1. Chapter 5:Part 1 The Upper Extremity: The Shoulder Region
KINESIOLOGY
Scientific Basis of Human Motion, 12th edition
Hamilton, Weimar & Luttgens
Presentation Created by
TK Koesterer, Ph.D., ATC
Humboldt State University
Revised by Hamilton & Weimar
McGraw-Hill/Irwin
Copyright © 2012 by The McGraw-Hill Companies, Inc. All rights reserved.

2. 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. 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. Sternoclavicular (SC) Joint
Fig 5.2
Proximal clavicle articulates with sternum and cartilage of 1st rib.
Capsule thickened by anterior & posterior sternoclavicular ligaments.
The only bony connection between the humerus and axial skeleton.
Permits limited motion of the clavicle.
Partially responsible for movements of the scapula.
Clavicular movements at the SC joint:
elevation & depression,
protraction & retraction,
forward & backward rotation.

5. Movements of the Shoulder Girdle
Fig 5.3 a & b
Abduction (Protraction)
Adduction (Retraction)
Elevation
Depression

6. Movements of the Shoulder Girdle
Fig 5.3 c & d
Upward rotation
Downward rotation
Anterior tilt
Posterior tilt

7. MUSCLES OF THE SHOULDER GIRDLE
Location:
Anterior
Pectoralis minor, Serratus anterior, Subclavius
Posterior
Levator scapulae, Rhomboids, Trapezius

8. Pectoralis Minor Function:
Movements of scapula: downward rotation, anterior tilt, depression.
Lifting effect on ribs in forced inspiration and posture.
Fig 5.4

9. Serratus Anterior Function: Abduct (protract) scapula.
Fig 5.4
Function:
Abduct (protract) scapula.
With trapezius, upward rotation of scapula.
Active in reaching and pushing.

10. Subclavius Function: Protect and stabilize sternoclavicular joint.
Fig 5.4
Function:
Protect and stabilize sternoclavicular joint.
Depress scapula.

11. Levator Scapulae Function: Elevation and downward rotation of scapula.
Fig 5.5

12. Rhomboids, Major and Minor
Function:
Downward rotation, adduction (retraction), & elevation of scapula.
Works with trapezius for maintenance of good posture.
Fig 5.5

13. Trapezius Function: I. Elevation
Fig 5.6
Function:
I. Elevation
II. Elevation, upward rotation, adduction
III. Adduction
IV. Upward rotation, depression, adduction

14. GLENOHUMERAL (Shoulder) JOINT Structure
Fig 5.7
Articulation of spherical head of humerus with small, shallow glenoid fossa of scapula.
Fig 5.8
Glenoid labrum deepens the fossa and cushions impact of humeral head in forceful movements.

15. Ligamentous Reinforcements
Fig 5.9
Coracohumeral
Glenohumeral
Coracoacromial

16. Muscular Reinforcements
Superior: supraspinatus & long head of biceps.
Inferior: long head of triceps.
Anterior: subscapularis, pectoralis major, & teres major.
Posterior: infraspinatus & teres minor.

17. Movements of the Shoulder Joint
Internal rotation
External rotation
Flexion / Extension
Hyperextension
Circumduction
Abduction / Adduction
Horizontal
Diagonal
Internal / External Rotation

18. 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.

19. Pectoralis Major
Fig 5.11
Function: Clavicular portion – flexion, horizontal adduction, and internal rotation of humerus. Sternal portion – downward & forward movements of arm, & internal rotation with adduction.

20. Coracobrachialis Function: Horizontal adduction
Fig 5.12
Function:
Horizontal adduction
Acts like a guy wire to stabilize the shoulder joint.

21. Biceps Brachii Function: Flexion at the elbow & supination of forearm.
Fig 5.12
Function:
Flexion at the elbow & supination of forearm.
Horizontal adduction at shoulder.
Short head sometimes active in adduction & internal rotation.

22. Deltoid
Fig 5.14
Function:
Anterior – all forward movements & internal rotation of humerus.
Middle – abduction
Powerful abductor of humerus.
Posterior – extension, hyperextension, horizontal extension, adduction.

23. Subscapularis Function:
Internal rotation of humerus as part of the rotator cuff.
Contributes to stability of shoulder joint.
Fig 5.13a

24. Supraspinatus Function: Acts with deltoid in abduction of the arm.
Active in flexion & horizontal extension.
Contributes to stability of shoulder joint.
Part of the rotator cuff.
Fig 5.13b

25. 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

26. Latissimus Dorsi Function:
Fig 5.14
Function:
Extension & adduction of arm, internal rotation.

27. Teres Major
Function:
Internal rotation, extension, & adduction of the arm.
Fig 5.15

28. Triceps Brachii Function:
Long head assists in adduction, extension, and hyperextension of the humerus.
Fig 5.15

29. and the shoulder (glenohumeral) joint.
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.

30. Movements in the Frontal Plane
Fig 5.16
Shoulder Joint: Abduction
Deltoid & supraspinaus
Shoulder Girdle: Upward rotation of scapula
Serratus anterior; trapezius II & IV
Fig 5.17
Shoulder Joint: Adduction
Latissimus dorsi, teres major, pectoralis major (sternal), & post. deltoid.
Shoulder Girdle: reduction of upward rotation
Rhomboids & pectoralis minor.

31. 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

32. Movements in the Sagittal Plane
Fig 5.19
Fig 5.20
Shoulder Joint: Extension
Pectoralis major (sternal), teres major, latissimus dorsi, post. deltoid.
Shoulder Girdle: Reduction of upward rotation of scapula
Relaxation of agonists
Against resistance - trapezius IV, rhomboids, pect. minor.
Shoulder Joint: Hyperextension
Teres major, latissimus dorsi, post. Deltoid.
Shoulder Girdle: Anterior tilt of scapula
Pectoralis minor.

33. Movements in the Horizontal Plane
Shoulder Joint: External Rotation
Infraspinatus & teres minor
Shoulder Girdle: Adduction of scapula
Rhomboids & trapezius III.
Fig 5.22a

34. Movements in the Horizontal Plane
Fig 5.22b
Shoulder Joint: Internal Rotation
Subscapularis, teres major, latissimus dorsi, ant. deltoid, pectoralis major.
Shoulder Girdle: Abduction of scapula
Serratus anterior & pectoralis minor.
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.

35. Diagonal Movements
Diagonal forward-downward and slightly inward movement of the arm.
Fig 5.23
Fig 5.10

36. 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.

37. 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.

38. 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.

39. 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.

40. 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.