anatomi dan kinesiologi shoulder part 2
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SHOULDER GIRDLE
Part 2
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The Suprahumeral Joint• Not a true joint
• Articulation between
– Head humerus
– Ligament connecting the
coracoid and acromial proc.
• Coracoacromial arch
– Prevents trauma from above to
the glenohumeral joint
– Prevents upward dislocation of
the humerus• Proximity :
– Obstacle abduction of arm in
coronal plane
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology VolumeFour of the Philippine Physical Therapy. U.S.T. Printing, 1978
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The Suprahumeral Joint
• Small area, but contains many
sensitive tissue :
– Portion subacromial bursa,
subcoracoid bursa,
supraspinatus tendon & muscle,superior portion of the
glenohumeral capsule,
portion of biceps tendon,
connective tissue
•Impairment immobility,pain, disability
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology VolumeFour of the Philippine Physical Therapy. U.S.T. Printing, 1978
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The Scapulothoracic Joint
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The Scapulothoracic JointTranslatory Rotatory
GLIDING MANNER
End Result : glenoid
fossa directed upwards or
downwards
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology VolumeFour of the Philippine Physical Therapy. U.S.T. Printing, 1978
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The Scapulothoracic Joint
Shoulder Girdle
Motions
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The Scapulothoracic Joint
Prime Movers :•Trapezius
•Serratus Anterior
Other muscles:
•Levator Scapulae
•Rhomboids major & minor
•Latissimus Dorsi
•Pectoralis major & minor
•Teres major
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology VolumeFour of the Philippine Physical Therapy. U.S.T. Printing, 1978
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Trapezius
Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.Davis Company. 2006
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Trapezius
Upper portion
•
Pulls scapula upward• Inward pivoting about
acromioclavicular
joint
Middle portion:
Fix the scapula during
arm abduction
Lower portion:
Pull medial border of
scapular spine down
and in
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology VolumeFour of the Philippine Physical Therapy. U.S.T. Printing, 1978
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Serratus Anterior
Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.Davis Company. 2006
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Combined Movement
Upper Trapezius
Lower Trapezius
Serratus Anterior
Elevation of the
Glenoid fossa
Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.Davis Company. 2006
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Levator Scapulae
Rhomboids Minor &
Major
Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.Davis Company. 2006
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Combined MovementLevator Scapulae
Rhomboids
Pectoralis Minor
Downward rotation of
the Glenoid fossa
Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.Davis Company. 2006
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Latissimus dorsi
Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.Davis Company. 2006
Reversal action important to patient with spinalcord injury at upper thoracic level ambulate
by hip-hiking
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Teres MajorPectoralis Major & Minor
Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.Davis Company. 2006
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Scapulohumeral Rhythm
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Scapulohumeral Rhythm
• Every 15° of abduction of the arm 10°
gleohumeral joint, 5° rotation of the scapula
upon chest wall
• 2:1 Ratio in abduction
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology VolumeFour of the Philippine Physical Therapy. U.S.T. Printing, 1978
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The Sternoclavicular & Acromioclavicular Joint
• Coracoclavicular ligament prevents scapular rotation in
coronal plane
• Scapula pivots about the acromioclavicular joint from
elevation of the sternoclavicular joint
• Arm elevation overhead clavicle rotation
• The first 30
elevate at sternoclavicular, next 30
rotate at its long axisReyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume Four of the Philippine
Physical Therapy. U.S.T. Printing, 1978
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sternocleidomastoid
O sternum, clavicula
I mastoid process
A Acting alone, tilts head to its ownside and rotates it so the face is
turned towards the opposite side.
Acting together, flexes the neck,
raises the sternum and assists in
forced inspiration.
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology VolumeFour of the Philippine Physical Therapy. U.S.T. Printing, 1978
Subclavius Muscle
O Inferior Clavicle
I 1st Rib
A Depressing clavicleRaising 1st rib as clavicle rise
Protect Subclavian vessels
during fractures of the clavicula
N Nerve to subclavius C5-6
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BICEPS MECHANISM
Passive mechanism to assist deltoid
(anterior) in forward flexing the
shoulder
Deltoid paralysis
substitute with trick motions
Abduction external rotation, fixed
elbow (weak)
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology VolumeFour of the Philippine Physical Therapy. U.S.T. Printing, 1978
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Composite Shoulder Girdle
MovementAbduction of arm
2 : 1
Glenohumeral Joint :Scapular Rotation
• Full elevation of arm :
120° GH joint + 60° Scapular Rotation
• Internal rotation : only 60° humeral abduction
•External rotation : 90
° actively abducted120° passively abducted
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Composite Shoulder Girdle
MovementScapular Rotation
Coracoclavicular ligament prevents scapular rotation
in coronal plane
Scapula pivots about the acromioclavicular joint from :• Elevation of the sternoclavicular joint
– 10° arm elevation 4° clavicle elevation
At 90 ° arm elevation max 30° clavicle elevation
•Rotation of the clavicle – 45° clavicle external rotation the remaining 30° scapular
rotation
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Composite Shoulder Girdle
Movement
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Composite Shoulder Girdle
Movement
• Elevation of the sternoclavicular joint
– 10° arm elevation 4° clavicle elevation
Elevation 30°
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Composite Shoulder Girdle
MovementElevation 90°
• Elevation of the sternoclavicular joint
–10
° arm elevation
4
° clavicle elevation
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Composite Shoulder Girdle
MovementElevation 180°
Rotation of the clavicle
45° clavicle external rotation the remaining 30° scapular
rotation
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PATHOMECHANICS•
Serratus anterior paralysis medial winging of
scapula (opening the book)
•Trapezius paralysis
lateral winging of scapula
(sliding door)
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology VolumeFour of the Philippine Physical Therapy. U.S.T. Printing, 1978
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PATHOMECHANICS
Deltoid paralysis Steindler procedureSurgical reconstruction,
transplant tendons and
muscles for subtitute of muscle
paralysis
Movements Children Adult
Abduction 70° 60°
ForwardFlexion 45° 45
°
Internal
Rotation
20-25° 20-25°
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology VolumeFour of the Philippine Physical Therapy. U.S.T. Printing, 1978
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Thoracic Outlet Syndrome
• Neurovascular Compression Syndrome
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TOS - Etiology
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Thoracic Outlet Syndrome
1. Scalenus Anticus
and Cervical rib
syndrome
2. Costoclavicularsyndrome
3. Hyperabduction
syndrome
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TOS - Scalenus Anticus and Cervical
Rib Syndrome
• Compression of
subclavian vessel &
brachial plexus by
anterior scalene• Adson’s manuver :
changes in radial
pulse when the neck
fully extended, chintoward same side &
holding breathPositive : Change in Radial Pulse
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TOS – Costoclavicular Syndrome• Compression in the
space between theclavicle and the first
rib
• Costoclavicular /
Military Test : pullingthe arm downwards,
patients take a deep
breath, while
monitoring radial
pulse
Positive : Change in Radial Pulse
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TOS – Hyperabduction Syndrome
• Compression under
the insertion of the
Pectoralis minor in
the coracoidprocess
• Wright test :
hyperabduct the
shoulder, whilechecking the radial
pulse
Positive : Change in Radial Pulse
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TOS – Nerve Conduction Velocity
• Reduction in NCV to
less than 85 m/s of
either the ulnar or
median nervesacross the thoracic
outlet corroborates
the clinical diagnosis.
Positive : NCV < 85 m/s
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TERIMA KASIH
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Daftar Pustaka
• Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume Four
of the Philippine Physical Therapy. U.S.T. Printing, 1978.
• Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.
Davis Company. 2006