1. to identify the structure of the shoulder and the shoulder girdle, including joint type, articular shape, and
the surrounding tissues
2. to describe joint motions occurring at the shoulder complex, including osteokinematic and
arthrokinematic movements, muscle actions, and factors checking shoulder motions
3. to understand the stability mechanism of the shoulder complex and the possible mechanisms of injury
4. to distinguish the three-degree-of-freedom joint from the one- or two-degree-of-freedom joint
5. to understand the effect of muscle synergies and the influence of weakness or paralysis of one single
muscle in coupled-muscle motions
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sternoclavicula
r joint
acromioclavic
ular joint
scapulothoraci
c articulation:
msucle-bone
articulation
NOTE:
classified by
Smith et al.,
1996
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functional joints
scapulothoracic articulation
suprahumeral articulation (subacromial articulation): the articulation between the
coracoacromial ligament and the humerus
bicipital groove: the groove between the greater and lesser tuberosities of the humerus
NOTE: clavicle
convex forward medially and concave forward laterally
quadripedal animals do not have clavicles
isokinetic strength of shoulder flexor and abductor decreases 50% if the clavicle is removed
Suprahumeral articulation
synonym: subacromial joint
coracoacromial arch: composed of the coracoacromial
ligament
spraspinatus tendon passing underneath this arch
not for joint stability
shoulder impingement occurs if the subacromial space is
insufficient
insufficient inferior glide of the humeral head
during arm elevation
insufficient external rotation of the humerus during
arm elevation
inflammation of the tendon of the supraspinatus
hypertrophy of the tendon of the supraspinatus
subacromial (subdeltoid) bursa
Bicipital groove
groove between greater and lesser tuberosities of the humerus covered with the transverse humeral
ligament
passing tendon of long head of biceps brachii
intra-articular but extra-synovial
Plane of scapula
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joint involved
glenohumeral joint (principal joint)
sternoclavicular joint
acromioclavicular joint
scapulothoracic articulation
plane of motion: sagittal plane
axis of rotation: transverse axis through the center of the humeral head
osteokinematic movements
range of motion (ROM)
glenohumeral joint: 0-90º for shoulder flexion and 0-45º or 60º for shoulder
extension
closed kinematic chain motions
pull-up (引體向上)
push-up (伏地挺身)
rowing
upper extremity cycling on an ergometer
arthrokinematic movements
posterolateral glide of the humeral head on the glenoid cavity with shoulder flexion
anteromedial glide of the humeral head on the glenoid cavity with shoulder extension
factors limiting shoulder flexion
inferior glenohumeral ligament (most important)
tightness of the posterior joint capsule
factors limiting shoulder extension
superior and middle glenohumeral ligament (most important)
joint involved
glenohumeral joint (principal joint)
sternoclavicular joint
acromioclavicular joint
scapulothoracic articulation
plane of motion: transverse plane
axis of rotation: vertical axis through the center of the humeral head
osteokinematic movements
range of motion (ROM)
shoulder internal rotation: 0-70º as the arm at 90º of shoulder abduction and 90º
elbow flexion
shoulder external rotation: 0-90º as the arm at 90º of shoulder abduction and 90º
elbow flexion
Note: If the elbow is extended, shoulder rotation occurs simultaneously with
forearm rotation.
arthrokinematic movements
posterolateral glide of the humeral head on the glenoid cavity with shoulder internal
rotation
anteromedial glide of the humeral head on the glenoid cavity with shoulder external
rotation
arthrokinematic movement
elevation of the scapula on the rib cage
inferior glide of the clavicle on the sternum in most people
limited by the costoclavicular and interclavicular ligaments and the subclavicius muscle
shoulder girdle depression
important for crutch walking
definition: ST joint depression associated with SC depression
joint involved
scapulothoracic articulation
sternoclavicular joint
acromioclavicular joint
range: 10-15 cm from maximum scapular elevated position
arthrokinematic movements
depression of the capula on the rib cage
superior glide of the clavicle in most people
limited by first rib
Scapulothoracic Rotation
upward rotation
definition: glenoid fossa facing upwards with
inferior angle of scapula sliding laterally and anteriorly
osteokinematic movements
fisrt 30º: elevation of the clavicle through
the axis at the base of the spine of scapula
last 30º: posterior rotation of the clavicle
and scapular rotation around AC joint
downward rotation
definition: glenoid fossa facing downwards with inferior angle of scapula sliding medially
and posteriorly
total range: 60º
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The muscle at the shoulder complex act together as a team to produce highly coordinated motions.
Serratus anterior
saw muscle
origin: rib 1-9
insertion: medial border of the
scapula
motion: protraction + upward
rotation
winging scapula if paralyzed
displacement of medial
border of the scapula
Pectoralis minor
levator scapula
latissimus dorsi
pectoralis major
trapezius: upper, middle, and lower
rhomboid major and minor
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Factors affecting stability of the glenohumeral joint: primarily dependent on muscles and ligaments
bony configuration
5º of superior inclination (upward tilt) of the glenoid cavity
shape of cartilage
deepened glenoid labrum
tension of ligaments
superior glenohumeral ligament
middle glenohumeral ligament
inferior glenohumeral ligament
coracohumeral ligament
muscular arrangement: rotator cuff
supraspinatus
infraspinatus
teres minor
subscapularis
capsule
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Direct stress
Repeated stresses
repeated shoulder rotation motions as the shoulder is placed at 90º of abduction repeated tensile
stress on rotator cuff rotator cuff tendinitis
Muscle paralysis
repeated shoulder rotation motions as the shoulder is placed at 90º of abduction repeated tensile
stress on rotator cuff rotator cuff tendinitis