislocation MOI

direct blow to posterior, forced abduction/ER/extension

anterior GH dislocation symptoms

prominent humeral head, flattened deltoid, arm carried in abduction/ER, can’t touch opposite shoulder

posterior GH dislocation MOI

FOOSH, forced adduction/IR

posterior GH dislocation symptoms

arm carried in adduction/IR, flattened deltoid, prominent acromion and coracoid process, head of humerus seen posterior, limited ER/elevation

complications of anterior GH dislocation

Bankart, Hill sachs, SLAP tear, rotator cuff tear, biceps subluxation

complications of posterior GH dislocation

reverse bankart, reverse hill sachs, subscap avulsion

bankart lesion symptoms

catching sensation, aching of shoulder

hill sachs lesion

posterolateral humeral head fracture

reverse hill sachs lesion

anteromedial humeral head fracture

SLAP tear MOI

FOOSH, ER during cocking

SLAP tear symptoms

vague pain deep in shoulder, pain worse with overhead, catching, popping, weakness, instability, night pain

special tests for SLAP tear

Yergason’s, crank/grind, o’brien’s, biceps load

what is impinged with subacromial impingement

long head of biceps, subacromial bursa, rotator cuff

subacromial impingement MOI

altered mechanics, unable to maintain humeral head centering

subacromial impingement symptoms

anterior and lateral pain, dull achy pain, pain with overhead, night pain, difficulty sleeping on affected side

subacromial impingement special tests

painful arc, crossover, neer, speed’s, yergason’s, empty can, drop arm, hawkins kennedy

what motion is restricted when athletes have greater than 15 degrees of GIRD

upward rotation

rotator cuff injury symptoms

pain/swelling at greater tuberosity, pain with raising or lowering arm, clicking when raising arm, pain causing waking up, pain when reaching behind back

special tests for rotator cuff injury

gerber lift off, empty can, drop arm, resisted ER

biceps tendonitis symptoms

anterior shoulder pain with overhead, snapping, crepitus, tenderness

special tests for biceps tendonitis

yergasons, speeds

what causes primary internal impingement

humeral retrotorsion

what causes secondary internal impingement

anterior instability, scapular dyskinesia

internal impingement symptoms

throwing pain, trouble getting loose, loss of velocity and command, pain at posterior GH joint line, side differences in ROM

special tests for internal impingement

anterior instability, kim test

SC joint sprain MOI

fall on tip of shoulder, FOOSH

anterior SC joint dislocation symptoms

head tilted toward side, pain worse when supine, can’t put shoulder flat on table