NMS

728/99

 

Shoulder Joint

7 joints

1. Glenohumeral
2. Suprahumreal
3. Costovertebral
4. AC
5. Scapulocostal
6. SC
7. Sternocostal

Normal

• Humeral scapular movement
• Abducting shoulder
• As glenohumeral abducts 180°, the scapulohumeral moves 60°
• Scapulohumeral rhythm
• Basic and fundamental for normal movement
• Tendonitis bursitis of the shoulder
• Have to look at the entire shoulder girdle
• Subscapular bursitis—very painful
• Primary cause of loss of motion
• Subscapularis muscle
• And tightness of subscapularis is not the main reasons why problem w/scapulohumeral rhythm
• Irritated tissues to make up the difference

1.      Rhomboids (major and minor) and levator scapulae—when tight do not allow for motion—many trigger points and tenderness—watch for movement of the scapula w/abduction

·        C5 innervates these muscles

·        Descending branch from C5

·        Subluxation of mid cervical could cause CES leading to particular muscles to go into spasm

·        Muscles attach upper thoracic vertebrae—need to keep joints moving

2.      Posture of the individual

·        Stooped shoulder appearance of posture

·        Seen w/age

·        Increase thoracic curvature

·        Pain into suprahumeral joint

·        Bumps greater trochanter w/acromion (bone on bone contact)

·        Many ligaments in this area

3.      Scoliosis

·        Low shoulder is compromised in motion

 

Arm Abduction

• When abduct arm, bring arm up to clap hands
• Externally rotate at we elevate
• If do not achieve external rotation, will not move greater trochanter to avoid acromion
• Abduction w/o external rotation is another major reason pinching these structures

 

Soft Tissues

• Easily compromised
• Subdeltoid fascia—highly innervated, primary source of pain
• Subdeltoid (subacromial) bursa
• Supraspinatus tendon—initiates abduction
• Irritated fascia—swells bursa—swells tendon
• Calcium causes the tendon to swell (toothpaste consistency)
• Bulging tendon—acute bursitis tendonitis—virtually impossible to distinguish b/w—if get one, get both
• Pathonomic sign is associated w/painful arc
• Shoulder hurts
• Abduction will be the most painful
• Painful arc
• Raise arm above shoulder
• 1^st 20°-30° elevation—no pain
• At 30° start impinging structures—pain starts
• Pain becomes intense at 90°
• At 120° pain starts to diminish
• Structures have slipped from under the structures
• Occurs in active and passive ROM
• Another way
• Bring shoulder into extension
• Brings bursa and humeral head out
• Push on humeral head and elicit pain

 

Passive Movements of the Shoulders

• Transalatory movement of the shoulder in x axis
• Distraction and compression of shoulder (long axis extension)—transalatory motion
• AP and PA motion—one of the better ones—z axis
• Inferior and anterior pull—y axis
• Codman pendular exercises
• Separate glenohumeral joint
• Increase suprahumeral space
• Relaxes muscles
•