shoulder complex function

(From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-30.) The labrum performs this important function in two ways. Sternum scapulothoracic joint function, as previous assessments of shoulder function following surgery have only focused on humerothoracic motion. Posterior view of the right shoulder complex after the arm has abducted 180 degrees. 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. Symptoms include pain and fatigue with elevating her arm and the inability to sleep on her right shoulder. Summary Joint Structure & Function: A Comprehensive Analysis, 6e Levangie PK, Norkin CC, Lewek MD. The cooperative nature of the shoulder musculature increases the versatility, control, and range of active movements available to the upper extremity. • Protraction of the clavicle The shoulder’s main motions are flexion, extension, abduction, adduction, internal rotation, and external rotation. The cords eventually branch into nerves that primarily innervate muscles of the upper extremity. The body or middle portion of the sternum serves as the anterior attachment for ribs 2 through 7. SHOULDER ANATOMY There are four main joints within the shoulder complex, and an even greater number of muscles involved in moving both the humerus (upper arm) and scapula (shoulder blade). • Horizontal adduction of the humerus This can be verified by performing abduction in the scapular plane, with the upper extremity positioned in internal rotation, in neutral, or in external rotation. The arthrokinematics of GH joint adduction is the same as that of shoulder abduction but in the reverse direction. First, the superior portion of the labrum is only loosely attached to the adjacent glenoid rim. SHOULDER ANATOMY There are four main joints within the shoulder complex, and an even greater number of muscles involved in moving both the humerus (upper arm) and scapula (shoulder blade). Supporting Structures of the Acromioclavicular Joint The humeral head is nearly one half of a full sphere that articulates with the glenoid fossa forming the glenohumeral joint. downward rotation Like most synovial joints, the articulating surfaces are covered with hyaline cartilage. The lesser tubercle is a sharp, anterior projection of bone just below the humeral head. The acromioclavicular (AC) joint is considered a gliding or plane joint, created by the articulation between the lateral aspect of the clavicle and the acromion process of the scapula (Figure 4-10). In essence, this joint links the motion of the scapula (and attached humerus) to the lateral end of the clavicle. athletic patients. The scapulothoracic joint is not a “true” joint in the traditional sense. During abduction or flexion of the shoulder, the clavicle rotates posteriorly about its longitudinal axis. These muscles surround the humeral head and actively hold the humeral head against the glenoid fossa. We’re going to focus on the two primary joints associated with major movements. Anterior view of the right acromioclavicular joint, including many of the surrounding ligaments. Clinicians therefore focus a great deal on evaluating and treating the quality and amount of motion between the scapula and the thorax. ), (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-2. “Put your shoulder to the wheel.” — Aesop The glenoid labrum is a fibrocartilaginous ring of connective tissue that increases the stability of the glenohumeral joint. Second, approximately 50% of the fibers of the long head of the biceps tendon are direct extensions of the superior glenoid labrum. Scapula 2011;46(4):349-357. 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). Supporting Structures of the Sternoclavicular Joint 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.   •   Privacy Policy The brachial plexus is formed by a network of nerve roots from the spinal nerves C5-T1. 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. Our study of the upper limb begins with the shoulder complex—a set of four articulations involving the sternum, clavicle, ribs, scapula, and humerus (Figure 4-1). extremity. 2. Injury to 1 or more of these components through overuse or acute trauma disrupts this complex interrelationship and places the shoulder at increased risk. Kibler WB. Arthrology This important concept is discussed further in a subsequent section. These relatively slight but important adjustment motions help to fine-tune the movements between the scapula and the humerus. Flexion and extension of the GH joint occur in the sagittal plane about a medial-lateral axis of rotation. + 30 degrees of acromioclavicular joint upward rotation To fully understand how the shoulder functions as a whole, we must first examine the structure and kinematics of each individual joint. Instead of your doctor simply saying that “the patient knee hurts”, he or she can say that “the patient’s knee hurts anterolaterally”. all 4 muscles help stabilize the humeral head within the glenoid fossa. 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 References. Ideally, the scapula is positioned on a rib cage that’s mounted on a fully functioning, symmetrical thoracic spine. Scapular elevation involves the scapula sliding superiorly on the thorax (e.g., shrugging the shoulders). Symptoms of SLAP lesions often involve pain with overhead activities and “clicking” or “popping” of the shoulder. Scapulothoracic Joint Symptoms of SLAP lesions often involve pain with overhead activities and “clicking” or “popping” of the shoulder. 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). Scapulohumeral Rhythm The distal humerus is discussed in the next chapter. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-13.) • Clavicular elevation and posterior rotation The flattened lateral portion—called the acromial end—articulates with the acromion of the scapula, forming the acromioclavicular joint. Not only does the humeral head lose its ledge on which to rest, but the direction of the upward forces created by the superior capsular ligaments is changed, reducing the overall potential of these structures to produce a passive compression force (CF). • Capsular Ligaments: A thin fibrous capsule that includes the superior, middle, and inferior glenohumeral ligaments. • Long Head of the Biceps: The proximal portion of the tendon wraps around the superior aspect of the humeral head, attaching to the superior glenoid tubercle. The primary stabilizing force of this joint is garnered from the surrounding musculature, particularly the rotator cuff muscles. An anterior view of the sternoclavicular joints with the capsule and some of the ligaments removed on the left side. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-28.) The shoulder is the group of structures in the region of the joint. The exact kinematics of this joint varies, depending on the range of motion through which the shoulder is being extended. Protraction describes the motion of the scapula sliding laterally on the thorax, away from midline, whereas retraction describes movement of the scapula toward the midline (Figure 4-9, B). The SC joint allows motion in all three cardinal planes, and it is supported by a thick network of ligaments, an articular disc, and a joint capsule. The larger, more rounded lateral projection of bone is the greater tubercle. This is a relatively common occurrence in throwing athletes such as baseball pitchers. Shoulder internal rotation often occurs naturally with pronation, whereas shoulder external rotation naturally occurs with supination. Scapulothoracic motion is an integral part of nearly every shoulder movement. Am J Sports Med. Y-T-W Drills. Elevation and Depression 7. Key Terms 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). Integrated Function of the Shoulder Complex … It must be understood, however, that movement of the entire shoulder is the result of movement in each of its four joints. The arthrokinematics of abduction involves the convex head of the humerus rolling superiorly while simultaneously sliding inferiorly (Figure 4-14, A). It is one of four joints that comprise the shouldercomplex. Clinicians therefore focus a great deal on evaluating and treating the quality and amount of motion between the scapula and the thorax. Regardless of the type of lesion, surgery may be indicated if the tear of the labrum is large—or if conservative methods of treatment are unsuccessful. Cite the proximal and distal attachments, actions, and innervation of the muscles of the shoulder complex. The glenohumeral joint or shoulder joint is a ball and socket type of synovial joint that permits a wide range of movements including flexion, extension, abduction, adduction, rotation (medial and lateral rotation), and circumduction. • Long Head of the Biceps: The proximal portion of the tendon wraps around the superior aspect of the humeral head, attaching to the superior glenoid tubercle. Motions at the scapulothoracic joint include elevation and depression, protraction and retraction, and upward and downward rotation (Figure 4-9). "The Shoulder Complex." Proximal attachments of muscles are shown in red, distal attachments in gray. • Identify the primary muscles involved with dynamic stabilization of the glenohumeral joint. 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). During shoulder movements such as lifting, certain muscle groups help to move the shoulder, while other muscle groups help to stabilize the shoulder complex. Large forces that tax the biceps tendon can partially detach or tear the loosely attached superior labrum. Rarely does a single muscle act in isolation at the shoulder complex. Even with the humerus in full external rotation, complete abduction of the shoulder may result in impingement if performed in the true frontal plane (Figure 4-16, A). San Diego, Calif.: American Council on Exercise. The static locking mechanism helps provide stability to this loose-fitting joint. Normally, the GH joint allows approximately 120 degrees of abduction; the full 180 degrees of shoulder abduction normally occurs by combining 60 degrees of scapular upward rotation with the abduction of the GH joint. The superior and inferior glenoid tubercles border the superior and inferior aspects of the glenoid fossa and serve as proximal attachments for the long head of the biceps and the long head of the triceps, respectively. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figures 5-7, A, and 5-9.) (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-17.). Putting It All Together As discussed, all four joints of the shoulder must cooperate to produce normal shoulder motion. 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. During abduction or flexion of the shoulder, the clavicle rotates posteriorly about its longitudinal axis. 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. Shoulder Abduction Acromioclavicular and Sternoclavicular Joint Interaction Within the Scapulohumeral Rhythm, Elevation and posterior rotation of the clavicle, Downward rotation and retraction of the scapula, Depression and retraction of the clavicle, Clavicular elevation and posterior rotation, Even with the humerus in full external rotation, complete abduction of the shoulder may result in impingement if performed in the true frontal plane (, A side view of the right glenohumeral joint comparing abduction of the humerus in the, Ideal posture of the scapula positions the glenoid fossa so that it is tilted about 5 degrees upward (. This tendon helps provide anterior stability because it acts as a partial extension of the glenoid labrum. The larger, more rounded lateral projection of bone is the greater tubercle. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-17.) A brief summary of the innervation scheme of the entire upper extremity is provided in the next section. 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. These muscles are discussed at length in a subsequent section. Sternoclavicular Joint When it comes to complex shoulder and elbow surgeries, 3D anatomical modeling can be used to help a surgeon plan the surgery […] Approximately 120 degrees of flexion and 45 degrees of extension are available to the GH joint. 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). The SC joint structure is a saddle joint with concave and convex surfaces on each of the joint’s articular surfaces (Figure 4-7). (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-38.) To achieve full range of motion during abduction, the prominent greater tuberosity must be positioned to clear the undersurface of the acromion; this can be accomplished by externally rotating the shoulder or performing abduction in the scapular plane. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-35.) The clavicle, commonly called the collarbone, is an S-shaped bone that acts like a mechanical rod that links the scapula to the sternum (Figure 4-3). 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. • Interclavicular Ligament: Spans the jugular notch, connecting the superior medial aspects of the clavicles The shoulder relies heavily on coordinated muscle activity for normal function owing to its limited osseous constraint. The next steps in treatment or work-up can then … This important concept is discussed further in a subsequent section. Description Anterior view of the left shoulder and acromioclavicular joints, and proper scapular ligaments. The limited range of motion experienced in a neutral or internally rotated position is caused by the greater tuberosity impinging against the acromion process. Figure 4-1 The joints of the right shoulder complex. Internal rotation results in the anterior surface of the humerus rotating medially, toward the midline, whereas external rotation results in the anterior surface of the humerus rotating laterally, away from the midline. Shoulder abduction in the scapular plane, often referred to as scaption, positions the greater tuberosity of the humerus under the highest point of the acromion and helps to prevent bony impingement, regardless of the amount of rotation of the glenohumeral joint. The lesser tubercle is a sharp, anterior projection of bone just below the humeral head. Sternum • Describe the location and primary function of the ligaments that support the joints of the shoulder complex. Dynamic stabilization results in a wide range of mobility for the shoulder complex and provides adequate stability when the complex is functioning normally. In treatment of a patient with a shoulder dysfunction, it is important to remember the integrated relationship of the joints within the shoulder complex, because a problem in one joint will likely affect the other three. Therapists often request that their patients perform shoulder exercises in the scapular plane as a way to prevent recurring impingement. Regardless of the type of lesion, surgery may be indicated if the tear of the labrum is large—or if conservative methods of treatment are unsuccessful. All four joints must properly interact for normal shoulder motion to occur. 120 degrees of glenohumeral joint abduction, + 60 degrees of scapulothoracic joint upward rotation. Shoulder Flexion Rather, muscles work in teams to produce highly coordinated movements that are expressed over multiple joints. Abduction and Adduction Cite the normal ranges of motion for shoulder flexion and extension, abduction and adduction, and internal and external rotation. Objective: Movements of the human shoulder represent the result of a complex dynamic interplay of structural bony anatomy and biomechanics, static ligamentous and tendinous restraints, and dynamic muscle forces. It is interesting to note that with optimal posture of the scapula, little GH joint muscle activity is required for stability at rest. Explain how the shoulder depressor muscles can be used to elevate the thorax. Common causes of shoulder pain include injuries, general wear and tear… READ MORE Yep, the shoulder complex is a tricky beast. • Describe the planes of motion and axes of rotation for the primary motions of the shoulder. Clinically, the inferior angle is important in helping track scapular motion. The clavicle rotates anteriorly, back to its rest position, as the shoulder is extended or adducted. https://fadavispt.mhmedical.com/content.aspx?bookid=1862§ionid=136085052. Normally, the GH joint allows approximately 120 degrees of abduction; the full 180 degrees of shoulder abduction normally occurs by combining 60 degrees of scapular upward rotation with the abduction of the GH joint. The distal humerus is discussed in the next chapter. Kinematics Often seen with baseball and football players who are professional overhead athletes … Internal and External Rotation The shoulder is a complex ball-and-socket joint comprising the head of the humerus, the clavicle (collarbone), and the scapula. The radial nerve follows this groove and helps define the distal attachment for the lateral and medial heads of the triceps. The muscles of the shoulder complex, therefore, must work in a highly coordinated fashion. For organizational purposes, this text divides these muscles into two categories: (1) Muscles of the shoulder girdle, and (2) muscles of the GH joint. Anterior view of the right glenohumeral joint showing many of the surrounding ligaments. 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. Muscles of the shoulder. • Describe the scapulohumeral rhythm. Figure 4-16 A side view of the right glenohumeral joint comparing abduction of the humerus in the (A) true frontal plane and in the (B) scapular plane. Movement away from the midline in the horizontal plane is considered horizontal abduction. To reduce the disproportion in surfaces, the glenoid fossa is deepened by a fibrocart… Common causes of shoulder pain include injuries, general wear and tear… READ MORE Figure 4-10 illustrates the supporting structures of the AC joint. The slightly concave anterior aspect of the bone is called the subscapular fossa, which allows the scapula to glide smoothly along the convex posterior rib cage. First, it deepens the socket of the shallow glenoid fossa, improving the “fit” of the joint. Furthermore, motion at the scapulothoracic joint is dependent on the combined movements of the AC and SC joints. More distally, on the lateral aspect of the upper one third of the shaft of the humerus is the deltoid tuberosity—the distal insertion of all three heads of the deltoid muscle. Study Questions The 60 degrees of scapular upward rotation and 120 degrees of glenohumeral (GH) joint abduction are shaded in purple. The labrum serves to deepen the socket of the GH joint, nearly doubling the functional depth of the glenoid fossa. Box 4-1   Summary of Bony Movements During Common Shoulder Motions static stability Even with the humerus in full external rotation, complete abduction of the shoulder may result in impingement if performed in the true frontal plane (Figure 4-16, A). ), (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-5.). • Explain how the shoulder depressor muscles can be used to elevate the thorax. The labrum serves to deepen the socket of the GH joint, nearly doubling the functional depth of the glenoid fossa. Second, approximately 50% of the fibers of the long head of the biceps tendon are direct extensions of the superior glenoid labrum. ), (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 5-13. This motion naturally occurs as an elevated upper extremity is lowered to one’s side. Horizontal abduction and horizontal adduction are commonly used terms to describe special motions of the shoulder and are described in the following section. Up to this point, we have discussed the arthrology and kinematics of each joint of the shoulder complex. • Cite the normal ranges of motion for shoulder flexion and extension, abduction and adduction, and internal and external rotation. Description Anterior view of the left shoulder and acromioclavicular joints, and proper scapular ligaments. 1. All the more reason to know how the shoulder muscles tasked with supporting this vital joint are supposed to function. Made the same as that of shoulder complex. is not necessary all the more reason know! Posterior thorax therefore, must work in a wide, flattened projection of bone just the. Shoulder flexion and 45 degrees of movement in each of its four joints must properly for..., abduction, the superior glenoid labrum motion is an integral role in performing athletic... 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