Shoulder

The winner gets a sur-Prize A.A.A. Contest Answer the Animated AnimaLS Throughout the slide show there will be slides with written questions. When you see a question, think of the answer, don’t answer it out loud --- this way, everyone gets a chance to think. Some slides with a question will have animations of animals cross the screen. When this happens, write down the answer on a post it note and quickly WALK it up to post on the board at the front of the class. The first person to post the correct answer on the board is the winner! You get to put a sticker on the “AAA Contest” board. The contest will continue throughout the quarter… at the end of the quarter, the person with the most stickers wins! The winner gets a sur-Prize

Bones of Shoulder Humerus & The shoulder girdle: Scapula Clavicle

The shoulder girdle attachment of the upper extremity to the trunk It consists of two bones: the scapula (shoulder blade) clavicle (collarbone)

Shoulder Girdle Scapula & Clavicle Link to Axial skeleton via sternoclavicular joint Lack of posterior attachment to the axial skeleton allows for a wide ROM Functions to allow attachment areas for numerous muscles that move the shoulder and elbow

What is the only true synovial joint where there is an articulation between the humerus and the axial skeleton? Sternoclavicular joint

Landmarks of Scapula Borders Angles Acromion process Spine of scapula superior, medial (vertebral), lateral (axillary) Angles inferior, superior Acromion process Spine of scapula Glenoid fossa Coracoid process Supraspinatus fossa, Infraspinatus fossa, Subscapular fossa Supraglenoid tubercle & Infraglenoid Tubercle With lecture show on skeleton and pass out scapula bones also Then before moving on to next slide, have students do worksheet to label scapula

Posterior View of Scapula

With Scapula, Humerus and Clavicle Anterior View of Shoulder Complex: With Scapula, Humerus and Clavicle

Lateral View of Scapula (Sagittal Cross Section) Anterior Posterior

Learning Activity: Label the landmarks of the scapula 1st try from memory (in a couple of minutes Zefire will put up a labeled picture so you can double check your answers, make corrections and additions)

Joints of the Shoulder Girdle Sternoclavicular joint 2. Acromioclavicular Joint Glenohumeral Joint (4) Scapulothoracic Joint - NOT really a synovial joint supported by muscles, not ligaments

Joints of the Shoulder Girdle 1. Sternoclavicular Sternum and clavicle gliding joint ligaments anterior sternoclavicular ligament posterior sternoclavicular ligament costoclavicular ligament interclavicular ligament

Joints of the Shoulder Girdle 2. Acromioclavicular Acromion Process of scapula and clavicle gliding joint ligaments coracoclavicular ligaments trapezoid ligament conoid ligament superior & inferior acromioclavicular ligaments

Acromioclavicular Joint The joint is surrounded by a weak capsule that is reinforced by strong inferior and superior acromioclavicular ligaments. These ligaments prevent backward displacement of the clavicle on the acromion. Further strengthening occurs through the coracoclavicular ligament formed of two strong fibre bundles, the lateral trapezoid and medial conoid ligaments. connects the scapula's coracoid process with the clavicle's inferior surface. These later ligaments prevent the scapula from rotating about the acromioclavicular joint, maintaining a constant relationship of the scapula to the clavicle. What is an AC joint separation? An AC joint separation occurs when the ligaments that stabilize the clavicle to the acromion process are injured or torn. As a result the clavicle can be displaced (moved) upwards. This condition is commonly known as a shoulder separation. There are different severities of AC joint separation. Classification of the different severities depends on the ligaments that are torn. One classification is as follows: Type I: A sprain (without a complete tear) of either of the ligaments holding the joint together. The clavicle is not displaced. Type II: A complete tear of the acromioclavicular ligament and a partial tear of the coracoclavicular ligaments. The clavicle is slightly displaced. Type III: A complete tear of both the acromioclavicular ligament and the coracoclavicular ligaments. When this occurs the clavicle is severely displaced (dislocated). Types IV, V, VI: A complete tear of the acromioclavicular ligament and the coracoclavicular ligaments. The clavicle is severely dislocated and usually requires surgical intervention. What can cause an AC joint separation? Injuries to the AC joint are usually caused by a direct blow to the shoulder. Traumatic contact from the side or from above the shoulder can tear the AC ligaments. Hockey players and football players commonly injure this joint when they make contact with the boards, ground or an opponent with their shoulder striking first. Injuries to the AC joint can also be caused by overstressing the joint with heavy weightlifting (i.e. deep bench-press techniques). This mechanism of injury is rare. What does an AC joint separation feel like? Immediately following an AC joint separation there is usually pain and swelling on the top of the shoulder. Depending on the severity of the injury, there may be some visible displacement of the clavicle. Activities such as pushing and pulling, reaching overhead and across the body will usually create pain in an acutely (recently) separated AC joint. Over time (usually 6 - 8 weeks or more) there may be little pain associated with an AC joint separation. Can an AC joint separation be detected on X-rays? X-rays are an effective tool for identifying AC joint separations. X-rays are usually taken while holding a weight in each hand to stress the joint and determine the degree of injury. What is the treatment for an AC joint separation? The treatment of AC joint separations depends on the severity of the injury. Treatment immediately following Type I and Type II AC joint separations may include an arm sling, icing, taping, pain medications and rest. As the symptoms improve a range of motion and strengthening program, as recommended by a physician and/or physical therapist, may begin. Individuals returning to sport can benefit from padding (a doughnut pad) over the AC joint to help protect the joint. Treatment following a Type III, IV, V and VI AC joint separation is more involved. In some cases surgery may be required to re-locate the clavicle. In other cases a non-operative approach may be chosen.   The joint is surrounded by a weak capsule that is reinforced by strong inferior and superior * acromioclavicular ligaments. Further strengthening occurs through the coracoclavicular ligament formed of two strong fibre bundles, the lateral trapezoid and medial conoid ligaments.

Joints of the Shoulder Girdle: 3. Glenohumeral Glenoid fossa and head of the humerus Ball and socket Joint that allows most movement of entire body Allows movement in 3 planes

“Shoulder Joint”: Glenohumeral Joint Process Fossa Fossa Labrum: a ring of fibrous cartilage surrounding the glenoid stabilizes the joint (makes a deeper socket)

“Shoulder Joint”: Glenohumeral Joint

Glenohumeral Joint: What is the bony landmark on the scapula that articulates with the humerus? Glenoid Fossa

Movements allowed by the “Shoulder” Glenohumeral Joint: Flexion + Extension ADduction + Abduction Circumduction: Flexion + Extension + Adduction + Abduction Medial Rotation + Lateral Rotation Horizontal ABduction + Horizontal ADduction

Movements allowed by the Scapulothoracic “joint” Abduction (Protraction) Adduction (Retraction) Depression: inferior movement Elevation: superior movement Downward (inward) rotation: inferior angle moves medially Upward (outward) rotation

Movements allowed by the Scapulothoracic “joint” Abduction (Protraction) – scapula move away from spine Adduction (Retraction) – scapula move closer to spine

Protraction Retraction Reach fingers forward. A widening between shoulder blades will occur. Try to keep space between the hands constant. Bring shoulder blades closer together. A widening across front of collarbone will occur. Try to keep space between the hands constant.

Movements allowed by the Scapulothoracic “joint” Depression: inferior movement Elevation: superior movement

Movements allowed by the Scapulothoracic “joint” Downward (inward) rotation: inferior angle moves medially, and acromion moves downward Upward (outward) rotation: inferior angle moves laterally, and acromion moves upward

Scapular Movements in Action What is the movement at the scapula as this man contracts his muscles? Elevation Superior movement of the shoulder girdle; moving the scapula up. http://www.exrx.net/Articulations/Scapula.html#anchor73267

Scapular Movements in Action Besides some depression of the scapula, what other primary motion is occurring at the scapula during the pull up? Downward Rotation Rotary movement of the scapula; Moving inferior angle of scapula medially and downward.

Scapular Movements in Action Upward Rotation Rotary movement of the scapula; Moving inferior angle of scapula laterally and upward.

Scapular Movements in Action During the push-up phase of the movement, what is the scapular action? Abduction (Protraction) Forward movement away the midline of the body; moving the scapula away from the spine.

Scapular Movements in Action What scapular movement is occurring during contraction? Adduction (Retraction) Backward movement toward the midline of the body; moving the scapula back toward the spine.

Sternoclavicular joint Acromioclavicular joint The scapula moves normally on the thorax only if the two joints by which it attaches to the axial skeleton are also free to move: Sternoclavicular joint Acromioclavicular joint

Sternoclavicular (SC) joint movements: CLAVICULAR ELEVATION AND DEPRESSION Clavicular protraction and Retraction BACKWARD AND FORWARD ROTATION OF CLAVICLE OCCUR

Acromioclavicular joint Mobility at the AC joint allows the scapula to move in three dimensions so that it follows the contours of the ribcage. Permits limited motion in all 3 planes of movement Scapular WINGING TIPPING UPWARD and DOWNWARD ROTATION

During shoulder elevation, the scapula and clavicle must rotate upwardly

Humeral Flexion and Extension http://www.biomech.jhu.edu/Projects/shoulder/Default.htm

There’s nothing like a good shoulder

Learning Activity: Individually, without your notes Take 10 minutes to write an outline of the movements possible at the Glenohumeral joint Scapulothoracic “joint” Then, answer these questions: Which of these joints allows more movement: AC - acromioclavicular joint or sternoclavicular joint? In how many planes does this more moveable joint allow movement? Try drawing diagrams to see if that helps

Learning Activity: 2) In small groups, your answers; make sure everyone understands. 3) With a scapula model, take turns, with each person showing the scapulothoracic movements on a group member’s back (while other group member(s) watch and help).