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BIOMECHANICS OF SHOULDER
JOINT
P.G Teaching class, Sept. 2016
Deptt. Of P.M. &R
S.M.S Medical College, Jaipur
Dr. Anurag Ranga
Resident Doctor, Deptt. Of P.M.&R
Introduction
The shoulder is composed of 3 Synovial Joints :
1) The Glenohumeral joint (GH)
2) The Acromioclavicular joint (AC)
3) The Sternoclavicular joint ( SC)
The scapulothoracic joint also functions as joints in the shoulder
complex.
SC joint connects the components of shoulder joint to the axial
skeleton. This puts greater demands on the muscles for securing
the shoulder girdle on thorax during static and dynamic
conditions (dynamic stabilization).
Components of shoulder complex
STERNOCLAVICULAR JOINT
STERNOCLAVICULAR JOINT
SC joint is a plane synovial joint.
Movement of the clavicle at the SC joint inevitably produces
movement of the scapula under conditions of normal
function, because the scapula is attached to the lateral end of
the clavicle.
The SC articulation consists of two saddle-shaped surfaces,
one at the sternal or medial end of the clavicle and one at the
notch formed by the manubrium of the sternum and first
costal cartilage.
biomechanics of shoulder
Sternoclavicular disc
It is a fibrocartilaginous disc to increase the congruency b/w
incongruent articular surfaces.
The disc diagonally transects the SC joint space and divides
the joint into 2 separate cavities.
The disc is considered part of the manubrium in
elevation/depression and thus the upper attachment of the
disc serves as pivot point and the disc acts as the part of the
clavicle in protraction/ retraction with lower attachment
serving as pivot point.
Sternoclavicular joint capsule
and ligaments
Sc joint is supported by fibrous capsule
3 ligaments:
Sternoclavicular ligament
Costoclavicular ligament
Interclavicular ligaments
ANTERIOR
POSTERIOR
ANTERIOR
LAMINA
POSTERIOR
LAMINA
biomechanics of shoulder
Sternoclavicular motions
3 rotatory degrees of freedom:
Elevation/depression
Protraction/retraction
Anterior/posterior rotation of clavicle
3 degrees of translatory motion at the SC joint (very small
in magnitude):
Anterior/posterior
Medial/lateral
Superior/inferior
Elevation/depression of clavicle
Clavicular elevation= upto 48 degrees
Clavicular depression= less than 15 degrees
Protraction/retraction of clavicle
• protraction= 15-20 degrees
• Retraction= 20-30 degrees
Anterior and Posterior Rotation
of the Clavicle
Posterior rotation= 50 degrees
Anterior rotation= less than 10 degrees
Acromioclavicular Joint
AC JOINT
•Plane synovial joint
•3 rotational and 3 translational degrees of freedom
•The primary function of the AC joint is to allow the scapula
additional range of rotation on the thorax and allow for
adjustments of the scapula outside the initial plane of the
scapula in order to follow the changing shape of the thorax
as arm movement occurs.
•In addition, the joint allows transmission of forces from the
upper extremity to the clavicle.
AC articulating surface
AC joint Capsule and ligaments
Superior acromioclavicular ligament
Inferior acromioclavicular ligament
Coracoclavicular ligament
TRAPEZOID
(LATERAL)
CONOID
(MEDIAL)
biomechanics of shoulder
•The capsule of the AC joint is weak and cannot maintain
integrity of the joint without reinforcement of the superior
and inferior acromioclavicular and the coracoclavicular
ligaments.
•Superior AC ligament is reinforced by aponeurotic
extensions from deltoid and trapezius.
•Trapezoid portion: oriented more horizontally. It resists
posterior forces on distal clavicle
•Conoid portion: oriented more vertically. It resists superior
and inferior forces
AC motions
3 rotatory motions:
Internal/external rotation
Anterior and posterior tipping
Upward and downward rotation
3 translatory motions:
Anterior/posterior
Medial/lateral
Superior/inferior
Axis and planes for AC joint motions
Internal/external rotation
Vertical axis
Anterior and posterior tipping
Oblique
coronal axis
Upward and downward rotation
Upward rotation=30 degrees
Downward rotation=17 degrees
Oblique A-P axis
Scapulo-thoracic joint
ST JOINT
It is not a true anatomic joint.
The functional ST joint is part of a true closed chain with the
AC and SC joints and the thorax.
•The linkage of the scapula to the AC and SC joints, however,
actually prevents scapular motions both from occurring in
isolation and from occurring as true translatory motions.
•Eg. When the arm is abducted, scapula undergoes upward
rotation, external rotation and posterior tipping (all movts
in combination).
RESTING POSITION OF SCAPULA
Resting position of scapula
2 inches from midline b/w 2nd and 7th
rib.
 Internally rot -30-45 degrees from
coronal plane. (sup. View)
Ant tipped -10-20degrees from frontal
plane( side view)
Upward rotated - 10-20 degrees from
sagittal plane( post view)
MOTIONS OF THE SCAPULA
Upward rotation
Elevation/depression
Protraction/retraction
UPWARD ROTATION
•Approx. 60 degrees of upward
rotation of the scapula on the
thorax is typically available.
•Upward rotation of the scapula
is produced by clavicular
elevation and posterior
rotation at the SC joint and by
rotations at the AC joint.
ELEVATION/DEPRESSION
•Elevation and depression of the
scapula are produced by
elevation/depression of the
clavicle at the SC joint and
requires subtle adjustments in
anterior/posterior tipping and
internal/external rotation at the
AC joint to maintain the scapula
in contact with the thorax.
PROTRACTION/RETRACTION
•Protraction and retraction of
the scapula are produced by
protraction/retraction of
the clavicle at the SC joint,
and by rotations at the AC
joint to produce internal rot
& ant tipping.
GLENO-HUMERAL JOINT
GH ARTICULATING SURFACE
Scapula-
•Glenoid fossa is facing upwards and 6-7 degrees retroverted.
•The radius of curvature of the fossa is increased by articular cartilage that is
thinner in the middle and thicker on the periphery, which improves
congruence with the much larger radius of curvature of the humeral head.
Humerus
•The head faces medially, superiorly, and posteriorly with regard to the shaft of the
humerus.
ANGLES:
1. Angle of inclination=130-150 degrees
2. Angle of torsion=30 degrees posteriorly
Angle of
inclination
Angle of
torsion
•Because of the internally rotated resting position of the
scapula on the thorax, retroversion of the humeral head
increases congruence of the GH joint.
GLENOID LABRUM
•Enhance the depth or curvature
of the fossa by 50%.
•It is a redundant fold of dense
fibrous connective tissue with
little fibrocartilage.
•It is attached to glenohumeral
ligament.
GH ligaments
•Superior GH lig.
•Middle GH lig.
•Inferior GH lig.
•Coracohumeral lig
Function of GH ligament
• Limits ant and inf translation in arm at
0 degrees of abductionSuperior GH Lig
• Limits anterior translation at arm 45
degrees abductionMiddle GH Lig
• Limits ant translation beyond 45
degrees abduction + external rotation
Anterior band of
IGHLC
• Limits posterior translation with arm
45 degrees abd+ internal rotation
Posterior band of
IGHLC
Glenohumeral motions
MOTIONS ROM available
Flexion 120
Extension 50
Abduction 90-120
Adduction
External rotation 60 degrees of combined motions (arm at side)
120 degrees of combined motions ( arm at 90
degrees abducted)
•For complete range of abduction to occur, there must be 35-40
degrees of lateral rotation, for the clearance of greater tubercle
under the Coracoacromial arch.
•MAXIMUM ABDUCTION IS FOUND TO OCCUR IN SCAPULAR
PLANE, i.e 30-40 degrees anterior to frontal plane. This is due to
lack of capsular tension in scapular plane.
Intra-articular Contribution to
Glenohumeral Motions
•The convex humeral head is a substantially larger surface
and have a different radius of curvature than the shallow
concave fossa.
•Given this incongruence, rotations of the joint around its
three axes do not occur as pure spins but have changing
centers of rotation and shifting contact patterns within the
joint.
•Without downward sliding of the articular surface of the
humeral head, the humeral head will roll up the glenoid
fossa and impinge upon the coracoacromial arch.
•Slight superior
translation of the center
of the humeral head can
still occur during
humeral abduction
despite inferior sliding of
the head’s articular
surface. (1-2mm)
Static Stabilization of the GH Joint in the
Dependent Arm- UNLOADED ARM
PASSIVE TENSION IN THE ROTATOR INTERVAL CAPSULE
AIR-TIGHT CAPSULE PRODUCING NEGATIVE INTRAARTICULAR
PRESSURE
GLENOID INCLINATION-THERE IS SLIGHT UPWARD TILT OF GLENOID
FOSSA EITHER DUE TO ANATOMICALLY OR DUE TO UPWARD ROTATION
OF THE SCAPULA.
UNLOADED ARM
LOADED ARM-STATIC STABILIZATION
•SUPRASPINATUS
ACTIVITY STARTS WHEN
THE PASSIVE TENSION IN
ROTATOR INTERVAL
CAPSULE IS INSUFFICIENT
AS IN LOADED ARM.
DYNAMIC STABILIZATION OF
THE GH JOINT
•The Deltoid and Glenohumeral Stabilization
•The majority of the force of contraction of the deltoid causes the
humerus and humeral head to translate superiorly; only a small
proportion of force is applied perpendicular to the humerus and
directly contributes to rotation (abduction) of the humerus.
•It also produces a shear force rather than a compressive force
•The deltoid cannot independently abduct (elevate) the arm. Another
force or set of forces must be introduced to work synergistically with
the deltoid for the deltoid to work effectively.
The Rotator Cuff and
Glenohumeral Stabilization
ROTATOR OR MUSCULOTENDINOUS CUFF MUSCLES ARE:
1) Supraspinatus (S)
2) Infraspinatus (I)
3) Teres minor(T)
4) Subscapularis(S)
INTEGRATED FUNCTION OF
SHOULDER COMPLEX
Scapulothoracic and Glenohumeral
Contributions
•SCAPULAR UPWARD ROT = 60 DEGREES
•SCAPULA not only upwardly rotates but also posteriorly tips to 30
degrees.
•GLENO-HUMERAL CONTRIBUTION = 100 to 120 of flexion and 90
to 120 of abduction.
• TOTAL MOVEMENT IN ELEVATION= OF 150-180 DEGREES
•The overall ratio of 2 of GH to 1 of ST motion during arm
elevation is commonly used, and the combination of concomitant
GH and ST motion most commonly referred to as scapulohumeral
rhythm.
Sternoclavicular and
Acromioclavicular Contributions
•The major shift in the axis of rotation( for scapular upward rotation)
happens because the ST joint motion can occur only through a
combination of motions at the SC and AC joints.
•When the axis of scapular upward rotation is near the root of the
scapular spine, ST motion is primarily a function of SC joint motion;
•when the axis of scapular upward rotation is at the AC joint, AC
joint motions predominate;
•when the axis of scapular upward rotation is in an intermediate
position, both the SC and AC joints are contributing to ST motion.
Integrated
movement
during elevation
Upward Rotators of the Scapula
•The motions of the scapula are primarily produced by a
balance of the forces between the trapezius and serratus
anterior muscles through their attachments on the clavicle
and the scapula.
•TRAPEZIUS WITH SERRATUS Anterior-forms a force couple for
scapular upward rotation
•INITIATION Of scapular rotation- upper trap + middle traps
•AT THE END RANGE= Lower traps
MUSCLES OF ELEVATION
DELTOID
•Scapular plane abduction- anterior and middle deltoid
•Maintenance of appropriate length-tension relationship of
deltoid is dependent on scapular position/movement and
stabilization. For example: when scapula cannot rotate,
there is more shortening of deltoid and thus loss of tension,
which causes elevation to upto 90 degrees only.
Supraspinatus
•Primary function is to produce abduction with deltoid muscle.
Infraspinatus, teres minor and
subscapularis
•These muscle function gradually increases from- 0-115 degrees
of elevation after which (115-180 degrees) it dropped.
•In the initial range of elevation, these muscles (infrasp and
t.minor) work to pull the humeral head down, and during the
middle range, these muscles act to externally rotate for clearing
greater tubercle under coracoacromial arch.
•Subscapularis helps as internal rot when arm is at side and
during initial range
•With more abduction, its inter rot capacity decreases.
•Then it acts with other Rotator Cuff muscles to promote stability
by compression.
How SA and trap work with
deltoid??
•Serratus anterior produces upward rotation, posterior tipping
and external rotation of scapula, which is necessary for upward
elevation of arm.
•The serratus anterior and trapezius muscles are prime movers
for upward rotation of the scapula. These two muscles are also
synergists for the deltoid during abduction at the GH joint.
•The trapezius and serratus anterior muscles maintain an
optimal length-tension relationship with the deltoid and permit
the deltoid to carry its heavier distal lever through full ROM.
Rhomboid
•It works eccentrically to control upward rotation of the
scapula produced by the trapezius and the serratus anterior
muscles.
•It adducts the scapula with lower traps to offset the lateral
translation component of the serratus anterior muscle.
Muscles of Depression
Latissimus Dorsi and
Pectoral Muscle Function
•When the upper extremity is free to move in space, the
latissimus dorsi muscle may produce adduction, extension,
or medial rotation of the humerus.
• Through its attachment to both the scapula and humerus,
the latissimus dorsi can also adduct and depress the
scapula and shoulder complex.
Pectoralis major muscle
Clavicular portion
Sternal portion
Abdominal portion
Flexion of shoulder
Depression of
shoulder
Depressor
function is
assisted by
pectoralis minor
Teres Major and Rhomboid
Muscle Function
•Teres major- adducts, medially
rotates, and extends the
humerus. It is active primarily
during resisted activities.
•In order for the teres major
muscle to extend the heavier
humerus rather than upwardly
rotate the lighter scapula, the
synergy of the rhomboid
muscles is necessary to
stabilize the scapula.
The muscles noted previously can be divided
into functional groups
Flexion
1. Pectoralis major
2. biceps brachii
3. and anterior deltoid
Extension
1. posterior deltoid
2. teres major
3. Latissimus dorsi
Abductors
1. Deltoid
2. Supraspinatus
3. trapezius,
4. serratus anterior.
Adduction
1. Subscapularis
2. Infraspinatus
3. teres minor
4. Pectoralis
5. Latissimus dorsi
6. teres major
Internal rotation
1. Subscapularis
2. latissimus dorsi
3. anterior fiber of the deltoid
4. pectoralis major
5. teres major.
External rotators
1. Infraspinatus
2. teres minor
3. posterior fibers of the deltoid.
REFERENCE:
• Joint structure and function. Lavangie and Norkin,
5th edition
•Biomechanics of the Locomotor Apparatus. F.
Pauwels
Thank you

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biomechanics of shoulder

  • 1. BIOMECHANICS OF SHOULDER JOINT P.G Teaching class, Sept. 2016 Deptt. Of P.M. &R S.M.S Medical College, Jaipur Dr. Anurag Ranga Resident Doctor, Deptt. Of P.M.&R
  • 2. Introduction The shoulder is composed of 3 Synovial Joints : 1) The Glenohumeral joint (GH) 2) The Acromioclavicular joint (AC) 3) The Sternoclavicular joint ( SC) The scapulothoracic joint also functions as joints in the shoulder complex. SC joint connects the components of shoulder joint to the axial skeleton. This puts greater demands on the muscles for securing the shoulder girdle on thorax during static and dynamic conditions (dynamic stabilization).
  • 5. STERNOCLAVICULAR JOINT SC joint is a plane synovial joint. Movement of the clavicle at the SC joint inevitably produces movement of the scapula under conditions of normal function, because the scapula is attached to the lateral end of the clavicle. The SC articulation consists of two saddle-shaped surfaces, one at the sternal or medial end of the clavicle and one at the notch formed by the manubrium of the sternum and first costal cartilage.
  • 7. Sternoclavicular disc It is a fibrocartilaginous disc to increase the congruency b/w incongruent articular surfaces. The disc diagonally transects the SC joint space and divides the joint into 2 separate cavities. The disc is considered part of the manubrium in elevation/depression and thus the upper attachment of the disc serves as pivot point and the disc acts as the part of the clavicle in protraction/ retraction with lower attachment serving as pivot point.
  • 8. Sternoclavicular joint capsule and ligaments Sc joint is supported by fibrous capsule 3 ligaments: Sternoclavicular ligament Costoclavicular ligament Interclavicular ligaments ANTERIOR POSTERIOR ANTERIOR LAMINA POSTERIOR LAMINA
  • 10. Sternoclavicular motions 3 rotatory degrees of freedom: Elevation/depression Protraction/retraction Anterior/posterior rotation of clavicle 3 degrees of translatory motion at the SC joint (very small in magnitude): Anterior/posterior Medial/lateral Superior/inferior
  • 11. Elevation/depression of clavicle Clavicular elevation= upto 48 degrees Clavicular depression= less than 15 degrees
  • 12. Protraction/retraction of clavicle • protraction= 15-20 degrees • Retraction= 20-30 degrees
  • 13. Anterior and Posterior Rotation of the Clavicle Posterior rotation= 50 degrees Anterior rotation= less than 10 degrees
  • 15. AC JOINT •Plane synovial joint •3 rotational and 3 translational degrees of freedom •The primary function of the AC joint is to allow the scapula additional range of rotation on the thorax and allow for adjustments of the scapula outside the initial plane of the scapula in order to follow the changing shape of the thorax as arm movement occurs. •In addition, the joint allows transmission of forces from the upper extremity to the clavicle.
  • 17. AC joint Capsule and ligaments Superior acromioclavicular ligament Inferior acromioclavicular ligament Coracoclavicular ligament TRAPEZOID (LATERAL) CONOID (MEDIAL)
  • 19. •The capsule of the AC joint is weak and cannot maintain integrity of the joint without reinforcement of the superior and inferior acromioclavicular and the coracoclavicular ligaments. •Superior AC ligament is reinforced by aponeurotic extensions from deltoid and trapezius. •Trapezoid portion: oriented more horizontally. It resists posterior forces on distal clavicle •Conoid portion: oriented more vertically. It resists superior and inferior forces
  • 20. AC motions 3 rotatory motions: Internal/external rotation Anterior and posterior tipping Upward and downward rotation 3 translatory motions: Anterior/posterior Medial/lateral Superior/inferior
  • 21. Axis and planes for AC joint motions
  • 23. Anterior and posterior tipping Oblique coronal axis
  • 24. Upward and downward rotation Upward rotation=30 degrees Downward rotation=17 degrees Oblique A-P axis
  • 26. ST JOINT It is not a true anatomic joint. The functional ST joint is part of a true closed chain with the AC and SC joints and the thorax. •The linkage of the scapula to the AC and SC joints, however, actually prevents scapular motions both from occurring in isolation and from occurring as true translatory motions. •Eg. When the arm is abducted, scapula undergoes upward rotation, external rotation and posterior tipping (all movts in combination).
  • 28. Resting position of scapula 2 inches from midline b/w 2nd and 7th rib.  Internally rot -30-45 degrees from coronal plane. (sup. View) Ant tipped -10-20degrees from frontal plane( side view) Upward rotated - 10-20 degrees from sagittal plane( post view)
  • 29. MOTIONS OF THE SCAPULA Upward rotation Elevation/depression Protraction/retraction
  • 30. UPWARD ROTATION •Approx. 60 degrees of upward rotation of the scapula on the thorax is typically available. •Upward rotation of the scapula is produced by clavicular elevation and posterior rotation at the SC joint and by rotations at the AC joint.
  • 31. ELEVATION/DEPRESSION •Elevation and depression of the scapula are produced by elevation/depression of the clavicle at the SC joint and requires subtle adjustments in anterior/posterior tipping and internal/external rotation at the AC joint to maintain the scapula in contact with the thorax.
  • 32. PROTRACTION/RETRACTION •Protraction and retraction of the scapula are produced by protraction/retraction of the clavicle at the SC joint, and by rotations at the AC joint to produce internal rot & ant tipping.
  • 34. GH ARTICULATING SURFACE Scapula- •Glenoid fossa is facing upwards and 6-7 degrees retroverted. •The radius of curvature of the fossa is increased by articular cartilage that is thinner in the middle and thicker on the periphery, which improves congruence with the much larger radius of curvature of the humeral head. Humerus •The head faces medially, superiorly, and posteriorly with regard to the shaft of the humerus. ANGLES: 1. Angle of inclination=130-150 degrees 2. Angle of torsion=30 degrees posteriorly
  • 36. •Because of the internally rotated resting position of the scapula on the thorax, retroversion of the humeral head increases congruence of the GH joint.
  • 37. GLENOID LABRUM •Enhance the depth or curvature of the fossa by 50%. •It is a redundant fold of dense fibrous connective tissue with little fibrocartilage. •It is attached to glenohumeral ligament.
  • 38. GH ligaments •Superior GH lig. •Middle GH lig. •Inferior GH lig. •Coracohumeral lig
  • 39. Function of GH ligament • Limits ant and inf translation in arm at 0 degrees of abductionSuperior GH Lig • Limits anterior translation at arm 45 degrees abductionMiddle GH Lig • Limits ant translation beyond 45 degrees abduction + external rotation Anterior band of IGHLC • Limits posterior translation with arm 45 degrees abd+ internal rotation Posterior band of IGHLC
  • 40. Glenohumeral motions MOTIONS ROM available Flexion 120 Extension 50 Abduction 90-120 Adduction External rotation 60 degrees of combined motions (arm at side) 120 degrees of combined motions ( arm at 90 degrees abducted)
  • 41. •For complete range of abduction to occur, there must be 35-40 degrees of lateral rotation, for the clearance of greater tubercle under the Coracoacromial arch. •MAXIMUM ABDUCTION IS FOUND TO OCCUR IN SCAPULAR PLANE, i.e 30-40 degrees anterior to frontal plane. This is due to lack of capsular tension in scapular plane.
  • 42. Intra-articular Contribution to Glenohumeral Motions •The convex humeral head is a substantially larger surface and have a different radius of curvature than the shallow concave fossa. •Given this incongruence, rotations of the joint around its three axes do not occur as pure spins but have changing centers of rotation and shifting contact patterns within the joint.
  • 43. •Without downward sliding of the articular surface of the humeral head, the humeral head will roll up the glenoid fossa and impinge upon the coracoacromial arch.
  • 44. •Slight superior translation of the center of the humeral head can still occur during humeral abduction despite inferior sliding of the head’s articular surface. (1-2mm)
  • 45. Static Stabilization of the GH Joint in the Dependent Arm- UNLOADED ARM PASSIVE TENSION IN THE ROTATOR INTERVAL CAPSULE AIR-TIGHT CAPSULE PRODUCING NEGATIVE INTRAARTICULAR PRESSURE GLENOID INCLINATION-THERE IS SLIGHT UPWARD TILT OF GLENOID FOSSA EITHER DUE TO ANATOMICALLY OR DUE TO UPWARD ROTATION OF THE SCAPULA.
  • 47. LOADED ARM-STATIC STABILIZATION •SUPRASPINATUS ACTIVITY STARTS WHEN THE PASSIVE TENSION IN ROTATOR INTERVAL CAPSULE IS INSUFFICIENT AS IN LOADED ARM.
  • 48. DYNAMIC STABILIZATION OF THE GH JOINT •The Deltoid and Glenohumeral Stabilization •The majority of the force of contraction of the deltoid causes the humerus and humeral head to translate superiorly; only a small proportion of force is applied perpendicular to the humerus and directly contributes to rotation (abduction) of the humerus. •It also produces a shear force rather than a compressive force •The deltoid cannot independently abduct (elevate) the arm. Another force or set of forces must be introduced to work synergistically with the deltoid for the deltoid to work effectively.
  • 49. The Rotator Cuff and Glenohumeral Stabilization ROTATOR OR MUSCULOTENDINOUS CUFF MUSCLES ARE: 1) Supraspinatus (S) 2) Infraspinatus (I) 3) Teres minor(T) 4) Subscapularis(S)
  • 51. Scapulothoracic and Glenohumeral Contributions •SCAPULAR UPWARD ROT = 60 DEGREES •SCAPULA not only upwardly rotates but also posteriorly tips to 30 degrees. •GLENO-HUMERAL CONTRIBUTION = 100 to 120 of flexion and 90 to 120 of abduction. • TOTAL MOVEMENT IN ELEVATION= OF 150-180 DEGREES •The overall ratio of 2 of GH to 1 of ST motion during arm elevation is commonly used, and the combination of concomitant GH and ST motion most commonly referred to as scapulohumeral rhythm.
  • 52. Sternoclavicular and Acromioclavicular Contributions •The major shift in the axis of rotation( for scapular upward rotation) happens because the ST joint motion can occur only through a combination of motions at the SC and AC joints. •When the axis of scapular upward rotation is near the root of the scapular spine, ST motion is primarily a function of SC joint motion; •when the axis of scapular upward rotation is at the AC joint, AC joint motions predominate; •when the axis of scapular upward rotation is in an intermediate position, both the SC and AC joints are contributing to ST motion.
  • 54. Upward Rotators of the Scapula •The motions of the scapula are primarily produced by a balance of the forces between the trapezius and serratus anterior muscles through their attachments on the clavicle and the scapula.
  • 55. •TRAPEZIUS WITH SERRATUS Anterior-forms a force couple for scapular upward rotation •INITIATION Of scapular rotation- upper trap + middle traps •AT THE END RANGE= Lower traps
  • 57. DELTOID •Scapular plane abduction- anterior and middle deltoid •Maintenance of appropriate length-tension relationship of deltoid is dependent on scapular position/movement and stabilization. For example: when scapula cannot rotate, there is more shortening of deltoid and thus loss of tension, which causes elevation to upto 90 degrees only. Supraspinatus •Primary function is to produce abduction with deltoid muscle.
  • 58. Infraspinatus, teres minor and subscapularis •These muscle function gradually increases from- 0-115 degrees of elevation after which (115-180 degrees) it dropped. •In the initial range of elevation, these muscles (infrasp and t.minor) work to pull the humeral head down, and during the middle range, these muscles act to externally rotate for clearing greater tubercle under coracoacromial arch. •Subscapularis helps as internal rot when arm is at side and during initial range •With more abduction, its inter rot capacity decreases. •Then it acts with other Rotator Cuff muscles to promote stability by compression.
  • 59. How SA and trap work with deltoid?? •Serratus anterior produces upward rotation, posterior tipping and external rotation of scapula, which is necessary for upward elevation of arm. •The serratus anterior and trapezius muscles are prime movers for upward rotation of the scapula. These two muscles are also synergists for the deltoid during abduction at the GH joint. •The trapezius and serratus anterior muscles maintain an optimal length-tension relationship with the deltoid and permit the deltoid to carry its heavier distal lever through full ROM.
  • 60. Rhomboid •It works eccentrically to control upward rotation of the scapula produced by the trapezius and the serratus anterior muscles. •It adducts the scapula with lower traps to offset the lateral translation component of the serratus anterior muscle.
  • 62. Latissimus Dorsi and Pectoral Muscle Function •When the upper extremity is free to move in space, the latissimus dorsi muscle may produce adduction, extension, or medial rotation of the humerus. • Through its attachment to both the scapula and humerus, the latissimus dorsi can also adduct and depress the scapula and shoulder complex.
  • 63. Pectoralis major muscle Clavicular portion Sternal portion Abdominal portion Flexion of shoulder Depression of shoulder Depressor function is assisted by pectoralis minor
  • 64. Teres Major and Rhomboid Muscle Function •Teres major- adducts, medially rotates, and extends the humerus. It is active primarily during resisted activities. •In order for the teres major muscle to extend the heavier humerus rather than upwardly rotate the lighter scapula, the synergy of the rhomboid muscles is necessary to stabilize the scapula.
  • 65. The muscles noted previously can be divided into functional groups Flexion 1. Pectoralis major 2. biceps brachii 3. and anterior deltoid Extension 1. posterior deltoid 2. teres major 3. Latissimus dorsi
  • 66. Abductors 1. Deltoid 2. Supraspinatus 3. trapezius, 4. serratus anterior. Adduction 1. Subscapularis 2. Infraspinatus 3. teres minor 4. Pectoralis 5. Latissimus dorsi 6. teres major
  • 67. Internal rotation 1. Subscapularis 2. latissimus dorsi 3. anterior fiber of the deltoid 4. pectoralis major 5. teres major. External rotators 1. Infraspinatus 2. teres minor 3. posterior fibers of the deltoid.
  • 68. REFERENCE: • Joint structure and function. Lavangie and Norkin, 5th edition •Biomechanics of the Locomotor Apparatus. F. Pauwels