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@!EXAM #1: Biomechanics Shoulder Pt.1

front 1

Intro of shoulder complex

back 1

  • 4 articulations (sternum, clavicle, ribs, scapula, and humerus
  • Has high amounts of mobility = low stability
  • Almost no single muscle works in isolation; all work in teams = produce coordinated movement (synergies)

front 2

Osteology: BONES

back 2

  • sternum
  • clavicle
  • scapula
  • (proximal) humerus

front 3

Sternum

back 3

  • Features:
    1. manubrium
    2. clavicular facets
    3. costal facets
    4. jugular notch

front 4

Clavicle (posterior/back view)

back 4

  1. shaft
  2. sternal end
  3. costal facet
  4. costal tuberosity
  5. acromial end
  6. acromial facet
  7. conoid tubercle
  8. trapezoid line

front 5

Both shoulders view (with angles)

back 5

  • 20 degrees = clavicle
  • 30-40 degrees = scapular plane
  • 30 degrees = humeral head retroversion to mid-lateral axis at the elbow

front 6

Glenoid Fossa

back 6

  • space between scapula and humerus head

front 7

Coracoid Process w/ scapula

back 7

  • attachment points for muscles and ligaments
  • projects out sharply like crows beak

front 8

coracoid process (superior view)

back 8

front 9

Proximal to humerus

back 9

front 10

Proximal-to-mid Humerus: Retroversion

back 10

front 11

Clinical Application: Retroversion

back 11

Loss of IR in pitching arm is okay, as long as Total ROM is equal bil

front 12

Proxima-to-humerus: With muscles

back 12

front 13

The major sandwich

back 13

front 14

Antrology

back 14

  • the study of anatomy, function, dysfunction and treatment of joints and articulations => JOINT SURFACES
    • Sternoclavicular, arcomioclavicular, glenohumeral, scapulothoracic (physiologic)
  • ROLL-SLIDE MECHANICS

front 15

Scapulothoracic Movements: Different types

back 15

  1. Elevation and depression
  2. Protraction and retraction
  3. upward and downward rotation

front 16

Scapualr movements: key things to know

back 16

  • multiple joints working together = ST movements
  • Goal: keep humeral head in as much contact with the glenoid as possible!!

front 17

Scapular joint

back 17

  • ONLY attachment of shoulder complex to axial skeleton = very robust
  • LARGE ROM
  • How?
    • extensive connective tissue
    • saddle joint

front 18

#Sternoclavicular joints (anterior of capsule and ligament section)

back 18

front 19

SC osteokinematics

back 19

  • elevation+depression
  • protraction+retraction
  • posterior clavicular rotation

front 20

SC arthrokinematics

back 20

  1. Elevation (Roll Up // Slide down) = convex+concave
  2. Depression (Roll down // slide up) = convex+concave
  3. Retraction (Roll and Slide Up)

front 21

Acromioclavical joint: what behavior?

back 21

  • A gliding or plane joint
  • NO role-slide arthrokinematics

front 22

AC Joint Osteokinematics

back 22

  • NO ROLL-SLIDE mechanics
  • Rotation
    • UP/DOWN and Internal/External

front 23

Scapulothoracic "joint" kinematics

back 23

  • Posterior view
    • elevation (SC joint)
    • downward rotation (AC joint)
  • Superior view
    • protraction (SC joint)
    • internal rotation (AC joint)

front 24

Acromioclavicular Joint

back 24

A gliding or a plane joint => NO roll-slide arthrokinematics

front 25

Acromioclavicular joint with ligaments

back 25

front 26

AC Joint Osteokinematics

back 26

  • NO ROLL SLIDE
  • Upward/Downward rotation
  • Internal/External rotation
  • Anterior/Posterior tilting

front 27

Scapulothoracic “joint” kinematics: Protraction (hunch shoulders)

back 27

  • Protraction(SC joint) + internal rotation (AC joint)

front 28

Scapulothoracic “joint” kinematics: Upward rotation (raise shoulders)

back 28

  • elevation (SC joint) + downward rotation (AC joint)

front 29

#Scapulothoracic “joint” kinematics: Elevation (raise arm up)

back 29

  • upward elevation (SC joint) + upward rotation (AC joint)

front 30

Glenohumeral Joint

back 30

  • Glenohumeral (GH) + ST = large AROM
  • glenoid is directed anterolaterally in the plane of the scapula and with upward inclination
    • => to keep humerus in as much contact as possible

front 31

#Glenohumeral Joint: Fibrous capsule

back 31

  • GHJ is surrounded by a fibrous capsule
  • volume of capsule = 2x the side of the humeral head( Axillary pouch =large ROM)
  • fibrous capsule is thin, = reinforced by thicker external ligaments
    • stability of the GHJ is not from passive structures = from active ones (muscles)

front 32

Additional Stability from Muscles & Labrum

back 32

front 33

Anterior view of arm

back 33

front 34

#GH Joint stability (slight incline)

back 34

  • slight incline of glenoid "locks" the joint
  • passive tension of superior capsular structure (CSC) to combat gravity (G) and yield compression force (CF)

front 35

GH Osteokinematics

back 35

  • EXT/FLX
  • I.Rotation + Ex. Rotation
  • Abbduction+Adduction

front 36

GH Arthrokinematics: Flexion/Extension

back 36

  • SPIN + UP FLEXION

front 37

GH Arthrokinematics: Abduction

back 37

  • UP ROLL + DOWN SLIDE + UP Abduction
  • convex on concave

front 38

GH Arthrokinematics: ER/IR

back 38

  • ROLL UP + SLIDE DOWN + EXTERNAL ROTATION UP
  • convex on concave

front 39

The Six Kinematic Principles 1

back 39

  • scapulohumeral rhythm = active simultaneous of 180 degrees
    • HOW: simultaneous 120 degrees of glenohumeral (GH) joint abduction
    • HOW: 60 degrees scapulothoracic upward rotation

front 40

The Six Kinematic Principles 2

back 40

  • 60 degrees of upward rotation of scapula during full shoulder abduction
    • simultaneous

front 41

The Six Kinematic Principles 3

back 41

  • the clavicle retracts at the sternoclavicular joint(SC) during shoulder abduction

front 42

The Six Kinematic Principles 4

back 42

scapular posteriorly tilts & externally rotates (@full shoulder abduction)

front 43

The Six Kinematic Principles 5

back 43

clavicle posteriorly rotates around OWN axis @shoulder abduction

front 44

The Six Kinematic Principles 6

back 44

GH joint externally rotates during shoulder abduction

front 45

The Six Kinematic Principles: picture

back 45

front 46

why is the clavicle curvy?

back 46

  • AC joint party location
    • serratus muscle pulls up = coracoclavicular ligament is pulled tight
      • creates tension + rotates clavicle posteriorly (back) => allows AC joint to full upward rotation

front 47

Muscles of the Shoulder Complex: categories

back 47

  • proximal stabilizers
  • distal mobilizers

front 48

ST Joint: Elevators Muscles

back 48

  • Muscle:
    • upper trapezius
    • levator scapulae
    • rhomboids (lesser extent)
  • keeps shoulder gridle elevated + upward inclination of glenoid = MORE COMPRESSION FORCE

front 49

ST: Depressor Muscles

back 49

  • Lower Trapezius
  • Latissimus Dorsi
  • Pec minor
  • Subclavius (lesser extent)

front 50

When scapular depression is “blocked”

back 50

  • force from the depressor msucels raise the thorax RELATIVE to fixed scapula and ulna
  • lower traps+lats elevate up => pelvic trunk segment moves to fixed scapula arm segment

front 51

ST: Protraction

back 51

  • muscle
    • serratus anterior

front 52

ST: Retractors

back 52

  • Muscles:
    • Middle Trapezius
    • Rhomboids
    • Lower trap

front 53

Upper Extremity: Elevation

back 53

  • “Elevation” of the UE requires:
    • Elevation of the GH joint
    • Upward rotation of the ST joint
    • Dynamic stability/control of arthrokinematics of the GHJ (via the rotator cuff)

front 54

GH Joint: Elevators muscles

back 54

front 55

GH Joint: Elevators muscles

ABDUCTION

back 55

  • Anterior Deltoid
  • Middle Deltoid
  • Supraspinatus

front 56

GH Joint: Elevators muscles

FLEXION

back 56

  • Anterior deltoid
  • Coracobrachialis
  • Long head of biceps brachii

front 57

Glenohumeral joints muscles flexion

biceps flexion GHJ

back 57

front 58

ST: Upward rotators & synergy!

back 58

  • Muscles:
    • Serratus anterior
    • Upper Trapezius
    • Lower Trapezius

front 59

GH and rotator cuff

back 59

  • GH is loose = high mobility
  • rotator cuff controls motion of the humeral head

front 60

The Rotator Cuff muscles

back 60

  • Supraspinatus
  • Subscapularis
  • Infraspinatus
  • Teres Minor

front 61

Shoulder: Adduction & Extension

back 61

  • (sternocostal portion) Pectoralis major*
  • Latissimus dorsi*
  • Teres major*
  • Posterior deltoid
  • Long head of triceps brachii

front 62

Shoulder: IR (internal rotation)

back 62

  • MORE MUSCLE MASS THAN ER
  • SALT P
  • Subscapularis
  • Anterior deltoid
  • Latissimus dorsi
  • Teres Major
  • Pectoralis Major

front 63

Shoulder: ER (external rotation)

back 63

  • Infraspinatus
  • Teres Minor
  • Posterior Deltoid

front 64

Muscle for scapula thoracic protraction

back 64

Serratus anterior