1. Shoulder joint
Mazyad Alotaibi

2. SCAPULA
Scapula Abduction and Upward Rotation
Scapula Elevation
Scapula Adduction
Scapula Depression and Adduction
Scapula Adduction and Downward Rotation

3. Scapular motions

4. Scapula Abduction and Upward Rotation
1- Prime mover/agonist:
Serratus anterior
Synergist/ Accessory muscles:
Pectoralis minor.
2- Range of motion:
measure the distance between spine process and
medial border of scapula

5. Scapula Abduction and Upward Rotation
3-Fixation:
a. in strong scapular abduction, by pull of obliqus externus abdominis on
same side.
b. By weight of thorax.
4- Effect of weakness/contracture/shortening:
Effect of weakness result in:
- Winging of Scapula
- In ability to raise the arm overhead.
5- Factor limited range of motion:
a. Tension of trapezoid ligament.
b. Tension of trapezius and rhomboid major and rhomboid minor muscles.
6- Substitution:
None.

6. Scapula Abduction and Upward Rotation
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient
Patient Position:
Patient should be supine with shoulder flexed to 90. The shoulder should be raised off the table, hand in a fist.
Therapist and Patient Instructions:
Therapist stands over the patient, resistance is given over the hand in a downward direction. The stabilizing hand is placed around the wrist.

7. Scapula Elevation 1- Prime mover/agonist:
-Trapezius (superior fibers(
- Levator scapulae
Synergist/ Accessory muscles: Rhomboids major and minor
2- Range of motion:
measure the distance between top of the shoulder
and loops of ear.

8. Scapula Elevation 3- Fixation:
a. flexor muscles of cervical spine..
b. weight of head.
4-Effect of weakness/contracture/shortening:
Effect of weakness result in: Inability to raise shoulder upwards; either bilateral or unilateral weakness.
5-Factor limited range of motion:
a. Tension of costoclavicular ligament.
b. Tension of scapular depression muscle and clavicle: pectoralis minor, subclavius, and trapezius (lower fibers) muscles.
6-Substitution:
by Rhomboids (scapula adduction and downward rotation)
inferior angle will move medially.

9. Scapula Elevation 7- Procedures: a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient

10. Scapula Adduction (Retraction)
1- Prime mover/agonist:
Trapezius) (middle fibers)
Synergist/ Accessory muscles:
Rhomboid major and minor, and Trapezius
(upper and lower fibers)
2- Range of motion:
measure the distance between transverse process and
medial border of scapula

11. Scapula Adduction (Retraction)
3- Fixation:
- weight of thorax.
4- Effect of weakness/contracture/shortening:
- Inability to adduct the scapula.
5- Factor limited range of motion:
a. Tension of conoid ligament.
b. Tension of pectoralis major and minor, and serratus anterior muscles.
c. Contact of vertebral border of scapula with spinal musculature.
6- Substitution:
- Rhomboids (scapula adduction and downward rotation)
inferior angle will move medially.
- Post. Deltoid if the scapular muscles are absent (horizontal adduction of shoulder will occur).

12. Scapula Adduction (Retraction)
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient

13. Scapula Depression and Adduction
1- Prime mover/agonist:
Trapezius (lower fibers)
Synergist/ Accessory muscles: latissimus dorsi.
2- Range of motion:
measure the distance between spine process and
inferior angle of scapula

14. Scapula Depression and Adduction
3- Fixation:
a. By contraction pf spinal extensor muscles.
b. By weight of thorax.
4- Effect of weakness/contracture/shortening:
Effect of weakness result in:
- In ability to raise the arm overhead.
5- Factor limited range of motion:
a. Tension of inter clavicular ligament and articular disk of sternoclavicular joint.
b. Tension of trapezius muscle.
6- Substitution:
None.

15. Scapula Depression and Adduction
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient

16. Scapula Adduction and Downward Rotation
1- Prime mover/agonist:
Rhomboid major and minor
Synergist/ Accessory muscles:
Levator scapulae.
2- Range of motion:
The distance between the vertebral
border of scapula and vert sp.

17. Scapula Adduction and Downward Rotation
3- Fixation:By weight of thorax.
4- Effect of weakness/contracture/shortening:
- The scapula will abduct and the inferior angle rotate outward.
- Inability to adduct & downward rotate the scapula.
5- Factor limited range of motion:
a. Tension of conoid ligament.
b. Tension of pectoralis major and minor, serratus anterior muscles.
c. Contact of vertebral border of scapula with spinal musculature.
6- Substitution:
by middle trapezius (only adduct the scapula without downward rotation).

18. Scapula Adduction and Downward Rotation
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient

19. Shoulder flexion 1- Prime mover/agonist: Synergist/ Accessory muscles:
Anterior Deltoid
Coracobrachialis
Synergist/ Accessory muscles:
Pectoralis minor (upper), deltoid (middle), serratus anterior
2- Range of motion:
0 to 80-90

20. Shoulder flexion 3- Fixation:
a. By Contraction of trapezius and serratus anterior muscles.
4- Effect of weakness/contracture/shortening:
Effect of weakness result in:
- Decrease the strength of shoulder flexors.
5- Factor limited range of motion:
a. Contact of greater tubercle and humerus with anterior surface of acromion.
b. Tension of shoulder extensor muscles.
6- Substitution:
by:
a. in the absence of a Deltoid the patient may attempt to flex the shoulder with the Biceps brachii by first externally rotating the shoulder then flex it.
b. the upper Trapezius results in shoulder elevation.
c. the Pectoralis major results in horizontal adduction.
d. the patient may lean backward or try to elevate the shoulder girdle to assist in flexion.

21. Shoulder flexion 7- Procedures: a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient

22. Shoulder extension 1- Prime mover/agonist:
Latissimus dorsi)
Deltoid
Teres major
Synergist/ Accessory muscles:
Triceps brachii (long head).
2-Range of motion:
from 90 to 0 from prone lying position is shoulder extension.
from 0 to 45 up to 60 is hyperextension

23. Shoulder extension 3-Fixation:
a. By contraction of rhomboideus major and minor, and trapezius muscles.
b. By weight of trunk.
4-Effect of weakness/contracture/shortening:
Effect of weakness result in:
- Weakness of latissimus dorsi result in: diminishing the strength of shoulder extension and lateral trunk flexion.
- Weakness of teres major result in: diminishing the strength shoulder extension and medial rotation.
5-Factor limited range of motion:
a. Tension of shoulder flexor muscles.
b. Contact of greater tubercle and humerus with acromion posteriorly.
6-Substitution:
by Rhomboids (scapula adduction and downward rotation)
inferior angle will move medially.

24. Shoulder extension a- Position of Patient:
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient

25. Shoulder abduction Deltoid (medial fibers) 1- Anatomy
Prime mover/agonist:
Deltoid (medial fibers)
Supraspinatus)
Synergist/ Accessory muscles:
Deltoid ( Ant& Pos fibers)
2- Range of motion:
from 0 to 170 (0 to 90 is pure abduction-
then surgical neck will impact with glenoid cavity
so to do up to 180 the arm must lateral rotate.

26. Shoulder abduction 3- Fixation:
a. By contraction of trapezius and serratus anterior muscles.
4- Effect of weakness/contracture/shortening:
Effect of weakness result in:
- inability to lift arm in abduction.
- Paralysis of Deltoid tends to sublax the shoulder downward.
- Weakness of supraspinatus or rupture of its tendon: decreases the shoulder joint stability.
5- Factor limited range of motion:
a. Contact of greater tubercle and humerus with lateral surface of acromion.
b. Tension of shoulder adductor muscles.
6- Substitution:
None.

27. Shoulder abduction a- Position of Patient:
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient