THis PPT will give you knowledge about the principles of shoulder; articulating surface, motions, ligamentous structure and musculature structure that related to shoulder region.

1. KINESIOLOGY
SHOULDER
By Hermizan Halihanafiah
College of Allied Health and Science, Malaysia
1

2. SHOULDER JOINT
• Glenohumeral joint
• Articulation surface – between head of
humerus and glenoid fossa of scapula
• Ball and socket joint – allows 3 degrees of
freedom
• Flexion/extension, abduction/adduction,
internal/external rotation, horizontal
adduction/horizontal abduction
2

3. Kinematics
Shoulder abduction/adduction
• Occur in the frontal plane/anteroposterior axis of
rotation
• Range of motion
- full abduction: 180 deg (120 shoulder abd + 60 deg
scapular upward rotation)
- adduction : vice versa (120 shoulder add + 60 deg
scapular downward rotation)
• Involve the head of humerus rolling superiorly and slide
inferiorly within glenoid fossa.
• Without inferior slide, the humeral head stuck into the
acromion ---- impingement (suprasapinatus tendon or
subacromial bursa) 3

4. Shoulder Impingement
4

5. Kinematics
Shoulder flexion/extension
• Occur in sagittal plane/medial-lateral axis of
rotation
• ROM
- full flexion: 120 deg shoulder flexion + 60 deg
scapular upward rotation
- extension : reverse action of flexion + 40 – 60
deg of hyperextension
5

6. Kinematics
Shoulder internal/external rotation
• Occur in horizontal plane/vertical axis of rotation
• Rotation results in the anterior surface of
humerus rotates medially/internally (internal
rotation) or rotates laterally/externally (external
rotation)
• ROM
- external rotation : about 90 deg (80-100 deg)
- internal rotation : about 70 deg (65 – 80deg)
6

7. Kinematics
Shoulder horizontal abduction/horizontal adduction
• SPECIAL MOVEMENT
• Occur when shoulder 90 deg abd, humerus will
move in horizontal plane
• Humerus move towards midline – horizontal
adduction
• Humerus move away form midline – horizontal
abduction
7

8. Supporting Structure
• Shoulder joint – highly mobile (TRIAXIAL JOINT,
LARGE ROM) but less stability
• Due to large, rounded head of humerus and the
shallowness of glenoid fossa of scapula
• Strengthen by :
1. Rotator cuff muscles
2. Capsular ligaments
3. Coracohumeral ligament
4. Glenoid labrum
5. Long head of the biceps
8

9. ROTATOR CUFF MUSCLES
• ROTATOR CUFF MUSCLES – CENTRE OF
STABILITY
• Consist of SITS; Supraspinatus, Infraspinatus,
Teres minor and Subascapularis muscles
• Function – centralizing and stabilizing the
humeral head within glenoid fossa
• Surround humeral head anteriorly, superiorly
and posteriorly, and providing muscular force
that pulls the humeral head towards glenoid
fossa.
9

10. 10

11. Ligamentous Structure
Capsular lig
• Consist of superior, inferior and middle
glenohumeral lig, attaches between the rim of
gleoid gossa and anatomical neck of humerus
Coracohumeral lig
• Prevents inferior displacement of humeral
head, prevent excessive motion of flexion,
extension and external rotation, attaches
between coracoid process of scapula and
greater tubercle of humerus.
11

12. 12

13. 13

14. 14

15. Others Structure
Glenoid Labrum
• A fibrocartilaginous riing that encircles the edge
of glenoid fossa, deepen the glenoid fossa (nearly
doubling the function of glenoid fossa)
Long Head of the Biceps
• The proximal portion of the tendon wraps around
the superior aspect of the humeral head
(originates form supraglenoid tubercle), provide
anterior stability of shoulder joint.
15

16. Scapulohumeral Rhythm
• The full range of shoulder motion normally is combination
between the motion in glenohumeral and scapulothoracic joint.
• A natural rhythm/ratio between GH joint and scapulothoracic
joint --- 2:1
• That’s means for every 2 deg of shoulder abduction/flexion, the
scapula must upward rotate roughly 1 deg. (vice versa for
adduction/extension)
• The full ROM of shoulder abduction/flexion= 180 deg, which
combination between 120 deg shoulder abduction/flexion + 60
deg scapular upward rotation.
180 degrees of shoulder abduction/flexion =
120 degrees of glenohumeral joint abduction +
60 degrees of scapulothoracic joint upward rotation
16

17. Scapulothoracic (ST) Joint
• Not a truth joint
• Articulating between anterior surface of scapula to
posterior thorax (ribs 2-7)
• Movements : permits scapular elevation/depression,
protraction/retraction, upward/downward rotation
• Motion of ST joint is dependent on the combined
movement of the acromioclavicular (AC) and
sternoclavicular (SC) joint.
• The full 60 deg ST joint upward rotation = 30 deg of SC
joint elevation + 30 deg AC joint upward rotation
17

18. THE RELATIONSHIP BETWEEN
AC, SC, ST AND GH JOINTS MOTIONS.
180 degrees of shoulder abduction/flexion =
120 degrees of GHJ abduction +
60 degrees of STJ upward rotation
60 degrees STJ upward rotation =
30 degrees of SCJ elevation +
30 degrees of ACJ upward rotation
18

19. SCAPULOTHORACIC JOINT MUSCLES
Primary Elevators of ST joint
• Upper fiber of trapezius
• Levator scapulae
• Rhomboids
Primary Depressor of ST joint
• Lower fiber of trapezius
• Latissimus dorsi 19

20. Upper / Superior
Fiber of Trapezius
• Origin – medial one third of
the superior nuchal line,
external occipital
protuberance and ligamentum
nuchae.
• Insertion – posterior border of
the lateral one third of the
clavicle.
• Action – scapular elevation
20

21. Levator Scapulae
• Origin – transverse process of
Superior four or five cervical
vertebrae.
• Insertion – superior vertebral
border of scapula
• Action – Elevates scapula and
rotates it downward.
• Nerve supply – dorsal
scapular nerve and cervical
spinal nerve
21

22. Rhomboid Major
• Origin – Spine of 2nd to 5th
thoracic vertebrae
• Insertion – vertebral border
of scapula inferior to spine of
scapula
• Action – elevates and
adducts scapula and rotate it
downward; stabilize scapula
• Nerve – dorsal scapular
nerve
22

23. Rhomboid Minor
• Origin – Spine of 7th cervical
and 1st thoracic vertebrae.
• Insertion – Vertebrae border
of scapula superior to spine
• Action – elevates and adducts
scapula and rotate it
downward; stabilize scapula
• Nerve – dorsal scapular nerve
23

24. Lower / Inferior Fiber of Trapezius
• Origin – spinous
process of T6-T12
• Insertion – spine of the
scapula
• Action scapular
depression and
adduction
24

25. Latissimus Dorsi
• Origin – Spines of inferior 6 thoracic
vertebrae (T6-T12), lumbar vertebrae
(L1-L5), crest of sacrum and illiac crest
of hip bone, inferior four ribs and
inferior angle of scapula.
• Insertion – Intertubecular sulcus of
humerus
• Action
– Extends, adduction and medial
rotation arm at shoulder joint.
• Nerve supply - Thoracodorsal nerve 25

26. SCAPULOTHORACIC JOINT MUSCLES
Primary upwards rotators of ST joint
• Upper fiber of trapezius
• Lower fiber of trapezius
• Serratus anterior
Primary downward rotators of ST joint
• Rhomboids
• Pectoralis minor
26

27. Serratus Anterior
• Origin – Superior 8 or 9 ribs
• Insertion – vertebral border and
inferior angle of scapula
• Action
– Abduction and rotates the
scapula upward
– Elevate ribs when scapula
stabilized.
– Also known as “boxer’s
muscles”
• Nerve supply
– Long thoracic nerve
27

28. Pectoralis Minor
• Origin
– 2nd - 5th ribs, 3rd – 5th ribs
or 2nd – 4th ribs.
• Insertion
– Coracoid process of
scapula
• Action
– Abduction scapula and
rotates it downward
– Elevate the ribs during
forced inhalation.
• Nerve supply
– Medial pectoral nerve 28

29. SCAPULOTHORACIC JOINT MUSCLES
Primary protractors of ST joint
• Serratus anterior
Primary retractors of ST joint
• Rhomboids
• Middle fiber of trapezius
29

30. Middle Fiber of Trapezius
• Origin – spinous process
of T1 – T5
• Insertion – medial border
of the acromion process
of scapula, and superior
border of the spine of the
scapula.
• Action – scapular
adduction.
30

31. Glenohumeral Joint Muscles
Primary GH Joint Abductors
• Anterior fiber of deltoid
• Middle fiber of deltoid
• Supraspinatus
Primary GH Joint Adductors
• Latissimus dorsi
• Teres major
• Pectoralis major (sternal head)
31

32. Anterior Fiber of Deltoid
• Origin – anterior border of
the lateral one third of the
clavicle
• Insertion – deltoid
tuberosity
• Action – abduction,
flexion and middle
rotation arm at GH joint.
32

33. Middle fiber of Deltoid
• Origin – lateral border and
superior surface of the
acromion process of the
scapula
• Insertion – deltoid
tuberosity
• Action – abduction arm at
GH joint
33

34. Supraspinatus Muscle
• Origin – supraspinous fossa
of scapula
• Insertion – Greater tubercle
of humerus (anterior aspect)
• Action – initially abduction
(15 degrees) at shoulder
joint, stabilizing shoulder
joint
• Nerve supply -
Suprascapular nerve
34

35. Latissimus Dorsi
• Origin – Spines of inferior 6 thoracic
vertebrae (T6-T12), lumbar vertebrae
(L1-L5), crest of sacrum and illiac crest
of hip bone and inferior four ribs.
• Insertion – Intertubecular sulcus of
humerus
• Action
– Extends, adduction and medial
rotation arm at shoulder joint.
• Nerve supply - Thoracodorsal nerve
35

36. Sternal origin of Pectoralis Major
• Origin – anterior surface of
sternum, costal cartilage of
2nd -6th ribs.
• Insertion – greater tubercle
and intertubercular sulcus
of humerus
• Action – extend arm at
shoulder joint.
• Nerve supply
– Medial and lateral
pectoral nerve
36

37. Teres Major
• Origin – Inferior angle of
scapula
• Insertion – Intertubecular
sulcus of humerus
• Action
– Extends arm at
shoulder joint
– Assist in adduction and
medial rotation of arm
at shoulder joint.
• Nerve supply
– Lower subscapular
nerve 37

38. Glenohumeral Joint Muscles
Primary GH Joint Flexors
• Anterior fiber of deltoid
• Pectoralis major (clavicular head)
• Coracobrachialis
• Biceps brachii
Primary GH Joint Extensors
• Latissimus dorsi
• Teres major
• Pectoralis major (sternal head)
• Posterior deltoid
• Long head of triceps
38

39. Clavicle origin of
Pectoralis Major
• Origin – medial half of anterior
clavicle
• Insertion – greater tubercle and
intertubercular sulcus of
humerus
• Action – Flexion, adduction and
medial rotation arm at shoulder
joint.
• Nerve supply
– Medial and lateral pectoral
nerve
39

40. Coracobrachialis
• Origin - Coracoid process of
scapula
• Insertion - Middle of medial
surface of shaft of humerus.
• Action - Flexion and adduction
arm at shoulder joint.
• Nerve supply -
Musculocutaneous nerve
40

41. Short head of Biceps
• Origin – Coracoid process of
scapula
• Insertion – radial tuberosity of
radius
• Action – Flexion forearm at
elbow joint, flexion arm at GH
joint and supination at
radioulnar joint.
• Nerve supply -
Musculocutaneous nerve 41

42. Long head of Biceps
• Origin – Tubercle above the
glenoid cavity of scapula
(supraglenoid tubercle)
• Insertion – Radial tuberosity of
radius
• Action – flexion forearm at
elbow joint, flexion arm at GH
joint and supination forearm at
radioulnar joint.
• Nerve supply -
Musculocutaneous nerve
42

43. Posterior Fiber of Deltoid
• Origin – inferior lip of the
crest of the spine of the
scapula
• Insertion – deltoid
tuberosity
• Action – extension and
lateral rotation arm at GH
joint.
43

44. Long head of Triceps
• Origin – tubercle below to
glenoid cavity of scapula
(infraglenoid tubercle)
• Insertion – Olecranon of ulna
• Action - Extends forearm at
elbow joint , Extends arm at
shoulder joint
• Nerve supply - Radial nerve
Posterior View
44

45. Glenohumeral Joint Muscles
Primary GH Joint Internal Rotators
• Anterior fiber of deltoid
• Pectoralis major
• Latissimus dorsi
• Teres major
• Subscapularis
Primary GH Joint External Rotators
• Posterior deltoid
• infraspinatus
• Teres minor
45

46. Infraspinatus Muscle
• Origin – Infraspinous fossa
of scapula
• Insertion – Greater tubercle
of humerus (posterior
aspect)
• Action – Laterally rotation
and adduction arm at
shoulder joint
• Nerve supply -
Suprascapular nerve
46

47. Teres Minor
• Origin – Inferior lateral
border of scapula
• Insertion – Greater tubercle
of humerus (inferior aspect)
• Action – Laterally rotation,
extends and adduction arm
at shoulder joint
• Nerve supply – axillary
nerve
47

48. Subscapularis Muscle
• Origin – subscapular
fossa of scapula
• Insertion – lesser tubercle
of humerus
• Action – Medial rotation
arm at shoulder joint
• Nerve supply – upper and
lower subscapular nerve
48