Chapter 20

Objectives

After completion of this chapter, the physical therapist should be able to do the following:

• Review the functional anatomy and biomechanics associated with normal function of the shoulder joint complex.

• Differentiate the various rehabilitative strengthening techniques for the shoulder, including both open- and closed-kinetic-chain isotonic, plyometric, isokinetic, and proprioceptive neuromuscular facilitation exercises.

• Compare the various techniques for regaining range of motion, including stretching exercises and joint mobilization.

• Administer exercises that may be used to reestablish neuromuscular control.

• Relate biomechanical principles to the rehabilitation of various shoulder injuries/pathologies.

• Discuss criteria for progression of the rehabilitation program for different shoulder injuries/pathologies.

• Describe and explain the rationale for various treatment techniques in the management of shoulder injuries.

Functional Anatomy and Biomechanics

The anatomy of the shoulder joint complex allows for tremendous range of motion. This wide range of motion of the shoulder complex proximal permits precise positioning of the hand distally, to allow both gross and skilled movements. However, the high degree of mobility requires some compromise in stability, which, in turn, increases the vulnerability of the shoulder joint to injury, particularly in dynamic overhead athletic activities.5

The shoulder girdle complex is composed of 3 bones—the scapula, the clavicle, and the humerus—that are connected either to one another or to the axial skeleton or trunk via the glenohumeral joint, the acromioclavicular joint, the sternoclavicular joint, and the scapulothoracic joint (Figure 20-1). Dynamic movement and stabilization of the shoulder complex require integrated function of all four articulations if normal motion is to occur.

Figure 20-1

Skeletal anatomy of the shoulder complex

(Reproduced with permission from Prentice. Principles of Athletic Training. 14th ed. New York: McGraw-Hill; 2011.)

Sternoclavicular Joint

The clavicle articulates with the manubrium of the sternum to form the sternoclavicular joint, the only direct skeletal connection between the upper extremity and the trunk. The sternal articulating surface is larger than the sternum, causing the clavicle to rise much higher than the sternum. A fibrocartilaginous disk is interposed between the 2 articulating surfaces. It functions as a shock absorber against the medial forces and also helps to prevent any displacement upward. The articular disk is placed so that the clavicle moves on the disk, and the disk, in turn, moves separately on the sternum. The clavicle is permitted to move up and down, forward and backward, in combination, and in rotation.

The sternoclavicular joint is extremely weak because of its bony arrangement, but it is held securely by strong ligaments that tend to pull the sternal end of the clavicle downward and toward the sternum, in effect anchoring it. The main ligaments are the anterior sternoclavicular, which prevents upward displacement of the clavicle; the posterior sternoclavicular, which also prevents upward displacement of the clavicle; the interclavicular, ...

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