Applied Images: The Shoulder (Exam 2)

Acromion Process

Coracoid Process

Subscapular Fossa

Glenoid Fossa

“Plane of the scapula”

Where the head of the humerus sits

Spine of Posterior Scapula

Supraspinous Fossa of Posterior Scapula

Infraspinous Fossa of Posterior Scapula

Body of Posterior Scapula

Medial Border of Posterior Scapula

Lateral Border of Posterior Scapula

Superior Border of Posterior Scapula

Superior Angle of Posterior Scapula

Inferior Angle of Posterior Scapula

Humerus Head

Humerus Anatomical Neck

Humerus Surgical Neck

Humerus Body

Humerus Deltoid Tuberosity

Humerus Greater Tubercle

Humerus Lesser Tubercule

Humerus Bicipital/ Intertubercular Groove

True Joints:

1. Sternoclavicular (SC)

2. Acromioclavicular (AC)

3. Glenohumeral (GH)

Functional Joints:

1. Scapulothoracic

2. Coracoacromioal

Acromioclavicular Joint - AC Ligament

Acromioclavicular Joint - Coracoacromial Ligament

Acromioclavicular Joint - Trapezoid Ligament APART of Coracolavicular Ligament

Acromioclavicular Joint - Conoid Ligament APART of Coracolavicular Ligament

Sternoclavicular Joint Costoclavicular Ligament

Sternoclavicular Joint Interclavicular Ligament

Sternoclavicular Joint Anterior SC Ligament

Glenohumeral Joint

Glenohumeral Ligaments (4)

1. Anterior GH Ligament

2. Posterior GH Ligament

3. Inferior GH Ligament

4. Transverse Humeral Ligament

Coracohumerual Ligament

Dynamic support

Rotator Cuff Teres Minor

Rotator Cuff Infraspinatus

Rotator Cuff Supraspinatus

Rotator Cuff Subscapularis

1. Elevation (Shrug)

2. Depression (Down)

3. Protraction (Pull Forward)

4. Retraction (Pull Back)

5. Upward Rotation (Inferior Angle Sliding up and down)

6. Downward Rotation (Returning to rest from the above)

Coracoacromial Arch

• Not a true joint

• Formed by Coracoacromial ligament

• Prevent superior translation of the humerus

Anterior

1. Pectoralis Minor

2. Serratus Anterior

3. Subclavian

Posterior

1. Levator Scapulae

2. Rhomboids

3. Trapezius

Pectoralis Minor

O: Ribs (3,4,5)

I: Coracoid process

A: Protraction of scapula (pulls it forward)

N: Medial pectoral n.

Serratus Anterior

O: Angles of ribs (1-8)

I: Medial border of scapula

A: Scapular protraction (brings inward)

N: Long thoracic

Subclavis

O: 1st rib (between clavicle and 1st rib)

I: Inferior clavicle

A: Depresses clavicle ( brings down- to hold into place)

N: Nerve to subclavius

Levator Scapulae

O: Transverse processes of C1-C4

I: Superior/medial portion of scapula

A: Scapular elevation Neck extension

N: Nerve roots C2-C4

Rhomboid Major

O: T2 – T5

I: Medial border of scapula

A: Scapular retraction ( pulling back)

N: Dorsal scapular n.

Rhomboid Minor

O: C7 – T1

I: Medial border of scapula

A: Scapular retraction

N: Dorsal scapular n.

Upper Trapezius

O: Ext occipital protuberance

• Occiput (Base of your skull)

• SP of C7 (Spinus Process - Broad and Wide Origin and Insertion)

I: Lateral 1/3 clavicle

• Acromion process

A: Scapular elevation

• Neck extension

N: Spinal Accessory n.

Anterior

1. Pectoralis major

2. Coracobrachialis

3. Biceps brachii

4. Subscapularis (RC)

Posterior

1. Infraspinatus (RC)

2. Teres minor (RC)

Superior

1. Deltoid

2. Supraspinatus (RC)

Inferior

1. Latissimus dorsi

2. Teres Major

3. Triceps brachii

Pectoralis Major

O: Clavicle

• Sternum

• Ribs

I: Lesser tubercle (humerus)

A: Adduction

• Horizontal adduction

• Flexion

N: Medial & lateral pectoral nn.

Coracobrachialis

O: Coracoid process

I: Medial 1/3 of humerus

A: Flexion

• Horizontal adduction

N: Musculocutaneous n.

Biceps Brachii

O:

• Glenoid (long head) (on bone itself and part of labrum)

• Coracoid (short head)

I: Tuberosity of radius

A: Shoulder flexion (weak)

• Elbow flexion

• Supination

N: Musculocutaneous

(crosses 2 joints)

Subscapularis [RC (Rotator Cuff)]

O: Subscapular fossa

I: Lesser tubercle (the only lesser of RC)

A: Internal Rotation

N: Subscapular n.

Supraspinatus (RC)

O: Supraspinous Fossa

I: Greater tubercle

A: Abduction

N: Suprascapular n.

Infraspinatus (RC)

O: Infraspinous Fossa

I: Greater tubercle

A: External Rotation (rotating out)

N: Suprascapular n.

Teres Minor (RC)

O: Lateral border of scapula

I: Greater tubercle

A: External Rotation (same as infraspinatus)

N: Axillary n.

Teres Major

(NOT an RC Muscle) (the LATS helper)

O: Lateral border of scapula

I: Lesser tubercle

A: Extension

• Adduction

• Internal rotation

N: Axillary n.

Deltoid

O: Scapula

• Clavicle

I: Deltoid tuberosity

A: (Fibers)

• Flexion (ant.)

• Abduction (mid.)

• Extension (post.)

N: Axillary n.

Latissimus Dorsi

O: Thoracolumbar fascia (on the fascia)

• Thoracic vertebrae

• Lumbar vertebrae

I: Lesser tubercle

A:

• Extension

• Adduction

• Internal rotation

N: Thoracodorsal n.

Triceps Brachii

O:

• Lateral border of scapula (long head)

• Posterior humerus (medial & lateral heads)

I: Olecranon process

A:

• Shoulder extension (weak)

• Elbow extension

N: Radial n.

2 joint muscle

1. Glenohumeral Joint (GH)

2. Scapulothoracic (ST)

3. Sternoclavicular (SC)

4. Acromioclavicular (AC)

Coordination of movements between the clavicle, scapula, and humerus

120 degrees ;

ST, SC, and AC contribute the remaining 60º

2:1 ratio of GH:ST movement through full 180º of motion

0º-90 º total motion

90 º-180 º total motion

0º-90 º

GH contribution

• 60 º abduction/flexion of humerus

ST contribution

• 30 º upward rotation of scapula

• Corresponds with 30 º of clavicular elevation at the SC joint

• Costoclavicular ligament limits amount of clavicular elevation

90º-180 º

GH contribution

• 60 º abduction/flexion of humerus

ST contribution

• 30 º upward rotation of scapula

• Corresponds with 30 º of posterior rotation at the AC joint

1. Wind-Up (W- Wally)

2. Stride (S- Sam)

3. Cocking (C- Came)

4. Acceleration (A- Alive)

5. Deceleration (D- During)

6. Follow Through (F- Fun)

Cocking - External Rotation AND its Concentric (your LATS)

Acceleration - Internal Rotation AND its Concentric

Deceleration - External Rotation AND its Eccentric (lengthening)

Follow-Through- Eccentric (lengthening)

*Force deceleration = Eccentric*

Reaching overhead and forward

• Sequence of movement

• Joint motion

• Muscle activity

Open Chain:

• Individual Muscles

• Focus on weakness

Closed Chain:

• Multiple muscles active

• More functional

• Inherently unstable joint

• Complex relationship between ligaments, joint capsule, muscles

• If one goes, others must compensate

• Posture and strength imbalances cause biggest problems

• Concentric-eccentric relationship

• Don’t forget the role of the scapula!!!