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LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of this chapter the student should be able to demonstrate the following competencies and proficiencies concerning rehabilitation of the shoulder:

  • Describe and understand the anatomy and kinematics of the shoulder complex (glenohumeral, acromioclavicular, sternoclavicular joints, and scapulothoracic articulation)

  • Describe shoulder and scapular muscles and their action on the shoulder

  • Describe and understand the force couple relationships about the shoulder

  • Describe and implement range of motion, isometric, isotonic, and functional exercises for the shoulder complex

  • Describe and perform glenohumeral, acromioclavicular, and sternoclavicular mobilizations

  • Explain and implement rehabilitation exercise programs for shoulder pathologies

  • Explain and implement rehabilitation exercise programs for post-operative shoulder injuries

  • Describe and understand adhesive capsulitis

  • Understand the rehabilitation for total shoulder arthroplasty

INTRODUCTION

Many daily, recreational, and athletic activities require the use and movement of the shoulder. The shoulder complex is frequently injured in the athletic and non-athletic patient. The glenohumeral joint, sternoclavicular joint, acromioclavicular joint, and scapulothoracic articulation make up the shoulder complex. When functioning properly, these joints enable the shoulder complex to have more movement than any other joint in the body.1,2

Pain-free shoulder function in activity and sport relies heavily on the proper functioning of the joints in the shoulder complex. If one or more of these joints is not functioning properly, stress is transferred to the other joints, resulting in dysfunctional movement patterns and eventually injury. For example, if the scapula is hypermobile (unstable), the rotator cuff will overwork, which will lead to a rotator cuff injury. The potential for the shoulder complex to be injured while participating in sport, work, or activity is high because the shoulder has to maintain a delicate balance between stability and mobility.

Successful rehabilitation of the shoulder complex requires a thorough understanding of shoulder mechanics and the relationship among the three bones (clavicle, humerus, and scapula), four joints/articulations (sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic), and 26 muscles that comprise this unique joint. This chapter will review functional anatomy and mechanics of each joint within the shoulder complex and describe rehabilitation techniques for the shoulder complex in the non-throwing patient. The overhead patient is discussed in detail in Chapter 23.

ANATOMY AND MECHANICS

Full mobility of the shoulder is dependent on coordinated, synchronous motion in all joints that comprise the shoulder complex. The shoulder complex is traditionally thought of as the clavicle, scapula, and the humerus (Fig. 21-1). However, the cervical and thoracic spines are important components of proper shoulder function and must not be overlooked during the rehabilitation process. Although some occupations and sports require a wide range of movement, most activities can be performed despite loss of shoulder complex motion, providing mobility is unimpaired in the cervical spine, elbow, wrist, and hand.1,2 The shoulder complex is mainly suspended from the cervical and thoracic spine through its many ...

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