shoulder complex. extrinsic shoulder muscles review the following: review the following: pectoralis...
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Extrinsic Shoulder MusclesExtrinsic Shoulder Muscles
Review the following:Review the following:Pectoralis majorPectoralis majorPectoralis minorPectoralis minorSerratus anteriorSerratus anteriorTrapezius complexTrapezius complexLatissimus dorsiLatissimus dorsiLevator scapulaeLevator scapulaeRhomboideus majorRhomboideus majorRhomboideus minorRhomboideus minor
Sensory Supply to ShoulderSensory Supply to Shoulder
Supraclavicular nerves:Supraclavicular nerves:From cervical plexusFrom cervical plexus
C3-4C3-4
Supply skin over clavicle and over the Supply skin over clavicle and over the superior-lateral aspect of pectoralis majorsuperior-lateral aspect of pectoralis major
Cutaneous branches of dorsal rami:Cutaneous branches of dorsal rami:Penetrate deep and superficial back musclesPenetrate deep and superficial back muscles
Supply skin on either side of midline of backSupply skin on either side of midline of back
Shoulder MovementsShoulder Movements
Elevation (scapula):Elevation (scapula):Levator scapulae and Levator scapulae and rhomboidsrhomboids
Depression (scapula):Depression (scapula):Latissimus dorsiLatissimus dorsi
Shoulder MovementsShoulder Movements
Abduction (scapula):Abduction (scapula):Serratus anteriorSerratus anterior
Abduction (shoulder):Abduction (shoulder):Middle deltoidMiddle deltoid
Biceps brachii assistsBiceps brachii assists
Adduction (scapula):Adduction (scapula):Middle trapeziusMiddle trapezius
Adduction (shoulder):Adduction (shoulder):Pectoralis major (clav)Pectoralis major (clav)
Latissimus dorsiLatissimus dorsi
Shoulder MovementsShoulder Movements
Upward rotation (scapula):Upward rotation (scapula):Serratus anteriorSerratus anterior
Upper and lower Upper and lower trapezius (force couple)trapezius (force couple)
Downward rotation (scapula):Downward rotation (scapula):RhomboidsRhomboids
Levator scapulaeLevator scapulae
Quadrilateral SpaceQuadrilateral Space Boundaries:Boundaries:
Inferior glenohumeral Inferior glenohumeral capsule.capsule.Teres major.Teres major.Triceps longus.Triceps longus.Surgical neck of Surgical neck of
humerus.humerus. Contents:Contents:
Axillary nerve.Axillary nerve.Posterior circumflex Posterior circumflex humeral artery.humeral artery.
Shoulder Complex JointsShoulder Complex Joints
Sternoclavicular joint (SC)Sternoclavicular joint (SC)Acromioclavicular joint (AC)Acromioclavicular joint (AC)Glenohumeral joint (GH)Glenohumeral joint (GH)
Sternoclavicular Joint (SC)Sternoclavicular Joint (SC)
Plane synovial jointPlane synovial jointArticulating surfaces:Articulating surfaces:
Sternal end of clavicleSternal end of clavicle
Articular notch on manubriumArticular notch on manubrium
First costal cartilageFirst costal cartilage3 degrees of freedom3 degrees of freedom
SC Joint MovementsSC Joint Movements
Elevation and depression:Elevation and depression:Occurs around AP axisOccurs around AP axisElevation = 45 degreesElevation = 45 degreesDepression = 15 degreesDepression = 15 degrees
Protraction and retraction:Protraction and retraction:Occurs around vertical axisOccurs around vertical axisProtraction ROM = 15 degreesProtraction ROM = 15 degreesRetraction ROM = 15 degreesRetraction ROM = 15 degrees
Rotation:Rotation:Occurs around transverse axisOccurs around transverse axis
Sternoclavicular JointSternoclavicular Joint
Joint discJoint discFibrocartilage meniscusFibrocartilage meniscus
Attached to:Attached to:Clavicle inferiorlyClavicle inferiorly
Manubrium and first costal cartilage inferiorlyManubrium and first costal cartilage inferiorly
Ligaments:Ligaments:Anterior/posterior sternoclavicular ligaments:Anterior/posterior sternoclavicular ligaments:
Check anterior/posterior movements of Check anterior/posterior movements of clavicular head.clavicular head.
SC Joint LigamentsSC Joint Ligaments
Costoclavicular ligament:Costoclavicular ligament:Axis for elevation and depressionAxis for elevation and depression
Axis for protraction and retractionAxis for protraction and retraction
Main check for elevationMain check for elevation InterclavicularInterclavicular
Acromioclavicular JointAcromioclavicular Joint
Plane synovial jointPlane synovial joint3 degrees of freedom3 degrees of freedomArticulation surfaces:Articulation surfaces:
Convex facet on lateral end of clavicleConvex facet on lateral end of clavicle
Concave facet on acromionConcave facet on acromion
AC Joint MovementsAC Joint Movements
Scapular rotation:Scapular rotation:Occurs around AP axis.Occurs around AP axis.
Winging of vertebral border of scapula:Winging of vertebral border of scapula:Occurs around vertical axis.Occurs around vertical axis.
Tipping of inferior angle of scapula:Tipping of inferior angle of scapula:Occurs around coronal axis.Occurs around coronal axis.
Acromioclavicular JointAcromioclavicular Joint
Acromioclavicular Acromioclavicular ligaments:ligaments:
Superior and Superior and inferiorinferior
Reinforce joint Reinforce joint capsulecapsule
Coracoclavicular:Coracoclavicular:Trapezoid (lateral)Trapezoid (lateral)
Conoid (medial)Conoid (medial)
Glenohumeral JointGlenohumeral Joint
Ball-and-socket jointBall-and-socket jointSynovial Synovial Components:Components:
Head of humerusHead of humerus
Glenoid fossa of scapulaGlenoid fossa of scapula
Glenoid labrumGlenoid labrumFibrocartilage meniscusFibrocartilage meniscus
Deepens articulating surface of glenoid Deepens articulating surface of glenoid fossafossa
Glenohumeral JointGlenohumeral Joint
Ligaments:Ligaments:Glenohumeral Glenohumeral
Coracohumeral Coracohumeral
CoracoacromialCoracoacromial Joint capsule:Joint capsule:
Very laxVery lax
Up to an inch of Up to an inch of passive distractionpassive distraction
GH Joint MovementsGH Joint Movements
Flexion/extension of brachium:Flexion/extension of brachium:Abduction/adduction of brachium:Abduction/adduction of brachium:Lateral/medial rotation of brachium:Lateral/medial rotation of brachium:
Shoulder Complex ComponentsShoulder Complex Components
Scapulothoracic joint:Scapulothoracic joint:Not a true anatomic jointNot a true anatomic joint
Represented by sliding of scapula on thoracic Represented by sliding of scapula on thoracic cagecage
Coracoacromial arch:Coracoacromial arch:Components:Components:
AcromionAcromion
Coracoid processCoracoid process
Coracoacromial ligamentCoracoacromial ligament
Subacromial/subdeltoid bursaeSubacromial/subdeltoid bursae
Rotator CuffRotator Cuff
Composed of four muscles whose tendons Composed of four muscles whose tendons of insertion form a partial “cuff” around the of insertion form a partial “cuff” around the head of the humerus.head of the humerus.
Involved in snubbing and rotating head of Involved in snubbing and rotating head of humerushumerus
Rotator Cuff ComponentsRotator Cuff Components
Supraspinatus Supraspinatus SS Infraspinatus Infraspinatus IITeres minorTeres minor TTSubscapularis Subscapularis SS
Scapulohumeral RhythmScapulohumeral Rhythm
Refers to relatively uninterrupted Refers to relatively uninterrupted movement of upper extremity from movement of upper extremity from dependent position to full abduction.dependent position to full abduction.
Requires simultaneous and coordinated Requires simultaneous and coordinated movements of all the previous-named movements of all the previous-named joints.joints.
Scapulohumeral RhythmScapulohumeral Rhythm
ROM:ROM:Full abduction:Full abduction:
180 degrees180 degrees
Contributed by glenohumeral joint:Contributed by glenohumeral joint:
120 degrees120 degrees
Contributed by scapulothoracic movement:Contributed by scapulothoracic movement:
60 degrees:60 degrees:
Sternoclavicular joint = 40 degreesSternoclavicular joint = 40 degrees
Acromioclavicular joint = 20 degreesAcromioclavicular joint = 20 degrees
Ratio of GH to ST = 2:1Ratio of GH to ST = 2:1
Steps in Arm AbductionSteps in Arm Abduction
Movement (searching) of scapula:Movement (searching) of scapula:Serratus anterior clamps scapula to thoracic wallSerratus anterior clamps scapula to thoracic wall
Snubbing of head of humerus into glenoid fossa:Snubbing of head of humerus into glenoid fossa:Rotator cuff musclesRotator cuff muscles
First few degrees of abduction:First few degrees of abduction:SupraspinatusSupraspinatus
External rotation of humerus:External rotation of humerus:InfraspinatusInfraspinatus
Clinical ApplicationsClinical Applications
Deltoid paralysis:Deltoid paralysis:Axillary nerveAxillary nerve
Serratus anterior paralysis:Serratus anterior paralysis:Long thoracic nerveLong thoracic nerve
Tears in rotator cuffTears in rotator cuffSupraspinatus most often torn:Supraspinatus most often torn: