SHOULDER

1
SHOULDER
2
Shoulder Joint - Glenohumeral (G/H)

• Articulation between the head of the humerus and
  the glenoid fossa
• Stability vs. Mobility
• G/H allows a great deal of movement of the joint
  due to the large humeral head articulating with
  the smaller, shallow glenoid fossa.
• Stability is sacrificed for mobility.
• Ball and Socket Joint

3
(No Transcript)
4
(No Transcript)
5
Cartilage

• Both humeral head and glenoid fossa are covered
  with hyaline cartilage.
• Glenoid fossa is also protected by a flat rim of
  fibrocartilage called the glenoid labrum.

6
Capsule

• Joint entirely enveloped in a loose joint capsule
• Loose joint capsule allows increased mobility

7
Bursa

• A synovial fluid filled sac which cushions the
  joint and facilitates movement of tendons.
• Subacromial bursa has the most clinical
  significance

8
Ligaments

• Coracohumeral
• Glenohumeral
• superior, middle, inferior
• Coracoacromial- function unknown

9
(No Transcript)
10
(No Transcript)
11
MUSCLES

• Muscles of the shoulder joint insert on and move
  the humerus
• Eleven muscles cross the shoulder joint

12
ANTERIOR LINE OF PULL

• Pectoralis Major
• Coracobrachialis
• Subscapularis
• Biceps brachii
• Anterior Deltoid

13
Pectoralis Major

• Clavicular head
• Proximal attachment clavicle
• Distal attachment humerus
• Movements
• Flex
• Horizontal adduction
• Internal rotation

14
Pectoralis Major

• Sternal head
• Proximal attachment sternum
• Distal attachment humerus
• Movements
• Extension
• Horizontal adduction
• Internal rotation

15
(No Transcript)
16
Coracobrachialis

• Proximal attachment coracoid process
• Distal attachment humerus
• Movements Horizontal adduction
• Secondary flexion, internal rotation

17
(No Transcript)
18
Subscapularis

• One of four rotator cuff muscles
• Proximal attachment anterior scapula
• Distal attachment lesser tuberosity of humerus
• Movements Internal rotation

19
(No Transcript)
20
BICEPS BRACHII

• Not a main shoulder mover
• Proximal attachment
• Long head superior glenoid fossa
• Short head coracoid process
• Distal attachment radius
• Movements
• Flexion
• Abduction with resistance when elbow is extended
• Horizontal adduction

21
(No Transcript)
22
(No Transcript)
23
ANTERIOR DELTOID

• Proximal attachment clavicle
• Distal attachment deltoid tuberosity of humerus
• Movements Flexion, horizontal adduction
• Secondary internal rotation, abduction

24
(No Transcript)
25
(No Transcript)
26
SUPERIOR LINE OF PULL

• Middle Deltoid
• Supraspinatus

27
MIDDLE DELTOID

• Proximal Attachment acromion
• Distal Attachment deltoid tuberosity
• Movements Abduction 90 to 180 degrees

28
(No Transcript)
29
(No Transcript)
30
SUPRASPINATUS

• Rotator cuff muscle
• Proximal Attachment Supraspinous fossa
• Distal Attachment Greater tuberosity of humerus
• Movements Initiation of abduction (primarily
  first 60 degrees), although it is active through
  110 degrees of motion

31
(No Transcript)
32
(No Transcript)
33
POSTERIOR LINE OF PULL

• Infraspinatus
• Teres minor
• Posterior Deltoid

34
INFRASPINATUS

• Rotator cuff muscle
• Proximal attachment Infraspinous Fossa
• Distal attachment Greater tuberosity
• Movements External rotation
• Secondary horizontal abduction, extension

35
(No Transcript)
36
(No Transcript)
37
TERES MINOR

• Rotator cuff muscle
• Proximal attachment Infraspinous Fossa
• Distal attachment Greater tuberosity
• Movements External rotation
• Secondary Horizontal abduction, Extension

38
(No Transcript)
39
(No Transcript)
40
POSTERIOR DELTOID

• Proximal attachment spine of scapula
• Distal attachment deltoid tuberosity
• Movements Extension, horizontal abduction
• Secondary External rotation, abduction

41
(No Transcript)
42
(No Transcript)
43
INFERIOR LINE OF PULL

• Latissimus Dorsi
• Teres Major
• Triceps Brachii

44
LATISSIMUS DORSI

• Proximal attachment Lower 6 thoracic all
  lumbar vertebrae, posterior sacrum, iliac crest,
  lower three ribs
• Distal attachment anterior humerus
• Movements Adduction, extension
• Secondary Internal rotation, horizontal abduction

45
(No Transcript)
46
(No Transcript)
47
TERES MAJOR

• Proximal attachment scapula
• Distal attachment Anterior humerus
• Movements Adduction, extension
• Secondary Internal rotation, horizontal abduction

48
(No Transcript)
49
(No Transcript)
50
TRICEPS BRACHII

• Lateral Head
• Proximal attachment upper half of the posterior
  surface of the humerus
• Middle Head
• Proximal attachment distal two-thirds of
  posterior surface of the humerus
• Long Head
• Proximal attachment infraglenoid tubercle of
  the scapula
• Distal attachment Olecranon process of ulna
• Movements Assists with adduction, extension
  (hyperextension)

51
(No Transcript)
52
(No Transcript)
53
SHOULDER GIRDLE

• PURPOSE Movements of the shoulder girdle are
  mainly for the purpose of placing the glenoid
  fossa in a favorable position to augment movement
  of the Humerus.

54
Bones of the Shoulder Girdle

• Sternum
• Two clavicles
• Two scapula
• Scapula do not unite in back, so the girdle is
  incomplete

55
(No Transcript)
56
Articulations

• Sternoclavicular (S/C)
• Acromioclavicular (A/C)
• Scapulothoracic
• Coracoclavicular (C/C)
• Not in text
• Not a true articulation
• Formed by coracoclavicular ligament

57
ARTICULATIONS

• Acromioclavicular joint (A/C)
• diarthrodial, gliding joint with limited motion
  in all three planes
• A/C ligament

58
(No Transcript)
59
ARTICULATIONS

• Sternoclavicular (S/C)
• double arthrodial joint due to 2 joint spaces
• only bony connection between humerus and axial
  skeleton
• limited motion in all 3 planes
• pivot point for shoulder girdle movement

60
Sternoclavicular Joint

• Ligaments
• Sternoclavicular
• Anterior
• Posterior
• Interclavicular
• Costoclavicular

61
(No Transcript)
62
ARTICULATIONS

• Coracoclavicular
• Comprised of the Conoid and Trapezoid ligaments
• Synarthroidal (syndesmosis ligament type joint)
• limited movement

63
Movements of Shoulder Girdle

• Pg 98, Fig 5.3
• ELEVATION/DEPRESSION
• PROTRACTION (abduction lateral tilt)
• True abduction does not occur
• RETRACTION (adduction lateral tilt reduction)
• UPWARD ROTATION/DOWNWARD ROTATION
• UPWARD TILT
• REDUCTION OF UPWARD TILT

64
(No Transcript)
65
(No Transcript)
66
ANTERIOR MUSCLES

• Pectoralis minor
• Serratus anterior
• Subclavius

67
PECTORALIS MINOR

• Proximal attachment coracoid process
• Distal attachment ribs 3,4,5
• Movement
• Downward rotation
• Protraction
• Depression
• Upward tilt
• Function helps to expand chest during exercise
• acts as a scapular stabilizer

68
(No Transcript)
69
SERRATUS ANTERIOR

• Proximal attachment ribs 1-9
• Distal attachment Anterior scapula
• Movement
• Upward rotation
• Protraction
• Some depression

70
(No Transcript)
71
SUBCLAVIUS

• Proximal attachment 1st rib
• Distal attachment lateral, inferior, clavicle
• Movement
• Slight scapular depression via attachment on
  clavicle
• Function protect and stabilize S/C joint

72
(No Transcript)
73
POSTERIOR MUSCLES

• Levator scapulae
• Rhomboids
• Trapezius

74
LEVATOR SCAPULAE

• Proximal attachment C1-4 transverse process
• Distal attachment superior border of scapula
• Movements
• Elevation
• Downward rotation
• If scapula is fixed, lateral flexion of neck
  occurs

75
(No Transcript)
76
RHOMBOIDS (minor and major)

• Proximal attachment spinous processes of C7
  T1-5
• Distal attachment vertebral border of scapula
• Movements
• Retraction
• Downward rotation
• Elevation
• Function stabilizes scapula works with
  Trapezius III for good shoulder posture

77
(No Transcript)
78
Upper Trapezius (I, II)

• Trap I - base of skull to clavicle
• Movement elevation
• Trap II - neck ligament to acromion process
• Movement
• Elevation
• Upward rotation
• Retraction (adduction)

79
(No Transcript)
80
Middle Trapezius (III)

• Trap III - C7 thru T3 to spine of scapula
• Movement retraction (adduction)

81
(No Transcript)
82
Lower Trapezius (IV)

• Trap IV - low thoracic spine to base of scapular
  spine
• Movement
• Upward rotation
• Depression
• Retraction (adduction)

83
(No Transcript)
84
SCAPULOHUMERAL RHYTHM

• The G/H joint can only Abduct 30 degrees and Flex
  60 degrees without movement of the scapula
  occurring
• The scapula rotates 1 degree for every 2 degrees
  of G/H motion

85
Range of Motion

• Flexion 180 degrees
• Extension 180 degrees
• Hyperextension 60 degrees
• Abduction 180 degrees
• Adduction 180 degrees
• Internal Rotation 70 degrees
• External Rotation 90 degrees

86
Shoulder Girdle and GH Joint

• GH movement
• Abduction
• Adduction
• Flexion
• Extension
• Hyperextension
• Int. rotation
• Ext. rotation
• Horizontal Adduction
• Horizontal Abduction

• Shoulder Girdle
• Upward rotation
• Reduction of Upward rotation
• Elevation/Upward Rotation
• Depression/Downward Rotation
• Upward tilt
• Protraction
• Retraction
• Protraction
• Retraction