Shoulders Shoulder anatomy - PowerPoint Presentation

Slide1

Shoulders

Slide2

Shoulder anatomy

Three Bones:

Humerous

, clavicle, and scapula

Three Joints:

Glenohumeral

,

acromioclavicular

, and

sternoclavicular

Slide3

Glenohumeral Joint

Slide4

Acromioclavicular

Slide5

S

ternoclavicular

Slide6

Rotator Cuff

What is the rotator

cuff injury?

glenohumeral

compression, rotation and dynamic stability

The Rotator cuff is made up of: supraspinatus,

infraspinatus

,

teres

minor, and

subscapularis

(SITS)

Shoulder pain is the worst pain

What type of joint is the shoulder (

glenohumeral

joint)?

Ball and socket

Slide7

Function of SITS

Supraspinatous

Abduct the shoulder

Stabilize the head of

humerus

in the

glenoid

Infraspinatous

Lateral rotate

Adduct the shoulder

Stabilize the head of

humerus

in the

glenoid

Teres

Minor

Lateral rotate

Stabilize the head of

humerus

in the

glenoid

Subscapularis

Medially rotate

Stabilize the head of

humerus

in the

glenoid

.

Slide8

Rotator Cuff tear/tendonitis

Degenerative process

More prevalent with advancing age

Not all RC tears require

surgury

Complete tear/partial tear usually occur with increasing age of populations

Muscle imbalance and capsular tightness impact the rotator cuff pathology and outcomes.

Slide9

Treatment?

Posture reeducation

ROM

PROM,AAROM, AROM

Strengthening

Education proper positioning (Support elbow while driving).

PAMs.

Manual therapy

Slide10

RC no tear/small tear

PROM and AAROM are initiated

May present with limited shoulder flexion and internal rotation.

Phase 1: forward flexion and ER supine (minimizes excessive tension)

Phase 2: extension, internal rotation and cross-body stretches.

Slide11

Treatment Ideas?

Slide12

Shoulder Impingements

Excessive and repetitive contact of the greater tuberosity of the humeral head with the

posterosuperior

aspect of the

glenoid

when it is repetitive abduction and external rotation.

Subscapularis

: Between the coracoid process and lesser tuberosity

Also identify as in the impingement category.

Slide13

Slide14

Importance of the scapula

Main stabilizers

Levator

scapula, rhomboid,

serratus

anterior, and trapezius

Improve scapular stabilization= better posture=more functional during ADL/IADL tasks.

Scapular plays major role in shoulder function.

Slide15

Scapulohumeral

rhythem

First 30 degrees of shoulder abduction, the scapular remains stationary

For every two degrees of

glenohumeral

movement, for every 1 degree of

scapulothoracic

movement

Slide16

Question

What nerve is involved with scapular winging:

A

.)

Thoracodorsal

nerve

B.) Axillary

C.)Long thoracic nerve

Slide17

Question

What are the movements of the scapula:

Elevation/depression, protraction/retraction, IR/ER, anterior/posterior tilt.

Slide18

Question

What two joint are under the most stress if a person has a hunch-over posture

SC and AC

Slide19

Question

What does a

kyphotic

posture look like?

Slide20

Slide21

Question

What provocative test is this?

Slide22

Question

What pathology does the speed’s test test for?

Long head of the biceps and superior

glenoid

labrum

Slide23

Frozen Shoulder

Other name for FS

-Adhesive Capsulitis

Freezing Phase

-Pain starts with sleep and ADL tasks

-Client tends to limit movement due to an increase in pain

Frozen Phase

-This may last up to a year and compensate for GH by substituting ST motion

Thawing Phase

-Can last up to 26 months. Recent study shows 90% of patients have return full motion when compared to their contralateral side.

Slide24

Thoracic Outlet Syndrome (TOS)

Compression can happen at:

Scalene triangle,

costoclavicular

space, and

pec

minor

Vascular damage is uncommon (3% to 5%)

Majority of TOS is brachial plexus related.

Slide25

Question

An OTR receives an order to work on a

nonresistive

exercise program with a patient who had a shoulder fracture 2 weeks ago.

Initial

OT treatment should include:

A. pendulum

exercises

B. active

ROM

C. weight

bearing exercises

D. isotonic

strengthening

Slide26

Question

An OTR is treating a patient who has a C6 complete spinal cord injury. The patient demonstrates Fair plus (3+/5) strength in scapular depression and Fair (3/5) should flexion and abduction bilaterally. The patient’s goal is to be able to sit at the edge of the bed independently. The

best

compensatory strategy for this patient to use would be full wrist extension along with shoulder:

A.)depression

, protraction, and external rotation

B.)elevation

, protraction, and external rotation

C.)elevation

, retraction, and internal rotation

D.)depression

, retraction, and internal rotation

Slide27

Question

During an upper extremity assessment, a patient demonstrates 45 degrees of active shoulder flexion while in a seated position. The OTR is able to passively move the limb through the full ROM. To accurately grade the strength of this muscle group, the OTR should

NEXT

:

A.)apply

resistance in midrange with the shoulder in the frontal plane

B.)apply

resistance in midrange to the opposing muscle groups

C.)determine

the end-feel of the

glenohumeral

joint

D.)determine

active motion in a gravity-eliminated position

Slide28

Question

6. A patient who had a left CVA a month ago reports constant pain in the right arm. The OTR notes that the patient’s right hand is hypersensitive and the skin is mottled. This condition is indicative of:

A.)a

hand contracture

B.)complex

regional pain syndrome

C.)a

brachial plexus injury

D.)thalamic

pain syndrome

Slide29

Question

A patient who has had a CVA has mild motor and sensory loss in the upper extremity. The patient tells the OTR that the lotion being provided for sensory input is causing a skin rash. The OTRs

best

response would be to:

A.)have

the patient rinse with water after using lotion

B.)refer

the patient to an allergist

C.)use

alternating heat and cold prior to applying lotion

D.)rub

the arm with objects of varied textures instead of lotion

Slide30

Question

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