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Chapter 5 the Shoulder Joint

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Chapter 5 the Shoulder Joint The Shoulder Joint • Shoulder joint is attached to axial skeleton via the clavicle at SC joint • Scapula movement usually occurs with movement of humerus Chapter 5 – Humeral flexion & abduction require scapula The Shoulder Joint elevation, rotation upward, & abduction – Humeral adduction & extension results in scapula depression, rotation downward, & adduction Manual of Structural Kinesiology – Scapula abduction occurs with humeral internal R.T. Floyd, EdD, ATC, CSCS rotation & horizontal adduction – Scapula adduction occurs with humeral external rotation & horizontal abduction © McGraw-Hill Higher Education. All rights reserved. 5-1 © McGraw-Hill Higher Education. All rights reserved. 5-2 The Shoulder Joint Bones • Wide range of motion of the shoulder joint in • Scapula, clavicle, & humerus serve as many different planes requires a significant attachments for shoulder joint muscles amount of laxity – Scapular landmarks • Common to have instability problems • supraspinatus fossa – Rotator cuff impingement • infraspinatus fossa – Subluxations & dislocations • subscapular fossa • spine of the scapula • The price of mobility is reduced stability • glenoid cavity • The more mobile a joint is, the less stable it • coracoid process is & the more stable it is, the less mobile • acromion process • inferior angle © McGraw-Hill Higher Education. All rights reserved. 5-3 © McGraw-Hill Higher Education. All rights reserved. From Seeley RR, Stephens TD, Tate P: Anatomy and physiology , ed 7, 5-4 New York, 2006, McGraw-Hill Bones Bones • Scapula, clavicle, & humerus serve as • Key bony landmarks attachments for shoulder joint muscles – Acromion process – Humeral landmarks – Glenoid fossa • Head – Lateral border • Greater tubercle – Inferior angle • Lesser tubercle – Medial border • Intertubercular groove • Deltoid tuberosity – Superior angle – Spine of the scapula © McGraw-Hill Higher Education. All rights reserved. 5-5 © McGraw-Hill Higher Education. All rights reserved. 5-6 1 Glenohumeral Joint Glenohumeral Joint – Glenoid labrum • multiaxial ball- slightly &-socket enhances stability • enarthrodial © McGraw-Hill Higher Education. All rights reserved. 5-7 © McGraw-Hill Higher Education. All rights reserved. 5-8 Glenohumeral Joint Glenohumeral Joint – Glenohumeral – Ligaments are quite lax until extreme ligaments provide ranges of motion reached due to wide stability range of motion involved • especially – Stability is sacrificed to gain mobility anteriorly & inferiorly • inferior glenohumeral ligament © McGraw-Hill Higher Education. All rights reserved. 5-9 © McGraw-Hill Higher Education. All rights reserved. 5-10 Glenohumeral Joint Glenohumeral Joint • Determining – 90 to 95 degrees exact range of abduction each – 0 degrees adduction, movement is 75 degrees anterior difficult due to to trunk accompanying shoulder girdle movement © McGraw-Hill Higher Education. All rights reserved. 5-11 © McGraw-Hill Higher Education. All rights reserved. 5-12 2 Glenohumeral Joint Glenohumeral Joint – 40 to 60 degrees of – 70 to 90 degrees of internal & external extension rotation – 90 to 100 degrees of flexion © McGraw-Hill Higher Education. All rights reserved. 5-13 © McGraw-Hill Higher Education. All rights reserved. 5-14 Glenohumeral Joint Glenohumeral Joint – 45 degrees of • Frequently injured due to anatomical design horizontal – shallowness of glenoid fossa abduction – laxity of ligamentous structures – 135 degrees of – lack of strength & endurance in muscles horizontal adduction – anterior or anteroinferior glenohumeral subluxations & dislocations – common – posterior dislocations – rare – posterior instability problems somewhat common © McGraw-Hill Higher Education. All rights reserved. 5-15 © McGraw-Hill Higher Education. All rights reserved. 5-16 Pairing of shoulder girdle & shoulder joint Glenohumeral Joint movements • Rotator cuff is frequently injured Shoulder joint Shoulder girdle Abduction Upward rotation – Subscapularis, supraspinatus, infraspinatus, & teres minor muscles Adduction Downward rotation – attach to the front, top, & rear of humeral head Flexion Elevation/upward rotation – point of insertion enables humeral rotation Extension Depression/downward rotation – vital in maintaining humeral head in correct Internal rotation Abduction (protraction) approximation within glenoid fossa while more External rotation Adduction (retraction) powerful muscles move humerus through its wide Horizontal abduction Adduction (retraction) range of motion Horizontal adduction Abduction (protraction) © McGraw-Hill Higher Education. All rights reserved. 5-17 © McGraw-Hill Higher Education. All rights reserved. 5-18 3 Movements Movements • Abduction • Flexion – upward lateral – movement movement of humerus of humerus out to the side, away straight from body anteriorly • Adduction • Extension – downward movement – movement of humerus medially of humerus toward body from straight abduction posteriorly © McGraw-Hill Higher Education. All rights reserved. 5-19 © McGraw-Hill Higher Education. All rights reserved. 5-20 Movements Movements • Horizontal adduction • External rotation (transverse flexion) – movement of – movement of humerus in a humerus laterally horizontal or transverse around its long axis plane toward & across chest away from midline • Horizontal abduction • Internal rotation (transverse extension) – movement of – movement of humerus in a humerus medially horizontal or transverse around its long axis plane away from chest toward midline © McGraw-Hill Higher Education. All rights reserved. 5-21 © McGraw-Hill Higher Education. All rights reserved. 5-22 Movements Muscles • Diagonal abduction • Intrinsic glenohumeral muscles – movement of humerus – Originate on scapula & clavicle in a diagonal plane – Deltoid, Coracobrachialis, Teres major away from midline of – Rotator cuff group body • subscapularis, supraspinatus, infraspinatus, & • Diagonal adduction teres minor – movement of humerus • Extrinsic glenohumeral muscles in a diagonal plane – latissimus dorsi & pectoralis major toward midline of body © McGraw-Hill Higher Education. All rights reserved. 5-23 © McGraw-Hill Higher Education. All rights reserved. 5-24 4 Muscles Muscles • Anterior • Superior – Pectoralis major – Deltoid – Coracobrachialis – Supraspinatus – Subscapularis • Posterior • Superior – Latissimus dorsi – Deltoid – Teres major – Supraspinatus – Infraspinatus – Teres minor From Shier D, Butler J, Lewis R: Hole’s essentials of human anatomy and physiology , ed 9, New York, 2006, McGraw-Hill. From Shier D, Butler J, Lewis R: Hole’s essentials of human anatomy and physiology , ed 9, © McGraw-Hill Higher Education. All rights reserved. New York, 2006, McGraw-Hill. 5-25 © McGraw-Hill Higher Education. All rights reserved. 5-26 Nerves Nerves • All shoulder joint muscles are innervated from • Axillary nerve branching the brachial plexus from C5 & C6 • Lateral pectoral nerve arising from C5, C6, & – Deltoid C7 – Teres minor – Pectoralis major (clavicular head) – Sensation to lateral patch of • Medial pectoral nerve arising from C8 & T1 skin over deltoid region of – Pectoralis major (sternal head) arm • Thoracodorsal nerve arising from C6, C7, & C8 • Upper subscapular nerves – Latissimus dorsi arising from C5 & C6 – Subscapularis © McGraw-Hill Higher Education. All rights reserved. 5-27 © McGraw-Hill Higher Education. All rights reserved. 5-28 Nerves Nerves • Lower subscapular nerve arising from • Musculotaneous nerve C5 & C6 branching from C5, C6, & – Subscapularis C7 – Teres major – Coracobrachialis • Suprascapula nerve originating from – Sensation to radial aspect C5 & C6 of forearm – Supraspinatus – Infraspinatus © McGraw-Hill Higher Education. All rights reserved. 5-29 © McGraw-Hill Higher Education. All rights reserved. 5-30 5 Deltoid Muscle Pectoralis Major Muscle Upper fibers (clavicular head): Anterior fibers: Posterior fibers: internal rotation, horizontal abduction, flexion, abduction, extension, adduction, flexion, abduction (once horizontal adduction, horizontal abduction, arm is abducted 90 degrees, upper fibers assist in further abduction), & & internal rotation & external rotation adduction (with arm below 90 degrees of abduction) Middle fibers: Lower fibers (sternal abduction head): internal rotation, horizontal adduction, extension, & adduction © McGraw-Hill Higher Education. All rights reserved. 5-31 © McGraw-Hill Higher Education. All rights reserved. 5-32 Latissimus Dorsi Muscle Coracobrachialis Muscle Adduction Extension Flexion Adduction Internal rotation Horizontal adduction Horizontal abduction © McGraw-Hill Higher Education. All rights reserved. 5-33 © McGraw-Hill Higher Education. All rights reserved. 5-34 Rotator cuff muscles Rotator cuff muscles • Supraspinatus • not very large – attach to greater tubercle from above (Abduct) • must possess strength & muscular endurance • Infraspinatus • conducting repetitious overhead activities – attach to greater tubercle posteriorly (Ext. Rot.) (throwing, swimming, & pitching) with poor • Teres Minor technique, muscle fatigue, or inadequate warm- – attach to greater up & conditioning leads to failure of rotator cuff tubercle posteriorly muscle group in dynamically stabilizing humeral (Ext. Rot.) head in glenoid cavity S • ubscapularis • leads to further rotator cuff problems such as – attach to lesser tendinitis & rotator cuff impingement within tubercle anterior (Int. subacromial space Rot.) © McGraw-Hill Higher Education. All rights reserved. 5-35 © McGraw-Hill Higher Education. All rights reserved. 5-36 6 Subscapularis
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