kinesiology 2012 tccd massage therapy … · explain why the term shoulder joint complex is a...

KINESIOLOGY 2012 TCCD MASSAGE THERAPY PROGRAM

GOALS: Define the key terms of this chapter and state the meanings of the word origins of this chapter.

Describe why the term shoulder corset might be a better term than shoulder girdle.

Explain why the term shoulder joint complex is a better term than shoulder joint when describing movement of the shoulder. Describe the concepts of mobility and stability as they pertain to the glenohumeral joint, and explain why the glenohumeral joint is often called a muscular joint.

Explain why the scapulocostal joint is considered to be a functional joint, not an anatomic joint.

Describe why the sternoclavicular joint can be classified as either biaxial or triaxial.

Explain why stabilization of the sternoclavicular joint is important toward proper functioning of the upper extremity.

Describe the importance of acromioclavicular joint motion to motion of the shoulder girdle.

Let’s find out why.

Shoulder joint complex

Glenohumeral joint

Scapulocostal joint

Sternoclavicular joint

Acromioclavicular joint

Elbow joint complex

Elbow joint

Radioulnar joints

Wrist joint complex

Carpometacarpal joints

Saddle joint of the thumb

Intermetacarpal joints

Metacarpophalangeal (MCP) joints

Interphalangeal joints (IP) of the hand

Shoulder Joint Complex

Joints of the Shoulder Joint Complex: Glenohumeral (GH) joint

Sternoclavicular (SC) joint

Acromioclavicular (AC) joint

Scapulocostal (ScC) joint

Glenohumeral Joint

Figure a shows flexion of the arm at the shoulder joint. Figure b shows extension of the arm at the shoulder joint.

abduction and adduction in the frontal plane around an anteroposterior axis

Lateral rotation and medial rotation take place around a vertical axis

Structure: Synovial joint Ball-and-socket joint

Function: Diarthrotic Triaxial

Major motions: Flexion/extension Abduction/adduction Lateral/medial rotation

Major ligaments: Fibrous joint capsule Superior glenohumeral ligament Middle glenohumeral ligament Inferior glenohumeral ligament Coracohumeral ligament

The coracohumeral ligament runs from the coracoid process of the scapula to the greater tubercle of the humerus. The coracoclavicular ligament runs from the coracoid process to the lateral clavicle; the coracoacromial ligament runs from the coracoid process to the acromion process; and the acromioclavicular ligament runs from the acromion process to the lateral clavicle.

● This illustration shows the glenoid labrum, which is a rim of cartilage surrounding the glenoid fossa of the scapula.

● What is the function of the glenoid labrum? It deepens the glenoid fossa and cushions the GH joint.

The subacromial bursa is shown here between the acromion process of the scapula and the rotator cuff tendon of the supraspinatus muscle.

It is also known as the scapulothoracic joint.

Figure a shows elevation of the right scapula,

Figure b shows depression of the right scapula,

Figure c shows protraction of the right scapula, and

Figure d shows retraction of the right scapula.

This figure illustrates upward rotation of the right scapula at the scapulocostal joint. The left scapula is in anatomic position of full downward rotation.

Lateral tilt of the right scapula is illustrated in Figure a with the left scapula in anatomic position of downward tilt. Upward tilt of the right scapula is shown in Figure b with the left scapula in anatomic position of medial tilt.

Structure: Functional joint Major motions:

Protraction/retraction Elevation/depression Upward/downward rotation

● The sternoclavicular joint is located between the manubrium of the sternum and the medial end of the clavicle.

Structure: Synovial joint Saddle

Function: Diarthrotic Biaxial

Major motions:

Protraction/retraction Elevation/depression Upward/downward rotation

● The sternoclavicular joint actually permits motion in three planes about three axes; therefore it could also be classified as triaxial. Why, then, is it most often classified as biaxial?

It is most often classified as being biaxial because (similar to the saddle joint of the thumb) its rotation actions cannot be isolated.

Major ligaments: Fibrous capsule Anterior sternoclavicular ligament Posterior SC ligament Interclavicular ligament Costoclavicular ligament

● What movements are shown in these illustrations? Figure 9-12a depicts elevation of the right clavicle at the sternoclavicular (SC)

joint. Figure 9-12b shows depression of the right clavicle. ● Elevation and depression motions of the clavicle at the sternoclavicular joint

are not oriented perfectly in the frontal plane. At rest, the clavicle is actually oriented approximately 20 degrees posterior to the frontal plane.

● What movements are shown in these illustrations?

Figure a illustrates protraction of the right clavicle at the sternoclavicular (SC) joint. Figure b shows retraction of the right clavicle.

● This figure illustrates upward rotation of the right clavicle at the sternoclavicular joint. What position is the left clavicle in?

The left clavicle is in anatomic position, which is full downward rotation. ● Upward rotation of the clavicle cannot be isolated. In this figure the arm is

abducted at the shoulder joint, resulting in the scapula upwardly rotating, which results in upward rotation of the clavicle at the sternoclavicular joint.

the SC joint: Is stabilized by its fibrous capsule, anterior and posterior SC ligaments, the

interclavicular ligament, the costoclavicular ligament, and by the attachments of the sternocleidomastoid, sternohyoid, and sternothyroid muscles.

The acromioclavicular joint, also known as the AC joint, involves the acromion process of the scapula and the lateral end of the clavicle.

Structure: Synovial joint Plane

Function: Diarthrotic Nonaxial

Motions allowed: Upward/ downward rotation

Major ligaments: Fibrous capsule Acromioclavicular (AC) ligament Coracoclavicular ligament

Closed-packed position: Full upward rotation of the scapula

The AC joint is stabilized by its fibrous capsule, the AC ligament, and the coracoclavicular ligament.

Explain the concept of scapulohumeral rhythm, and give an example for each of the six cardinal ranges of motion of the arm at the shoulder joint. Describe the concept and importance of the carrying angle. Describe the component motions that occur at the proximal and distal radioulnar joints that create pronation and supination of the forearm

Shoulder joint complex

Glenohumeral joint

Scapulocostal joint

Sternoclavicular joint

Acromioclavicular joint

Elbow joint complex

Elbow joint

Radioulnar joints

Wrist joint complex

Carpometacarpal joints

Saddle joint of the thumb

Intermetacarpal joints

Metacarpophalangeal joints

Interphalangeal joints of the hand

Sagittal plane actions Frontal plane actions

Transverse plane actions Other coupled actions

● Scapulohumeral rhythm is the coupled joint actions of the arm, scapula, and clavicle.

● Of all aspects of scapulohumeral rhythm, the most well researched and published motion is frontal plane abduction of the arm.

● In each plane and in other coupled movements, the coupled action of the scapula facilitates further movement of the arm in the direction it is moving. The scapula usually begins to move before the arm moves as much as it can; from that point onward, motion is a combination of arm and shoulder girdle movements.

Figure 9-19a illustrates a right arm that has been abducted relative to the trunk 180 degrees. Figure 9-19b shows that of the 180 degrees of abduction of the arm relative to the trunk, only 120 degrees of that motion is the result of abduction of the arm at the GH joint.

● The remaining 60 degrees of motion are the result of what action? They are the result of the upward rotation of the scapula at the

scapulocostal joint.

● The elbow joint is unusual in what way?

It is unusual in that three

articulations are enclosed within one joint capsule.

● This figure shows an anterior

view of the right elbow joint complex.

Three Articulations: Humeroulnar joint

Humeroradial joint

Proximal radioulnar joint

Humeroulnar Joint: Structure: Synovial joint

Hinge Function: Diarthrotic

Uniaxial

Humeroradial Joint: Structure: Synovial joint

Atypical ball-and-socket Function: Diarthrotic

Biaxial

● When motion occurs at the elbow joint, it occurs at these two joints. ● Because the elbow joint is a uniaxial hinge joint, it is quite stable and

experiences few pathologic injuries.

● The elbow joint allows flexion and extension of the forearm in the sagittal plane around a mediolateral axis.

● Figure 9-22a shows flexion of the forearm at the elbow joint. Figure 9-22b illustrates extension of the forearm at the elbow joint.

● Figure a gives a medial view of the elbow joint capsule and the medial collateral ligament. What are the three parts of the medial collateral ligament?

They are the anterior part, posterior part, and transverse part. ● Figure b demonstrates a lateral view of the elbow joint capsule, lateral collateral ligament, and

the annular ligament of the proximal radioulnar joint.

Elbow Joint:

Major actions: Flexion/extension Major ligaments:

Fibrous capsule Medial collateral ligament Lateral collateral ligament

● The reverse action is that the arm can move relative to the forearm at the elbow joint.

● What are some examples of this reverse action?

Pull-ups, using a banister to go upstairs, handicap bars, and using oars in a canoe are all common examples of this reverse action.

● The closed-packed position of the elbow joint is extension.

● The medial collateral ligament is also known as the ulnar collateral ligament. The lateral collateral ligament is also called the radial collateral ligament.

Three Radioulnar Joints:

Proximal radioulnar joint Middle radioulnar joint Distal radioulnar joint

Radioulnar Joints: Major actions: Pronation/supination

● The proximal RU joint is located between the head of the radius and the radial notch of the ulna.

● The middle RU joint is located between the shafts of the radius and ulna.

● The distal RU joint is located between the head of the ulna and the ulnar notch of the radius.

● Pronation and supination are joint actions created by a combination of motions at the proximal, middle, and distal RU joints.

● Figure a illustrates pronation of the right forearm. Figure b shows supination, which is the anatomic position for the forearm

Ligamentous Structures of the RU Joints:

The joint capsule of the distal RU joint is also seen in Figure a and the RU disc of the distal RU joint is illustrated in Figure b.

Describe the structure and function of the hand.

Describe the structure and function of the wrist and, specifically, the carpal tunnel.

Explain why the radiocarpal joint is the major articulation between the forearm and the hand.

Describe the importance of motion at the 4th and 5th carpometacarpal joints.

Radioulnar joints Wrist joint complex Carpometacarpal joints Saddle joint of the thumb Intermetacarpal joints Metacarpophalangeal (MCP) joints Interphalangeal joints (IP) of the hand

an overview of the wrist/hand region and covers the wrist joint complex and carpometacarpal joints.

Three Regions: Carpus Metacarpus Phalanges (fingers)

General Organization: Wrist joint

Radiocarpal joint Midcarpal joint

Carpometacarpal joints Intermetacarpal joints Metacarpophalangeal (MCP) joints Interphalangeal (IP) joints

Carpal Tunnel ● What is the carpal tunnel and where is it located?

The carpal tunnel is a tunnel formed by the arrangement of the carpal bones. It is between the archlike transverse concavity of the carpal bones and the transverse carpal ligament that spans across the top of the carpal bones. ● The carpal tunnel provides a safe passageway for the median nerve and distal tendons of the extrinsic finger flexor muscles to enter the hand. ● Carpal tunnel syndrome is a result of the impingement of the median nerve due to injury or overuse.

● Movement at the wrist joint occurs at two joints: the radiocarpal joint and the midcarpal joint. Therefore, it is better termed the wrist joint complex.

Radiocarpal joint Midcarpal joint Intercarpal joints

Do the intercarpal joints contribute to movement of the hand relative to the forearm at the wrist joint?

No, they do not.

Structure: Synovial joint

Condyloid Function: Diarthrotic

Biaxial

Major Motions Allowed:

Flexion/extension Radial/ulnar deviation Closed-Packed Position: Extension and slight ulnar deviation

Ligaments of the Wrist Joint Complex: Fibrous capsule of the radiocarpal joint Radioulnar disc Fibrous capsule of the midcarpal joint Transverse carpal ligament Extrinsic ligaments Intrinsic ligaments

● Five carpometacarpal (CMC) joints are formed between the distal row of carpals and the metacarpal bones. ● The CMC joints primarily allow flexion and extension and are stabilized by their joint capsules as well as carpometacarpal ligaments. ● CMC joints contribute to motion at a ray (finger).

● This anterior view of the right hand depicts the concept of the relative mobility of the first, fifth, and fourth CMC joints and the relative rigidity/stability of the second and third CMC joints.

Actions of the Thumb at the Saddle Joint:

● Figure a and Figure b show opposition and reposition of the thumb, respectively. Figure c and Figure d illustrate flexion and extension, respectively, and occur in the frontal plane. Figure e and Figure f are abduction and adduction, respectively. These actions occur in the sagittal plane. ● Note: Medial and lateral rotation couple with flexion and extension, respectively.

● Figure a shows the palmar view of the ligaments of the first carpometacarpal joint of the right thumb in which the ulnar collateral and anterior oblique ligaments are seen. ● Figure b illustrates the radial view in which the radial collateral and posterior oblique ligaments are seen. ● The intermetacarpal ligament between the thumb and index finger is also seen.

The intermetacarpal (IMC) joints are located between the metacarpal bones of the hand.

Four proximal IMC joints and three distal IMC joints exist.

the metacarpophalangeal joints are shown here illustrating flexion and extension, respectively, of fingers #2 through #5 at the MCP joints.

Flexion of the fingers at the interphalangeal joints is also seen.

47 abduction and adduction of fingers #2 through #5 at the MCP joints.

● Lateral movement of the middle finger is termed radial abduction; medial movement of the middle finger is termed ulnar abduction. ● Radial abduction and ulnar abduction of the middle finger at the third MCP joint are illustrated here.

● Figure a shows an anterior view of the fibrous capsules, collateral ligaments, and palmar plates of the MCP joints (and the palmar plates of the interphalangeal joints). ● The palmar plate is a ligamentous-like thick disc of fibrocartilage. What is another name for the palmar plate? It is also known as the volar plate.

Figure b shows an ulnar view of a finger illustrating the fibrous capsule, ulnar collateral ligament, and palmar plate of the MCP joint (and the palmar plate of the IP joint). ● The closed-packed position of the MCP joints is 70 degrees of flexion.

● The interphalangeal (IP) joints of the hand are located between the phalanges of the fingers. There are nine IP joints found in the hand. ● There is one IP joint in the thumb. It is located between the proximal and distal phalanges of the thumb. ● Each of fingers #2 through #5 has three phalanges. Two IP joints exist in each of these fingers; a proximal interphalangeal (PIP) joint and a distal interphalangeal (DIP) joint.

Major Motions Allowed:

Flexion Extension

● Flexion of the fingers at the interphalangeal joints is shown here in Figure a. Flexion is also seen at the MCP joints. ● Extension of the fingers at the PIP and DIP joints is shown in Figure b. Extension is also seen at the MCP joints. ● What is the closed-packed position of the interphalangeal joints? It is approximately full extension.

This illustration shows a dorsal view of the IP joints with the IP joints opened up. The PIP joint is stabilized by a fibrous capsule, collateral ligaments, a palmar plate, and two check-rein ligaments. The DIP joint is stabilized by a fibrous capsule, collateral ligaments, and a palmar plate.

54 The End

kinesiology 2012 tccd massage therapy … · explain why the term shoulder joint complex is a...

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