![Page 1: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/1.jpg)
The Shoulder Complex
![Page 2: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/2.jpg)
The Shoulder Complex
A. General Structure & Function
B. Structure & Function of Specific Joints
C. Muscular Considerations
D. Specific Functional Considerations
E. Common Injuries
![Page 3: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/3.jpg)
The Shoulder Complex
A. General Structure & Function
B. Structure & Function of Specific Joints
C. Muscular Considerations
D. Specific Functional Considerations
E. Common Injuries
![Page 4: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/4.jpg)
General Structure
![Page 5: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/5.jpg)
General Function
Provides very mobile, yet strong base for hand to perform its intricate gross and skilled functions
Transmits loads from upper extremity to axial skeleton
![Page 6: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/6.jpg)
Shoulder Girdle
![Page 7: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/7.jpg)
Shoulder Complex Movements Shoulder Girdle
Elevation & depression Protraction & retraction Upward & downward rotation Upward tilt
Shoulder (glenohumeral) FL, EXT, HyperEXT ABD, ADD, HyperADD, HyperABD MR, LR, HorizontalABD, HorizontalADD
![Page 8: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/8.jpg)
Abduction/Lateral Tilt (Protraction)
Adduction/Reduced Lateral Tilt (Retraction)
Linear MovementFrontal PlaneAngular movementTransverse Plane
![Page 9: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/9.jpg)
Depression
Elevation
Linear MovementFrontal Plane
![Page 10: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/10.jpg)
Downward rotation
Upward rotation
![Page 11: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/11.jpg)
Shoulder Complex Movements
Upward tiltReduction of Upward Tilt
Angular movementSagittal plane
![Page 12: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/12.jpg)
Limited by capsular torsion
Limited by bony impingement of greater tubercle on acromion
![Page 13: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/13.jpg)
![Page 14: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/14.jpg)
Large ROM Due To:
Poor bony structure Poor ligamentous restraint Scapulohumeral cooperative action
![Page 15: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/15.jpg)
The Shoulder Complex
A. General Structure & Function
B. Structure & Function of Specific Joints
C. Muscular Considerations
D. Specific Functional Considerations
E. Common Injuries
![Page 16: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/16.jpg)
Structure & Function of Specific Joints
1. Sternoclavicular Joint
2. Acromioclavicular Joint
3. Scapulothoracic Joint
4. Glenolhumeral Joint
5. Coracoacromial Arch
![Page 17: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/17.jpg)
Sternoclavicular Joint: Bony Structure
PoorDiarthrodial Biaxial
![Page 18: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/18.jpg)
Sternoclavicular Joint: Capsule
Very strong
![Page 19: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/19.jpg)
Sternoclavicular Joint: Interclavicular Ligament
Resists superior & anterior (posterior portion) motion
![Page 20: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/20.jpg)
Sternoclavicular Joint: Sternoclavicular Ligament
Resists anterior (PSL), posterior (ASL), & superior motion
![Page 21: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/21.jpg)
Sternoclavicular Joint: Costoclavicular Ligament
Resists upward and posterior motion
![Page 22: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/22.jpg)
Sternoclavicular Joint: Accessory Structures
Resists medial & inferior displacement via articular contact
![Page 23: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/23.jpg)
Sternoclavicular Joint: Articular Surfaces
Medial end of clavice
is convex
Clavicular facet is
reciprocally shaped
![Page 24: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/24.jpg)
Sternoclavicular Joint: Motions
Axial Rotation: 50°EL/DEP: 35°PROT/RET: 35°
![Page 25: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/25.jpg)
Sternoclavicular Joint: Motions
Frontal planeElev/Dep
Sagittal planePost Rot
Horizontal planeProT/ReT
Ant/Post axisVertical axis
![Page 26: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/26.jpg)
Acromioclavicular JointBony Structure
PoorDiarthrodial Nonaxial
![Page 27: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/27.jpg)
Acromioclavicular Joint:Joint Capsule
Very weak
![Page 28: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/28.jpg)
Acromioclavicular JointAcromioclavicular Ligament
Resists axial rotation & posterior motion
![Page 29: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/29.jpg)
Acromioclavicular JointCoracoclavicular Ligament
Resists superior motion
![Page 30: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/30.jpg)
Acromioclavicular JointAccessory Structures
Articular disc
![Page 31: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/31.jpg)
Acromioclavicular Joint: Motion
Little relative motion at AC joint
UR/DR: 60°EL/DEP: 30°PROT/RET: 30-50°
![Page 32: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/32.jpg)
Acromioclavicular Joint: Osteokinematics
Horizontal plane
adjustments
during scapulothoracic
protraction
Sagittal plane adjustment
during scapulothoracic
elevation
![Page 33: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/33.jpg)
Clavicle
Acts a strut connecting upper extremity to thorax
Protects brachial plexus & vascular structures
Serves as attachment site for many shoulder muscles
![Page 34: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/34.jpg)
Scapula
![Page 35: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/35.jpg)
Scapular Plane
![Page 36: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/36.jpg)
Scapulothoracic Joint
No osseous connection
SUBSCAP & SA
![Page 37: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/37.jpg)
Glenohumeral Joint: Humerus
Retroversion angle: 30°
![Page 38: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/38.jpg)
Glenohumeral Joint: Humerus
Inclination angle: 45°
![Page 39: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/39.jpg)
Glenohumeral Joint: Glenoid Fossa
Inclination angle: 5° Retroversion angle: 7°
![Page 40: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/40.jpg)
Glenohumeral Joint: Glenoid Fossa
Articular cartilage thicker on periphery
Shallow fossa 1/3 diameter of humeral head
![Page 41: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/41.jpg)
Glenohumeral Joint: Bony Structure
Pure rotation Bony restraint poor Head 4-5X larger than
fossa Close-packed position
ABD with LR
![Page 42: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/42.jpg)
Glenohumeral Joint: Joint Capsule
Inherently lax Surface area 2X
head Provides restraint for
ABD, ADD, LR, MR
![Page 43: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/43.jpg)
Glenohumeral Joint:Superior GH Ligament
Resists inferior translation in rest or adducted arm
Well-developed in 50%
![Page 44: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/44.jpg)
Glenohumeral Joint: Coracohumeral Ligament
Resists inferior translation in shoulders with less-developed SGH
![Page 45: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/45.jpg)
Glenohumeral Joint:Middle GH Ligament
Great variability in proximal attachment & morphology
Absent in 30% Resists inferior
translation in ABD & ER
Restrains anterior translation (45° ABD)
![Page 46: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/46.jpg)
Glenohumeral Joint:Inferior GH Ligament
3 components (A,P,Ax)
Resists inferior, anterior, & posterior translation
![Page 47: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/47.jpg)
Glenohumeral Joint: Bursae
Subcoracoid Subacromial Subscapular
![Page 48: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/48.jpg)
Glenohumeral Joint: Accessory Structures
50% of depth Increases tangential stability 20%
Labrum
![Page 49: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/49.jpg)
Glenohumeral Joint: Intra-articular Pressure
Synovial fluid causes adhesion
Provides ~50% restraint
![Page 50: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/50.jpg)
Coracoacromial Arch
![Page 51: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/51.jpg)
Glenohumeral Joint: ROM
Flexion (167° W; 171° M) 30° in max LR
Extension (60°) Abduction (180°)
60° in max IR Hyperadduction (75°)
![Page 52: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/52.jpg)
Glenohumeral Joint: ROM
Medial rotation (90°) Lateral rotation (90°)
Horizontal abduction (45°) Horizontal adduction (135°)
Total rotation 180°
Total ROT 90° in 90° ABD
Role of multiarticular muscles???
![Page 53: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/53.jpg)
Soft Tissue Restraint Summary Anterior
Capsule Labrum Glenohumeral lig Coracohumeral lig Subscapularis Pectoralis major
Inferior Capsule Triceps brachii (L)
Posterior Capsule Labrum Teres minor Infraspinatus
Superior Labrum Coracohumeral lig Suprapinatus Biceps brachii (L) Coracoacromial arch Subacromial bursa
![Page 54: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/54.jpg)
The Shoulder Complex
A. General Structure & Function
B. Structure & Function of Specific Joints
C. Muscular Considerations
D. Specific Functional Considerations
E. Common Injuries
![Page 55: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/55.jpg)
Shoulder girdle has its own set of muscles.
![Page 56: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/56.jpg)
Retraction of the Scapulothoracic Joint
Levator scapula
![Page 57: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/57.jpg)
Protraction of the Scapulothoracic Joint
Pectoralis minor
![Page 58: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/58.jpg)
Pathomechanics of a weak serratus anterior muscleDeltoid force causes scapula to downwardly rotate.
Unstable and cannot resist deltoid force
![Page 59: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/59.jpg)
![Page 60: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/60.jpg)
![Page 61: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/61.jpg)
GH Flexion
Prime flexors: Anterior deltoid Pectoralis major: clavicular portion
Assistant flexors: Coracobrachialis Biceps brachii: short head
![Page 62: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/62.jpg)
GH Extension
Gravitational force Posterior deltoid Latissimus dorsi Pectoralis major (sternal) Teres major (with resistance)
![Page 63: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/63.jpg)
Abduction at Glenohumeral Joint Major abductors of humerus:
Supraspinatus Initiates abduction Active for first 110 degrees of abduction
Middle deltoid Active 90-180 degrees of abduction Superior dislocating component neutralized
by infraspinatus, subscapularis, and teres minor
![Page 64: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/64.jpg)
Adduction of Glenohumeral Joint Primary adductors:
Latissimus dorsi Teres major Sternocostal pectoralis
Minor assistance: Biceps brachii: short head Triceps brachii: long head Above 90 degrees- coracobrachialis and
subscapularis
![Page 65: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/65.jpg)
GH Medial Rotation
Subscapularis Latissimus dorsi Pectoralis major Teres major (with resistance)
Decreased activity with ABD
![Page 66: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/66.jpg)
GH Lateral Rotation
Primary Infraspinatus
Assistant: Teres minor Posterior deltoid
![Page 67: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/67.jpg)
Horizontal Adduction and Abduction
Anterior to joint: Pectoralis major (both heads), anterior
deltoid, coracobrachialis Assisted by short head of biceps brachi
Posterior to joint: Middle and posterior deltoid, infraspinatus,
teres minor Assisted by teres major, latissimus dorsi
![Page 68: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/68.jpg)
Muscle Strength
Adduction (2X ABD) Extension Flexion Abduction Internal rotation (max in neutral) External rotation (max at 90° FL)
Role of multiarticular muscles???
![Page 69: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/69.jpg)
The Shoulder Complex
A. General Structure & Function
B. Structure & Function of Specific Joints
C. Muscular Considerations
D. Specific Functional Considerations
E. Common Injuries
![Page 70: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/70.jpg)
Specific Functional Considerations
Stability Functions of Shoulder Girdle Mobility Functions of Shoulder Girdle Rotator Cuff Function
![Page 71: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/71.jpg)
Stability Functions of Shoulder Girdle
Provides stable base from which shoulder muscles can generate force Shoulder girdle muscles as stabilizers Maintain appropriate force-length
relationship Maintain maximum congruence of shoulder
joint
![Page 72: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/72.jpg)
Specific Functional Considerations
Stability Functions of Shoulder Girdle Mobility Functions of Shoulder Girdle Rotator Cuff Function
![Page 73: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/73.jpg)
Mobility Functions of Shoulder Girdle
Permits largest ROM of any complex in the body Shoulder girdle increases ROM with less
compromise of stability (scapulohumeral rhythm) (4 joints vs. 1 joint)
Facilitate movements of the upper extremity by positioning GH favorably
![Page 74: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/74.jpg)
Dynamic Stabilization Mechanisms
Passive muscle tension Compressive forces from muscle
contraction Joint motion that results in tightening of
passive structures Redirection of joint force toward center
of GH joint
![Page 75: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/75.jpg)
Muscular Considerations
Force-length relationships quite variable due to multiple joints
Tension development in agonist frequently requires tension development in antagonist to prevent dislocation of the humeral head
Force couple – 2 forces equal in magnitude but opposite in direction
![Page 76: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/76.jpg)
Movements in the Frontal PlaneGH Joint - Abduction
Shoulder Girdle: UR Totals
Upward rotation - 60° GH Abduction - 120°
2:1 (.66) ratio 1.25:1 after 30° 0.5-0.75 across
individuals
ABD
30°
ABD - 30°
UR - 40°
ABD - 60°
UR - 20°
![Page 77: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/77.jpg)
Movements in the Frontal PlaneGH Joint - Adduction
Shoulder Girdle: DR
Fig 5.17
![Page 78: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/78.jpg)
Movements in the Sagittal PlaneGH Joint – Flexion & Extension
Shoulder Girdle: UR ELEV (>90°) PROT ( to 90°) RET (>90°)
Fig 5.18
![Page 79: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/79.jpg)
Movements in the Sagittal PlaneGH Joint - Hyperextension Shoulder Girdle: Upward tilt of scapula
Fig 5.20
![Page 80: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/80.jpg)
Movements in the Transverse PlaneGH Joint – MR & LR
Fig 5.22a
![Page 81: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/81.jpg)
Spinal Contribution to GH Motion
![Page 82: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/82.jpg)
Movements in the Transverse PlaneGH HAdd & HAbd
![Page 83: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/83.jpg)
Large ROM Due To:
Poor bony structure Poor ligamentous restraint Scapulohumeral coordination
Normal movement dependent on interrelationships of 4 joints
Restriction in any of these four can impair normal function
![Page 84: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/84.jpg)
Specific Functional Considerations
Stability Functions of Shoulder Girdle Mobility Functions of Shoulder Girdle Rotator Cuff Function
![Page 85: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/85.jpg)
Subscapularis
Teres minorSupraspinatus
Infraspinatus
![Page 86: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/86.jpg)
![Page 87: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/87.jpg)
Function of Rotator Cuff
Large external muscles (e.g., lats, delts) create shear forces
Rotator cuff provides Joint compression Tangential restraint
(Ant, Post, Sup)
![Page 88: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/88.jpg)
Destabilizing Action of Deltoid
![Page 89: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/89.jpg)
Deltoid produces superior shear force at GH joint.
![Page 90: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/90.jpg)
Subscapularis
Resists superior shear
Produces simultaneous internal rotation
![Page 91: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/91.jpg)
Infraspinatus & Teres Minor
Resists superior shear
Neutralizes SUBSCAP internal rotation
![Page 92: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/92.jpg)
Supraspinatus
![Page 93: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/93.jpg)
Summary of Active Arthrokinematics Resisting Shear
![Page 94: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/94.jpg)
Destabilizing Action of Latissimus Dorsi
LD pulls humerus INF
SSP resists INF force
INF & SUBSCAP create compressive force
![Page 95: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/95.jpg)
The Shoulder Complex
A. General Structure & Function
B. Structure & Function of Specific Joints
C. Muscular Considerations
D. Specific Functional Considerations
E. Common Injuries
![Page 96: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/96.jpg)
Common Shoulder Injuries
Joint dislocations Clavicular fracture Rotator cuff injuries Other rotational injuries Subscapular neuropathy
![Page 97: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/97.jpg)
Impingement
Possible mechanisms Weak or inflexible rotator cuff Small anatomical space Hyperabduction of GH joint GH ABD + ROT
![Page 98: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/98.jpg)
Impingement: Roll-Slide Kinematics
“Roll” created by abduction not countered with “Slide” action
![Page 99: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/99.jpg)
During ABD SSP tendon pushed into
acromion process & CA ligament
During ROT SSP tendon dragged along the
inferior surface of the acromion process
![Page 100: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/100.jpg)
Wind-Up Phase
Kinesiological breakdown of overhand throwing
First Motion Maximum knee lift of leg
![Page 101: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/101.jpg)
•Shoulder ABD (DELT & SSP) •RC maintain proper humeral head position
Kinesiological breakdown of overhand throwing
Stride
Lead leg begins to moveArms separate
Lead foot contacts the ground
![Page 102: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/102.jpg)
• ER in ABD position; ER 150-180°• ECC action of SUBSCAP (decelerates ER
humerus)• RC stabilization
Kinesiological breakdown of overhand throwing
Arm Cocking
Lead foot contact Maximum shoulder external rotation
![Page 103: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/103.jpg)
• Concentric IR (PMJR & LD ) • IR velocity (> 1000 °/s)• RC stabilization
Kinesiological breakdown of overhand throwing
Arm Acceleration
Maximum shoulder ER Ball release
![Page 104: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/104.jpg)
• Decelerating IR & ADD • ECC action of TMin• RC stabilization
Kinesiological breakdown of overhand throwing
Arm Deceleration
Ball release Maximum shoulder IR
![Page 105: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/105.jpg)
• Decelerating IR• ECC action of TMin• RC stabilization
Kinesiological breakdown of overhand throwing
Follow Through
Maximum shoulder IR Ends in balanced position
![Page 106: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/106.jpg)
Rotator Cuff Injuries: Solution
Alter technique during problem phases to avoid impingement Arm cocking Arm acceleration
Strengthen rotator cuff Surgical repair
Video techniques
![Page 107: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/107.jpg)
Intrinsic Risk Factors
Age and gender Physical fitness Overtraining Skeletal abnormalities Technique Warm-up Psychological factors
![Page 108: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/108.jpg)
Technique
Technique refers to the movement pattern of an individual during a particular movement or sequence of movements. Good technique is a movement pattern not only effective in performance, but also one that minimizes risk of injury by appropriately distributing the overall load throughout the kinetic chain. Poor technique is characterized by inappropriate utilization and summation of muscular effort and abnormal joint movements, both of which result in localized overload and, therefore, increased risk of injury.
![Page 109: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/109.jpg)
Swimming
Mechanism: ABD + IR
Solutions: Lead with hand to ↓ IR Increase body roll to ↓ ABD
![Page 110: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/110.jpg)
Supraspinatus Tear
![Page 111: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/111.jpg)
Other Rotational Injuries
Tears of labrum Mostly in anterior-superior region
Tears of biceps brachii tendon Due to forceful rotational movements
Also: calcification of soft tissues, degenerative changes in articular surfaces, bursitis
![Page 112: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/112.jpg)
Biceps Tendon Tear
![Page 113: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/113.jpg)
Subscapular Neuropathy
Denervation of INF with ↓ strength GH ER
Mechanism: Repeated stretching of nerve
![Page 114: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/114.jpg)
Injury Potential in the Shoulder Complex - Impacts
Sternoclavicular Joint not commonly injured may sprain anteriorly if fall on
top of shoulder or middle delt - pain in horizontal abd
children may dislocate anteriorly during throwing because of increased joint mobility as compared to adults
posterior dislocation may occur when force is applied to sternal end of clavicle; serious because of trachea, esophagus, and blood vessels located posteriorly
Clavicular Injuries fx to any part due to direct trauma fx to middle 1/3 can occur by
falling on shoulder, outstretched arm, or direct trauma to shoulder that transmits force down shaft of clavicle
AC Injuries dislocation from fall on shoulder,
fall on elbow or outstretched arm overuse injuries from overhand
pattern (throwing, tennis, swimming) or sports that repeatedly load in the overhead position (wrestling, wt lifting)
![Page 115: The Shoulder Complex. A.General Structure & Function B.Structure & Function of Specific Joints C.Muscular Considerations D.Specific Functional Considerations](https://reader036.vdocument.in/reader036/viewer/2022062417/5519d062550346443e8b4a37/html5/thumbnails/115.jpg)
Glenohumeral Injuries
Most common dislocation in anterior (anterior-inferior 95%)
most commonly dislocated when abducted and ER overhead
recurrence rate 33-50% (66-90% <20 yrs)