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Flashcards in Shoulder Deck (29):
0

Scapulothoracic
*not an actual joint

Motions:
abduction (protraction) / adduction (retraction)
elevation / depression
upward / downward rotation (glenoid fossa point of reference)

1

Sternoclavicular
~ Motions

Tri-axial complex joint:
Elevation (45) / Depression (15): z
Protraction (15) / Retraction (15): y
Anterior (10) / Posterior Rotation (50): x (flexion/ext of shoulder)

2

Sternoclavicular
~ Ligamentous Support

Costoclavicular
Interclavicular (limits excessive depression)
Anterior / Posterior SC
Subclavian Muscle

3

Sternoclavicular
~ Translatory / Rotary Motion

Protraction / Retraction: concave on convex (opposite)
Elevation / Depression: convex on concave (same)

4

Acromioclavicular
~Motions

Complex, Triaxial Joint
1. Medial / Lateral Rotation (winging): y
2. Anterior / Posterior Tipping: x (point of reference - superior border of scap)
3. Upward / Downward Rotation: z (point of reference - fossa)

5

Acromioclavicular
~ Ligamentous Support

Superior / Inferior AC
Coraclavicular Ligament: Conoid (medial), Trapezoid (lateral)

6

Glenohumeral
~ Motions

Tri-axial, Complex: ball and socket, synovial
1. Flexion (180) / Extension (40-60): x
2. Abduction (180) / Adduction (back to neutral 0): z
3. Internal (70) / External (80-90) Rotation: y

Horizontal abduction (45) / adduction (90) : y; elbow @ 90
Scaption: Abduction & Flexion (very functional)

7

Glenohumeral
~ Ligamentous Support

Coracohumeral
Superior GH
Middle GH
Inferior GH
Rotator Cuff Muscles

Joint Capsule: more relaxed anteriorly, tighter posteriorly

8

Scapulohumeral Rhythm

Abduction ROM 0 - 180
0 - 90: Phase 1
60 GH
30 Scapula (25 SC / 5 AC)

90-180: Phase 2
60 GH
30 Scapula (5 SC / 25 AC)

Scapula contributes 60
GH contributes 120

9

Shoulder Impingement

Coracoacromial Ligament: protects subacromial space

Scapulohumeral Space
Acromial Space and Orientation (congenital)
Bone Spurs
Lack of Scapular Movement (abnormal mechanics)
Weak Rotator Cuff (humeral head down as delts contract)
Inflammation of Soft Tissue

Space decreases as you raise arm up.

Acromioplasty: remove or shave part of the acromion to increase space.

10

Group 1: Truck to Shoulder Girdle

Serratus Anterior
Trapezious (Upper/Middle/Lower)
Levator Scapulae
Pectoralis Minor
Subclavius
Rhomboids (Major and Minor)

11

Serratus Anterior

Upper 8/9 Ribs - Costal Surface of Medial Scapulae
Abduction (protraction), upward rotation of scap
Long Thoracic Nerve - winging if lesion

MMT: arm abducted @ 135 + protraction

12

Trapezius
Upper, Middle, Lower

Upper:
occiput, cervical vertebrae - lateral 1/3 of clavicle and acromion
elevate and upwardly rotate scap
ears to shoulders / shrug
holds shoulder girdle up against gravity
Middle:
T1-T5 spinous process - superior lip os spine of scapula
adductor; pinch shoulder blades together
Lower:
T6-T12 spinous process - root of spine of scapula (medial)
depressor, adductor, upward rotator

13

Rhomboids

Minor: (top) C7-T1 spinous process - medial border @ level of spine of scap

Major: (lower) T2-T5 spinous process - between spine & inferior border

Action: adductor, downward rotator, weak elevator
Fibers course down obliquely

14

Levator Scapulae

Transverse Process C1-C4 - medial border between spine and superior angle
Elevator, downward rotation, little adductor

15

Pec Minor

Ribs 3-5 (anterior and lateral surface) - coracoid process
Elevate Ribs (accessory respiratory muscle)
Depression, little protraction, downward rotation of scap

16

Subclavious

costal cartilage of 1st rib - inferior clavicle
stabilize SC joint, pulls clavicle down

17

Group 2: Shoulder Girdle to Humerus (7)

1. Coracobrachialis
2. Supraspinatus
3. Deltoids (ant, middle, post)
4. Infraspinatus
5. Teres Minor
6. Subscapularis
7. Teres Major

18

Coracobrachialis

Coracoid process - 1/2 way down humerus on medial side
Shunt muscle (insertion far from joint)
Flexion, Adductor

19

Supraspinatus

Supraspinous Fossa - superior facet of greater tuberosity
Primarily abductor.
Stabilize glenohumeral joint, steer humeral head when you elevate arm 0-90.

20

Deltoids: Anterior, Middle, Posterior

Anterior: lateral 1/3 of clavicle - deltoid tuberosity
Flexion, horizontal adductor, weak internal rotator

Middle: acromion - deltoid tuberosity
Abduction 90-180

Posterior: inferior lip of spine of scapula - deltoid tuberosity
Extension, horizontal abduction, external rotator

21

Infraspinatus

infraspinatus fossa - greater tuberosity
external rotation, steer abduction (critical) - gets greater tuberosity out of the way so it doesn't hit acromion shelf

22

Teres Minor

Upper 2/3 axillary border - greater tuberosity
External rotator, adduction, rotator cuff

23

Subscapularis

anterior scapula
subscapular fossa - lesser tuberosity
internal rotator, rotator cuff
inferior translation of humeral head

24

Teres Major

inferior 1/3 angle of scapula - just medial to bicipital groove
internal rotation, adduction, extension
"mini lat"

25

Group 3: Trunk to Humerus (3)

1. Latissimus Dorsi
2. Pectoralis Major

26

Latissimus Dorsi:

T7-L5, thoraco-lumbar fascia, posterior iliac, floating ribs, inferior scap angle - medial side of bicipital groove near lesser tuberosity

Adductor, internal rotator, extensor, depress/downward rotate shoulder girdle.

27

Pectoralis Major

Sternal Head: costal cartilage (1-6) - lateral bicipital groove
Clavicular Head: medial 1/3 clavicle - lateral to bicipital groove

Both: Internal Rotator, Horizontal Adductor
Clavicular Head: weak flexor
Sternal Head: shoulder depression

28

Synergistic Action in Shoulder Girdle (5)

1. Upper, Lower Traps + Serratus Anterior = Upward Rotation
2. Levator + Rhomboids + Pec Minor = Downward Rotation
3. Deltoid + Rotator Cuff = Dynamic Stability during abduction
4. Deltoid + Upper Traps = Avoid Scapular Depression
5. Rhomboids + Teres Major = prevents scapular upward rotation (stabilize scapulae)