5. Shoulder - Lopez

Bone Framework of the Shoulder (3)

1. Proximal Humerus

2. Pectoral girdle

   1. Scapula

   2. Clavicle

Scapula

• Where is it positioned?

• Where is the medial border?

• ROM results in what?

• scapula is usually positioned between the 2nd and 7th ribs

• medial border is located about 6cm lateral to the spine

• ROM results w/ cooperation between the SC and AC joints

5 Shoulder Joints and Spaces (4, 1)

• which one is not a true joint

1. Scapulothoracic

   • not a true joint

2. Sternoclavicular

3. Acromioclavicular

4. Glenohumeral

5. Subacromial Space

Scapulothoracic Joint

• function

• located where?

• physiological joint that allows the scapula to move in relation to the thoracic cage

• between rib cage and scapula

What are the 3 degrees of freedom of the scapula?

1. elevation/depression

2. protraction/retraction

3. downward rotation/upward rotation

aka

1. up/down

2. forward/backward

3. rotate inwards/outwards on the chest wall

Acromioclavicular Joint

• joint between what?

• what type of joint?

• functions? (3)

• between Scapula and Clavicle

• AC joint is a multiaxial joint

• 3 Degrees of Freedom:

  • protraction/retraction

  • elevation/depression

    • total range of motion 15^o

  • lateral rotation/medial rotation

    • total range of motion 30^o

Acromioclavicular Joint

• what test can assess this joint for osteoarthritis?

Cross Body Adduction Test

Sternoclavicular Joint

• involves what? (3)

• functions (3)

• involves:

  • medial end of the clavicle

  • clavicular facet on the sternum

  • superior border of the cartilage of the first rib

• 3 degrees of freedom:

  • elevation/depression

  • protraction/retraction

  • axial rotation

The following joints provide Ligament Stability to what ligaments?

1. Sternoclavicular Joint (3)

2. Acromioclavicular Joint (2)

3. Coracoclavicular Joint (2)

Sternoclavicular Joint

• Costoclavicular ligament

• Sternoclavicular ligament

• Articular disc

Acromioclavicular Joint

• Acromioclavicular ligament

• Coracoacromial ligament

Coracoclavicular

• Trapezoid

• Coronoid

Glenohumeral Joint

• connects what? (2)

• characteristic

• function (3)

• main joint in the shoulder

• connects the humeral head with glenoid fossa

• 3 degrees of freedom

  • flexion/extension

  • abduction/adduction

  • internal/external rotation

Shoulder Stability

Further divided into what types? (2)

• Examples of each (4, 2)

Static Stabilizers and Dynamic Stabilizers

Static Stabilizers

• examples (3)

Static Stabilizers

• Glenohumeral capsule

• Coracohumeral ligament

• Glenohumeral ligaments

  • Superior

  • Medial

  • Inferior

What muscle groups move the shoulder? (2)

1. Axio-appendicular Muscles

2. Scapulohumeral Muscles

Axio-appendicular Muscles

• connect what?

• primary functions (2)

• connect the axial skeleton (spine/ribs) to the appendicular skeleton (shoulder girdle, upper limb)

• functions:

  • stabilize and move the shoulder girdle

Axio-appendicular Muscles

• further divided into what 2 groups?

  • muscles of each group (4, 3)

Anterior Axio-appendicular Muscles

• Pectoralis Major

• Pectoralis Minor

• Subclavius

• Serratus Anterior

Posterior Axio-appendicular Muscles

• Trapezius

• Rhomboids

• Latissimus Dorsi

Scapulohumeral Muscles

• connect what? (2)

• function

• connect the Scapula to the Humerus

• primarily moves the shoulder joint

Scapulohumeral Muscles

• muscles within this group (3 - 1,1,4)

Muscles:

• Deltoid

• Teres Major

• Rotator cuff muscles

  • Supraspinatus

  • Infraspinatus

  • Teres Minor

  • Subscapularis

Rotator Cuff Muscles

• part of what muscle group?

• muscles within this group? (4)

• Rotator cuff muscles

  • Supraspinatus

  • Infraspinatus

  • Teres Minor

  • Subscapularis

Scapulohumeral Muslces

Trapezius

• action (4)

• innervation (2)

• location

Trapezius

• action:

  • elevates, retracts and rotates the scapula

  • lower fibers depress the scapula

• innervation

  • spinal accessory nerve (CN XI)

  • cervical plexus (C3, C4)

Latissimus Dorsi

• action (3)

• innervation (1)

• location

Latissimus Dorsi

• action:

  • extends, adducts, and medially rotates the humerus

• innervation:

  • thoracodorsal nerve (C6-C8)

Levator Scapulae

• action (3)

• innervation (2)

• location

Levator Scapulae

• action:

  • elevates the scapula

  • tilts its glenoid cavity inferiorly by rotating the scapula

• innervaation:

  • dorsal scapular nerve (C5)

  • cervical nerves (C3, C4)

Rhomboid Major/Minor

• action (4)

• innervation (1)

• location

Rhomboid Major/Minor

• action:

  • retracts the scapula

  • rotates the scapula to depress glenoid cavity

  • stabilizes the scapula

• innervation:

  • dorsal scapular nerve (C4, C5)

Pectoralis Major

• action (3)

• innervation (2)

• location

Pectoralis Major

• action:

  • adducts and medially rotates the humerus

  • clavicular head assists in flexion

• innervation:

  • medial + lateral pectoral nerves (C5-T1)

Pectoralis Minor

• action (3)

• innervation (1)

• location

Pectoralis Minor

• action:

  • stabilizes the scapula by drawing it inferiorly and anteriorly against the thoracic wall

• innervation:

  • medial pectoral nerve (C8, T1)

Serratus Anterior

• action (3)

• innervation (1)

• location

• injury causes what

Serratus Anterior

• action:

  • protracts and rotates the scapula

  • holds it against the thoracic wall

• innervation:

  • long thoracic nerve (C5-C7)

injury causes Winged Scapula

Deltoid

• action (3-2,1,2)

• innervation (1)

• location

Deltoid

• action:

  • anterior fibers - flex and medially rotate the arm

  • middle fibers - abduct the arm

  • posterior fibers - extend and laterally rotate the arm

• innervation:

  • axillary nerve

Subscapularis

• action (2)

• attaches where?

• innervation (2)

• location

Subscapularis

• attaches to the lesser tubercle of the humerus!

• action:

  • medially rotates the arm

  • stabilizes the humeral head

• innervation:

  • upper/lower subscapular nerves (C5, C6)

Supraspinatus

• action (2)

• innervation (1)

• location

Supraspinatus

• action:

  • initiates abduction of the arm (first 15^o)

  • stabilizes the humeral head

• innervation:

  • suprascapular nerve (C5, C6)

Infraspinatus

• action (2)

• innervation (1)

• location

Infraspinatus

• action:

  • laterally rotates the arm

  • stabilizes the humeral head

• innervation:

  • suprascapular nerve (C5, C6)

Teres Minor

• action (2)

• innervation (1)

• location

Teres Minor

• action:

  • laterally rotates the arm

  • stabilizes the humeral head

• innervation:

  • axillary nerve

Testing for Subscapularis (3)

1. Bear Hug Test

2. Belly Press Test

3. Lift Off Test

What joint is the most mobile joints in the body? allowing a wide range of motion (ROM)

The Shoulder Joint

Supraspinatus Tests? (2)

1. Hawkins-Kennedy Test

2. Empty Can (Jobe) Test

Shoulder Joint

• movements in the Sagittal Plane? (2)

• movements in the Coronal (Frontal) Plane (2)

• multiplanar movement? (1)

• Movements in the Sagittal Plane

  • flexion

  • extension

• Movements in the Coronal (Frontal) Plane

  • adduction

  • abduction

• Multiplanar movement

  • circumduction

Shoulder Joint

• movements in the Transverse (Axial/Horizontal) Plane? (4)

• Internal (medial) rotation

• External (lateral) rotation

• Horizontal Abduction/flexion

• Horizontal Adduction/extension

Movements in the Sagittal Plane

• 2 groups?

• movement, ROM, and muscles of each

  • 2, 1, 2

  • 1, 1, 3

Movements in the Transverse Plane

• Horizontal Extension/Abduction

• movement, ROM, and muscles

  • 1, 1, 4

Movements in the Transverse Plane

• Horizontal Flexion/Adduction

• movement, ROM, and muscles

  • 1, 1, 3

Movements in the Coronal (Frontal) Plane

• Adduction

• movement, ROM, and muscles

  • 1, 2, 3

Movements in the Coronal (Frontal) Plane

• Abduction

• movement, ROM, and muscles

  • 1, 1, 3

SUPRASPINATUS (not subscapularis)

Movements in the Coronal (Frontal) Plane

• muscles + angles (3)

SUPRASPINATUS (not subscapularis)

Movements in the Transverse Plane

• External (Lateral) Rotation

• movement, ROM, and muscles

  • 1, 1, 3

Movements in the Transverse Plane

• Internal (Medial) Rotation

• movement, ROM, and muscles

  • 2, 2, 5

• Which muscle is the main internal rotator?

Subscapularis is the main internal rotator!

Arterial Supply of Scapular Region

• 2 main ones?

1. Subclavian Artery

2. Axillary Artery

Subclavian Artery

• what comes off of it? (6)

Thyrocervical Trunk

• Suprascapular Artery

• Transverse Cervical Artery

  • Superficial branches

  • Deep branches

    • Dorsal Scapular artery

Axillary Artery

• what comes off it? (5)

• Subscapular Artery

  • Circumflex Scapular Artery

  • Thoracodorsal Artery

• Anterior Circumflex Humeral Artery

• Posterior Circumflex Humeral Artery

Scapular Anastomosis

• between what? (2,2)

Suprascapular Artery (from thyrocervical trunk) ←→ Circumflex Scapular Artery (from suprascapular artery)

Dorsal Scapular Artery (from transverse cervical artery) ←→ Circumflex Scapular Artery (from Subscapular)

Label nerves, arteries, muscles, structures