1
Q
Purposeful Movement of the Shoulder
A
- where the kinetic change starts
- involved cooperative and synchronous motion of the scapula, clavicle, and humerus
- allows us to position the arm in space for occupational performance
- scapulohumeral rhythm
2
Q
Components of the Shoulder Complex
A
- scapulothoracic (ST) joint
- glenohumeral (GH) joint
3
Q
Scapulohumeral rhythm
A
Patterns of movement between the scapula and the humerus
4
Q
Bony landmarks of the shoulder
A
- medial and lateral border of the scapula
- inferior and superior angle of the scapula
- acromion process
- humeral head
- olecranon process
5
Q
Scapulothoracic (ST) joint
A
- the scapula glides, rotates, and tilts across the rib cage
- serves as the foundation for kinetic chains of the upper extremity
- functional movement involves a combination of scapular movement
movements:
- elevation/depression
- retraction/protraction
- upward/downward rotation
- looking for symmetry in movement
- can complete manual mobilization/PROM to assess mobility
6
Q
Sternoclavicular (SC) joint
A
Movements:
- elevation/depression
- protraction/retraction (abduction/adduction)
- posterior/anterior rotation
- only the bony attachment of the shoulder to the axial skeleton (meaning the only bony attachment of the upper extremity to the rest of the body)
- cooperates with the scapula to facilitate the movement of the humerus
7
Q
Acromioclavicular (AC) joint
A
Movements:
- anterior/posterior gliding
- superior/inferior gliding
- assists in facilitating movement of the shoulder complex
8
Q
Glenohumeral joint (GHJ)
A
Movements:
- flexion/extension
- abduction/adduction
- horizontal abduction/adduction
- internal/external rotation
- movement depends on stability and mobility of the scapula and clavicle
- 60 degrees = scapular rotation
- 120 degrees = glenohumeral joint
9
Q
Typical ROM of shoulder flexion (GHJ)
A
170 degrees
10
Q
Prime movers of shoulder flexion (GHJ)
A
- anterior deltoid
- pectoralis major
- biceps brachii
11
Q
Typical ROM of shoulder extension (GHJ)
A
60 degrees
12
Q
Primer movers of shoulder extension (GHJ)
A
- posterior deltoid
- latissimus dorsi
13
Q
Typical ROM of shoulder abduction
A
170 degrees
14
Q
Primer movers of shoulder abduction (GHJ)
A
- deltoid
- supraspinatus
15
Q
Typical ROM of shoulder horizontal abduction (GHJ)
A
45 degrees
16
Q
Prime movers of shoulder horizontal abduction (GHJ)
A
- posterior deltoid
17
Q
Typical ROM of shoulder horizontal adduction (GHJ)
A
135 degrees
18
Q
Primer movers of shoulder horizontal adduction (GHJ)
A
- anterior deltoid
- pectoralis major
19
Q
Typical ROM of shoulder external rotation (GHJ)
A
90 degrees
20
Q
Primer movers of shoulder external rotation (GHJ)
A
- posterior deltoid
- infraspinatus
- teres minor
21
Q
Typical ROM of shoulder internal rotation
A
70 degrees
22
Q
Primer movers of shoulder internal rotation
A
- subscapularis
- teres major
- anterior deltoid
23
Q
MMT of shoulder flexion
A
- against gravity position = sitting with shoulder flexed to 90 degrees and forearm neutral (thumb up)
- stabilizing hand = superior aspect of shoulder girdle
- resistive hand = superior aspect of distal humerus
- force application = against flexion
- gravity eliminated position = side lying on non-test side; shoulder and forearm neutral
- palpation = anterior deltoid
24
Q
MMT of shoulder extension
A
- against gravity position = prone with shoulder in midrange extension
- stabilizing hand = posterior scapula
- resistive hand = distal posterior humerus
- force application = against extension
- gravity eliminated position = side lying on non-test side
- palpation = posterior deltoid
25
MMT of shoulder abduction
- against gravity position = sitting, with shoulder abducted to 90 degrees, shoulder externally rotated and forearm supinated (thumb up)
- stabilizing hand = superior aspect of shoulder girdle
- resistive hand = lateral aspect of distal humerus
- force application = against abduction
- gravity eliminated position = supine
- palpation = middle deltoid, supraspinatus
* you don’t test shoulder adduction for MMT
26
MMT of shoulder horizontal abduction
- against gravity position = prone with shoulder abducted to 90 degrees and elbow flexed to 90 degrees in midrange horizontal abduction
- stabilizing hand = posterior scapula
- resistive hand = posterior aspect of distal humerus
- force application = against horizontal abduction
- gravity eliminated position = sitting with shoulder supported in 90 degrees abduction and elbow in 90 degrees flexion
- palpation = posterior deltoid
27
MMT of shoulder horizontal adduction
- against gravity position = supine with shoulder abducted to 90 degrees and elbow flexed to 90 degrees in midrange horizontal adduction
- stabilizing hand = anterior shoulder girdle over clavicle (opposite shoulder)
- resistive hand = anterior aspect of distal humerus
- force application = against horizontal adduction
- gravity eliminated position = sitting with shoulder supported in 90 degrees abduction and elbow in 90 degrees flexion
- palpation = pectoralis major
28
MMT of shoulder external rotation
- against gravity position = prone with shoulder abducted to 90 degrees and elbow flexed to 90 degrees, shoulder in midrange external rotation
- stabilizing hand = posterior humerus against plinth
- resistive hand = dorsal aspect of distal forearm
- force application = against external rotation
- gravity eliminated position = sitting with upper arm against side of body and elbow flexed to 90 degrees
- palpation = posterior deltoid, infraspinatus, and teres minor
29
MMT of shoulder internal rotation
- against gravity position = prone with shoulder abducted to 90 degrees and elbow flexed to 90 degrees, shoulder in midrange internal rotation
- stabilizing hand = posterior humerus
- resistive hand = volar aspect of distal forearm
- force application = against internal rotation
- gravity eliminated position = sitting with upper arm against side of body and elbow flexed to 90 degrees
- palpation = anterior deltoid and subscapularis anterior shoulder
30
Clinical implications
- scapular winging
- postural compromise
- subacromial impingement
- thoracic outlet syndrome
- glenohumeral subluxation
- bicipital tendinitis
- rotator cuff tear
- joint dislocation
- osteoarthritis
31
Scapular winging
- caused by weakness of the serratus anterior which stabilizes the scapula against the rib cage
- can be caused by neurological conditions
- interventions = strengthening serratus anterior and other scapular stabilizers
32
Postural compromise
- balanced upright posture is important for maintaining purposeful movement of the shoulder
- sitting for long periods of time can lead to trunk fatigue and slouching
- pec muscles tighten and scapular stabilizing muscles weaken and lengthen
- can lead to subacromial impingement and thoracic outlet syndrome
- interventions = postural education, workplace modifications, exercises to counteract postural difficulties
33
Subacromial impingement
Compression of the soft tissue between the acromion and the humeral head
34
Thoracic outlet syndrome
Compression of the structures beneath the clavicle and pectoralis muscles
35
Glenohumeral subluxation
- partial dislocation of the GHJ due to elongating of ligaments of the joint capsule
- often caused by hemiparesis after CVA where gravity pulls the joint apart
- interventions = supportive tray/positioning or GivMor Sling
36
Bicipital tendinitis
- weakness of the rotator cuff that causes the long head of the biceps to become inflamed
- caused by repetitive shoulder flexion
- interventions = activity modification, rest, pain management
37
Rotator cuff tear
- SITS = subscapularis, infraspinatus, teres minor, supraspinatus
- incidence increases with age
- can develop slowly or develop suddenly with acute injury
- **supraspinatus is the most often injured**
38
Joint dislocation
- **most commonly dislocated joint = GHJ**
- can involve damage to the labrum
- depending on severity, injury may require surgical intervention
- conservative interventions = strengthening of rotator cuff to promote dynamic stability
39
Osteoarthritis
- caused by repetitive use over time
- may require activity modification due to functional limitations and pain
- interventions = surgery, adaptive equipment
40
ROM of shoulder flexion (GHJ)
- prime movers = anterior deltoid, pectoralis major, and biceps brachii
- patient position = sitting with arm relaxed at the side, forearm neutral (thumb pointing anteriorly)
- goniometer axis = lateral aspect of the humeral head
- stationary arm = lateral midline of the trunk
- moving arm = midline of lateral humerus
- compensatory movement = trunk rotation, trunk extension, scapular elevation
41
ROM of shoulder extension (GHJ)
- prime movers = posterior deltoid, latissimus dorsi
- patient position = prone
- goniometer axis = lateral aspect of the humeral head
- stationary arm = lateral midline of the trunk
- moving arm = midline of the lateral humerus
- compensatory movement = trunk extension, trunk rotation, scapular retraction
42
ROM of shoulder abduction (GHJ)
- prime movers = deltoid, supraspinatus
- patient position = sitting with arm relaxed at the side, forearm supinated and thumb pointing laterally
- goniometer axis = posterior or anterior aspect of the humeral head
- stationary arm = parallel to the trunk and perpendicular to the floor
- moving arm = posterior or anterior midline of the humerus
- compensatory movement = scapular elevation, contralateral trunk flexion
43
ROM of horizontal abduction (GHJ)
- prime movers = posterior deltoid
- patient position = sitting with the shoulder abducted to 90 degrees
- goniometer axis = superior aspect of humeral head
- stationary arm = parallel to frontal plane at midline of trunk
- moving arm = superior aspect of humerus
- compensatory movement = trunk extension, trunk rotation, scapular retraction
44
ROM of horizontal adduction (GHJ)
- prime movers = anterior deltoid, pectoralis major
- patient position = sitting with the shoulder abducted to 90 degrees and elbow flexed to 90 degrees
- goniometer axis = superior aspect of the humeral head
- stationary arm = parallel to frontal plane at midline of the trunk
- moving arm = superior aspect of the humerus
- compensatory movement = trunk flexion, trunk rotation, scapular protraction
45
ROM of external rotation (GHJ)
- prime movers = posterior deltoid, infraspinatus, teres minor
- patient position = prone with shoulder abducted to 90 degrees and elbow flexed to 90 degrees
- goniometer axis = olecranon process
- stationary arm = perpendicular to ceiling
- moving arm = midline of the ulna
- compensatory movement = shoulder abduction, trunk rotation
46
ROM of internal rotation (GHJ)
- prime movers = subscapularis, teres major, anterior deltoid
- patient position = prone with shoulder abducted to 90 degrees and elbow flexed to 90 degrees
- goniometer axis = olecranon
- stationary arm = perpendicular to ceiling
- moving arm = midline of the ulna
- compensatory movement = shoulder adduction, trunk rotation
