The Shoulder

Sternoclavicular Joint

• Only attachment of upper extremity to trunk

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Acromioclavicular Joint

• AC ligament– Anterior– Posterior– Superior– Inferior

• Coracoclavicular Ligament

Glenohumeral Joint

• Humeral head is larger than glenoid• Static stabilizers- Labrum and glenohumeral

ligaments• Dynamic Stabilizers- Rotator cuff and Deltoid• Long head of biceps tendon passes superiorly

to the head of the humerus

Scapulothoracic Joint

• Movement of the scapula on the thoracic wall is critical to shoulder joint motion

• Muscles that attach to scapula must stabilize scapula providing a base for the head of humerus to rotate on.

Scapulohumeral Rhythm

• Movement of the scapula relative to the movement of the humerus in abduction

• First 30 degrees of abduction- no scapular movement

• 30-90 degrees of abduction- 1:2 ratio of scapula:humerus

• Above 90 degrees of abduction- 1:1 ratio of scapula:humerus

Stretching Exercises

• Static Hang from chin up bar• Codman’s Pendulums- Early in Rehab below 90• Sawing- Early in Rehab below 90• Wall Climb- Flexion and Abduction• Corner Stretch- Anterior Structures• Wand Stretches• Sleeper Stretch

Strengthening Exercises

• Free Weights• Weight Machines• Exercise Tubing

Strengthening Exercises• Bench Press• Horizontal Flys• Military Press• Front Raises• Side Raises• Reverse Flys• I’s• Y’s • T’s• Push-up with a plus• Push ups• Rows• Upright Rows• Ball push ups

Plyometric Exercises

• Need rebouder or partner• Single-arm toss• Double-arm toss with trunk rotation• Double-arm toss overhead• Push ups with a clap• Push ups on a box

Reestablishing Neuromuscular Control

• Weight Shifting– Table– Swiss Ball– Fitter Board– Wobble Board– Weighted Ball

• Slide Board• Rhythmic Stabilization• Body Blade

AC Sprain

• MOI- Fall on tip of shoulder• Rehab Concerns-Focus on Deltoid, Trapezius,

and Pectoralis Major muscles. Also focus on scapular stabilizers

• Grade I- Sling for a couple of Days. Begin AROM exercises immediately

• Grade II- 7-14 days in sling. Full RTP for contact sports 8-12 weeks.

Clavicle Fx

• MOI- FOOSHA, Direct Blow• Immobilization for 6-8 weeks• Regain ROM• Regain Strength– Deltoid– Pectoralis Major– RC– Scapular Stabilizers

Glenohumeral Dislocation

• MOI- 90 degree abduction, 90 degree elbow flexion and external rotation is most common

• 85-90% will dislocate again• Likely to tear labrum also• Avoid Following Postions– Anterior- Combined ER and Abduction. Fly, Pull Down,

Bench, Military Press– Posterior- Combined IR, Horizontal Adduction, and Flexion.

Fly, Bench, Weight bearing exercises– Inferior- Full Elevation. Shrugs, elbow curls, military press

GH Dislocation Cont.• Up to 3 weeks in sling

– Passive ROM– Isometrics– Scapular exercises without elevation

• Weeks 3-8– Restore full AROM– Begin neuromuscular control exercises

• Weeks 6-12– Begin scapular and rotator cuff exercises– Add motion neuromuscular control exercises– Begin Plyometrics– Begin Body Blade

• Weeks 12-20– Begin sport specific drills

Shoulder Impingement

• Mechanical compression of supraspinatus tendon, subacromial bursa, and biceps tendon

• MOI-Dynamic and static stabilizers fail to maintain subacromial space. Acute and Chronic

• Rehabilitation Concerns– Avoid activities above 90 degrees of flexion and abduction

early. – Focus on RC strength– Strengthen scapular stabilizers– Strengthen LE and Core to reduce stress on throwing shoulder