Shoulder Girdle Analysis

The shoulder helps you to have full range of movement of your arm so that you can move your arm in a complete circle. Different bones and muscles make up the shoulder. There is the scapula, or the shoulder bone, this is the flat triangular bone that you feel in your back. Extending over the front of the shoulder and over is the clavicle, or collar bone, which is attached to the scapula and sternum, helping to stabilize the movement of the shoulder. The humerus is the longest bone in the arm and is connected to the scapula and clavicle.

Walch et al first described the internal impingement as an intraarticular impingement of the rotator cuff in the abducted and externally rotated shoulder. With 90 degrees of both abduction and external rotation, the articular surface of the posterior superior rotator cuff becomes pinched between the labrum and the greater tuberosity.5 The authors separated the labral lesions from SLAP lesions which extended anteriorly to the biceps anchor at the supraglenoid tubercle, concluding that internal impingement may be responsible for a subset of patients with isolated posterior SLAP tears.5

Inspection of the right shoulder joint reveals atrophy. Movements are restricted with flexion to 90 degrees limited by pain and abduction to 75 degrees limited by pain. Hawkin’s test, Neer’s test, Shoulder crossover test, Empty Cans test, Lift-off test, and Apprehension test is positive. On palpation, tenderness is noted in the acromioclavicular joint and subdeltoid

DOI: 2/24/2016. Patient is a 46-year-old male production technician who sustained injury while he was lifting a heavy door when he felt immediate pain in his right shoulder. Per OMNI, he was initially diagnosed with right shoulder strain.

On examination of the right shoulder, there is pain on range of motion. Abduction was 160 degrees. Forward flexion was 165 degrees.

^8,5 ASI occurs when the arm is in adduction with the shoulder internally rotated. The biceps complex pulley, also known as a capsuloligamentous complex, adjoins the anterior glenoid causing injury when in extreme motions. With the PSI, the pulley is put into risk with abduction and external rotation on the posterosuperior glenoid. ^8 PSI is also associated with partial-thickness tears on the deep side of the articular surface of the rotator cuff. ^5 This can be a common cause for a peel-back mechanism associated with a SLAP lesion. ^8 Peel-back mechanisms can be produced many different ways, but are mostly seen with a SLAP lesion or internal impingement. These can occur when the shoulder is placed into abduction and extreme external rotation with a torsional force added to the labro-bicipital complex that is at the base of the biceps on the posterior superior labrum. ^1,5 This causes fatigue and failure of the humeral head that rotates medially over the upper rim of the glenoid fossa creating a shearing force. ^1,5 Increased superior labral strain in overhead athletes occurs during the late-cocking phase of throwing when arm is externally rotated. ^1

MRI of the right shoulder report dated 03/04/14 revealed tear of the supraspinatus/infraspinatus tendon and subscapularis tendon. There is tendinosis of the teres minor. Abnormal signal is noted within the biceps tendon concerning for tear. Degenerative changes involving humeral head are seen. Bone marrow edema is noted involving the superior lateral aspect of the humeral head and the glenoid bone. Degenerative changes at the glenohumeral joint and the acromioclavicular joint are noted. There is edema and sclerosis of the posterior glenoid. Abnormal cortex of the posterior glenoid is demonstrated

Patient came into the hospital as an outpatient claiming that they were experiencing tenderness and stiffness in their left shoulder. Upon reading the requisition as well as asking the patient more questions I discovered that the patient had slipped and fell onto the ice 3 days previous. This patient explained that they were reluctant to go to the doctors as they already had stiffness in the left shoulder and they were convinced it was nothing serious. After taking the first image (the AP) it became clear that there was a comminuted fracture of the proximal humerus. A

He had a huge deformity, one of the largest I've seen. His condition required a complex surgery that orthopedic surgeons usually perform with an open shoulder. We managed to successfully address the issues arthroscopically, and perform a minimally invasive shoulder surgery that left minimal, almost none scarring, and successfully treated Mr. Appel’s shoulder injuries. Moreover, the arthroscopic approach allowed for Mr. Appel to leave the surgical center the same day, and regain his full strength within the span of one month,” said Dr. Tehrany.

Pull the ball low and away with the left stick for a Back Shoulder Pass. It will help you go for red zone scores, but bear in mind that you will need to practice a lot before actually trying this pass in a game, because it can easily lead you to turnovers. This pass is ideal for the “outside the numbers” area of the field.

The patient was an active participant in both contact as well as non-contact athletic activities. The patient reported occurrence of different symptoms that included; pain, weakness, instability, paresthesia, crepitus, as well as instability of the shoulder during sleep. Sulculus sign was conducted to assess the rotator interval and load and shift test for determination of the patient’s posterior stability. The doctor diagnosed positive for multidirectional instability. The patient’s multidirectional instability was not caused by a traumatic event. The patient had not exercised the joint over a long period of time, hence he had a weak shoulder joint, particularly the rotator cuff. The doctor recommended that the patient should be treated for the pain and inflammation of the shoulder caused by the multidirectional instability and then placed on physical therapy aimed for one year aimed at helping in the strengthening of the muscles of the patient that support the scapula (shoulder blade) and the rotator cuff (shoulder joint) so as to help the patient in returning to normal physical activity and also prevent an injury at the same place

In 1990 the acronym “SLAP lesion” (Superior Labral Anterior and Posterior) was coined by Synder et al, a shoulder pathology previously made known after arthroscopically identified by Andrews et al in 1985. 2,3 The prevalence of SLAP lesions in recreational athletic and athletic populations ranges from 3.9 %- 11.8%. 4 Kim, et al noted out of 544 shoulders arthroscopically evaluated, 25% were diagnosed with a SLAP lesion, and 88%, about 120 subjects, presented with another pathology.6

The baseball star, David Wright, is having another setback in his game because the newly diagnosed right shoulder impingement that requires immediate care and treatment. According to Mets General Manager, Sandy Alderson, Mets third baseman will have to sit out the games for the following few weeks and concentrate on the complete recovery.

*insert article *attachedBesides being able to see the inside of a shoulder, doctors use different physical tests to evaluate the shoulder in order to determine what type of injury and how severe an injury may be. One such test was recently developed by Dr. Carl J. Basamania at the Womack Army Medical center in Fort Bragg, N.C. The test was developed to evaluate shoulder instability in a patient. During the test the Dr. or examiner stands next to the patient who is to lay flat on his/her back. The hand of the examined should is held firmly by the examiner. The examiner then pushes against the clavicle to stabilize th scapula, while they also gently hold the pectoral muscle with their thumb in order to be able to assess relaxation. The examiner then rotates the arm form neutral to full external rotation. If the patient has AIGHL incompetence there is a lack of tightening as the arm reaches full external rotation. The test has appeared to be highly accurate and may be of value to Dr.'s and surgeons alike. After doctors have determined what type and what degree of injury a patient has sustained using various tests it is on to the next step, rehabilitation.

This section of the literature review will deal with the anatomy of the shoulder. “Anatomy” can roughly be defined as a branch of science that is concerned with the bodily structure of living things, such as humans and animals and/or a study of the internal workings of something. (Dictionary) This