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Rajala 1001 - BISC 1 Dr G Rajala Fall 2008 The Shoulder and...

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Unformatted text preview: BISC 1 Dr. G. Rajala Fall 2008 The Shoulder and Rotator Cuff Tears Superior surface A. Shoulder Girdle 1. clavicle Acromialend a. acromialend b. sternalend Sternal end Shaft body Inferior surface 2. scapula superior and inferior angles subscapular fossa coracoid process spine and acromion supraspinatus fossa infraspinatus fossa glenoid cavity Acromial face! Ameriol Sternal facet qurhsvancrm 3. humerus(proxima| end) a. head b. anatomical and surgical neck c. greater and lesser tubercles d. deltoid tuberosity Acromion Coracnid process Clavicle (Cut) /Superior angle Anatomical neck Greater tubercle Lesser iubercle Surgical neck Clenoid cavity of scapula Head of humerus Inferior angle Scapula Humerus Delloid tuberositv clavicle (cut) CoraCOId process Acromion g Superior angle N”; Supraspinous fossa / ‘ ° Spine Greater (ubercle lnfraspinous lossa Head of humerus Anatomical neck Surgical neck Inferior angle Delloid luberosity Scapula Humerus B. Shoulder Joint 1. 2. ball and socket (enarthrodial) ligaments C. Range of Motion (ROM) 1. 89‘9“wa flexion extension abduction add uction internal or medial rotation external or lateral rotation circumduction D. Scapular Motion 1. 2. 3. upward (lateral) rotation downward (medial) rotation other motion Fig.3 RANGE OF TRUE GLENOHUMERAL MOTION Fig.0 ”COMBINED' GLENOHUMERAL AND SOAPOLOTNORAOIC MOTION JNWARD ROTATION (internal) MOTION of the ARM at the SHOULDER VERTICAL PLANE 'I'. I". III ”II 921:7, 7/ ’l'. NEUTRAL THE SHOULD ER (ROTATION) NEUTRAL o O OUTWARD ROTATION \ ('el'crnol) 90 Fig. A ROTATION WITH ARM AT SlDE OUTWARD ROTATION \ (external) INWARD ROTATION (internal) 0 0 NEUTRAL 90 Fig.8 ROTATION IN ABDUCTlON Anterior View Acmmion Delloid muscle E. Muscles 1. deltoid o. clavicle, acromion, spine i. deltoid tuberosity a. abduction 2. rotator cuff (sits) supraspinatus o. suprasinatus fossa i. greater tubercle Posteriorview a. abduction infraspinatus o. infraspinatus fossa i. greater tubercle Dehoid ' ~ 1 " ' ‘ Acromion a. lateral rotation "‘“SC'e ’ ‘ ” ‘ Trapezius muscle Supraspinatus muscle Spine of scapula Infraspinalus ‘ I s ‘ ' lnfraspinalus muscle teres minor fascia o. lateral scapula i. greater tubercle a. lateral rotation f subscapualris fgl‘lfl; o. subscapular fossa =--.-.--== i. lesser tubercle a. medial rotation Teres minor muscle 3. combined rotator cuff action- hold the head ofthe humerus in place during shoulder motion Acromion Posterlor Vlew InfraSpinatus tendon (reflected) Joint capsule ul shoulder Deltoid muscle ireflectedl Teres minor muscle Supraspinalus muscle (cut) ' isca la ' ‘ Spine o pu Anterior View A\cromion \ / Supraspinalus tendon , Greater tubercle of humerus \ , Subscapulanstendon \ ‘ lnfraspinatus muscle (cut) Subscapularis muscle Subscapularis muscle F. Rotator Cuff Tear most often is supraspinatus Rotator Cuff Tear Subscapularis m, Humerus Biceps brachii tendon , Infraspinatus m. , » .' . Supraspinatus m. . . , r v Acute rupture (superior View). Orten asso- a '9' ciated with splitting tear parallel to tendon fibers. Further retraction results in Crescentic defect as shown at right G. Surgical Repair and Rehab Test for partial tear of cuff is inability to maintain 90° abduction against mild resustance PHYSICAL EXAM Extensive rupture of left curt To bring about abduction, delmid muscle contracts strongly but only pulls humerus upward toward acromion while scapula rotates and shoulder girdle is elevated. 45° abduction thus possible Quick Shoulder Exam Active Range of Motion: flexion extension abduction adduction medial rotation lateral rotation Comparative Strength: deltoid medial rotators lateral rotators Supraspinatus Test: negative weakness positive weakness Your Name: Partner’s Name: ...
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