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Chapter 4 the Shoulder Girdle

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Chapter 4 the Shoulder Girdle Bones • Key bony landmarks – Manubrium – Clavicle Chapter 4 – Coracoid process The Shoulder Girdle – Acromion process – Glenoid fossa – Lateral border – Inferior angle – Medial border © McGraw-Hill Higher Education. All rights reserved. 4-1 © McGraw-Hill Higher Education. All rights reserved. 4-2 Bones Joints • Key bony landmarks • Shoulder girdle (scapulothoracic) – Acromion process – scapula moves on the rib cage – Glenoid fossa – joint motion occurs at sternoclavicular joint – Lateral border & to a lesser amount at the – Inferior angle acromioclavicular joint – Medial border – Superior angle – Spine of the scapula From Seeley RR, Stephens TD, Tate P; anatomy and physiology , ed 7, New York, 2006, McGraw-Hill © McGraw-Hill Higher Education. All rights reserved. 4-3 © McGraw-Hill Higher Education. All rights reserved. 4-4 Joints Joints • Sternoclavicular (SC) • Sternoclavicular (SC) – (multiaxial) arthrodial classification – Ligamentous support – Movements • anteriorly by the anterior SC ligament • anteriorly 15 degrees with protraction • posteriorly by the posterior SC ligament • posteriorly 15 degrees with retraction • costoclavicular & interclavicular • superiorly 45 degrees with elevation ligaments provide stability against • inferiorly 5 degrees with depression superior displacement © McGraw-Hill Higher Education. All rights reserved. 4-5 © McGraw-Hill Higher Education. All rights reserved. 4-6 1 Joints Joints • Acromioclavicular (AC) • Scapulothoracic – arthrodial classification – not a true synovial joint – 20- to 30-degree total gliding & rotational motion – does not have regular synovial features accompanying other shoulder girdle & shoulder – movement depends on SC & AC joints joint motions which allows the scapula to move – supported by • 25-degrees abduction-adduction • Coracoclavicular ligaments • 60-degrees upward-downward rotation • Superior acromioclavicular ligament • Inferior acromioclavicular ligament • 55-degrees elevation-depression – often injured – supported dynamically by its muscles – no ligamentous support © McGraw-Hill Higher Education. All rights reserved. 4-7 © McGraw-Hill Higher Education. All rights reserved. 4-8 Movements Movements • Focus on specific • Abduction bony landmarks (protraction) – inferior angle – scapula moves – glenoid fossa laterally away from – acromion process spinal column • Shoulder girdle • Adduction (retraction) movements = scapula – scapula moves movements medially toward spinal column © McGraw-Hill Higher Education. All rights reserved. 4-9 © McGraw-Hill Higher Education. All rights reserved. 4-10 Movements Movements • Downward rotation • Depression – returning inferior angle – downward or inferior inferomedially toward movement, as in spinal column & glenoid returning to normal fossa to normal position position • Upward rotation • Elevation – turning glenoid fossa upward & moving inferior – upward or superior angle superolaterally movement, as in away from spinal column shrugging shoulders © McGraw-Hill Higher Education. All rights reserved. 4-11 © McGraw-Hill Higher Education. All rights reserved. 4-12 2 Movements Movements • Shoulder joint & shoulder girdle work • Shoulder girdle muscles together in carrying out upper extremity – Stabilize scapula so the shoulder joint activities muscles will have a stable base from which to exert force for moving the humerus • Shoulder girdle movement is not – Contract to maintain scapula in a relatively dependent upon the shoulder joint & its static position during shoulder joint actions muscles – Contract to move shoulder girdle & to enhance movement of upper extremity when shoulder goes through extreme ranges of motion © McGraw-Hill Higher Education. All rights reserved. 4-13 © McGraw-Hill Higher Education. All rights reserved. 4-14 Movements Movements • For some shoulder girdle movements, • Anterior tilt (upward tilt) scapula must rotate or tilt on its axis – rotational movement of scapula about frontal axis • Lateral tilt (outward tilt) occurring during glenohumeral hyperextension – during abduction – superior border moving anteroinferiorly & inferior – scapula rotates about its vertical axis resulting in posterior movement of medial border & anterior angle moving posterosuperiorly movement of lateral border • Posterior tilt (downward tilt) • Medial tilt (return from lateral tilt, inward tilt) – rotational movement of scapula about frontal axis – during extreme adduction occurring during glenohumeral hyperflexion – scapula rotates about its vertical axis resulting in anterior movement of medial border & posterior – superior border moving posteroinferiorly & inferior movement of lateral border angle moving anterosuperiorly © McGraw-Hill Higher Education. All rights reserved. 4-15 © McGraw-Hill Higher Education. All rights reserved. 4-16 Movements Movements • Synergy with muscles of glenohumeral joint • Synergy with muscles of glenohumeral joint – As shoulder joint goes through more extreme – This works through the appropriate muscles of ranges of motion, scapular muscles contract to both joints working in synergy to accomplish the move shoulder girdle so that its glenoid fossa will desired action of the entire upper extremity be in a more appropriate position from which the – Ex. to raise our hand out to the side laterally as humerus can move high as possible, the serratus anterior & trapezius (middle & lower fibers) muscles upwardly rotate – Without the accompanying scapula movement scapula as supraspinatus & deltoid initiate humerus can only be raised into approximately 90 glenohumeral abduction degrees of total shoulder abduction & flexion – This synergy between scapula & shoulder joint muscles enhances movement of entire upper extremity © McGraw-Hill Higher Education. All rights reserved. 4-17 © McGraw-Hill Higher Education. All rights reserved. 4-18 3 Elevation Shoulder Muscles Girdle • 5 muscles primarily involved in shoulder Movements girdle movements – All originate on axial skeleton & insert on scapula and/or clavicle Abduction Adduction – Do not attach to humerus & do not cause shoulder joint actions D ard – Essential in providing dynamic stability of ow pw n the scapula so it can serve as a relative R n U tio o w ota base of support for shoulder joint activities ta a R ti rd such as throwing, batting, & blocking on Depression © McGraw-Hill Higher Education. All rights reserved. 4-19 © McGraw-Hill Higher Education. All rights reserved. 4-20 Shoulder Girdle Muscles Shoulder Girdle Muscles • 5 muscles primarily • Location & action involved in shoulder – Anterior girdle movements • Pectoralis minor – abduction, downward rotation, & – Trapezius - upper, depression middle, lower • Subclavius – depression – Rhomboid - deep – Posterior & laterally – Levator scapula • Serratus anterior – abduction & upward rotation – Serratus anterior – Pectoralis minor - deep © McGraw-Hill Higher Education. All rights reserved. 4-21 © McGraw-Hill Higher Education. All rights reserved. 4-22 Shoulder Girdle Muscles Trapezius muscle Upper fibers: elevation • Location & action of scapula, extension – Posterior & rotation of head • Trapezius • Upper fibers – elevation & extension of the head Middle fibers: elevation, • Middle fibers – elevation, adduction, & upper upward rotation, & rotation adduction • Lower fibers – adduction, depression, & upper rotation Lower fibers: • Rhomboid – adduction, downward rotation, & depression, elevation adduction, & • Levator scapulae – elevation upward rotation © McGraw-Hill Higher Education. All rights reserved. 4-23 © McGraw-Hill Higher Education. All rights reserved. 4-24 4 Levator scapulae muscle Rhomboid muscles - major & minor Elevates the medial Rhomboid major & minor muscles margin of the work together scapula Adduction (retraction): draw scapula toward spinal column Downward rotation: from upward rotated position they draw scapula in downward rotation Elevation: slight upward movement accompanying adduction © McGraw-Hill Higher Education. All rights reserved. 4-25 © McGraw-Hill Higher Education. All rights reserved. 4-26 Serratus anterior muscle Pectoralis minor muscle Abduction (protraction): draws medial Abduction (protraction): draws border of scapula away from vertebrae scapula forward & tends to tilt Upward rotation: lower border away from ribs longer, lower Downward rotation: as it fibers tend to abducts, it draws draw inferior scapula downward angle of scapula farther Depression: when away from scapula is rotated vertebrae, thus upward, it assists rotating in depression scapula upward slightly © McGraw-Hill Higher Education. All rights reserved. 4-27 © McGraw-Hill Higher Education. All rights reserved. 4-28 Subclavius muscle Scapula Abduction Stabilization & protection of • Scapula move laterally away from sternoclavicular joint spinous processes without rotation Depression • EX. Push-up & bench press Abduction • Agonists – Pectoralis minor – Serratus anterior © McGraw-Hill Higher Education. All rights reserved. 4-29 © McGraw-Hill Higher Education. All rights reserved. 4-30 5 Scapula Adduction Scapula Upward Rotation • Return from • Lateral & abduction upward • Occurs with movement retractions • Agonists • Agonists – Middle Trapezius – Middle Trapezius – Lower – Rhomboids Trapezius – Serratus anterior © McGraw-Hill Higher Education. All rights reserved. 4-31 © McGraw-Hill Higher Education. All rights reserved. 4-32 Scapula Downward Rotation Scapula Elevation • Downward & Medial Movement • Lifting scapula without rotation in anatomic position • Glenoid Fossa is rotated downward when downward • Shoulder Shrug movement of shoulder joint occurs • Agonists • EX. Lat Pulls - – Levator pulling wt. down Scapula • Agonists – Upper – Pectoralis Minor Trapezius – Rhomboid – Rhomboid © McGraw-Hill Higher Education. All rights reserved. 4-33 © McGraw-Hill Higher Education. All rights reserved. 4-34 Scapula Depression • EX. Dip • Agonists – Lower Trapezius – Pectoralis Minor © McGraw-Hill Higher Education. All rights reserved. 4-35 6.
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