Understanding the Shoulder Article-2014

In this article, we will review the anatomy of the shoulder, common injuries to the shoulder, functional assessments and training strategies to work with clients with previous shoulder injuries. For more information, please visit Teaching The Science Behind The Movement
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  The shoulder: understanding the sciencebehind both movement and dysfunctionBy Chris Gellert, PT, MMusc & Sportsphysio, MPT,CSCS, MS !ntroduction The shoulder is a complex joint. That is involved in daily activities such as getting dressed or reaching into a cupboard. Because the shoulder is truly a ball and socket joint, providingit to move freely in six dierent motions, this makes it more susceptible to injury. In this article, we will review the anatomy of the shoulder, common injuries to the shoulder, functional assessments and training strategies to work with clients with previous shoulder injuries. unctional natomy  et!s look at two common functional tasks that everyone performs on a daily basis.The rst is getting dressed. The movement of putting a shirt on, biomechanically, re#uires the shoulder to undergo initial hori$ontal adduction, elbow %exion, then shoulder abduction and external rotation. &natomically, the posterior deltoid contracts during hori$ontal abduction, supraspinatus and medial deltoid abduct the shoulder, while teres minor and infraspinatus externally rotates the shoulder.a. 'etting dressed   igure #$ Getting dressed igure %$ Medial deltoid and supraspinatus b. (eaching into cupboard 1  The process of reaching into the cupboard biomechanically re#uires shoulder %exion as seenin the gure below. )ere during shoulder %exion, the humerus glides inferiorly*down+ on the glenoid cavity. &natomically, the anterior deltoid and coracobrachialis %ex the shoulder.  igure $ igure '$ nterior igure ($ Coracobrachialis)eaching into a cupboarddeltoidBasic anatomy et!s look at the shoulder anatomically There are four major joints within the shoulder complex, which include the glenohumeral joint, acromioclavicular joint, sternoclavicular joint and scapulothoracic joint. igure *$ +oints ithin the shoulder comple-  Muscles The four primary muscles that make up the rotator cu include supraspinatus, infraspinatus, teres minor and subscapularis. These four muscles provided stability and are involved in multiple daily activities, such as reaching, lifting, getting dressed and throwing a ball. 2    Supraspinatus muscle !nfraspinatus muscle Teres minor muscleSubcapularis muscle -ide raises the arm xternally rotates the armxternally rotates the arm Internally rotates the arm igure .$ )otator cu/ musclesBiomechanics /. 0uring shoulder %exion and abduction*side raising, there is #%0 degrees of movement that occurs at the glenohumeral joint and *0 degrees  at the scapulothoracic joint. This is called the scapulohumeral rhythm, *-)(+ as seen in gure 1. -)( is de ned as the movement relationship between the humerus and the scapula during arm raising movements.2. &s seen in gure 1, the humerus slides down in the glenoid cavity as the scapula rotates.3. & force couple is formed during abduction*side raising+ of the shoulder. The importance of this force couple* gure 4+, is that when these low trape$ius and searattus anterior are working synergistically,they biomechanically together cause upward rotation of the scapula on the thorax. This upward rotation of the scapula on the thorax is re#uired to raise them arm to the side. Individuals suering from impingement syndrome and rotator cu repair have an altered rthym as seen in the gure below. 3  igure 1$ 2ormal scapulohumeral rthym igure 3$  force couple is formed by the   low trape$ius and serratus anterior causing upward rotation and gliding of the scapula on the thorax igure #0$ bnormal scapular rthymCommon in4uries and causes There are dierent types of injuries the shoulder can sustain. The most common of the shoulder are impingement syndrome, rotator cu repair and sprain,. In this next section, we will review each condition providing a deeper understanding of each. a$ !mpingement syndromeMechanism of in4ury5pathophysiology: -houlder impingement may be either primary or secondary, diagnosed by physicians. There are two types of shoulder impingement, which is described below. #$ Primary6Mechanical7 impingement Is caused by a mechanical dysfunction such as bursa, acromioclavicular joint, acromion, humerus or rotator cu5supraspinatus tendon beneath thecoracromial arch. This is a mechanical   problem that may result from sub acromial crowding. %$ Secondary6Structural7  impingement Is caused by a relative decrease in subacromial spacecaused by instability of the glenohumeral joint, tight posterior capsule and weakness 4
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