1. Chapter 5 Functional Anatomy of the Upper Extremity

2. Review of Anatomical Structures
Shoulder girdle
An incomplete bony ring in the upper extremity formed by the two scapulae and clavicles
Scapula
Flat, triangular bone on the upper posterior thorax
Clavicle
“S”-shaped bone articulating with scapula and sternum
“Collar bone”
Glenoid fossa
Depression in lateral superior scapula
Socket for shoulder joint
Glenoid labrum
Ring of fibrocartilage around rim of glenoid fossa
Deepens socket for shoulder joint

3. Review of Anatomical Structures (cont.)
Bursa
Fibrous, fluid-filled sac that reduces friction
Located between bones, tendons, and other structures
Subacromial bursa
Bursa between acromion process and insertion of supraspinatus muscle
Coracoid process
Curved process arising from upper neck of scapula
Overhangs shoulder joint

4. The Shoulder Complex Sternoclavicular joint
Articulation between sternum and clavicle
Acromioclavicular joint
Articulation between acromion process of scapula and lateral end of clavicle
Scapulothoracic joint
Physiological joint between the scapula and thorax
Glenohumeral joint
Articulation between the head of the humerus and the glenoid fossa of the scapula

5. Movements of the Shoulder Complex
Dislocation
Rotation
Elevation and Depression
Protraction and Retraction
Horizontal Flexion and Extension

6. Scapular Movements

7. Shoulder Joint Range of Motion

8. Shoulder Joint Movement Characteristics
Large range of motion (ROM) at shoulder
Extreme ROM required by many activities
Swimming, throwing, gymnastics
Ligaments and muscles provide stability
Scapular and clavicular movements accompany any arm movement
Scapulohumeral rhythm
Movement relationship between humerus and scapula during arm raising movements

9. Muscular Actions Review Figure 5-9 on page 148
17 muscles that contribute to scapula and shoulder joint movements are listed
Major muscles
Deltoid, trapezius, rhomboids, pectoralis major, latissimus dorsi, serratus anterior
Rotator cuff (4 muscles surrounding shoulder joint)
Infraspinatus, supraspinatus, teres minor, subscapularis

10. Arm Abduction and Flexion

11. Muscle Action on the Shoulder Girdle

12. Shoulder Muscle Strength
Generate greatest strength in adduction
Abduction used frequently in daily living
Weakest movements are internal and external rotation
Muscles generate high forces within joint
Almost 90% of body weight at 90° abduction
Implications?

13. Shoulder Strength & Conditioning
Shoulder muscles easy to stretch and strengthen
Stretching
Active and passive
Strength training
Weight training, limb/body weight exercises
Rotator cuff strength and flexibility important
Stabilization of joint
Widely used in daily living

14. Stretching & Strengthening Exercises
Review Figure 5-14 on pages 152 and 153.

15. Injury Sprain Rupture of fibers of ligament Subluxation
Partial dislocation
Fracture
Break in bone, often clavicle
Ectopic calcification
Hardening of organic tissue through deposit of calcium salts in areas away from the normal sites
Degeneration
Deterioration of tissue

16. Injury (cont.) Bursitis Inflammation of bursa Impingement syndrome
Irritation of structures above shoulder joint
Due to repeated compression between greater tuberosity and acromion process
Subacromial bursitis
Common from impingement syndrome
Bicipital tendinitis
Inflammation of the tendon of the biceps brachii

17. Elbow and Radioulnar Joints
Radiohumeral joint
Articulation between radius and humerus
Capitulum
Eminence on distal end of lateral epicondyle
Articulates with head of radius at elbow
Ulnar-humeral joint
“Elbow”
Articulation between ulna and humerus
Medial and lateral epicondyles
Carrying angle
Angle between ulna and humerus with elbow extended
10–20°

18. Carrying Angle

19. Elbow and Radioulnar Joints (cont.)
Articulations between ulna and radius
Proximal and distal
Pronation, supination
Interosseous membrane
Thin layer of tissue running between ulna and radius
Medial and lateral epicondyles

20. Elbow Movement Characteristics and Muscular Actions
All 3 joints never close packed at same time
Movements limited by several factors
Soft tissue, ligaments, joint capsule, muscles
24 muscles cross elbow
Most of these muscles capable of multiple movements
Muscles better at some movements than others

21. Elbow Flexor Moment Arms

22. Biceps Brachii Action

23. Forearm Strength and Conditioning
Flexor group nearly twice as strong as extensor
Effectiveness of strengthening/stretching exercises
Depends on position of arm
Length-tension relationship
Numerous exercises

24. Stretching and Strengthening Exercises
Review Figure 5-21 on page 162.

25. Injury to Forearm Overuse injuries more common than trauma
Throwing, tennis serve
Ectopic bone
Bone formation away from normal site
Rupture
Torn or disrupted tissue
Muscle
Olecranon bursitis
Irritation of the olecranon bursae
Commonly caused by falling on elbow

26. Injury to Forearm (cont.)
Medial tension syndrome
“Pitcher’s elbow”
Medial elbow pain from excessive valgus forces
May include ligament sprain, medial epicondylitis, tendinitis, avulsion fracture
Osteochondritis dissecans
Inflammation of bone and cartilage resulting in splitting pieces of cartilage into the joint

27. Wrist & Fingers Manipulation activities Very fine movements
Many stable, yet mobile, segments

28. Joints of the Wrist Radiocarpal “Wrist” Ellipsoid joint
Flexion/extension, radial/ulnar flexion
Distal radioulnar
Ulna makes NO contact with carpals
Does NOT participate in wrist movements
Midcarpal
Articulation between two rows of carpals
Intercarpal
Articulation between a pair of carpals

29. Joints of the Wrist (cont.)
Carpometacarpal
Articulations between carpals and metacarpals
Metacarpophalangeal
Articulations between metacarpals and phalanges
Interphalangeal
Articulations between phalanges

30. Muscular Actions Most originate outside hand region Thenar eminence
Mound on radial side of palm formed by intrinsic muscles acting on thumb
Hypothenar eminence
Mound on ulnar side of palm created by intrinsic muscles acting on little finger

31. Muscular Actions (cont.)
Hand flexion/extension
Hand radial/ulnar flexion
Finger flexion/extension
Finger abduction/adduction
Thumb flexion/extension
Thumb abduction/adduction
Thumb opposition

32. Conditioning Why condition hand region? Improve grip strength
Enhance wrist action for throwing, striking
Prevent injury
Exercises
Wrist curls
Gripping exercises
Stretching

33. Contributions of the Wrist & Hand
Power grip
Powerful hand position
Maximally flexing fingers around object
Precision grip
Fine-movement hand position
Minimally flexing fingers around object
Examples:
Eating with fork
Throwing softball
Spiking volleyball
Dribbling basketball
Changing channel with remote control

34. Grip

35. Injury of the Wrist & Hand
Bennett’s fracture
Longitudinal fracture of base of first metacarpal
Mallet finger
Avulsion of finger extensor tendons at distal phalanx
Result of forced flexion
Boutonniere deformity
Stiff proximal interphalangeal articulation
Caused by injury to finger extensor mechanism

36. Injury of the Wrist & Hand (cont.)
Jersey finger
Avulsion of finger flexor
Result of forced hyperextension
Trigger finger
Snapping during flexion and extension of fingers
Created by nodules on tendons

37. Injury of the Wrist & Hand (cont.)
Tenosynovitis
Inflammation of sheath surrounding tendon
Carpal tunnel syndrome
Pressure and constriction of median nerve
Caused by repetitive actions at wrist

38. Carpal Tunnel

39. Stretching and Strengthening Exercises
Review Figure 5-27 on page 172.

40. Contribution of Upper Extremity Musculature to Sports Skills or Movements
Upper extremity is obviously important in:
Everyday activities
Pushing up out of a chair
Carrying, lifting
Sporting/leisure activities
Swimming, throwing, striking (golf, volleyball)

41. Overhand Throwing

44. The Golf Swing

46. Summary Questions What do the upper extremities enable us to do?
What stabilizes the structures of the upper extremities?
What are potential injuries to the upper extremities?
What causes these injuries?
How can injuries be prevented?
What are some exercises for stretching and strengthening the upper extremities?