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Shoulder

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by

Irma Lobaton

on 26 October 2015

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Transcript of Shoulder


• Flexion/extension, abduction/adduction, and medial/lateral rotation
• Abduction occurs with lateral rotation and flexion occurs with simultaneous rotation
• Translation accompanies glenohumeral rotations
• Other joints of the shoulder complex can substitute for glenohumeral joint motion
• Glenohumeral ROM: 100–120° of flexion and abduction, 70–90° of medial and lateral rotation

Trapezius
Upper Trapezius
actions:
elevation of sternoclavicular joint
scapular elevation
scapular adduction
scapular upward rotation
effects of weakness:
diminished strength in elevation of the shoulder girdle
standing posture by depression, abduction, & forward tilting of the scapula
effects of tightness:
elevated shoulders or asymmetrical head positions
restricted head & neck ranges of motion
upward rotation of scapula
Lower Trapezius
actions:
scapular depression
scapular adduction
scapular upward rotation
stabilizes scapula
effects of weakness:
stabilizing scapula
effects of tightness:
unclear
Serratus Anterior
Middle Trapezius
actions:
scapular adduction
scapular elevation
effects of weakness:
scapular adduction scapular elevation
effects of tightness:
rare
Shoulder

Serratus Anterior
Upper Portion
scapular elevation
Lower Portion
scapular abduction
scapular upward rotation
effects of weakness:
injury to its nerve supply (long thoracic nerve)
scapular abduction
upward rotation
effects of tightness:
posture of elevated shoulders & upwardly rotated scapulae

Levator scapulae, Rhomboid Major & Rhomboid Minor

Levator Scapulae, Rhomboid Major & Rhomboid Minor
actions:
scapular elevation
scapular adduction
scapular downward rotation
effects of weakness:
pulling actions are impaired
effects of tightness
no direct link b/w tightness & rounded shoulder posture
Pectoralis Minor
Pectoralis Minor
actions:
scapular anterior tilt
scapular elevation
scapular depression
scapular adduction
scapular abduction
scapular upward rotation
effects of weakness:
control of shoudler girdle
scapula instability
effects of tightness:
"rounded shoulder posture"
Subclavius
Subclavis
actions:
depresses the clavicle
effects of weakness & tightness:
joint instability
limiting elevation
Sternocleidomastoid
Pectoralis Major
Pectoralis Major
Smaller Clavicular Portion
actions:
shoulder flexion
shoulder medial rotation
shoulder depression
effects of weakness:
shoulder flexion
effects of tightness:
unlikely
shoulder lateral rotation

Pectoralis Major
Larger Sternal Portion
actions:
shoulder extension against resistance
shoulder flexion
shoulder adduction
shoulder medial rotation
shoulder depression
effects of weakness:
shoulder extension
effects of tightness:
shoulder abduction & flexion
restrict shoulder lateral rotation
Axiohumeral Muscles
actions:
upper portion
scapular elevation
larger lower portion
scapular abduction
scapular upward rotation
effects of weakness:
injury to long thoracic nerve
scapular abduction
upward rotation
medial wingling
effects of tightness:
posture of elevated shoulders & upwardly rotated scapulae
Scapulohumeral Muscles
Deltoid
Anterior Deltoid
Origin:
Anterior & Superior faces of the lateral one third of the clavicle
Insertion:
Deltoid tuberosity
Muscle Action:
Shoulder flexion
Effects of weakness:
Likely to produce weakness in shoulder flexion.
Effects of tightness:
Can diminish shoulder extension & lateral rotation ROM.
Middle Deltoid
Origin:
Lateral border & superior
Insertion:
Deltoid tuberosity of humerus
Muscle action:
Shoulder abduction
Shoulder flexion
Effects of weakness
Weakens active abduction
Effects of tightness
Unlikely restrict adduction ROM
Posterior Deltoid
Origin:
Lower lip of crest of scapular spine
Insertion:
Deltoid tuberosity of humerus
Actions:
Shoulder extension
Shoulder abduction
Effects of weakness
Decreased extension strength
Effects of tightness
Restricted shoulder flexion & horizontal adduction

Supraspinatus
Infraspinatus
Teres Major
Teres Minor
Subscapularis
Rotator Cuff
Supraspinatus
Origin
Medial two thirds of supraspinous fossa
Insertion
Superior facet of greater tubercle of humerus & glenohumeral joint capsule
Actions
Shoulder abduction
Shoulder Lateral rotation
Shoulder Medial rotation
Shoulder Stabilization
Effects of Weakness
Rather common
Significant decrease in strength of shoulder abduction
Effects of Tightness
Spontaneous unlikely
Abduction or medial rotation with shoulder hyperextension stretches supraspinatus
Infraspinatus
Origin
Medial two thirds of ingraspinous fossa
Insertion
Middle facet on greater tubercle of humerus and glenohumeral joint capsule
Action
Shoulder lateral rotation
Shoulder horizontal abduction
Shoulder abduction
Shoulder stabilization
Effects of weakness
Isolated weakness is unusual
Clinically significant reduction in strength of lateral rotation of shoulder
Effects of tightness
Decreased ROM of shoulder medial rotation

Axioscapicular & Axioclavicular Muscles
Muscles:
Trapezius
Serratus Anterior
Levator Scapulae
Rhomboid Major & Minor
Pectoralis Minor
Subclavis
Sternocleidomastoid


• In active shoulder flexion or abduction, the glenohumeral joint contributes most of the motion.
• Scapulothoracic joint rotates upwardly and externally and tilts posteriorly during flexion and abduction.
• Scapulothoracic and glenohumeral joints move simultaneously throughout the motion.
• Humerus and scapula move in a coordinated and systematic rhythm.
• Exact ratio of scapulothoracic and glenohumeral joint motion may vary with plane of movement and location within the ROM.

Scapulohumeral rhythm indicates the proportion of glenohumeral and scapulothoracic joint motion in shoulder motion.
• Sternoclavicular joint elevates approximately 40° with full flexion or abduction.
• Sternoclavicular joint undergoes upward rotation flexion and abduction.
• Acromioclavicular joint undergoes motion to allow the clavicle and scapula to move independently.
• Impairments in mobility can affect any of the four joints of the shoulder complex.

Sternocleidomastoid
Absence of glenohumeral motion results in 50-65% loss in ROM
Loss of sternoclavicular or acromioclavicular joint motion affects the ability of the scapulothoracic joint to move.

Actions:
Elevates clavicle
Short momentum arm and a poor mechanical advantage for sternoclavicular joint elevation


• Impingement syndrome is the cluster of signs and symptoms that result from chronic irritation of any or all of the structures in the subacromial space.

Muscles:
Pectoralis Major
Smaller Clavicular Portion
Larger Sternal Portion
Latissimus Dorsi
MOTIONS OF THE
GLENOHUMERAL JOINT

Sternoclavicular and Acromioclavicular Motion during Arm–Trunk Elevation
Muscles:
Deltoid
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
Teres Major
Coracobrachialis
Latissimus Dorsi
Latissimus Dorsi
actions:
shoulder extension
shoulder adduction
shoulder medial rotation
shoulder depression
effects of weakness:
all ROM above
effects of tightness:
limits ROM in flexion, lateral rotation
Teres Minor
Origin
Superior two thirds of lateral aspect of dorsal surface of scapula
Insertion
Inferior facet of greater tubercle of humerus and distally on shaft of humerus
Actions
Shoulder lateral rotation
Shoulder adduction
Shoulder stabilization
Effects of weakness
Can contribute to decrease in strength of shoulder lateral rotation
Effects of tightness
Unlikely
Likely to accompany tightness of infraspinatus
Teres Major
Origin
Dorsal surface of inferior angle of scapula and surrounding fascia
Insertion
Medial lip of intertubercular groove of humerus
Actions
Shoulder medial rotation
Shoulder extension
Shoulder adduction
Effects of weakness
Logical to expect weakness in shoulder medial rotation, extension and hyperextension, and adduction
Effects of tightness
Could influence resting position and mobility of scaputhoracic joint and rounded-shoulder posture

Subscapularis
Origin
Suvscapularis fossa and lateral border of ventral surface of the scapula. Also attaches to tendinous intramuscular septa and aponeurosis.
Insertion
Lesse tubercle of humerus and anterior aspect of glenohumeral joint capsule
Actions
Shoulder medial rotation
Shoulder abduction
Shoulder adduction
Shoulder stabilization
Effects of weakness
Significant decrease in strength of shoulder medial rotation
Effects of tightness
Decreased lateral rotation ROM of shoulder.
Coracobrachialis
Origin
Tip of coracoid process of scapula
Insertion
Middle of medial aspect of shaft of humerus between attachments of triceps brachii and brachialis
Actions
Inadequate evidence
Effects of weakness
Hypothesized diminished strength in flexion and adduction of shoulder
Effects of tightness
Hypothesized decreased ROM in abduction and extension of shoulder
Movement of the Scapula and Humerus
during Arm–Trunk Elevation
Loss of Joint Motion
Shoulder Impingement Syndrome
Structure and Function of
Bones and Joints of the
shoulder Girdle

Superior surface is smooth and readily palpated on the skin
Anterior surface is roughened by attachment of the pectoralis major
Posterior is roughened on the lateral one third by attachment to the trapezius

Clavicle
Scapula
Origin: 1st costal cartilage
Insertion: inferior surface of clavicle
Insertion:
Clavicle, lat. 1/3 Acromion, medial edge
Spine of scapula
Superior margin


Origin:
Superior nuchal line
Ligamentum nuchae
7th cervical & all thoracic vertebral spines
Origin: Sternal menubrium
Insertion: Mastoid process of temporal lobe
Origin: lower ribs, thoracolumbar fascia, iliac crest
Insertion: Intertubercular sulcus of humerus
Origin: Sternum & costal cartilages 1-6
Insertion: Humerus
Origin:
Upper 8 ribs anterolaterally
Insertion:
Scapula, medial border, entire length
Levator Scapulae
Origin: Cervical transervse processes 1-4
Insertion: Scapula b/w superior angle & rhomboid minor
Rhomboid Major

Origin: 2nd-5th thoracic vertebral spines
Insertion: Scapula, medial border inferior to spine

Is a little curved to fir the chest wall
Has a costal or anterior surface and dorsal(posterior) surface
Dorsal surface Is divided into two regions by the spine of the scapula
. Supraspinous fossa
. Infraspinous fossa
At the end of the spine is the Acromion process.
Also on the scapula is the corocoid process

The head of the scapula gives rise to the glenoid fossa that provides the scapula’s articular surface for the glenohumeral joint.

Rhomboid Minor
Origin: Lower ligament nuchae to 1st thoracic vertebral spine
Insertion: Scapula, medial border at spine
• The humeral head projects medially, superiorly and posteriorly. On the lateral aspect of the humerus is the greater tubercle. A large bony prominence that is easily palpated on the lateral aspect of the shoulder complex. On the anterior aspect is small bony projections lesser tubercle.
• Separating tubercles is the intertubercular or bicipetal groove containing the tendon of the long head of the biceps brachii.
• The depth of the groove varies, a shallow groove appears to be a contributing factor in dislocation of the biceps tendon.

Humerus
Origin:
Ribs 3-5 anterolaterally
• The superior portion of the stenum , ( the marubrum) provides an articular surface called clavicular notch, for the proximal end of each clavicle. The two clavicular notches are separated by the sterna; or jugular notch on the superior aspect of the manubrium
Thorax
• The bony thorax forms the substrate on which the two scapulae slide. The shaft of the thorax serves as a constraint to the movement of the scapula.
• As the scapula glides superiorly on the thorax, it also tilts anteriorly.

Insertion:
Coracoid process
Sternum and Thorax
Structure of the joints and supporting structures of the shoulder complex
All synovial joints except for scapulothoracic
Sternoclavicular joint
Triaxial- joint occurs about 3 axes
-Includes the clavicle, sternum and the
superior aspect of the first coastal cartilage

supporting structures
synovial capsule
Anterior and posterior sternoclavicular ligaments
intra articular disc
Acromioclavicular joint
gliding joint with articular surfaces covered by fibrocartilage
supporting structures
capsule and ligaments
Trapezoid ligament and coracoclavicular ligament fix the underside of the clavicle to the coricoid process
Dislocation of Ac joint is a common sport injury espcial in contact sports like football and rugby
• Ac joints is also a common site for osteoarthritis particularly in individuals who have a history of heavy labor or athletic activities
Clinical relevance
Scapulothoracic Joint
Not a traditional joint because muscles rather than cartilage or fibrous material separates its moving component.
Primary role is to increase range and diversity movements between arm and trunk
Primary motions
Elevation and Depression
Abduction and Adduction
Downward and Upward rotations
Internal and External rotation
scapular tilt


• Glenohumeral Joint
ball and socket joint
most mobile joint in the body
two articular surfaces
head of the humerus
glenoid fossa
supporting structures
Labrum
Capsule
three glenohumeral ligaments
coracohumeral ligament
surrounding muscle


Structure of the Bones of the shoulder complex
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