The Shoulder. Anatomy and Injuries PSK 4U Unit 3, Day 4

Transcription

1 The Shoulder Anatomy and Injuries PSK 4U Unit 3, Day 4

2 Shoulder Girdle Shoulder Complex is the most mobile joint in the body. Scapula Clavicle Sternum Humerus Rib cage/thorax

3 Shoulder Girdle It also includes Sternoclavicular joint Acromicoclaviulcar joint Glenohumeral joint Scapulothoracic articulation Shoulder joint is attached to axial skeleton via the clavicle at sternoclavicular joint

4 The Shoulder Joint Wide range of motion of the shoulder joint in many different planes requires a significant amount of laxity Common to have instability problems Rotator cuff impingement Subluxations & dislocations The price of mobility is reduced stability The more mobile a joint is, the less stable it is & the more stable it is, the less mobile McGraw-Hill Higher Education. All rights reserved. 5-4

5 Shoulder Girdle Ligaments Sternoclaviular Joint-Joint connecting the sternum to the clavicle on each side of the body.

6 Shoulder Girdle Ligaments Acromioclavicular Joint- joint connecting the acromion process to the clavicle at the distal end of the clavicle.

7 Shoulder Girdle Joints Glenohumeral joint- joint where the humerus fits into the glenoid fossa of the scapula.

8 Shoulder Girdle Ligaments Scapulothoracic joint- joint where the scapula slides over the thorax or rib cage.

9 Bones Scapula, clavicle, & humerus serve as attachments for shoulder joint muscles Scapular landmarks supraspinatus fossa infraspinatus fossa subscapular fossa spine of the scapula glenoid cavity coracoid process acromion process inferior angle McGraw-Hill Higher Education. All rights reserved. 5-9 From Seeley RR, Stephens TD, Tate P: Anatomy and physiology, ed 7, New York, 2006, McGraw-Hill

10 Bones Scapula, clavicle, & humerus serve as attachments for shoulder joint muscles Humeral landmarks Head Greater tubercle Lesser tubercle Intertubercular groove Deltoid tuberosity McGraw-Hill Higher Education. All rights reserved. 5-10

11 multiaxial ball- &-socket Glenohumeral Joint McGraw-Hill Higher Education. All rights reserved. 5-11

12 Bones of Shoulder Joint Clavicle Acromion Process Glenoid Posterior Anterior

13 McGraw-Hill Higher Education. All rights reserved. 5-13

14 Glenoid labrum slightly enhances stability Glenohumeral Joint McGraw-Hill Higher Education. All rights reserved. 5-14

15 GLENOID LABRUM Cartilage ring around the glenoid fossa. Deepens the socket of the G-H Joint.

16 Glenohumeral Joint Glenohumeral ligaments provide stability especially anteriorly & inferiorly inferior glenohumeral ligament McGraw-Hill Higher Education. All rights reserved. 5-16

17 Acromioclavicular Coracoclavicular Coracoacromial Lig. Superior, Middle and Inferior Glenohumeral Ligament

18 Glenohumeral Joint Ligaments are quite lax until extreme ranges of motion reached due to wide range of motion involved Stability is sacrificed to gain mobility McGraw-Hill Higher Education. All rights reserved. 5-18

19 Glenohumeral Joint Frequently injured due to anatomical design shallowness of glenoid fossa laxity of ligamentous structures lack of strength & endurance in muscles anterior or anteroinferior glenohumeral subluxations & dislocations common posterior dislocations rare posterior instability problems somewhat common McGraw-Hill Higher Education. All rights reserved. 5-19

20 Glenohumeral Joint Rotator cuff is frequently injured Subscapularis, supraspinatus, infraspinatus, & teres minor muscles attach to the front, top, & rear of humeral head point of insertion enables humeral rotation vital in maintaining humeral head in correct approximation within glenoid fossa while more powerful muscles move humerus through its wide range of motion McGraw-Hill Higher Education. All rights reserved. 5-20

21 Movements Abduction upward lateral movement of humerus out to the side, away from body Adduction downward movement of humerus medially toward body from abduction McGraw-Hill Higher Education. All rights reserved. 5-21

22 Flexion movement of humerus straight anteriorly Extension movement of humerus straight posteriorly Movements McGraw-Hill Higher Education. All rights reserved. 5-22

23 Movements Horizontal adduction (transverse flexion) movement of humerus in a horizontal or transverse plane toward & across chest Horizontal abduction (transverse extension) movement of humerus in a horizontal or transverse plane away from chest McGraw-Hill Higher Education. All rights reserved. 5-23

24 Movements External rotation movement of humerus laterally around its long axis away from midline Internal rotation movement of humerus medially around its long axis toward midline McGraw-Hill Higher Education. All rights reserved. 5-24

25 Movements Diagonal abduction movement of humerus in a diagonal plane away from midline of body Diagonal adduction movement of humerus in a diagonal plane toward midline of body McGraw-Hill Higher Education. All rights reserved. 5-25

26 Scapula movement usually occurs with movement of humerus: Humeral flexion & abduction require scapula elevation, rotation upward, & abduction Humeral adduction & extension results in scapula depression, rotation downward, & adduction Scapula abduction occurs with humeral internal rotation & horizontal adduction Scapula adduction occurs with humeral external rotation & horizontal abduction McGraw-Hill Higher Education. All rights reserved. Glenohumeral Joint 5-26

27 Glenohumeral Joint Determining exact range of each movement at the glenohumeral joint is difficult due to accompanying shoulder girdle movement (movement at the scapula) Shoulder Flexion Extension Hyperextension Adduction Abduction Medial rotation Lateral rotation Shoulder girdle Up rotation Down rotation Scapular tilt Down rotation Up rotation Protraction Retraction McGraw-Hill Higher Education. All rights reserved. 5-27

28 Scapulohumeral rhythm The first 30 degrees of motion is shoulder. After that the for every 2 degrees the humerus moves the scapula upwardly rotates 1 degree.

29 Lets try it Stand next to a partner that you are comfortable touching on their back. Person in anatomical position, place your hand on the axillary border of the scapula. Ask them to abduction and see what happens when they get above 30 degrees. The scapula will start rotating upward

30 Shoulder Injuries

31 Shoulder Separation Separation: occurs when bones held together by fibrous ligaments tear and separate from each other. There are several grades of separation depending on the severity of the torn ligaments

32 Grades of Shoulder Separation

33 Healthy Shoulder Separated Shoulder

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35 Shoulder Dislocation Dislocation occurs when a bone is displaced from its original location Usually involves damage to the joint capsule and the ligaments that hold the joint together Signs and symptoms include: Joint looks awkward or deformed Joint is painful Joint is not useable

36 Healthy Shoulder Dislocated Shoulder

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38 Shoulder bursitis Occurs from trauma or overuse or direct impact Signs and symptoms are: pain with movement; tenderness to palpation in area just under acromion

39 Shoulder Impingement Cause: mechanical compression of supraspinatus tendon, the subacromial bursa, and long head of biceps tendon; most common in overhead activities Signs and symptoms: diffuse pain around the acromion in overhead position; external rotators weaker than internal; tightness in posterior and inferior capsules;

40 First Aid Care The first aid care for the majority of these shoulder injuries is PIER. After PIER and further monitoring, further medical attention may be required.