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purpose
- all the hand to be placed in various positions to accoomplish a multitude of tasks
- do not ignore the shoulder complex when treating the distal UE
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Shoulder complex=
shoulder girdle(scapula and clavicle)
- Shoulder joint
- (scapula and humerus)
-
bones of shoulder complex
-
 bones of the shoulder complex
- scapula
- clavicle
- sternum
- humerus
- rib cage
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articulations of the shoulder complex
- sternoclavicular joint
- acromioclavicular jhoint
- glenohumeral joint
- scapulothoracic articulation
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shoulder girdle
- term used to discuss activities of the scapula
- clavicle
- sternum
- sternoclavicular(SC) and acromioclavicular(AC) joints allow shoulder girdle motions
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shoulder girdle
movements
- elevation and depression
- protraction and retraction
- upward and downward rotation
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scapulothoracic articulation
not a joint
scapila moves over the rib cage of the thorax
not directly attached
connected indirectly via the clavicle and several muscles
provides motion and also stability to the shoulder
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bones and landmarks
scapula
attaches indirectly to the rib cage
anteriorly concave and glides over the conves rib cage posteriorly
located between the second and seventh ribs
vertebral border 2-2 lateral from the spinous process
spine of scapula levels with 3rd and 4th thoracic vertebrae spinous process
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shoulder girdle
- 5 muscles attach to the scapula and/or clavicle and provide shoulder girdle motion
- trapezius
- levator scapulae
- rhomboid muscles
- serratus anterior
- pectoralis minor
-
Trapezius
- Upper Trapezius
- elevation
- upward rotation
- middle trapezius
- adduction(retraction)
- Lower Trapezius
- depression
- upward rotation
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levator scapulae
- Elevation
- downward rotation
-
rhomboids
downward rotation
assists in elevation
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serratus anterior
upward rotation
underneath scapula and comes out to the ribs
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pectoralis minor
depression
downward rotation
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joint motions
elevation-depression
protraction-retraction
upward rotation-downward rotation
- scapular tilt-
- occurs with GH hyperextension
- superior end of scapula tilts forward
- inferior end tilts posteriorly
- ex: wind-up or pre-release phase of softball pitching
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scapular rotation
inferior angle is the point of reference for rotation
- upward rotation
- inferior angle moves away from the spine
- downward rotation
- inferior angle moves toward the spine
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shoulderjoint=glenohumeral joint
Scapula and humerus motions
flexion,extension, and hyperextension
abduction(ABD) and adduction(ADD)
medial and lateral rotation
horizontal ABD and ADD
- mobile joint, few ligaments
- nine muscles are primary movers or the shoulder joint
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shoulder joint
- ball and socket
- humeral head articulating with glenoid fossa of scapula
- movement in all three planes around all three axes
- most movable joint in the body
- one of the least stable
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muscles of the shoulder joint (11)
- deltoid
- supraspinatus
- pectoralis major
- latissimus dorsi
- teres major
- infraspinatus
- teres minor
- subscapularis
- coracobrachialis
- biceps brachii
- triceps brachii, long head
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companion motions
shoulder joint and shoulder girdle
movement of the scapula is accompanied by movements of the glenohumeral joint and vice-versa
- ex:shoulder flexion accompanies upward scapular rotation
- impairment of one joint will also impair function at the other
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companion motions
shoulder jt/shoulder girdle
flexion/up rotation,protraction
extension/dn rotation,retraction
hyperex/scapular tilt
abduction/up rotation
adduction/dn rotation
medial rotation/protraction
lateral rotation/retraction
horz abduction/retraction
horz adduction/protraction
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scapulohumeral rhythm
describes the movement relationship between the shoulder girdle and shoulder joint
*****first 30 degree of shoulder joint motion is pure glenohumeral (GH) motion
- ***after that for every 2 Degree of shoulder flexion or abduction, the scapula rotates 1 degree
- ****2:1 ratio-scapulohumeral rhythm
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force couple
upward rotation
muscles pulling in different directions to accomplish the same motion
Ex: upward rotation
- upper trapezius pulls up
- lower trapezius pulls down
- lower serratus pulls out
- Anterior
- net effect upward rotation
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force couple
downward rotation
- levator scapulae pull up
- rhomboids pulls in
- pectoraliz minor pulls down
- net effect
- downward rotation
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shoulder stability
shoulder joint allows a great deal of motion
unstable joint
many anatomical structures contribbute to the stability of the shoulder
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shoulder stability
- anatomical structures that contribute to stability
- 1. glenoid labrum-catilage
- 2. glenoid fossa-boney part
- 3. joint capsule reinforced by the coracohumeral and glenohumeral ligaments
- 4. capsule completely surrounds fossa creating a partial vacuum
- 5. rotator cuff muscles
- 6. shoulder muscles
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joint capsule
- thin-walled, spacious container
- attaches around rim of glelnoid fossa of the scapula and anatomical neck of the humerus
outer fibrous membrane
inner synovial membrane-lubercates-
taut/slack
- arm hanging at side, superior portion taut/tight(pulling)
- shoulder abducted, inferior taut, superior slack
ex: boot on a stick shift
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glenoid labrum (E)
fibrous tissue surrounding glenoid fossa
deepens the articular cavity
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shoulder stability
- example of multi-support-glenohumeral subluxation(stroke) after a CVA:
- lack of socket depth
- loss of muscle tone
- upper extremity weight
- gravity
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other structures
bursae(synovial sac, provides cushion)
- subdeltoid bursa
- large
- located between the deltoid muscle and joint capsule
- subacromial bursa
- lies below the acromion and coracoacromial ligment, between them and the joint capsula
- frequently continuous with the subbdeltoid bursa
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glenohumeral movement
- A. deltoid muscle on the humeral shaft gives the muscle an upward direction of pull
- B. deltoid muscle's isolated action is elevation, impinging the humeral head directly up under the coracoacromial arch
always thumb UP
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shoulder abduction
- as the shoulder abducts
- humeral head rolls across the glenoid fossa
- humeral head glides inferiorly
- accomplished by the actions of the rotator cuff muscles
- for full shoulder ABDuction
- the shoulder joint must also ER(REMEMBER: this will come back to haunt you!)
allow the greater tubercle to pass the acromion
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rotator cuff tendons
SITS
- tendinous band formed by the insertions of:
- supraspinatus(D)
- infraspinatus(E)
- teres minor (F)
- subscapularis
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rotator cuff tear-repair
/
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rotator cuff-tendinitis
when humerous bone is held at 90o angle to the scapula
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reversal of muscle action
reversal of muscle action occurs when the more movable end becomes less move able
- chin up as reversal of muscle action
- typically insertion moves toward the origin
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referral pain
referral zone
- c4-5-brachial plexus
- changes in the vertebrae can impendge and effect
- pain in diaphram/comes from another area
- gall bladder/pain in lower scapular
- heart/left upper extermities-mostly men
- women different-unusual fitigue
- or back pain
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shoulder complex
- scapula
- clavicle
- sternum
- rib cage
- humerus
-
scapulothoracic articulation
-
-
-
scapulohumeral rhythm
movement relationship between the shoulder girdle and shoulder joint
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sternoclavicular
connects sternum to clavicle
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costoclavicular
connects first rib to clavicle
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interclavicular
connects clavicles
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acromioclavicular
connects scapula to clavicle
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sternoclavicular ligament
acromioclavicle ligament
reinforces the capsule
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costoclavicular ligament
limits clavicular elevation
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articular disk
acts as a shock absorber
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interclaviculoar ligament
limits clavicular depression
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coracoacromial ligament
serves as roof over humeral head
provides protective arch
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elevation
- upper trapezius
- rhomboids
- levator scapula
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depression
- lower trapezius
- pectoralis minor
-
protraction
- serratus anterior
- pectoralis minor
-
retraction
- middle trapezius
- rhomboids
-
upward rotation
- upper trapezius
- lower trapezius
- serratus anterior
-
downward rotation
- rhomboids
- pectoralis minor
- levator scapula
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which plane do the motions of scapula occur?
- saggital plane
- frontal plane
- transverse plane
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in an erect posture, scapular elevation is moving against gravity and is produced by a _____________ contraction of the __________ and ___________ muscles.
- concentric
- levator scapula
- upper trapezius
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scapulahumeral rhythm
"inchworm" effect
action of the shoulder girdle and deltoid muscles (middle) during shoulder abduction. If humerus moved dduring abduction, the middle deltoid muscle would quickly run out of contractile power as it approached 90o. the middle deltoid muscle is effective throughout the entire range.
For every 2o the shoulder joint abducrts. the shoulder girdle upwardlly roates 1o.
with this upward rotation of the scapula, the origin of the deltoid muscle ( acromion process. the lateral eld of the clavicle, the scapular spine) moves away from thje insertion on the humerus. this motion lengthens the muscle, resoiring its contractrile potential, and allows it to continue to effedctively contract throughout its entire range.
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shoulder joint-motions
- flex/enten/hyper exten
- abduc/adduc
- medial/lateral rotation
- horizontal add/abduct
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shoulder girdle-motions
- elevation/depression
- protraction/retraction
- upward/downward rotation
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shoulder joint
type of joint?
shape of joint?
ball/socket triaxel synovial
concave/convex
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shoulder joint
motion/plane/axis
- flex/exten/hyper
- saggital plane
- frontal axis
- abduc/add
- frontal plane
- saggital axis
- medial/lateral rotation
- transverse plane
- longitunal axis
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shoulder joint
closed-packet position?
loose-packed position?
abduc/lateral rotation-closed
abduction/horizontal rotation-loose
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thoracolumbar fascia
provides attachment for the latissimus dorsi muscle
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glenoid labrum
deepens the joint
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rotator cuff
keeps the humeral head rotating in contact with the glenoid fossa
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joint capsule
surrounds the joint
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coracohumeral
strengthens the upper part of the joint capsule
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subdeltoid bursa
decreases friction between the deltoid muscle and the joint capsule
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subacromial bursa
decreases friction between the acromion process, the coracoacromial ligament, and the joint capsule
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shoulder joint
flexion
muscles
- pectoralis major clavicular
- anterior deltoid
- coracobrachalis
-
shoulder joint muscles
extension
- posterior deltoid
- pectoralis major sternal
- latissimus dorsi
- teres major
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shoulder joint muscles
hyperextension
- posterior deltoid
- latissimus dorsi
-
shoulder joint muscles
medial rotation
- anterior deltoid
- subscapularis
- pectoralis major clavicular
- pectoralis major sternal
- latissimus dorsi
- teres major
-
shoulder joint muscles
later rotation
- posterior deltoid
- teres minor
- infraspinatus
-
shoulder joint muscles
abduction
- anterior deltoid
- middle deltoid
- posterior deltoid
- supraspinatus
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shoulder joint muscles
adduction
- coracobrachalis
- pectoralis major clavicular
- pectoralis major sternal
- latissimus dorsi
- teres major
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shoulder joint muscles
horizontal adduction
- pectoralis major clavicualar
- pectoralis major sternal
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shoulder joint muscles
Horizontal abduction
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function of rotator cuff muscles during shoulder flexion or abduction
keep the head of the humerous rotating aginst the glenoid fossa during joint motion
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which major nerve unit is located in the axilla
- axillary nerve
- location in relation to the head of the humerus?
major blood vessel close?
subclavian
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raising your hand over your head requires the combined action of which 3 shoulder girdle muscles?
- serratus anterior
- upper & lower trapezius
biomechanical term for this function
force couple
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starting at the inferior angle and ging clockwise, name the shoulder girdle muscles that attach to the posterior surface of the right scapula.
- rhomboids
- all trapezius
- levator scapula
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pectoralis minor is deep to what muscle
pectoralis major
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as you look at the lateral chest wall, the serratus anterior muscle is deep to what tow muscles?
- pectoralis major
- latissimus dorsi
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closing a window by pulling down
shoulder girdle motion____________
contraction?
shoulder joint motion?
- downward rotation
- concentric (shorten)
- (shoulder extension)
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opening a window by pulling up
contraction?
shoulder girdle motion____________
- upward rotation
- concentric
- (flexion)
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carrying a heavy suitcase
shoulder girdle motion___________
shoulder joint motion____________
- elevation
- isometric
- (no shoulder motion)
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combing your hair in the back
shoulder girdle motion________
shoulder joint motion___________
- upward rotation & retraction
- isometric
- shoulder flexion & lateral rotation
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reaching across the table
shoulder girdle motion_____
contraction?
shoulder joint motion________
- protraction
- concentric
- flexion
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lie prone on a table with your right arm hanging onver the side of the table and holding a weight in your right hand. using only shoulder girdle motion and noshoulder motion, pull the weight straight up from the floor
joint motion at girdle?
muscles of girdle action
open or closed chain?
scapular retraction
middle trap,rhomboids
open
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lie prone on a table with your right arm hanging over the side of the table and holding a weight in your right hand. Move youre arm up and out by doing shoulder horizontal abduction.
what girdle motion is accompanying shoulder horizontal abduction?
muscles of girdle motion?
contraction?
shoulder retracrtion
rhomboids, middle trap
concentric
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sit in a chair that has arms; place your hands on the armrests in a postioin that puts your shoulders in hyperextension. push down on the armrests and raise your butt off the seat of the chair.
shoulder girdle motion (shoulder flexion action from hyperextension)?
muscles of girdle??
concentric or eccentric
scapular depression (upward rotation)
lower trap, pector minor (upper trap,serratus anterior)
concentric
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lie in a prone position with your legs together, hands on the table next to your shulders with your fingers pointing forward. push up with your hands as far as you can while straightening your elbows, bending yoour knees, and keeping your back straight.
shoulder girdle motion?
muscles?
open or closed chain activity?
scapular protraction/upward rotation
- serratus anterior
- pect minor
- upper/lower trap
closed
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using a lat pull-down machine of the universal gym, reach up and grasp the handles. pull down while keeping your arms moving in the frontal plane.
shoulder girdle motion?
shoulder joint motion?
girdle muscles?
joint muscles?
concentric/eccentric?
scapular retraction/downward rotation
ashoulder adduction/lateral rotation
- middle trap,
- rhomboids
- levator scapula
- pectoralis manor
concentric
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