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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Chapter 5: The Upper Extremity: The Shoulder Region KINESIOLOGY Scientific Basis of Human Motion, 11 th edition Hamilton, Weimar & Luttgens Presentation Created by TK Koesterer, Ph.D., ATC Humboldt State University Revised by Hamilton & Weimar
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Objectives 1. Name, locate, & describe the structure & ligamentous reinforcements of the joints. 2. Name & demonstrate movements possible. 3. Name & locate muscles & muscle groups, and name their primary actions. 4. Analyze the fundamental movements with respect to joint & muscle actions. 5. Describe common injuries.
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Acromioclavicular (AC) Joint Articulation of acromion & distal end of clavicle. Acromioclavicular ligament strengthens joint superiorly. Aponeurosis of trapezius & deltoid strengthen joint posteriorly. Coracoclavicular ligament further stabilizes joint. Fig 5.1
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Sternoclavicular (SC) Joint Proximal clavicle articulates with sternum and cartilage of 1 st rib. Capsule thickened by anterior & posterior sternoclavicular ligaments. Fig 5.2
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Sternoclavicular (SC) Joint Great importance because it is the only bony connection between the humerus and axial skeleton. Permits limited motion of the clavicle. Is partially responsible for movements of the scapula. Clavicle movements at the SC joint: elevation & depression, protraction & retraction, and forward & backward rotation.
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements of the Shoulder Girdle Fig 5.3 a & b Abduction (Protraction) Adduction (Retraction) Elevation Depression
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements of the Shoulder Girdle Fig 5.3 c & d Upward rotation Downward rotation Anterior tilt Posterior tilt
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. MUSCLES OF THE SHOULDER GIRDLE Location: Anterior Pectoralis minor, Serratus anterior, Subclavius Posterior Levator scapulae, Rhomboids, Trapezius
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Pectoralis Minor Function: Movements of scapula: downward rotation, anterior tilt, depression. Lifting effect on ribs in forced inspiration and posture. Fig 5.4
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Serratus Anterior Function: Abduct (protract) scapula. With trapezius, upward rotation of scapula. Active in reaching and pushing. Fig 5.4
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Subclavius Function: Protect and stabilize sternoclavicular joint. Depress scapula. Fig 5.4
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Levator Scapulae Function: Elevation and downward rotation of scapula. Fig 5.5
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Rhomboids, Major and Minor Function: Downward rotation, adduction (retraction), & elevation of scapula. With trapezius for maintenance of good posture. Fig 5.5
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Trapezius Function: I. Elevation II. Elevation, upward rotation, adduction III. Adduction IV. Upward rotation, depression, adduction Fig 5.6
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. GLENOHUMERAL (Shoulder) JOINT Structure Articulation of spherical head of humerus with small, shallow, somewhat pear-shaped glenoid fossa of scapula. Fig 5.7
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. GLENOHUMERAL (Shoulder) JOINT Structure Glenoid labrum deepens the fossa and cushion against impact of humeral head in forceful movements. Fig 5.8
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Ligamentous Reinforcements Coracohumeral Glenohumeral Coracoacromial Fig 5.9
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Muscular Reinforcements Above: supraspinatus & long head of biceps. Below: long head of triceps. Front: subscapularis, pectoralis major, & teres major. Behind: infraspinatus & teres minor.
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements of the Shoulder Joint Flexion / Extension Hyperextension Circumduction Abduction / Adduction Horizontal Diagonal Internal / External Rotation External rotation Internal rotation
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. MUSCLE OF THE SHOULDER JOINT Location: Anterior: Pectoralis major, coracobrachialis, subscapularis, biceps brachii. Posterior: Infraspinatus, teres minor. Superior: Deltoid, supraspinatus. Inferior: Latissimus dorsi, teres major, long head of triceps brachii.
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Pectoralis Major Function: Clavicular portion – flexion, horizontal adduction, and internal rotation of humerus. Sternal portion – downward & forward movements of arm, & internal rotation with adduction. Fig 5.11
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Coracobrachialis Function: Horizontal adduction Acts like a guy wire to stabilize the shoulder joint. Fig 5.12
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Biceps Brachii Function: Flexion at the elbow & supination of forearm. Horizontal adduction at shoulder. Short head sometimes active in adduction & internal rotation. Fig 5.12
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Deltoid Function: Powerful abductor of humerus. Middle – Abduction Anterior – all forward movements & internal rotation of humerus. Fig 5.14
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Subscapularis Function: Internal rotation of humerus as part of the rotator cuff. Contributes to stability of shoulder joint. Fig 5.13a
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Supraspinatus Function: Acts together with deltoid in abduction of the arm. Also acts in flexion & horizontal extension. Contributes to stability of shoulder joint. Part of the rotator cuff. Fig 5.13b
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Infraspinatus and Teres Minor Function: External rotation as part of the rotator cuff. With subscapularis depresses head of humerus. Contributes to stability of shoulder joint. Fig 5.13b
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Latissimus Dorsi Function: Extension & adduction of arm, internal rotation. Fig 5.14
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Teres Major Function: Internal rotation, extension, & adduction of the arm. Fig 5.15
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Triceps Brachii Function: Long head assists in adduction, extension, and hyperextension of the humerus. Fig 5.15
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. JOINT AND MUSCULAR ANALYSIS OF THE FUNDAMENTAL MOVEMENTS OF THE ARM ON THE TRUNK Movements of the arm on the trunk involve the cooperative action of the shoulder girdle Acromioclavicular joints Sternoclavicular joints and the shoulder (glenohumeral) joint. and the shoulder (glenohumeral) joint.
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Frontal Plane Shoulder Joint - Abduction Deltoid & supraspinatus Shoulder Girdle: Upward rotation of scapula. Serratus anterior; trapezius II & IV Fig 5.16
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Frontal Plane Shoulder Joint - Adduction Latissimus dorsi, teres major, pectoralis major (sternal), & post. deltoid. Shoulder Girdle: reduction of upward rotation. Rhomboids & pectoralis minor. Fig 5.17
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Sagittal Plane Shoulder Joint - Flexion Anterior deltoid & pectoralis major (clavicular). Shoulder Girdle: Upward rotation of scapula Serratus anterior & trapezius II & IV. Fig 5.18
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Sagittal Plane Shoulder Joint - Extension Pectoralis major (sternal), teres major, latissimus dorsi, post. Deltoid. Fig 5.19 Shoulder Girdle: Reduction of upward rotation of scapula Relaxation of agonists Against resistance - trapezius IV, rhomboids, pect. minor.
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Sagittal Plane Shoulder Joint - Hyperextension Teres major, latissimus dorsi, post. Deltoid. Shoulder Girdle: Anterior tilt of scapula Pectoralis minor. Fig 5.20
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Horizontal Plane Shoulder Joint - External Rotation Infraspinatus & teres minor. Shoulder Girdle: Adduction of scapula Rhomboids & trapezius III. Fig 5.22a
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Horizontal Plane Shoulder Joint - Internal Rotation Subscapularis, teres major, latissimus dorsi, ant. deltoid, pectoralis major. Shoulder Girdle: Abduction of scapula Serratus anterior & pectoralis minor. Fig 5.22b
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Movements in the Horizontal Plane Shoulder Joint - Horizontal Adduction Pectoralis major, ant. deltoid, & coracobrachialis. Shoulder Girdle: Abduction of scapula Serratus anterior & pectoralis minor Shoulder Joint – Horizontal Abduction Post. deltoid, post middle deltoid, infraspinatus, teres minor, long head of biceps. Shoulder Girdle: Adduction of scapula Rhomboids & trapezius III.
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Diagonal Movements Diagonal forward-downward and slightly inward movement of the arm. Fig 5.10 Fig 5.23
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. COMMON INJURIES OF THE SHOULDER REGION Acromioclavicular Sprain AC joint forced beyond normal ROM. Downward blow to outer end of shoulder. Fall on outstretched hand. Damage consists of tearing or severe stretching of AC ligaments.
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. COMMON INJURIES OF THE SHOULDER REGION Fracture of The Clavicle Clavicle fractures have causes similar to AC sprain: Downward blow to outer end of shoulder. Fall on outstretched hand. May indicate injury by supporting injured arm. Head may be tilted toward injured side with face turned to opposite side.
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. COMMON INJURIES OF THE SHOULDER REGION Dislocation of the Shoulder May be forward, downward, or posterior. Most likely when arm is forcefully abducted and laterally rotated. May occur by a blow to top of shoulder. Head of humerus is forced out of the glenoid fossa. Arm held out from side in a position of slight abduction and lateral rotation. Loss of normal rounded contour of deltoid muscle.
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. COMMON INJURIES OF THE SHOULDER REGION Rotator Cuff Tears Supraspinatus (supraspinatus tendon) most often injured. Nature of injury depends on arm kinematics. Caused by overuse, falls, or violent, fast arm motion.
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. COMMON INJURIES OF THE SHOULDER REGION Shoulder Impingement Soft tissue superior to humeral head pressed against acromion process. Due to overuse, inflammation, trapped bursa, degeneration with aging. Will cause pain and inflammation in shoulder.
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© 2008 McGraw-Hill Higher Education. All Rights Reserved. Chapter 5: The Upper Extremity: The Shoulder Region
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