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The shoulder joint - MCCC

T H E G L E N O H U M E R A L ( G H ) J O I N T THE shoulder joint CLARIFICATION OF TERMS shoulder girdle = scapula and clavicle shoulder joint (glenohumeral joint ) = scapula and humerus Lippert, p115 OSTEOLOGY OF THE GH joint (BONES) Scapula Glenoid fossa Glenoid labrum Subscapular fossa Infraspinous fossa Supraspinous fossa Axillary border Acromion process (Vertebral) (Axillary) (Axillary) (Vertebral) Scapula (Dorsal aspect) OSTEOLOGY OF THE GH joint (BONES)..CONT Humerus Head Surgical neck Anatomical neck Shaft Greater tubercle Lesser tubercle Deltoid tuberosity Bicipital groove Bicipital ridges Intertubercular groove (Bicepital groove) (Posterior aspect) Intertubercular Groove (bicepital groove) Deltoid Tuberosity Anatomical Neck joint STRUCTURE OF THE GH joint Ball and socket joint Movement in all three planes (3 degrees of freedom) Articulation between the humeral head of the humerus and the glenoid fossa of the scapula One of the most movable joints in the body and, consequently, one the _____ stable.

CLARIFICATION OF TERMS •Shoulder girdle = scapula and clavicle •Shoulder joint (glenohumeral joint) = scapula and humerus Lippert, p115

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Transcription of The shoulder joint - MCCC

1 T H E G L E N O H U M E R A L ( G H ) J O I N T THE shoulder joint CLARIFICATION OF TERMS shoulder girdle = scapula and clavicle shoulder joint (glenohumeral joint ) = scapula and humerus Lippert, p115 OSTEOLOGY OF THE GH joint (BONES) Scapula Glenoid fossa Glenoid labrum Subscapular fossa Infraspinous fossa Supraspinous fossa Axillary border Acromion process (Vertebral) (Axillary) (Axillary) (Vertebral) Scapula (Dorsal aspect) OSTEOLOGY OF THE GH joint (BONES)..CONT Humerus Head Surgical neck Anatomical neck Shaft Greater tubercle Lesser tubercle Deltoid tuberosity Bicipital groove Bicipital ridges Intertubercular groove (Bicepital groove) (Posterior aspect) Intertubercular Groove (bicepital groove) Deltoid Tuberosity Anatomical Neck joint STRUCTURE OF THE GH joint Ball and socket joint Movement in all three planes (3 degrees of freedom) Articulation between the humeral head of the humerus and the glenoid fossa of the scapula One of the most movable joints in the body and, consequently, one the _____ stable.

2 Lippert, p131 joint MOVEMENT OF THE GH joint Osteokinematics Flexion Extension Hyperextension Abduction Adduction Medial rotation (internal rotation) Lateral rotation (external rotation) Horizontal abduction Horizontal adduction Circumduction Scaption VISUAL EXERCISE: Watch your partner perform the following movements and guesstimate the degrees of motion for each of the following: shoulder flexion:_____ shoulder hyperextension:_____ shoulder abduction:_____ shoulder internal rotation:_____ shoulder external rotation:_____ joint MOVEMENT OF THE GH Arthrokinematics Concave-convex rule The convex humeral head moves within the concave glenoid fossa The convex joint surface (humeral head) moves in a direction opposite to the movement of the body segment (humeral shaft) Flexion humeral head glides _____ Abduction humeral head glides _____ Extension humeral head glides _____ Adduction humeral head glides _____ Internal rotation humeral head glides _____ External rotation humeral head glides _____ Lippert, p132 joint MOVEMENT OF THE GH Arthrokinematics The articular surface of the humeral head is greater than that of the glenoid fossa If the humeral head simply rotated in the glenoid fossa, it would run out of articular surface before full abduction occurred So, as abduction occurs, the humeral head rolls across the glenoid fossa and glides inferiorly (thanks to the rotator cuff)

3 Complete abduction can occur only with full external rotation SUPPORTING STRUCTURES OF THE GH joint Rotator cuff SITS muscles surround humeral head and actively hold it against the glenoid fossa Capsular ligaments Relatively loose capsule attaches the rim of the glenoid fossa and anatomic neck of the humerus Coracohumeral ligaments Connects coracoid process and anterior side of greater tubercle Glenoid labrum A fibrocartilaginous ring that encircles the rim of the glenoid fossa, deepening the socket and sealing the joint Long head of the Biceps The proximal portion of the tendon wraps around the superior aspect of the humeral head, providing anterior stability Mansfield, p58 MYOLOGY OF THE GH joint (MUSCLES) Deltoid Pectoralis major Latissimus dorsi Teres major Supraspinatus Infraspinatus Teres minor Subscapularis Coracobrachialis Biceps brachii Triceps brachii, long head Deltoid: Anterior Origin Anterior surface of the lateral aspect of the clavicle Insertion Deltoid tuberosity of the humerus Action Sh flexion, HADD, Sh IR, Sh ABD Innervation Axillary n.

4 Anterior Lippert, p136 ..strengthen the anterior deltoid Concentrically? Deltoid: Middle Origin Superior lateral surface of the acromion Insertion Deltoid tuberosity of the humerus Action Sh ABD, Sh flexion Innervation Axillary n. Middle Deltoid Lippert, p136 Deltoid: Posterior Origin Spine of the scapula Insertion Deltoid tuberosity of the humerus Action Sh extension, HABD, Sh ER Innervation Axillary n. Lippert, p136 Pectoralis Major Origin Clavicular portion: anterior margin of the medial portion of the clavicle Sternal portion: lateral margin of the manubrium and body of the sternum and cartilage of the first 6-7 ribs Insertion Crest of the greater tubercle of the humerus Action Clavicular: shoulder flexion, IR and Horiz ADD Sternal: Sh IR, Sh ADD, Sh extension to anatomic position Innervation Clavicular: lateral pectoral n. Sternal: lat & medial pectoral n.

5 Mansfield, p82 ..stretch the pectoralis major? ..strengthen the pectoralis major eccentrically? Latissimus Dorsi Origin Thoracolumbar fascia, spinous processes of lower thoracic and lumbar vertebrae, posterior iliac crest, lower 4 ribs and inferior angle of scapula Insertion Floor of intertubercular groove of humerus Action Sh ADD, Sh extension, Sh IR, scapular depression Innervation Thoracodorsal n. tidbit Necessary for crutchwalking and transfers! Lippert, p137 ..stretch the latissimus dorsi? Teres Major Origin Inferior angle of the scapula Insertion Crest of the lesser tubercle of the humerus Action Sh ADD, Sh extension, Sh IR Innervation Lower scapular n. Lippert, p138 SITS Supraspinatus Infraspinatus Teres Minor Subscapularis Supraspinatus Origin Supraspinous fossa of the scapula Insertion Greater tubercle of the humerus Action Sh ABD, stabilization of the GH, slight ER Innervation Suprascapular n.

6 Tidbit One of the rotator cuff muscles Lippert, p138 Infraspinatus Origin Infraspinous fossa of the scapula Insertion Greater tubercle of the humerus Action Sh ER, stabilization of the GH joint Innervation Suprascapular n. tidbit One of the rotator cuff muscles Lippert, p138 Teres Minor Origin Posterior lateral border of the scapula near the inferior angle Insertion Greater tubercle of the humerus (inferior to the infraspinaus) Action Sh ER, stabilization of the GH joint Innervation Axillary n. Lippert, p139 Subscapularis Origin Subscapular fossa of the scapula Insertion Lesser tubercle of the humerus Action Sh IR, stabilization of the GH joint Innervation Upper and lower subscapular n. tidbit One of the rotator cuff muscles Lippert, p140 Coracobrachialis Origin Coracoid process of the scapula Insertion Medial aspect of the proximal shaft of the humerus Action Assists with Sh flexion & add Innervation Musculocutaneous n.

7 Lippert, p140 Biceps Brachii Origin Long head: supraglenoid tubercle of glenoid fossa Short head: coracoid process of the scapula Insertion Radial tuberosity of the radius Action Sh flexion, elbow flexion, forearm supination Innervation Musculocutaneous n. tidbit The actions of the biceps brachii are perfect in combination for opening a bottle of wine. The Corkscrew effect Biceps Brachii Mansfield, p78 ..strengthen the biceps brachii isometrically? ..stretch the biceps brachii? Long Head of the Triceps Brachii Origin Infraglenoid tubercle of the scapula Insertion Olecranon process of the ulna Action Sh extension, elbow extension Innervation Radial n. Mansfield, p80 MYOLOGY OF THE GH joint (MUSCLES)..CONT Anatomical Relationsips Muscles that stabilize are deep to muscles that move. Therefore, glenohumeral joint muscles are superficial to shoulder girdle muscles Deltoid: forms a superficial cap over the anterior, lateral and posterior sides of the shoulder Anteriorly, pectoralis major covers most of the superficial chest wall Biceps brachii and triceps brachii encompass most of the anterior and posterior arm, respectively If the trapezius were removed, you would see the supraspinatus above the scapular spine and in descending order, the infraspinatus, teres minor and teres major below the scapular spine The latissimus dorsi covers the lumbar and lower thoracic region of the back Lippert, p140 MYOLOGY OF THE GH joint (MUSCLES).

8 CONT Anatomical Relationsips Lippert, p140 MYOLOGY OF THE GH joint (MUSCLES)..CONT Summary of Muscle Action: Action Muscles Flexion Anterior deltoid, pectoralis major (clavicular) Extension Posterior deltoid, lattisimus dorsi, teres major, pectoralis major (sternal) Hyperextension Latissimus dorsi, posterior deltoid Abduction Deltoid, supraspinatus Adduction Pectoralis major, teres major, latissimus dorsi Horizontal abduction Posterior deltoid, infraspinatus, teres minor Horizontal adduction Pectoralis major, anterior deltoid Lateral rotation Infraspinatus, teres minor, posterior deltoid Medial rotation Latissimus dorsi, teres major, subscapularis, pectoralis major, anterior deltoid (Lippert, p142) MYOLOGY OF THE GH joint (MUSCLES)..CONT Summary of Muscle Innervation: Lippert, p143 Muscle Nerve Segment Subscapularis Upper and lower subscapular C5, C6 Teres major Lower subscapular C5, C6 Pectoralis major Lateral and medial pectoral C5, C6, C7 & C8, T1 Latissimus dorsi Thoracodorsal C6, C7, C8 Supraspinatus Suprascapular C5, C6 Infraspinatus Suprascapular C5, C6 Deltoid Axillary C5, C6 Teres minor Axillary C5, C6 Coracobrachialis Musculocutaneous C6, C7 Biceps Musculocutaneous C5, C6 triceps radial C7, C8 COMMON shoulder PATHOLOGY AC separation: Fractures: shoulder dislocation and subluxation: Impingement: Adhesive Capsulitis: Rotator Cuff Tear: Bicipital Tendonitis: PIN THE TAIL ON THE DONKEY Point to shoulder flexors shoulder extensors shoulder abductors What upper extremity muscles can you identify on him?

9 Against Gravity Position Gravity Eliminated Position Gravity Assisted Position shoulder Extensors shoulder Abductors shoulder Internal Rotators During a push up, there is a raising of the body and a lowering of the body. Identify what type of contraction the muscle is doing during each component of a push up: Isometric Concentric Eccentric No contraction Raising the body Lowering the body Biceps brachii Triceps brachii Protractors Retractors Abdominals REFERENCES Lippert, (2011). Clinical Kinesiology and Anatomy, 5th ed. Philadelphia, PA: Davis. Mansfield, , & Neumann, (2009). Essentials of Kinesiology for the Physical Therapist Assistant. St. Louis, MO: Mosby Elsevier.


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