1. The Shoulder Girdle

2. Shoulder Girdle Bones
Clavicle and Scapula
Move as a unit

3. Scapula Key Bony Landmarks (Palpate)
Glenoid Fossa
Acromion Process- continuation of the spine of scapula and located at the lateral end of the clavicle
Coracoid Process- located just below the lateral end of the clavicle
Spine of Scapula
Lateral Border
Medial Border-vertebral border
Inferior Angle
Supraspinous Fossa- located superior to the spine of the scapula
Infraspinous Fossa- located inferior to the spine of the scapula
Students stand up and palpate key bony landmarks on each other

4. Scapula Key Bony Landmarks

5. Clavicle and Sternum Key Bony Landmarks
Sternal End-located proximal to sternum
Acromial End-located proximal to scapula
Sternum:
Manubrium
Body
Xiphoid Process

7. Scapulothoracic Joint
Not a true synovial joint
No ligamentous support
Supported dynamically and moves on the rib cage by two muscles; serratus anterior and subscapularis

8. Sternoclavicular Joint
Clavicle articulates with sternum
Synovial joint
Very strong joint and dislocation is rare

9. Acromioclavicular Joint
Acromion process of scapula articulates with clavicle
Sustains great forces
Commonly injured by collision sports such as hockey, football, rugby, horseback riding, mountain biking

10. Glenohumeral Joint Scapula articulates with head of humerus
The joint contains a shallow socket called the glenoid fossa
The glenoid fossa is only one-fourth the size of the humeral head

11. Movements of the Shoulder Girdle
Protraction (Abduction)
Retraction (Adduction)
Upward Rotation
Downward Rotation
Elevation
Depression
Anterior Tilt

12. Movements Focus on specific bony landmarks
inferior angle
glenoid fossa
acromion process
Shoulder girdle movements = scapula movement

13. Protraction (abduction)
scapula moves laterally away from spinal column
Retraction (adduction)
scapula moves medially toward spinal column
Pair students up, perform movements of shoulder girdle while palpating scapula

14. Upward Rotation
turning glenoid fossa upward & moving inferior angle superolaterally away from spinal column
Downward Rotation
returning inferior angle inferomedially toward spinal column & glenoid fossa to normal position

15. Elevation
upward or superior movement, as in shrugging shoulders
Depression
downward or inferior movement, as in returning to normal position

16. Anterior Tilt
Rotational movement of scapula occurring during glenohumeral hyperextension
Superior border moving anteroinferiorly & inferior angle moving posterosuperiorly

17. Scapulohumeral Rhythm
The coordinated movements of the scapula, clavicle, and humerus
Shoulder joint and shoulder girdle work together in carrying out upper extremity activities
Glenohumeral movement requires the scapulothoracic, acromioclavicular, and sternoclavicular joints to also move

18. Scapulohumeral Rhythm
Scapula rotates 1o for every 2o movement of the humerus (Overall 2:1 ratio of glenohumeral to scapulothoracic movement)
The scapula rotates 60 degrees, the humerus abducts 120 degrees , totaling 180 degrees of abduction at the GH joint

19. Shoulder Joint Shoulder Girdle
Flexion
Upward Rotation and Elevation
Extension
Downward Rotation and Depression
Abduction
Upward Rotation
Adduction
Downward Rotation
Horizontal Adduction
Protraction
Horizontal Abduction
Retraction
Medial Rotation
Lateral Rotation

20. Muscles that Move the Shoulder Girdle
5 muscles primarily involved in shoulder girdle movements
All originate on axial skeleton and insert on scapula and/or clavicle
Do not attach to humerus and do not cause shoulder joint actions
Essential in providing dynamic stability of the scapula so it can serve as a relative base of support for shoulder joint activities such as throwing, batting, and blocking

21. Muscles that Move the Shoulder Girdle
Posterior:
Trapezius (upper, middle, and lower)
Levator Scapula
Rhomboids (minor and major)
Anterior:
Serratus Anterior
Pectoralis Minor

22. Trapezius Origins
Upper Fibers: Occipital Bone (skull) and Spinous Process of C7
Middle Fibers: Spinous Process of T1-T5
Lower Fibers: Spinous Process of T6-T12
Ask students to abduct the shoulder and retract scapula to palpate

23. Trapezius Insertions Upper Fibers: Lateral 1/3 of clavicle
Middle Fibers:
Acromion Process of Scapula
Lower Fibers:
Root of the Spine of Scapula

24. Trapezius Actions Upper Fibers: Elevation of Scapula Middle Fibers:
Retraction
Upward Rotation of Scapula
Lower Fibers:
Depression
Upward rotation of Scapula

25. Trapezius Integrated Functions
Upper Fibers:
Provide dynamic stability to the cervical spine and shoulder
Middle Fibers:
Eccentrically decelerates scapular protraction
Assists in dynamically stabilizing the scapula
Lower Fibers:
Eccentrically decelerates scapular elevation

26. Levator Scapula Origin: Transverse Process of C1-C4 Insertion:
Medial Border of Scapula
Actions:
Elevation of Scapula
Downward Rotation of Scapula
Extension of Head and Neck
Most is deep to trapezius. When palpating relax trapezius. Downwardly rotate scapula and palpate superior to superior angle of scapula.

27. Levator Scapula Integrated Functions
Assists in eccentric deceleration of depression and upward rotation of scapula
Assists in eccentric deceleration of flexion of head and neck
Assists in dynamic stabilization of the cervical spine and scapula

28. Rhomboids Minor and Major
Origin:
Minor: Spinous Process of C7-T1
Major: Spinous Process of T2-T5
Insertion:
Minor: Root of the Spine of the Scapula
Major: Between the Root of the Spine of the Scapula and the Inferior Angle of the Scapula
Deep to trapezius. Downwardly rotate scapula and palpate between scapula and and spine (at level of inferior angle)

29. Rhomboids Minor and Major Actions
Retraction of Scapula
Downward Rotation of Scapula

30. Rhomboids Minor and Major Integrated Functions
Assists in eccentric deceleration of scapular protraction and upward rotation of scapula
Assists in stabilization of scapula

32. Serratus Anterior Origin: Ribs 1-9 Insertion:
Anterior surface of the medial border of scapula
Actions:
Protraction of Scapula
Upward Rotation of Scapula
Much of it is deep to the scapula. Flex shoulder to 90 degrees. Between lateral borders of pec and lats and feel for the ribs and serratus anterior.

33. Serratus Anterior Integrated Functions
Assists in eccentric deceleration of retraction of scapula
Assists in stabilization of the scapula
Helps to hold the scapulothoracic joint along the medial border of the scapula

34. Pectoralis Minor Origin: Ribs 3-5 Insertion:
Coracoid Process of Scapula
Actions:
Protraction of Scapula
Depression of Scapula
Downward Rotation of Scapula

35. Pectoralis Minor Integrated Functions
Assists in eccentric deceleration of retraction of scapula
Assists in dynamic stabilization of the scapula

36. Putting It All Together
Scapular Elevation:
Upper Trapezius
Levator Scapula
Scapular Depression:
Lower Trapezius
Pectoralis Minor
Scapular Protraction:
Serratus Anterior
Pectoralis Minor
Scapuluar Retraction:
Middle Trapezius
Rhomboids

37. Putting It All Together
Scapular Upward Rotation:
Serratus Anterior
Upper and Lower Trapezius
Scapular Downward Rotation:
Rhomboids
Levator Scapula
Pectoralis Minor

38. Scapular Winging
A winged scapula is a shoulder condition in which the scapula sticks out at the back, particularly when performing pushing exercises like the push up 
Common symptoms of a winged scapula include the following:
Pain and limited shoulder elevation
Difficulty in lifting weights
Pressure on the scapula
from a chair when sitting

39. Scapular Winging A winged scapula can be caused by one of two reasons:
Damage to the long thoracic nerve of the shoulder. It may cause paralysis of the serratus anterior. Medical clearance is necessary before engaging in any exercise
General weakness of the serratus anterior muscle. In this case, the winging scapula can be improved with corrective exercises designed to build strength in the weak serratus anterior muscle.

40. Three corrective exercises may strengthen serratus anterior:
Scapular Winging
Three corrective exercises may strengthen serratus anterior:
Hand Walks, Arm Shuffle, Push Up Plus
Pay careful attention to scapulohumeral rhythm and symmetry
Maintain a stable pelvis and neck

41. Hand Walks
The pattern is one hand up, next hand up, one hand down, other hand down, repeat.

42. Arm Shuffle
Begin with your hands very wide. Shift your weight back and forth while simultaneously touching one hand on top of the other as shown

43. Push Up Plus
Once you have completed a push up, add the “plus” motion by protracting your scapula as much as possible without changing your spinal alignment. Hands should be shoulder width apart.

44. Rounded Shoulders
A common postural condition in which the scapula are protracted and depressed and the humeri are medially rotated
When the trapezius muscles are weak they contribute to rounded shoulders because they are unable to efficiently oppose protraction of the scapula (especially if protractors pectoralis minor and serratus anterior are tight)

45. Trapezius Tightness
Whenever a phone is crimped between head and shoulder, it may cause tightness of the upper trapezius
Whenever a purse or book bag is carried upon the shoulder, people subconsciously elevate the scapula on the side which it is carried. This causes the elevators to isometrically contract for long periods of time
This is another common posture that may cause tightness of the upper trapezius

46. Rhomboids and Pectoralis Minor
When rhomboids are weak they can contribute to rounded shoulders because they cannot oppose protraction and depression of the scapula
When pectoralis minor is tight, they can contribute to rounded shoulders

47. Scapular Depression on Bench
This is an exercise for individuals who need to work the lower traps, rhomboids, and serratus anterior muscles
Maintain a tall posture throughout the exercise and good stability through the abdominal complex.

48. Supine Row Lie under bar so that the bar is at mid-sternum level
Activate core by drawing in
Perform row and lift body towards the bar
The bar should meet the mid-sternum.
Lower slowly
AVOID retracting the scapula before pulling yourself up, it should be a smooth action through the scapulothoracic joint as you lift yourself towards the bar.

49. Levator Scapula Stretch
In the proper posture sit on a ball or chair with a minimum of 90 degrees bend at the hips and knees
Draw your belly button inward toward your spine
Tuck your chin in and rotate the head in right direction of your opposite pocket while retracting and depressing shoulder of the side being stretched
Hold for seconds, repeat for 2-3 reps

50. Upper Trapezius Stretch
In optimal posture sit on the ball or bench with a minimum of 90 degree bend at the hips and knees.
Draw your belly button inward toward your spine
Tuck your chin in and slowly draw your left ear to your left shoulder until tension is felt
Hold for seconds, repeat for 2-3 reps

51. Foam Roll Rhomboids Draw your belly button inward toward your spine
Stabilize the head in “neutral”
Roll mid-back area on the foam roll
If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases