1. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Chapter 5: The Upper Extremity: The Shoulder Region KINESIOLOGY Scientific Basis of Human Motion, 11 th edition Hamilton, Weimar & Luttgens Presentation Created by TK Koesterer, Ph.D., ATC Humboldt State University Revised by Hamilton & Weimar

2. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Objectives 1. Name, locate, & describe the structure & ligamentous reinforcements of the joints. 2. Name & demonstrate movements possible. 3. Name & locate muscles & muscle groups, and name their primary actions. 4. Analyze the fundamental movements with respect to joint & muscle actions. 5. Describe common injuries.

3. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Acromioclavicular (AC) Joint  Articulation of acromion & distal end of clavicle.  Acromioclavicular ligament strengthens joint superiorly.  Aponeurosis of trapezius & deltoid strengthen joint posteriorly.  Coracoclavicular ligament further stabilizes joint. Fig 5.1

4. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Sternoclavicular (SC) Joint  Proximal clavicle articulates with sternum and cartilage of 1 st rib.  Capsule thickened by anterior & posterior sternoclavicular ligaments. Fig 5.2

5. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Sternoclavicular (SC) Joint  Great importance because it is the only bony connection between the humerus and axial skeleton.  Permits limited motion of the clavicle.  Is partially responsible for movements of the scapula.  Clavicle movements at the SC joint: elevation & depression, protraction & retraction, and forward & backward rotation.

6. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements of the Shoulder Girdle Fig 5.3 a & b Abduction (Protraction) Adduction (Retraction) Elevation Depression

7. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements of the Shoulder Girdle Fig 5.3 c & d Upward rotation Downward rotation Anterior tilt Posterior tilt

8. © 2008 McGraw-Hill Higher Education. All Rights Reserved. MUSCLES OF THE SHOULDER GIRDLE  Location:  Anterior  Pectoralis minor, Serratus anterior, Subclavius  Posterior  Levator scapulae, Rhomboids, Trapezius

9. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Pectoralis Minor Function:  Movements of scapula: downward rotation, anterior tilt, depression.  Lifting effect on ribs in forced inspiration and posture. Fig 5.4

10. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Serratus Anterior Function:  Abduct (protract) scapula.  With trapezius, upward rotation of scapula.  Active in reaching and pushing. Fig 5.4

11. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Subclavius Function:  Protect and stabilize sternoclavicular joint.  Depress scapula. Fig 5.4

12. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Levator Scapulae Function:  Elevation and downward rotation of scapula. Fig 5.5

13. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Rhomboids, Major and Minor Function:  Downward rotation, adduction (retraction), & elevation of scapula.  With trapezius for maintenance of good posture. Fig 5.5

14. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Trapezius Function: I. Elevation II. Elevation, upward rotation, adduction III. Adduction IV. Upward rotation, depression, adduction Fig 5.6

15. © 2008 McGraw-Hill Higher Education. All Rights Reserved. GLENOHUMERAL (Shoulder) JOINT Structure  Articulation of spherical head of humerus with small, shallow, somewhat pear-shaped glenoid fossa of scapula. Fig 5.7

16. © 2008 McGraw-Hill Higher Education. All Rights Reserved. GLENOHUMERAL (Shoulder) JOINT Structure  Glenoid labrum deepens the fossa and cushion against impact of humeral head in forceful movements. Fig 5.8

17. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Ligamentous Reinforcements  Coracohumeral  Glenohumeral  Coracoacromial Fig 5.9

18. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Muscular Reinforcements  Above: supraspinatus & long head of biceps.  Below: long head of triceps.  Front: subscapularis, pectoralis major, & teres major.  Behind: infraspinatus & teres minor.

19. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements of the Shoulder Joint  Flexion / Extension  Hyperextension  Circumduction  Abduction / Adduction  Horizontal  Diagonal  Internal / External Rotation External rotation Internal rotation

20. © 2008 McGraw-Hill Higher Education. All Rights Reserved. MUSCLE OF THE SHOULDER JOINT  Location:  Anterior: Pectoralis major, coracobrachialis, subscapularis, biceps brachii.  Posterior: Infraspinatus, teres minor.  Superior: Deltoid, supraspinatus.  Inferior: Latissimus dorsi, teres major, long head of triceps brachii.

21. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Pectoralis Major Function: Clavicular portion – flexion, horizontal adduction, and internal rotation of humerus. Sternal portion – downward & forward movements of arm, & internal rotation with adduction. Fig 5.11

22. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Coracobrachialis Function:  Horizontal adduction  Acts like a guy wire to stabilize the shoulder joint. Fig 5.12

23. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Biceps Brachii Function:  Flexion at the elbow & supination of forearm.  Horizontal adduction at shoulder.  Short head sometimes active in adduction & internal rotation. Fig 5.12

24. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Deltoid Function:  Powerful abductor of humerus.  Middle – Abduction  Anterior – all forward movements & internal rotation of humerus. Fig 5.14

25. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Subscapularis Function:  Internal rotation of humerus as part of the rotator cuff.  Contributes to stability of shoulder joint. Fig 5.13a

26. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Supraspinatus Function:  Acts together with deltoid in abduction of the arm.  Also acts in flexion & horizontal extension.  Contributes to stability of shoulder joint.  Part of the rotator cuff. Fig 5.13b

27. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Infraspinatus and Teres Minor Function:  External rotation as part of the rotator cuff.  With subscapularis depresses head of humerus.  Contributes to stability of shoulder joint. Fig 5.13b

28. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Latissimus Dorsi Function:  Extension & adduction of arm, internal rotation. Fig 5.14

29. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Teres Major Function:  Internal rotation, extension, & adduction of the arm. Fig 5.15

30. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Triceps Brachii Function:  Long head assists in adduction, extension, and hyperextension of the humerus. Fig 5.15

31. © 2008 McGraw-Hill Higher Education. All Rights Reserved. JOINT AND MUSCULAR ANALYSIS OF THE FUNDAMENTAL MOVEMENTS OF THE ARM ON THE TRUNK  Movements of the arm on the trunk involve the cooperative action of the shoulder girdle  Acromioclavicular joints  Sternoclavicular joints and the shoulder (glenohumeral) joint. and the shoulder (glenohumeral) joint.

32. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Frontal Plane  Shoulder Joint - Abduction  Deltoid & supraspinatus  Shoulder Girdle: Upward rotation of scapula.  Serratus anterior; trapezius II & IV Fig 5.16

33. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Frontal Plane  Shoulder Joint - Adduction  Latissimus dorsi, teres major, pectoralis major (sternal), & post. deltoid.  Shoulder Girdle: reduction of upward rotation.  Rhomboids & pectoralis minor. Fig 5.17

34. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Sagittal Plane  Shoulder Joint - Flexion  Anterior deltoid & pectoralis major (clavicular).  Shoulder Girdle: Upward rotation of scapula  Serratus anterior & trapezius II & IV. Fig 5.18

35. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Sagittal Plane  Shoulder Joint - Extension  Pectoralis major (sternal), teres major, latissimus dorsi, post. Deltoid. Fig 5.19  Shoulder Girdle: Reduction of upward rotation of scapula  Relaxation of agonists  Against resistance - trapezius IV, rhomboids, pect. minor.

36. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Sagittal Plane  Shoulder Joint - Hyperextension  Teres major, latissimus dorsi, post. Deltoid.  Shoulder Girdle: Anterior tilt of scapula  Pectoralis minor. Fig 5.20

37. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Horizontal Plane  Shoulder Joint - External Rotation  Infraspinatus & teres minor.  Shoulder Girdle: Adduction of scapula  Rhomboids & trapezius III. Fig 5.22a

38. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Horizontal Plane  Shoulder Joint - Internal Rotation  Subscapularis, teres major, latissimus dorsi, ant. deltoid, pectoralis major.  Shoulder Girdle: Abduction of scapula  Serratus anterior & pectoralis minor. Fig 5.22b

39. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Horizontal Plane  Shoulder Joint - Horizontal Adduction  Pectoralis major, ant. deltoid, & coracobrachialis.  Shoulder Girdle: Abduction of scapula  Serratus anterior & pectoralis minor  Shoulder Joint – Horizontal Abduction  Post. deltoid, post middle deltoid, infraspinatus, teres minor, long head of biceps.  Shoulder Girdle: Adduction of scapula  Rhomboids & trapezius III.

40. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Diagonal Movements  Diagonal forward-downward and slightly inward movement of the arm. Fig 5.10 Fig 5.23

41. © 2008 McGraw-Hill Higher Education. All Rights Reserved. COMMON INJURIES OF THE SHOULDER REGION Acromioclavicular Sprain  AC joint forced beyond normal ROM.  Downward blow to outer end of shoulder.  Fall on outstretched hand.  Damage consists of tearing or severe stretching of AC ligaments.

42. © 2008 McGraw-Hill Higher Education. All Rights Reserved. COMMON INJURIES OF THE SHOULDER REGION Fracture of The Clavicle  Clavicle fractures have causes similar to AC sprain:  Downward blow to outer end of shoulder.  Fall on outstretched hand.  May indicate injury by supporting injured arm.  Head may be tilted toward injured side with face turned to opposite side.

43. © 2008 McGraw-Hill Higher Education. All Rights Reserved. COMMON INJURIES OF THE SHOULDER REGION Dislocation of the Shoulder  May be forward, downward, or posterior.  Most likely when arm is forcefully abducted and laterally rotated.  May occur by a blow to top of shoulder.  Head of humerus is forced out of the glenoid fossa.  Arm held out from side in a position of slight abduction and lateral rotation.  Loss of normal rounded contour of deltoid muscle.

44. © 2008 McGraw-Hill Higher Education. All Rights Reserved. COMMON INJURIES OF THE SHOULDER REGION Rotator Cuff Tears  Supraspinatus (supraspinatus tendon) most often injured.  Nature of injury depends on arm kinematics.  Caused by overuse, falls, or violent, fast arm motion.

45. © 2008 McGraw-Hill Higher Education. All Rights Reserved. COMMON INJURIES OF THE SHOULDER REGION Shoulder Impingement  Soft tissue superior to humeral head pressed against acromion process.  Due to overuse, inflammation, trapped bursa, degeneration with aging.  Will cause pain and inflammation in shoulder.

46. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Chapter 5: The Upper Extremity: The Shoulder Region