General Features For organizational purposes, this text divides these muscles into two categories: (1) Muscles of the shoulder girdle, and (2) muscles of the GH joint. Joshi M, Thigpen CA, Bunn K, Karas SG, Padua DA.   •   Accessibility. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-2.) Scapulothoracic motion is an integral part of nearly every shoulder movement. The radial nerve follows this groove and helps define the distal attachment for the lateral and medial heads of the triceps. The labrum performs this important function in two ways. The coracoid process is the finger-like projection of bone from the anterior surface of the scapula, palpable about 1 inch below the most concave portion of the distal clavicle. Proximal attachments of muscles are shown in red, distal attachments in gray. The axes of rotation are color coded with the associated planes of motion. Proximal attachments of muscles are shown in red, distal attachments in gray. The labrum serves to deepen the socket of the GH joint, nearly doubling the functional depth of the glenoid fossa. Figure 4-14 A, Proper arthrokinematics of the glenohumeral (GH) joint during abduction involving a superior roll and inferior slide of the humeral head. 2. • Cite the proximal and distal attachments, actions, and innervation of the muscles of the shoulder complex. This is useful information, as the specific location of pain around body structures helps doctors and other health care providers to figure out what the cause of the patient’s pain is. Interaction Among the Joints of the Shoulder Complex These muscles surround the humeral head and actively hold the humeral head against the glenoid fossa. The brachial plexus is formed by a network of nerve roots from the spinal nerves C5-T1. The scapular plane is about 35 degrees anterior to the frontal plane (Figure 4-16, B). Internal and External Rotation Horizontal abduction and horizontal adduction are commonly used terms to describe special motions of the shoulder and are described in the following section. The acromion forms a functional “roof” over the humeral head to help protect the delicate structures within that area. Rather, muscles work in teams to produce highly coordinated movements that are expressed over multiple joints. A, Elevation and depression. For example, if the shoulder is abducted to 90 degrees, only about 60 degrees of that motion occurs from GH abduction; the additional 30 degrees or so is achieved through upward rotation of the scapula. The flattened lateral portion—called the acromial end—articulates with the acromion of the scapula, forming the acromioclavicular joint. The SC joint structure is a saddle joint with concave and convex surfaces on each of the joint’s articular surfaces (Figure 4-7). Putting It All Together Joint Structure and Function: A Comprehensive Analysis, 5e. The arthrokinematics of abduction involves the convex head of the humerus rolling superiorly while simultaneously sliding inferiorly (Figure 4-14, A). Describe the muscular interactions involved with active shoulder abduction. An anterior view of the sternoclavicular joints with the capsule and some of the ligaments removed on the left side. Upward rotation occurs as the glenoid fossa of the scapula rotates upwardly, as a natural component of raising the arm overhead (Figure 4-9, C). A brief summary of the innervation scheme of the entire upper extremity is provided in the next section. To fully understand how the shoulder functions as a whole, we must first examine the structure and kinematics of each individual joint. muscles of the shoulder; human muscle system Movement of all of these components must occur for the arm to achieve 180° of humeral elevation. In treatment of a patient with a shoulder dysfunction, it is important to remember the integrated relationship of the joints within the shoulder complex, because a problem in one joint will likely affect the other three. ACE Personal Trainer Manual (4th ed.). An excellent example of this interaction is the scapulohumeral rhythm. (November 2013) The Superior shoulder suspensory complex(SSSC) is, essentially, a bone and soft-tissue ring secured to the trunk by superior and inferior bony struts from which the … • Abduction of the humerus … (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-17.) It is interesting to note that the ligaments and capsule of the GH joint are relatively thin and provide only secondary stability to the joint. • Coracoclavicular Ligament: Composed of the conoid and trapezoid ligaments. ), (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-39. At the same time, it must be mobile enough for these actions to occur. It is one of four joints that comprise the shouldercomplex. The glenohumeral joint or shoulder joint is a ball and socket type of synovial joint that permits a wide range of movements including flexion, extension, abduction, adduction, rotation (medial and lateral rotation), and circumduction. athletic patients. Arthrology • Describe the location and primary function of the ligaments that support the joints of the shoulder complex. The full 60 degrees of scapulothoracic upward rotation is achieved by combining about 30 degrees of clavicular elevation with 30 degrees of AC joint upward rotation (see Figure 4-15). The SC joint allows motion in all three cardinal planes, and it is supported by a thick network of ligaments, an articular disc, and a joint capsule. Rather, muscles work in teams to produce highly coordinated movements that are expressed over multiple joints. Nerve roots C5 and C6 form the upper trunk, C7 forms the middle trunk, and C8 and T1 form the lower trunk. When these forces are combined, the resultant vector is a compressive force directed through the middle of the glenoid fossa, enhancing the static stability of the GH joint. The sternoclavicular (SC) joint is created by the articulation of the medial aspect of the clavicle with the sternum (Figure 4-6). Along with the acromion, the coracoacromial ligament completes the coracoacromial arch—a functional “roof” that protects the head of the humerus. Supporting Structures of the Sternoclavicular Joint, The SC joint structure is a saddle joint with concave and convex surfaces on each of the joint’s articular surfaces (Figure 4-7). During these actions, the humeral head spins on the glenoid fossa about a relatively fixed axis—an arthrokinematic roll and slide is not necessary. Abduction involves the 2 : 1 ratio of glenohumeral abduction to scapular upward rotation—the scapulohumeral rhythm. Upward rotation occurs as the glenoid fossa of the scapula rotates upwardly, as a natural component of raising the arm overhead (Figure 4-9, C). Anterior view of the right acromioclavicular joint, including many of the surrounding ligaments. Proximal-to-Mid Humerus Dec 5, 2016 | Posted by admin in MANUAL THERAPIST | Comments Off on Structure and Function of the Shoulder Complex, Interaction Among the Joints of the Shoulder Complex. Describe the location and primary function of the ligaments that support the joints of the shoulder complex. • Long Head of the Biceps: The proximal portion of the tendon wraps around the superior aspect of the humeral head, attaching to the superior glenoid tubercle. Even with the humerus in full external rotation, complete abduction of the shoulder may result in impingement if performed in the true frontal plane (Figure 4-16, A). Yep, the shoulder complex is a tricky beast. The ring is composed of the glenoidprocess, coracoid process, coracoclavicular ligament, distalclavicle, acromioclavicular joint, and acromialprocess. The axes of rotation are color coded with the associated planes of motion. This joint provides the only direct bony attachment of the upper extremity to the axial skeleton—accordingly, the joint must be stable while also allowing extensive mobility. It is interesting to note that the ligaments and capsule of the GH joint are relatively thin and provide only secondary stability to the joint. For that reason, and because of the dexterity of the shoulder joint itself, the musculature of the shoulder is complex, ranging from massive prime mover muscles to finer stabilizer and fixator muscles. SHOULDER COMPLEX ANATOMY Osseous Elements The shoulder complex includes the articulations of the humerus, the clavicle, the scapula, and the posterior surface of the ribs. She had a lumpectomy with sentinel node biopsy, followed by radiation treatments for 5 weeks. First, the superior portion of the labrum is only loosely attached to the adjacent glenoid rim. The clavicle rotates anteriorly, back to its rest position, as the shoulder is extended or adducted. Scapulothoracic Joint Commonly called the shoulder blade, the scapula is a highly mobile, triangular bone that rests on the posterior side of the thorax (Figure 4-4). • Coracohumeral Ligament: Attaches between the coracoid process and the anterior side of the greater tubercle. The glenohumeral (GH) joint, which links the humerus and scapula, has greater mobility than any other joint in the body. Muscle and Joint Interaction During abduction or flexion of the shoulder, the clavicle rotates posteriorly about its longitudinal axis. • Articular Disc: Acts as a shock absorber between the clavicle and the sternum; helps improve joint congruency Figure 4-9 Motions of the right scapula against the posterior-lateral thorax. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-3.) • Identify the bones and primary bony features relevant to the shoulder complex. This means that for every 2 degrees of GH abduction, the scapula must simultaneously upwardly rotate roughly 1 degree. Bankart lesions, on the other hand, involve tears to the anterior-inferior portion of the glenoid labrum. Regardless of the type of lesion, surgery may be indicated if the tear of the labrum is large—or if conservative methods of treatment are unsuccessful. As illustrated in Figure 4-17, B, when the scapula becomes downwardly rotated, as commonly occurs after a stroke involving weakness or paralysis of the trapezius muscles, the static locking mechanism becomes ineffective. Most often, this type of injury results in a. • Describe the planes of motion and axes of rotation for the primary motions of the shoulder. + 60 degrees of scapulothoracic joint upward rotation The shoulder is a complex ball-and-socket joint comprising the head of the humerus, the clavicle (collarbone), and the scapula. Not only does the humeral head lose its ledge on which to rest, but the direction of the upward forces created by the superior capsular ligaments is changed, reducing the overall potential of these structures to produce a passive compression force (CF). dynamic stabilizers Examples of these actions include a rowing motion or a push-up. • Coracoacromial Ligament: Attaches the coracoid process to the acromion process; one of the few ligaments of the body that attaches proximally and distally to the same bone. Scapular movements include: Anterior/posterior tilting, upward/downward rotation. ), (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-28. In essence, this joint links the motion of the scapula (and attached humerus) to the lateral end of the clavicle. Clinicians therefore focus a great deal on evaluating and treating the quality and amount of motion between the scapula and the thorax. F. during open-chain abduction of the shoulder, the arthrokinematic roll and slide occur in the same direction. These relatively slight but important adjustment motions help to fine-tune the movements between the scapula and the humerus. The next steps in treatment or work-up can then … Our study of the upper limb begins with the shoulder complex—a set of four articulations involving the sternum, clavicle, ribs, scapula, and humerus (Figure 4-1). Depression occurs when the scapula slides inferiorly on the thorax (, Protraction describes the motion of the scapula sliding laterally on the thorax, away from midline, whereas retraction describes movement of the scapula toward the midline (, Upward rotation occurs as the glenoid fossa of the scapula rotates upwardly, as a natural component of raising the arm overhead (, The acromioclavicular (AC) joint is considered a gliding or plane joint, created by the articulation between the lateral aspect of the clavicle and the acromion process of the scapula (Figure 4-10). References. The greater and lesser tubercles are divided by the intertubercular groove, often called the bicipital groove because it houses the tendon of the long head of the biceps. During normal shoulder abduction (or flexion), a natural 2 : 1 ratio or rhythm exists between the GH joint and the scapulothoracic joint. The muscles in the shoulder aid in a wide range of movement and help protect and maintain the main shoulder joint, known as the glenohumeral joint. Elevation and Depression scapulothoracic joint function, as previous assessments of shoulder function following surgery have only focused on humerothoracic motion. The medial or sternal end of the clavicle articulates with the manubrium of the sternum, forming the sternoclavicular joint. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-19, A.) INTEGRATED FUNCTION OF THE SHOULDER COMPLEX. Rarely does a single muscle act in isolation at the shoulder complex. The muscles of the shoulder bridge the transitions from the torso into the head/neck area and into the upper extremities of the arms and hands. Description Anterior view of the left shoulder and acromioclavicular joints, and proper scapular ligaments. Use the images below for reference. Anytime you watch an athlete perform an intricate task involving the shoulder complex, you can appreciate the diverse interactions and contributions of the lower extremities, core muscles, spine, and upper torso musculature. An excellent example of this interaction is the, During normal shoulder abduction (or flexion), a natural 2 : 1 ratio or rhythm exists between the GH joint and the scapulo. muscles of the shoulder; human muscle system. The right sternoclavicular joint showing the osteokinematic motions of the clavicle. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-13.) Most often, this type of injury results in a SLAP lesion (Superior Labrum from Anterior to Posterior), which involves the superior aspect of the labrum. The glenoid fossa is the slightly concave, oval-shaped surface that accepts the head of the humerus, composing the glenohumeral joint. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-19, (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-25. The divisions then reorganize into lateral, medial, and posterior cords, named by their position relative to the axillary artery. Most often, this type of injury results in a SLAP lesion (Superior Labrum from Anterior to Posterior), which involves the superior aspect of the labrum. • Capsular Ligaments: A thin fibrous capsule that includes the superior, middle, and inferior glenohumeral ligaments. Shoulder abduction in the scapular plane, often referred to as scaption, positions the greater tuberosity of the humerus under the highest point of the acromion and helps to prevent bony impingement, regardless of the amount of rotation of the glenohumeral joint. To fully understand how the shoulder functions as a whole, we must first examine the structure and kinematics of each individual joint. Summary The head of the humerus is much larger than the glenoid fossa, giving the joint a wide range of movement at the cost of inherent instability. These muscles surround the humeral head and actively hold the humeral head against the glenoid fossa. The role of the scapula in athletic shoulder function. These three segments are joined by three interdependent linkages: the sternoclavicular joint, the acromioclavicular (AC) joint, and the glenohumeral joint. • Upward rotation of the scapula American Council on Exercise (2010). The humerus is a long bone that forms the articulations of the glenohumeral joint proximally (with the scapula), and the humeral ulnar joint and humeral radial joint 2011;46(4):349-357. Each of them aids in a specific motion of your shoulder. Protraction and Retraction The clavicle, commonly called the collarbone, is an S-shaped bone that acts like a mechanical rod that links the scapula to the sternum (Figure 4-3). Elevation and depression of the SC joint is a near-frontal plane movement about a near–anterior-posterior axis of rotation, allowing roughly 45 degrees of clavicular elevation and 10 degrees of depression. • Rotator Cuff: A group of four muscles including the supraspinatus, infraspinatus, subscapularis, and teres minor. The objective of this study was to perform a comprehensive analysis of scapular kinematics before and after PSF and compare postoperative scapular kinematics in AIS to those of a typically developing cohort. The shoulder complex plays an integral role in performing an athletic skill involving the upper. Box 4-1   Summary of Bony Movements During Common Shoulder Motions The glenoid labrum is a fibrocartilaginous ring of connective tissue that increases the stability of the glenohumeral joint. Large forces that tax the biceps tendon can partially detach or tear the loosely attached superior labrum. Supporting Structures of the Glenohumeral Joint, Numerous structural and functional reasons explain why the labrum is so often involved with shoulder pathology. To illustrate this, first try to perform frontal plane abduction with your arm in full internal rotation (thumb pointing down), then in a neutral position (palm facing down), and finally in full external rotation (thumb pointing up). She localizes the pain primarily at the lateral proximal humerus (C5 dermatome region) but also reports pain in the upper trapezius. Figure 4-6 illustrates the supporting structures of the SC joint. The exact kinematics of this joint varies, depending on the range of motion through which the shoulder is being extended. The shoulder complex is built for mobility, however this ability to move comes with the designation of being the most unstable joint in the body. The following provides a summary of normal kinematic interactions among the humerus, the scapula, and the clavicle during common shoulder motions. Numerous structural and functional reasons explain why the labrum is so often involved with shoulder pathology. Glenohumeral Joint This will improve shoulder position and posture over time, which will ultimately lead to better function of the shoulder complex and can improve total kinetic chain movement. This chapter provides an overview of the kinesiology of the four joints of the shoulder complex and the important muscular synergies that support proper function of the shoulder (Figure 4-1). This bony conformation, in conjunction with the highly mobile scapula, allows for abundant motion in all three planes but does not promote a high degree of stability. Normal movement and posture of the scapulothoracic joint are essential to the normal function of the shoulder. Kinematics Horizontal abduction and horizontal adduction are commonly used terms to describe special motions of the shoulder and are described in the following section. • Long Head of the Biceps: The proximal portion of the tendon wraps around the superior aspect of the humeral head, attaching to the superior glenoid tubercle. An excellent example of this interaction is the scapulohumeral rhythm. Y-T-W Drills. The high degree of stability provided by this thick ligamentous network explains, in part, why fractures of the clavicle occur more frequently than dislocations of the SC joint. The acromioclavicular (AC) joint is considered a gliding or plane joint, created by the articulation between the lateral aspect of the clavicle and the acromion process of the scapula (Figure 4-10). Movement away from the midline in the horizontal plane is considered horizontal abduction. As illustrated in Figure 4-17, B, when the scapula becomes downwardly rotated, as commonly occurs after a stroke involving weakness or paralysis of the trapezius muscles, the static locking mechanism becomes ineffective. Together, these ligaments help suspend the scapula from the clavicle and prevent dislocation. Rather, muscles work in teams to produce highly coordinated movements that are expressed over multiple joints. B, Protraction and retraction. Rarely does a single muscle act in isolation at the shoulder complex. Large forces that tax the biceps tendon can partially detach or tear the loosely attached superior labrum. Along with the acromion, the coracoacromial ligament completes the coracoacromial arch—a functional “roof” that protects the head of the humerus. San Diego, Calif.: American Council on Exercise. 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