four joints that make up the shoulder
girdle or shoulder complex
- Glenohumeral Joint (GH joint): main shoulder mover:
- Scapulothoracic Joint: accessory joint that aids and stabilizes the GH joint
- Sternoclavicular Joint (SC joint): accessory joint that attaches the upper arm to the axial skeleton via the clavicle
- Acromioclavicular Joint (AC joint): accessory joint that attaches the scapula to the axial skeleton via the clavicle
Joint mobilizations on glenohumeral and scapulothoracic joints only.
Sternoclavicular Joint
- Type of Joint: synovial, saddle or plane, diarthrosis, multiaxial
- Articular Surfaces: convex sternal head of the clavicle on the concave manubrium of the sternum
- Accessory Ligaments: joint capsule, sternoclavicular ligament (anterior and posterior), interclavicular ligament, costoclavicular ligament and the articular disc
- Movements: elevation, depression, protraction, retraction and rotation
**this joint contains an articular disc
Acromioclavicular Joint
- Type of Joint: synovial, plane, diarthrosis, triaxial
- Articular Surfaces: convex acromion on the convex lateral clavicle
- Accessory Ligaments: fibrous capsule,
- acromioclavicular ligament,
- ligaments (trapezoid & conoid),
-coracoacromial ligament
- Movements: elevation, depression, abduction, adduction, upward rotation and downward rotation
Glenohumeral Joint (GH Joint)
- Type of Joint: synovial, ball & socket (spheroid), diarthrosis, multiaxial
- Articular Surfaces: convex head of the humerus in the concave glenoid cavity of the scapula
- Accessory Ligaments:
- anteriorly-superior, middle & inferior humeral ligaments,
- superiorly-coracohumeral ligament and
- the transverse humeral ligament (this ligament holds the tendon of the biceps inside the intertubercular groove).
4 .Movements: flexion & extension, abduction & adduction, horizontal abduction & adduction, medial & lateral rotation, circumduction (combination of flexion, abduction, extension and adduction).
- GH Joint Movements are coupled with movements in the AC and SC joints at the same time.
Shoulder Bursa: Largest
- Subacromial/subdeltoid bursa
- Lies just below the acromion and the deltoid muscle.
Others
- others: Some common bursa around the GH joint
Glenoid Labrum
Made of fibrocartilage attached to the rim of the glenoid cavity.
It deepens the cavity and increases the surface of the joint.
Glenohumeral Joint
Loose Packed or Resting Position:
40 - 55 degrees abduction
30 degrees of horizontal adduction (in the scapular plane)
Glenohumeral Joint
Close Packed position:
full abduction with lateral (external) rotation
Glenohumeral Joint
Capsular Pattern of Restriction:
First: lateral (external) rotation
Second: abduction
Third: medial (internal) rotation
Glenohumeral Joint
Ranges of Motions
- Flexion: 160-180 degrees
- Extension: 50-60 degrees
- Abduction: 170-180 degrees
- Adduction: 50-75 degrees
- Horizontal abduction/flexion: 130 degrees
- Horizontal adduction/ext: 45 degrees
- Internal Rotation: 80-90 degrees
- External Rotation: 80-90 degrees
GH Joint: Subacromial Space
Region between the humerus and the acromion. The roof is formed by the coracoacromial ligament.
Three structures live in this space:
- supraspinatus tendon
- biceps (long head) tendon
- subacromial bursa
Glenohumeral Joint
Special Tests:
Apley’s Scratch Test
Impingement Test
Neer test
Hawkins - Kennedy test
Scapulothoracic Joint (Rhythm)
- Type of Joint: not a true joint, modified gliding, mostly consists of muscle tissue (serratus anterior & subscapularis muscles), connective tissue, fascia and a large bursa (subscapular bursa)
- Articular Surfaces: concave subscapular fossa surface on the convex posterior ribs
Accessory Ligaments: none
Movements: sliding/gliding type of motion, protraction, retraction, elevation, depression, upward rotation of the glenoid fossa (lateral or external rotation), downward rotation of the glenoid fossa (medial or internal rotation)
Scapulothoracic Joint (Rhythm)
Loose Packed Position or Resting Position:
When the arm is resting at the side
There is no closed packed position for this joint.
