At the conclusion of this chapter, the reader will be able to:
Identify the key anatomical and biomechanical features of the shoulder and their impact on examination and intervention.
List and perform key procedures used in the orthopaedic manual physical therapy (OMPT) examination of the shoulder.
Demonstrate sound clinical decision-making in evaluating the results of the OMPT examination.
Use pertinent examination findings to reach a differential diagnosis and prognosis.
Discuss issues related to the safe performance of OMPT interventions for the shoulder.
Demonstrate basic competence in the performance of a skill set of joint mobilization techniques for the shoulder.
FUNCTIONAL ANATOMY AND KINEMATICS
Normal function of the shoulder joint complex requires the precise synchronization of four distinct articulations. The sternoclavicular, acromioclavicular, scapulothoracic, and glenohumeral joints compose a system of interdependent joints that serve a preeminent role in the function of the upper extremity. Cyriax1 describes the primary function of the shoulder as positioning the hand in space so as to allow an individual to interact with his or her environment and to perform fine motor functional tasks. See Table 22–1 for shoulder motions that are typically required to perform common functional activities.
Table 22–1Shoulder Motions Required for Functional Activities ||Download (.pdf) Table 22–1 Shoulder Motions Required for Functional Activities
|FUNCTIONAL ACTIVITY ||REQUIRED ROM |
|Brushing hair || |
120 degrees of abduction
90 degrees of external rotation
|Tuck in shirt || |
30 degrees extension
90 degrees internal rotation
60 degrees adduction
|Eating || |
60 degrees abduction
45 degrees horizontal adduction
|Apply deodorant || |
45 degrees flexion
60 degrees horizontal adduction
|Clean ear || |
110 degrees abduction
80 degrees external rotation
The Sternoclavicular Joint
The sternoclavicular (SC) joint is generally considered to be a saddle joint2,3 that operates about three axes of motion (Fig. 22–1). The head of the clavicle is larger than the articulating surface of the sternum, thus predisposing the joint to instability, particularly in response to medially directed forces. The sternal articular surface is concave in the frontal plane and convex in the sagittal plane, which corresponds to the medial articular surface of the clavicle. An intra-articular disc divides the joint into two individual synovial cavities and resists medial migration of the clavicle and provides shock absorption. The medial clavicle also articulates inferiorly with the costal cartilage of the first rib, which contributes to the stability of the SC joint.
The sternoclavicular "saddle" joint.
Stability of the SC Joint
The synovial capsule of the SC joint is considered to be least extensive at its inferior ...