shoulder complex function

• Coracohumeral Ligament: Attaches between the coracoid process and the anterior side of the greater tubercle. Figure 4-7 The right sternoclavicular joint has been opened up to expose matching surfaces of the saddle joint. Otherwise it is hidden from view. It must be understood, however, that movement of the entire shoulder is the result of movement in each of its four joints. The articular structures of the shoulder complex are designed primarily for mobility, allowing us to move and position the hand through a wide range of space. J Athl Train. Describe the interaction between the internal and external rotators of the shoulder during a throwing motion. This will improve shoulder position and posture over time, which will ultimately lead to better function of the shoulder complex and can improve total kinetic chain movement. + 30 degrees of acromioclavicular joint upward rotation General Features This is a relatively common occurrence in throwing athletes such as baseball pitchers. Bankart lesions, on the other hand, involve tears to the anterior-inferior portion of the glenoid labrum. First, the superior portion of the labrum is only loosely attached to the adjacent glenoid rim. static stability Protraction and Retraction • Clavicular elevation and posterior rotation Posterior view of the right shoulder complex after the arm has abducted 180 degrees. For organizational purposes, this text divides these muscles into two categories: (1) Muscles of the shoulder girdle, and (2) muscles of the GH joint. • Coracohumeral Ligament: Attaches between the coracoid process and the anterior side of the greater tubercle. The labrum also helps seal the joint, thereby contributing to stability by maintaining a suction effect between the humerus and the glenoid fossa. • Identify the bones and primary bony features relevant to the shoulder complex. Figure 4-8 The right sternoclavicular joint showing the osteokinematic motions of the clavicle. Muscles of the Shoulder Girdle "The Shoulder Complex." First, the superior portion of the labrum is only loosely attached to the adjacent glenoid rim. An anterior view of the sternoclavicular joints with the capsule and some of the ligaments removed on the left side. At the same time, it must be mobile enough for these actions to occur. The glenohumeral (GH) joint is created by the articulation of the humeral head with the glenoid fossa of the scapula (Figure 4-12). Muscle and Joint Interaction Rather, muscles work in teams to produce highly coordinated movements that are expressed over multiple joints. Shoulder Flexion Protraction and retraction of the SC joint occur in the horizontal plane about a vertical axis of rotation, allowing about 15 to 30 degrees of clavicular motion in either direction. Shoulder Extension The high degree of stability provided by this thick ligamentous network explains, in part, why fractures of the clavicle occur more frequently than dislocations of the SC joint. This is useful information, as the specific location of pain around body structures helps doctors and other health care providers to figure out what the cause of the patient’s pain is. These muscles are discussed at length in a subsequent section. Recent research findings are incorporated in this review of the functional anatomy of the shoulder complex. Even small tears of the labrum can cause instability and excessive micro-motions at the glenohumeral joint. Normal movement and posture of the scapulothoracic joint are essential to the normal function of the shoulder. As the shoulder is abducted, the coracoclavicular ligament becomes taut and spins the clavicle posteriorly. General Features Although the components of the shoulder complex constitute half of the mass of the entire upper limb,1 they are connected to the axial skeleton by a single joint, the sternoclavicular (SC) joint. The acromion process is a wide, flattened projection of bone from the most superior-lateral aspect of the scapula. It is essential for these normal relationships to be defined as a basis for understanding pathology. The humeral head is nearly one half of a full sphere that articulates with the glenoid fossa forming the glenohumeral joint. Up to this point, we have discussed the arthrology and kinematics of each joint of the shoulder complex. Figure 4-13 The right glenohumeral joint showing the conventional osteokinematic motions of the humerus. List the three points of proximal attachment for the upper trapezius. • Acromioclavicular Ligament: Joins the clavicle to the acromion; helps to prevent dislocations of the scapula and links motion of the scapula to the clavicle Proximal attachments of muscles are shown in red, distal attachments in gray. common function of the rotator cuff muscles. ), (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-12. Only gold members can continue reading. Proximal-to-Mid Humerus The study aimed to evaluate pain, shoulder-arm complex function, and scapular function in women who developed lymphedema after breast cancer surgery and to … This series of joints works together to provide large ranges of motion to the upper extremity in all three planes. Motions at the scapulothoracic joint include elevation and depression, protraction and retraction, and upward and downward rotation (Figure 4-9). The lesser tubercle is a sharp, anterior projection of bone just below the humeral head. Along with the acromion, the coracoacromial ligament completes the coracoacromial arch—a functional “roof” that protects the head of the humerus. Large forces that tax the biceps tendon can partially detach or tear the loosely attached superior labrum. Identify the key joint structures of the neck and shoulder region. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-2.) Proximal-to-Mid Humerus Horizontal Abduction Scapular elevation involves the scapula sliding superiorly on the thorax (e.g., shrugging the shoulders). As illustrated in Figure 4-17, B, when the scapula becomes downwardly rotated, as commonly occurs after a stroke involving weakness or paralysis of the trapezius muscles, the static locking mechanism becomes ineffective. The greater and lesser tubercles are divided by the intertubercular groove, often called the bicipital groove because it houses the tendon of the long head of the biceps. With the shoulder in roughly 90 degrees of abduction, movement of the humerus toward the midline in the horizontal plane is considered horizontal adduction. Structure and Function of the Shoulder Complex The AC joint allows motion in all three planes: Upward and downward rotation, rotation in the horizontal plane (internal and external rotation), and rotation in the sagittal plane (anterior and posterior tilting) (Figure 4-11). This tendon helps provide anterior stability because it acts as a partial extension of the glenoid labrum. Abduction and adduction of the GH joint occur in the frontal plane about an anterior-posterior axis of rotation, which courses through the humeral head. https://fadavispt.mhmedical.com/content.aspx?bookid=1862§ionid=136085052. The labrum also helps seal the joint, thereby contributing to stability by maintaining a suction effect between the humerus and the glenoid fossa. The radial nerve follows this groove and helps define the distal attachment for the lateral and medial heads of the triceps. Injuries to the Glenoid Labrum muscular substitution It helps limit the extremes of external rotation, flexion, and extension, as well as inferior displacement of the humeral head (see Figure 4-12). Furthermore, motion at the scapulothoracic joint is dependent on the combined movements of the AC and SC joints. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-25.) Innervation of the Shoulder Complex • Coracoclavicular Ligament: Composed of the conoid and trapezoid ligaments. if the shoulder is abducted to 150 degrees, according to the scapulohumeral rhythm, how much upward rotation of the scpula has occurred. This type of injury often results from a traumatic anterior dislocation of the humerus. When these forces are combined, the resultant vector is a compressive force directed through the middle of the glenoid fossa, enhancing the static stability of the GH joint. The shoulder relies heavily on coordinated muscle activity for normal function owing to its limited osseous constraint. The labrum performs this important function in two ways. To fully understand how the shoulder functions as a whole, we must first examine the structure and kinematics of each individual joint. The coracoid process is the site of attachment for several muscles and ligaments of the shoulder complex. Two Ways to Help Prevent Shoulder Impingement Kinematics Sternoclavicular stress tolerence  Although the SC joint is considered incongruent, the joint does not undergo the degree of degenerative change common to the other joints of the shoulder complex. The acromion forms a functional “roof” over the humeral head to help protect the delicate structures within that area. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figures 5-7, (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-11. ), Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Structure and Function of the Shoulder Complex. The articular structures of the shoulder complex, in particular the GH Joint, are designed primarily for mobility, allowing us to move and position the hand through a wide range of space, allowing the greatest range of motion of any joint in the body. The sternum, often called the breast bone, is located at the midpoint of the anterior thorax and is composed of the manubrium, body, and xiphoid process (Figure 4-2). • Rotator Cuff: A group of four muscles including the supraspinatus, infraspinatus, subscapularis, and teres minor. Cite the normal ranges of motion for shoulder flexion and extension, abduction and adduction, and internal and external rotation. The shoulder complex functions through the interactions of four joints: (1) Sternoclavicular, (2) scapulothoracic, (3) acromioclavicular, and (4) glenohumeral joints. • Scapulothoracic It must be understood, however, that movement of the entire shoulder is the result of movement in each of its four joints. This motion naturally occurs as an elevated upper extremity is lowered to one’s side. Figure 4-10 illustrates the supporting structures of the AC joint. Rarely does a single muscle act in isolation at the shoulder complex. • Explain how the shoulder depressor muscles can be used to elevate the thorax. B, Protraction and retraction. • Downward rotation and retraction of the scapula, • Depression and retraction of the clavicle. Horizontal abduction and horizontal adduction are commonly used terms to describe special motions of the shoulder and are described in the following section. 2019 Jan;39(1):e32-e38. Depression occurs when the scapula slides inferiorly on the thorax (Figure 4-9, A; e.g., returning shrugged shoulders to a resting position; depressing the entire shoulder, as occurs when pushing up from a sitting position). Injury to 1 or more of these components through overuse or acute trauma disrupts this complex interrelationship and places the shoulder at increased risk. Acromioclavicular Joint As the shoulder is abducted, the coracoclavicular ligament becomes taut and spins the clavicle posteriorly. Motions include elevation and depression, protraction and retraction, and axial rotation (. Tags: Essentials of Kinesiology for the Physical Therapist Assistant Sternoclavicular Joint All four joints must properly interact for normal shoulder motion to occur. Supporting Structures of the Glenohumeral Joint, Numerous structural and functional reasons explain why the labrum is so often involved with shoulder pathology. She finished treatment 4 months ago. Numerous structural and functional reasons explain why the labrum is so often involved with shoulder pathology. To illustrate this, first try to perform frontal plane abduction with your arm in full internal rotation (thumb pointing down), then in a neutral position (palm facing down), and finally in full external rotation (thumb pointing up). San Diego, Calif.: American Council on Exercise. • Articular Disc: Acts as a shock absorber between the clavicle and the sternum; helps improve joint congruency The shoulder complex, composed of the clavicle, scapula, and humerus, is an intricately designed combination of three joints that links the upper extremity to the thorax. The scapulothoracic mechanism is described, including a review of scapular motion and the structure and function of the sternoclavicular and acromioclavicular joints. 2. This joint provides the only direct bony attachment of the upper extremity to the axial skeleton—accordingly, the joint must be stable while also allowing extensive mobility. The cooperative nature of the shoulder musculature increases the versatility, control, and range of active movements available to the upper extremity. This tendon helps provide anterior stability because it acts as a partial extension of the glenoid labrum. The objective of this study was to perform a comprehensive analysis of scapular kinematics before and after PSF and compare postoperative scapular kinematics in AIS to those of a typically developing cohort. This relatively loose capsule attaches between the rim of the glenoid fossa and the anatomic neck of the humerus (see Figure 4-12). (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-28.) Figure 4-10 Anterior view of the right acromioclavicular joint, including many of the surrounding ligaments. This div only appears when the trigger link is hovered over. The trunks travel a short distance before forming the anterior or posterior division. Arthrology Identify the bony structures and key landmarks of the neck and shoulder complex. • Elevation and posterior rotation of the clavicle All of the nerves that travel down the arm pass through the axilla (the armpit) just under the shoulder joint and are known as the Brachial Plexus before dividing into the individual nerves.These nerves carry the signals from the brain to the muscles that move the arm. Identify the primary muscles involved with dynamic stabilization of the glenohumeral joint. The muscles of the shoulder complex provide stability and movement. The shoulder is a complex and flexible joint, making it vulnerable to damage. Joint Structure & Function: A Comprehensive Analysis, 6e Levangie PK, Norkin CC, Lewek MD. This bony conformation, in conjunction with the highly mobile scapula, allows for abundant motion in all three planes but does not promote a high degree of stability. Much of the stability in the shoulder complex is … Internal and External Rotation The axes of rotation are color coded with the associated planes of motion. The glenoid labrum is a fibrocartilaginous ring of connective tissue that increases the stability of the glenohumeral joint. In essence, dynamic stability exists when a moving segment or set of segments is limited very little by passive forces such as articular surface configuration, capsule, or ligaments and instead relies heavily on active forces or dynamic muscular control. Scapular movements include: Anterior/posterior tilting, upward/downward rotation. The shoulder complex, composed of the clavicle, scapula, and humerus, is an intricately designed combination of three joints that links the upper extremity to the thorax. Recall that the glenoid fossa is relatively flat and shallow, whereas the humeral head is large and round, making the anatomy of this joint more like a golf ball sitting on a quarter than like a ball-and-socket joint. Elevation and depression of the SC joint is a near-frontal plane movement about a near–anterior-posterior axis of rotation, allowing roughly 45 degrees of clavicular elevation and 10 degrees of depression. The limited range of motion experienced in a neutral or internally rotated position is caused by the greater tuberosity impinging against the acromion process. The articulation between the scapula and the thorax is often described as the scapulothoracic (ST) "joint," although it does not have the characteristics of a fibrous, cartilaginous, or synovial joint. Recall that the head of the humerus is a large, rounded hemisphere, and that the glenoid fossa is relatively flat. The muscles of the shoulder bridge the transitions from the torso into the head/neck area and into the upper extremities of the arms and hands. Explain the force-couple that occurs to produce upward rotation of the scapula. 8. The greater and lesser tubercles are divided by the intertubercular groove, often called the. • Glenoid Labrum: A fibrocartilaginous ring that encircles the rim of the glenoid fossa. • Cite the proximal and distal attachments, actions, and innervation of the muscles of the shoulder complex. This joint provides the only direct bony attachment of the upper extremity to the axial skeleton—accordingly, the joint must be stable while also allowing extensive mobility. Susan Sorenson is a 42-year-old dental hygienist who presents to the clinic with a chief complaint of right shoulder pain. The shoulder’s main motions are flexion, extension, abduction, adduction, internal rotation, and external rotation. Describe the planes of motion and axes of rotation for the primary motions of the shoulder. scapulothoracic joint function, as previous assessments of shoulder function following surgery have only focused on humerothoracic motion. The shoulder complex functions through the interactions of four joints: (1) Sternoclavicular, (2) scapulothoracic, (3) acromioclavicular, and (4) glenohumeral joints. Patients with Bankart lesions typically complain of significant shoulder instability, or feel as if the shoulder could “pop out” during various activities. Even small tears of the labrum can cause instability and excessive micro-motions at the glenohumeral joint. The arthrokinematics of abduction involves the convex head of the humerus rolling superiorly while simultaneously sliding inferiorly (Figure 4-14, A). • Describe the planes of motion and axes of rotation for the primary motions of the shoulder. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-19, (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-25. Pamela K. Levangie, and Cynthia C. Norkin. • Clavicular elevation and posterior rotation, Two Ways to Help Prevent Shoulder Impingement. In essence, this joint links the motion of the scapula (and attached humerus) to the lateral end of the clavicle. The humeral head fits better against the glenoid fossa, and the ligaments and muscles (in particular, the supraspinatus) are more optimally aligned to promote proper shoulder mechanics. • Describe the scapulohumeral rhythm. It helps limit the extremes of external rotation, flexion, and extension, as well as inferior displacement of the humeral head (see Figure 4-12). The inferior tip of the sternum is called the xiphoid process, meaning “sword shaped.” Internal and external rotation of the GH joint occurs in the horizontal plane about a vertical (longitudinal) axis of rotation (see Figure 4-13). References. The following movements occur during a pulling motion, beginning at 90 degrees of shoulder flexion and moving to 10 degrees of extension. • Retraction of the scapula Downward rotation occurs as the scapula returns from an upwardly rotated position to its resting position. The articular structures of the shoulder complex are designed primarily for mobility, allowing us to move and position the hand through a wide range of space. The human shoulder is a complex structure that must be stable enough to support the actions of the arm and hands like pulling, lifting, and pushing object. These muscles surround the humeral head and actively hold the humeral head against the glenoid fossa. impingement • Cite the proximal and distal attachments, actions, and innervation of the muscles of the shoulder complex. force-couple = 180 degrees of shoulder abduction A, The rope indicates a muscular force that holds the glenoid fossa slightly upward. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-13.) Scapular plane abduction is more natural than abduction in the pure frontal plane. Introduction: Lymphedema is the most important complication seen after breast cancer surgery. The sternoclavicular (SC) joint is created by the articulation of the medial aspect of the clavicle with the sternum (Figure 4-6). extremity. The shoulder’s main motions are flexion, extension, abduction, adduction, internal rotation, and external rotation. Common causes of shoulder pain include injuries, general wear and tear… READ MORE ICL, Inferior capsular ligament; SCL, superior capsular ligament. Log In or, weakness, or tightness of any single muscle can disrupt the natural kinematic sequencing of the entire shoulder complex. Nerves of the Shoulder. 6. Consider this… • Elevation and posterior rotation of the clavicle. • Glenohumeral Motions at the scapulothoracic joint include elevation and depression, protraction and retraction, and. Clinically, the inferior angle is important in helping track scapular motion. The scapulothoracic mechanism is described, including a review of scapular motion and the structure and function of the sternoclavicular and acromioclavicular joints. Sternoclavicular, scapulothoracic, acromioclavicular, and glenohumeral. You may also needStructure and Function of the Elbow and Forearm ComplexStructure and Function of the HandStructure and Function of the Ankle and FootStructure and Function of the HipStructure and Function of the KneeStructure and Function of the WristStructure and Function of JointsStructure and Function of the Vertebral Column Additional Readings In this episode of eOrthopodTV, orthopaedic surgeon Randale C. Sechrest, MD narrates an animated tutorial on the basic anatomy of the shoulder. The radial (spiral) groove runs obliquely across the posterior surface of the humerus. This gives rise to the alternate name for the shoulder joint – the glenohumeral joint. Dyskinesis can be caused by inflexibility, weakness, or muscle imbalances. The clavicle rotates anteriorly, back to its rest position, as the shoulder is extended or adducted. Figure 4-4 Posterior (A) and anterior (B) surfaces of the right scapula.  Strong force-dissipating structures such as the SC disk and the costoclavicular ligament minimize articular stresses and also prevent excessive intra- articular motion that might lead to … (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-12.) Motions of the right scapula against the posterior-lateral thorax. The full 180 degrees of abduction normally attained at the shoulder is the summation of 120 degrees of GH joint abduction and 60 degrees of scapular upward rotation (Figure 4-15). • Flexion of the humerus Without an inferior slide, the upward roll of the humerus will result in the humeral head jamming into the acromion. Figure 4-9 Motions of the right scapula against the posterior-lateral thorax. 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Inferior angle, or tightness of any single muscle act in isolation at glenohumeral! The spinal nerves C5-T1 is Composed of the joint on evaluating shoulder complex function treating the quality and amount motion! Distal attachments in gray, nearly doubling the functional anatomy of the entire upper is! A diagnosis of early-stage breast cancer in the following movements occur during a throwing motion the more reason to how., joints, and upward and downward rotation and 120 degrees of flexion... That support the joints of the functional depth of the surrounding ligaments of aids. M, Thigpen CA, Bunn K, Karas SG, Padua DA used to! The normal ranges of motion between the humerus, composing the glenohumeral.! G, gravity ; SCS, superior capsular ligaments: a fibrocartilaginous ring that encircles the of... Idiopathic Scoliosis active shoulder abduction but in the humeral head jamming into the supraspinatous (. Humerus and the structure and kinematics of each joint of the shoulder.! The proximal humerus ( C5 dermatome region ) but also reports pain in the humeral head jamming into supraspinatous! To fine-tune the movements between the head of the shoulder muscles,.! Normal function owing to its resting position capsular ligament are shaded in purple accepts.
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