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At the completion of this chapter, the reader will be able to:
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Describe the anatomy of the joints, ligaments, muscles, blood, and nerve supply that comprise the shoulder complex.
Describe the biomechanics of the shoulder complex, including the open- and close-packed positions, muscle force couples, and the static and dynamic stabilizers.
Describe the relationship between muscle imbalance and functional performance of the shoulder.
Describe the purpose and components of the tests and measures for the shoulder complex.
Perform a comprehensive examination of the shoulder complex, including history, systems review, palpation of the articular and soft tissue structures, specific passive mobility tests, passive articular mobility tests, and special tests.
Evaluate the key findings from the examination data to establish a physical therapy diagnosis and prognosis.
Summarize the various causes of shoulder dysfunction.
Describe and demonstrate intervention strategies and techniques based on the clinical findings and any established goals.
Evaluate the intervention effectiveness to determine progress and modify an intervention as needed.
Plan an effective home program and instruct the patient in its use.
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The shoulder is the most rewarding joint in the body because when a limited or painful movement is found, the finding is seldom ambiguous and often implicates the offending structure.
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—
James Cyriax, MD (1904–1985)
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The primary function of the shoulder complex is to position the hand in space, thereby allowing an individual to interact with his or her environment and to perform fine motor functions. An inability to position the hand results in profound impairment of the entire upper extremity.
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Secondary functions of the shoulder complex include the following:
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- Suspending the upper limb.
- Providing sufficient fixation so that motion of the upper extremity or trunk can occur.
- Serving as a fulcrum for arm elevation. Three types of arm elevation are recognized: an upward motion of the upper extremity in the scapular plane (
scaption) and the motions in either the coronal plane (
abduction) or in the sagittal plane (
flexion).
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The shoulder is endowed with a unique blend of mobility and stability. The degree of mobility is contingent on a healthy articular surface, intact muscle–tendon units, and supple capsuloligamentous restraints. The degree of stability is dependent on intact capsuloligamentous structures, proper function of the muscles, and the integrity of the osseous articular structures.
1Optimal functioning of the shoulder and arm can only take place if a delicate balance between mobility and stability is maintained.
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The shoulder complex functions as an integrated unit, involving a complex relationship between its various components. The components of the shoulder joint complex consist of (
Fig. 16-1):
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