Lecture 4: The shoulder

Question 1

The shoulder girdle comprises of what? what are the articulations
All these structures move the joint.
What are the movements of the shoulder girdle?

Answer 1

Clavicle, Scapula, humerus 
Articulations:
-Glenohumeral joint 
-acromioclavicular 
-sternoclavicular
-scapulothoracic

Shoulder movements:
Elevation, abduction, adduction, depression, downward rotation and upward rotation

Question 2

Applied anatomy:

Answer 2

• lax ligaments so extreme ranges of motion can occur at GH joint
• stability sacrificed to gain mobility
• ligaments provide most stability anteriorly and inferiorly
• The role of rotator cuff as dynamic stabilisers is very important, more so than role of ligaments as static stabilisers

Question 3

What are the shoulder girlde muscles i.e. scapula stabilisers?

What are the muscles of the rotator cuff?

What are the postural muscles?

Answer 3

• serratus anterior
• rhomboid major and minor

Rotator cuff:
-supraspinatus
-infraspinatus 
-teres minor 
-subscapularis 
deltoid has a role to play. 

Postural muscles?

• trapezius
• pectoralis major
• levator scapula

Question 4

What are the movements of the shoulder joint?
at the same time
What are the movements of the shoulder girdle?

Answer 4

slide 10

Question 5

How would you evaluate the shoulder?

Answer 5

1. Observation:
   - Bulk, symmetry, sulcus sign (instability)
2. ROM
   - in all movements
   - apleys scratch position
   - active abduction
   - scapulohumeral rhythm:
   - 0-30 degree= deltoid and rotator cuff. scapular remains stabilised, GH movement only
   - 30-180-> 1 : 1.5 ratio of scapular to GH movement
3. Palpation: feel area of complaint, or remote area if other causes aof pain are suspected
4. Ortho tests;

Question 6

What may cause altered scapulohumeral rhythm?

Answer 6

• excesssive scapular movement due to decreased rotator cuff strength i.e. patient has to move scap to allow abduction of arm
• excessive upper trap activation causing a hitch –> often due to deltoid weakness
• weak serratus anterior/ rhmoboid muscles causing scap winging
• hypertonic pec minor causes forward tilting of scap- rounded shoulder posture

Question 7

What are the musckuloskeletal sources of pain in the shoulder?

Answer 7

• Myosfascial
• rotator cuff injury
• Gh instability- entrament syndromes
• Glenoid labral tears
• impingement syndromes
• bursitis
• AC joint Injury

Question 8

What are some of the muscles that could cause pain around the arm or shoulder?

Answer 8

• supraspinatus -causes both shoulder and slow pain- can mimic tennis elbow
• infraspinatus - similar to above but doenst centre around the elbow
• terres minor- lateral boarder of scap
• subscapularis -often key to frozen shoulder symptoms- coz u lose external rotation this will be hypertonic
  
  • active in medial rotation and adduction
  • restrictions will be abduction, lateral rotation. Painis often at rest and in motion. Pain at wrist
  • prevents anterior discplacement