1. Method of Study for This Section (Applied Anatomy of the Musculoskeletal System)
Read assigned readings of text
Use the Dynamic Human CD-ROM and models and illustrations of the musculoskeletal system to help review structure of bones, joints, and muscles as necessary. This is the purpose of lab.
Complete labs conscientiously and study models of articulated skeleton, shoulder, spine, and knee
Lecture will only provide a selective review of structure, muscles & movements, and movement-related issues
For exams, review lecture notes and understanding questions in both lecture and labs

2. Objectives of Upper Ext Unit
Explain how anatomical structure affects movement capabilities on upper extremity articulations.
Identify factors influencing the relative mobility and stability of upper extremity movements
Identify muscles that are active during specific upper extremity movements
Describe the biomechanical contributions, specific structures, and movement-related causes of common injuries of the upper extremity.

3. Sh Jt & Girdle Ant Musculature

4. Sh Jt & Girdle Post Musculature

5. Upper Extremity – Chapter 7
Shoulder
Girdle
Structure:

6. Normal Rom of Shoulder girdle
Sternoclavicular joint
Protraction 15 deg, retraction 15 deg
Elevation 45 deg, depression 15 deg
Acromioclavicular joint
All directions deg

7. Muscles and Movement of Shoulder Girdle
Illustrations on next three slides
Trapezius (large, superficial medial and sup to scapulae)
Upper portion - elevation, upward rotation
Middle portion - adduction, or retraction
Lower portion - depression, upward rotation
Rhomboids -
elevation, downward rotation, adduction, or retraction
Serratus anterior (underneath scapulae)
abduction, upward rotation
Pectoralis minor (underneath pectoralis major)
downward rotation, abduction, or protraction
Levator Scapulae (underneath upper trapezius)
elevation, downward rotation

8. Elevation and Depression

9. Upward & Downward Rotation

10. Protraction & Retraction

11. Shoulder Joint Structure

12. Normal ROM of arm movements
Flexion – (arm at side is 0 deg) 180 deg, hyperextension 60 deg
Transverse flex (arm in front of chest is 0 deg) – 40 deg, transverse ext 90 deg
Rotation(arm abducted, elbow bent to 90 deg, arm at right angles to trunk is 0 deg)
Internal 90 deg, external 90 deg
Abduction 180 deg

13. Shoulder Joint Stabilizers
Stabilizers and rotators - Rotator cuff muscles –
Teres minor - external rotation
Infraspinatus - external rotation
Supraspinatus - abduction
Subscapularis - internal rotation

14. Shoulder Joint Primary Movers
Anterior movers – Anterior deltoid, pectoralis major
Superior movers - middle deltoid
Posterior movers - posterior deltoid
Inferior movers - latissimus dorsi, teres major, lower pectoralis m.
Force vectors of muscles (see next slide)

15. Shoulder Jt Muscles

16. Movements of Shoulder Complex
Every movement of upper extremity involves either stabilizing or accommodating action of the shoulder girdle.
If carrying something in arms, scapular elevators are involved
Arm elevation – scapular protraction and/or upward rotation (first 30°,1/5th is scapular movement; then 1/3rd scapular movement after that)

17. Shoulder Joint Impingement Syndrome
What is it? Pain from shoulder area resulting from impingement of structures between humeral head, acromion, and coracromial arch. Three stages:
Stage I - edema and hemorrhage of subacromial structures
Stage II - tendon fibrosis and bursal thickening
Stage III - rotator cuff tears, biceps tendon ruptures, and bone spurs
II:
III: I:

18. Causes of Sh Jt Impingement
Primary impingement:
Repeated movements requiring elevated and/or medially rotated humerus, compounded by weak rotator cuff muscles, causing: impingement of long head of biceps, supraspinatus
Secondary Impingement:
Decreased volume of subacromial space due to glenohumeral joint instability, and perhaps joint capsular tightness
Structural abnormalities:
hooked or curved acromion, calcium deposits, bone spurs, thickened bursa, thickened ligaments

19. Shoulder Jt Impingement (3)
Treatment:
Related to the cause - may involve surgery, rotator cuff strengthening, and flexibility exercises.
Later, avoid humeral elevation and rotation movements.
Website for Shoulder Joint Impingement Syndrome
(click on “view eorthopod”, then “shoulder”, then “impingement syndrome”)

20. Elbow Joint Structure

21. Elbow and Wrist Joint Muscles
True Flexor - Brachialis
Flexor-Supinator - Biceps brachii
Extensor - Triceps brachii
Wrist flexors (medial epicondyle of humerus)
Flexor carpi ulnaris and flexor carpi radialis
Wrist extensors (lateral epicondyle of humerus)
Extensor carpi ulnaris & extensor carpi radialis
Force vectors of muscles on next slide
KIN Biomechanics

22. Muscles of elbow joint:

23. Muscles and Movements of Radioulnar Joint
Elbow Flexion -
Forearm Supination - Biceps Brachii
Forearm Pronation - Pronator Teres
Elbow Extension -
Forearm Supination - Supinator
Forearm Pronation -Pronator Quadratus
Muscle force vectors on next slide
Epicondylitis
The most common cumulative trauma disorder (CTD), repetitive stress injury (RSI), repetitive motion disorder (RMD), or overuse syndrome (OS) is epicondylitis
Epicondylitis website (click on “view eorthopod”, then “elbow”, then “medial epicondylitis” or “lateral epicondylitis”

24. Normal ROM for forearm and wrist movements
Flexion 150 deg
Supination deg
Pronation deg
Wrist
Flexion 80 deg
Extension 70 deg
Radial flex 20 deg
Ulnar flex 30 deg

25. Radioulnar Jt Muscles

26. Bones of Wrist and Hand

27. Carpal Tunnel Syndrome
Background
Carpal tunnel includes
median nerve and
9 flexor tendons
( 4 flex dig sup,
4 flex dig prof,
1 fl pol l)

28. Carpal Tunnel Syndrome (cont’d)
Symptoms
Pain in wrist area, or referred proximally or distally
Tingling of thumb, fingers, or palmar side of hand
Loss of control of muscles affected by median nerve blockage
Causes
Enlargement of tissues within tunnel
Decreased size of tunnel
Extraneous tissue in tunnel
Treatment
Related to cause
Website on carpal tunnel syndrome (Click on “view eorthopod”, then “hand”, then “carpal tunnel syndrome”
KIN Biomechanics

29. Review & Homework Problems for Chapter 7
Review problems:
Torque at shoulder with elbow flexed vs extended
Fig 7-15, 7-16
Compressive force at shoulder jt
Fig 7-17, sample problem 1 p 197
Elbow flexion force
Figure 7-25, sample problem 2 p 206
Homework – Due Tuesday, March 7
Introductory problems, p 217: # 8,9,10
Additional problem, p 218: #10