1
Q
the shoulder girdle includes what joints
A
Sternoclavicular (SC)
Acromioclavicular (AC)
Scapulothoracic joints (ST)
Glenohumeral joint (GH)
Subacromial space-
2
Q
Shoulder Girdle function
A
Position hand in space for ADL
Transmit force
3
Q
IR and ER throughout the movement restraints
A
It will be different at different parts of the movement – different restraint to motion at different positions
4
Q
Horizontal abduction examples
A
can you touch the top of your shoulder, and wash the back of your head
5
Q
GH motion
A
Flexion/extension - 120
Abduction/adduction - 120
External/internal rotation – 90° &≈ 65°
Horizontal abduction/ adduction
6
Q
Glenohumeral Motion with other joints - example flexion
A
Responsible for 120 and scapula movement is responsible for the 60 degrees of movement
7
Q
Shoulder Girdle Motion is a Coordinated Motion of
A
G-H joint
A-C joint
S-C joint
S-T joint
8
Q
Glenohumeral Motion Arthrokinematics
A
Combine rotation & translation to keep humeral head centered on glenoid
9
Q
what happens if the humerus starts to come off the glenoid
A
Once the H head starts the come off the joint – we start to get funtional problems
10
Q
stability and mobility in the shoulder
A
the shoulders has more mobility and therefore has to sacrifice stability
11
Q
Flexion GH
A
Anterior-Superior roll, Posterior-inferior glide
12
Q
Extension GH
A
Posterior-inferior roll, anterior-superior glide
13
Q
Abduction GH
A
Superior roll, inferior glide
14
Q
External rotation GH
A
posterior roll, anterior glide
15
Q
Internal rotation GH ortho
A
anterior roll, posterior glide
16
Q
Horizontal Abduction GH
A
posterio-lateral roll, anteromedial glide
17
Q
Horizontal Adduction GH
A
anterio-medial roll, posterio-lateral glide
18
Q
GH Capsular tightness
A
results in abnormal arthrokinematics and limited joint motion
19
Q
Glenohumeral Motion is controlled by
A
these are mechanism that keep H head centered
Passive restraints
Active restraints
Interaction of passive & active restraints
20
Q
GH Passive Restraints
A
Bony geometry
Labrum
Capsuloligamentous structures - The capsule and its ligaments
Negative intra-articular pressure
Capsule is a closed structure
21
Q
the Humeral head is covered with
A
Covered with articular cartilage
22
Q
Humeral head faces
A
It faces superior – medially – posteriorly
23
Q
necks of the humerus
A
Anatomical Neck – attachment of capsule and mm
Surgical neck – the sight of attachment for muscles
24
Q
what is the Glenoid
A
Pear-shaped surface with ave. upward lift of 5°
25
Glenoid faces what direction
Projects laterally – anteriorly
26
S.I.T.S - rotator cuff
supraspinatus
infrascpinatus
teres minor
subsacpular
27
S.I.T.S action
all act to compresses the H into the center of the G
28
supraspinatus action
Initiates and assists deltoid in abduction of arm and acts with rotator cuff muscles
compressing the sup portion of the H closer to the G allowing for elevation of the H head without the H-head sliding
29
Infraspinatus action
Shoulder ER
and acts with rotator cuff muscles
30
Teres Minor
Shoulder ER
and acts with rotator cuff muscles
31
Subscapularis action
Shoulder IR
and acts with rotator cuff muscles
32
tendon vascularity
The end of the tendon has bad vascularity
33
ringing out effect
Tension rings out the fluid that is in the tendon
34
why do we abd someones arm in post shoulder care
We do not want ringing out effect
35
Glenoid labrum
Fibrocartilaginous ridge arising from the glenoid
Primary attachment site for the glenohumeral ligaments
36
what does the Glenoid labrum give rise to
Long Head of Biceps (LHB) superiorly
37
how thick is the Glenoid labrum
Approx. 9 mm thick (deepens the joint socket)
38
how much does the glenoid labrum deepen the depth
50%
39
Glenohumeral ligaments
External layers of the anterior and inferior walls of the joint capsule are thickened by fibrous CT
40
IGHL complex parts
anterior band – thickening
posterior band – thickening
axillary pouch – everything else
Does not engage until 90 degrees
supporting the inferior aspect of the shoulder.
41
Coracohumeral ligament location
superior to SGHL
42
Coracohumeral ligament taut with what motion
taut with Adduction & inferior translation of the humeral head; ER
43
Function of GH Capsule
Stability
44
what is stability based on
dependent on joint orientation
45
ER restraint is dependent on what
Dependent on arm position
46
0 of Abduction: restrict to ER
C-H ligament
SGHL – sp GH ligament
Subscapularis
47
45 of Abduction: restraint
MGHL
48
90 of Abduction
Anterior band IGHL
49
Subscapularis - Restraints to External Rotation at what postion
Effective restraint to ER with arm at side - 0
Ineffective restraint to ER with arm abducted to 900
50
Restraints to Internal Rotation is dependent on
Dependent on arm position
51
Restraints to Internal Rotation - 0 of Abduction
Posterior band IGHL
52
Restraints to Internal Rotation - 45 of Abduction
Anterior and Posterior band IGHL
53
Restraints to Internal Rotation - 90 of Abduction
Anterior and Posterior band IGHL
54
properties of Posterior dislocation
very unstable, not seen often
55
Restraints to Inferior Translation - 0 of Abduction
SGHL and CH-L
56
Restraints to Inferior Translation - 90 of Abduction
IGHL
57
Acromioclavicular Joint
A and clavicle
58
disc in the the AC joint
allows for translation motion, does not move that much – do not want to much movement
59
Acromioclavicular Joint- Joint capsule is reinforced by
Reinforced superiorly & inferior by A-C ligaments
60
Coracoclavicular ligaments is seen in what joint
AC joint
61
the two parts of the Coracoclavicular ligaments
conoid (medial)
trapezoid (lateral)
62
Coracoclavicular Ligaments is what
combined ligament is the primary support ligament of the AC Joint
63
Deltoid & Upper trap with the Acromioclavicular Joint
Deltoid & Upper trap cover the jt
64
Acromioclavicular Joint Movements
Axial rotation of clavicle (spin)
Adjusts the angulation between scapula & clavicle
65
Sternoclavicluar Joint is what kind of joint
Sellar Joint
66
Sternoclavicluar Joint link what
links the appendicular skeleton with the axial skeleton, saddle (concave-vex
67
Sup/inf direction Sternoclavicluar Joint
Proximal clavicle:
convex
Manubrium:
concave
68
Ant/post Sternoclavicluar Joint
Proximal clavicle:
concave
Manubrium:
convex
69
Sternoclavicular Joint Motions
Protraction/retraction (ant/post)
(concave surface is moving)
Elevation/depression (sup/inf)
(convex surface is moving)
Axial rotation (spin)
70
Sternoclavicular Joint Intra-articular disc
strengthens articulation & acts as shock absorber
71
Interclavicular ligament is part of which joint
Sternoclavicular Joint
72
Interclavicular ligament
connects medial ends of left & right clavicles
Rare as injury
73
Costoclavicular ligament is part of which joint
Sternoclavicular Joint
74
Costoclavicular ligament runs from
Attached below to the upper and medial part of the cartilage of the first rib, and is fixed above to the costal tuberosity on the under surface of the clavicle
75
sternoclavicular (SC) joint
is the linkage between the clavicle (collarbone) and the sternum (breastbone)
76
is S-T joint a true of false joint
false - it is not a true joint
77
Glenoid funtion for the humerous
Glenoid serves as platform for humeral head
78
how many muscle attachment are there in the scapula
Site of muscle attachment (17)
79
Scapula function
Serves to transfer force from trunk to upper extremity
80
Resting Position of Scapula - humerol head
the h-head rest on the inferior lip of the G
81
Resting Position of Scapula
Medial border nearly vertical
Abducted approximately 6 cm from spine
Tilted anteriorly approximately 200
5 – 10° of upward rotation
35° of IR
82
Resting Position of Scapula - dominent side
Depressed
Downwardly rotated
Anteriorly tilted
83
Support of Scapula
Scapular muscles
Suspension of scapula from clavicle at AC joint
Medial end of clavicle supported by SC joint
84
Subacromial Space is bounded by
Humeral head inferiorly
Coraco-acromial arch superiorly
85
Structures Within Subacromial Space
Long head of biceps
Superior capsule
Supraspinatus tendon
Upper margins of subscapularis & infraspinatus tendons
Subacromial bursa
Inferior surface of A-C joint
86
Elevation of arm requires- greater trochanter
external rotation of humerus to clear greater tubercle
upward rotation of scapula to elevate lateral end of acromion
87
Primary impingement
Narrowing of the space based on the
88
Secondary impingement
functional stenosis of subacromial space due to abnormal arthrokinematics
89
primer mover - Scapulohumeral
Deltoid
Pectoralis major
Latissimus dorsi
Teres major
Biceps
Coracobrachialis
Triceps
90
Rotator Cuff Muscles
Supraspinatus
infraspinatus
teres minor
subscapularis
91
h-head and the RC muscles
keep the h-head on the glenoid
all cover the humoral head
92
Supraspinatus actions
Abductor – first 30
external rotator
Superior compressor
93
supraspinatus innervation
Suprascapular Nerve
94
Infraspinatus
actions
external rotator
Abductor
Posterior compressor
95
infraspinatus innervation
Suprascapular Nerve
96
Teres minor actions
external rotator
weak adductor
Posterior compressor
97
teres minor innervation
Axillary Nerve
98
Subscapularis action
internal rotator
Balance in the frontal plane for the ER
Depresses the h-head
99
subscapularis innervation
U/L Subscapular Nerve
100
RC fails to cover two regions of the capsule
Inferiorly and the rotator interval
101
where is the rotator interval
A triangular area b/t supraspinatus, subscapularis, and the base of the coracoid
102
The rotator interval is reinforce by
the long head of the tendon and corachumeral ligament
103
in the shoudler where is the area of the most dislocations
Rotator interval – RIC
90-90
104
Supraspinatus assists deltoid with what action
abduction
105
what muscles depresses humeral head
teres minor, infraspinatus, and subscapularis
106
Transverse plane force couple
anterior vs. posterior RC
Subscapularis (anterior) vs. Infraspinatus & Teres Minor (posterior)
107
What direction does the transverse plane force couple pull
pull the glenoid into the humorous
108
Frontal plane force couple muscles
deltoid vs. inferior RC (INF, Teres Minor, Subscapularis)
109
action of the frontal plane force couple
the deltoid raises the arm and the inferior RC counteracts this movement
RC contract - pulling the humorous centered inferior – becoming the inferior compressor
110
Disruption of transverse plane results in
results in either anterior or posterior migration of humeral head
111
Disruption in the transverse plane may occur as a result of
Weakness
Tear
Paralysis…
112
Disruption of frontal plane force (superior vs. inferior) couple
results in superior migration of humeral head
113
Ringing out effect only for what muscle
supraspinatus
114
ringing out is seen with what action
adduction
115
is the Supraspinatus needed in the forcce couples
Essential force couples maintained
We still need balance between the ant and post
116
Supraspinatus tear strength & function
Normal strength & function possible
117
Supraspinatus/Posterior Cuff tear result
Essential force couples disrupted
ER weakness
little elevation is possible
118
Supraspinatus/Subscapularis tear
essential force couple is disrtupted
IR weakness
little elvation as possible
119
Massive Tear in the rotator cuff
Essential force couples disrupted
Weakness with internal & external rotation
Little active elevation possible
more then one group is effected
120
Pittsburgh Dynamic Shoulder Testing Model - 6 DF
Translation:
anterior/posterior
superior/inferior
medial/lateral
Rotation:
ER/IR
scapular plane abduction
horizontal abduction/adduction
121
Global Rotator Cuff Tear
Rotator Cuff & Joint capsule – transected from inferior border of subscapularis tendon through infraspinatus & teres minor tendon
122
Infraspinatus/Teres Minor reduce strain on what ligamant
Reduces strain on anterior band of IGHLC
123
Biceps tendon force increases what
torsional rigidity for ER
124
does the biceps tendon have an effect on the IGHL
No effect on strain of IGHLC- complex
125
SLAP lesion effects what mucsle
long head of the biceps
This decrease the ability of the long head of the biceps to act a s a compressor
Sup labral lesion running ant to post
126
biceps tendon does what kind of compression
Anterior Stabilizer as Capsuloligamentous Stability Decreases
127
Scapulothoracic Muscles
Trapezius
Upper
Middle
Lower
Serratus anterior
Rhomboids
Levator scapulae
Pectoralis minor
Subclavius
128
traps innervation
Spinal Accessory N.
129
serratus anterior inv
long thoracic
130
rhomboid (minor and major) inv
dorsal scapular
131
levator scapulae inv
dorsal scapular
132
pectoral minor inv
medial pectoral
133
subclavius inv
nerve to subclavius
134
Elevation/depression in the Scapulothoracic muscles
Composite of SC & AC joint rotations
Vertical axis
135
Protraction/retraction in the Scapulothoracic muscles
Summation of horizontal plane rotations at SC & AC
Medial – lateral axis
136
Upward/downward rotation Scapulothoracic muscles
Summation of clavicular elevation at SC joint & scapular upward rotation at the AC joint
The coupled rotations are essential to the full 60° of upward rotation
Normally follows a path close to it’s scapular plane
137
Force Couple at Scapulothoracic Joint
Serratus anterior
Upper trapezius
lower/middlt rap
138
total degree of elevation in the arm
180
120- GH
60 - ST
139
Force Couple at Scapulothoracic Joint- serratus anterior
pulls the scapula anteriorly and medially
140
Force Couple at Scapulothoracic Joint - upper trap
pulls the scapula medially
141
Force Couple at Scapulothoracic Joint - middle and lower scapula
stabilizes the scapula during upward rotation
Anatomy UE
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Decks in class (11)
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