Shoulder joint
Ball and socket joint, 3 plane movements. Humerus and Scapula (glenohumeral joint)
4 groups of motions
Flex/Ext.
Abd/Add.
internal/external rotation
Horizontal Abd/add
Scaption
Scaption
Similar to flexion/abduction but occurs in scapular plane as opposed to sagittal or frontal. Approximately 30 degrees forward of frontal plane. Not quite midway between flexion and abduction.180 degrees of down/up motion is possible. Most common functiona
Glenoid fossa
Egg shaped socket on superior end, lateral side. articulates with humerus.
Glenoid Labrum
Fibro cartilaginous ring attached to rim of Glenoid fossa, deepens articular cavity. Makes good for motion.
Subscapular Fossa
Most of the area on anterior surface, providing attachment for subscapularis muscles.
Supraspinous Fossa
Above the spine, providing attachment for supraspinatus muscle.
Infraspinous Fossa
Below the spine, providing attachment for infraspinatus muscle.
Axillary Border
Providing attachment for teres major and teres minor muscles.
Acromion Process
Broad, flat area on superior lateral aspect, providing attachment for middle deltoid muscle
Humerus Long bones where located
...
Shaft
Body, area between surgical neck proximally and epicondyles distally.
Head
Semirounded proximal end, articulates with the scapula
Surgical Neck
Slightly contricted area just below tubercles where head meets the body.
Anatomical Neck
Circumferential groove separating head from tubericle
Greater Tubricle
Large projection lateral to head nad lesser tubercle, provides attachment for supraspinatus, infraspinatus, and teres minor muscles.
Lesser tubercle
Smaller projection on anterior surface, medial to greater tubercle, provides attachment for subscapularis
Deltoid tuberosity
On lateral side near the midpoint, not usually well defined landmark.
Biciptial Groove/ Intertubercular groove
Longitudinal groove between tubercles, containing tendon of long head of the biceps.
Rotator cuff
Tendinous band formed by blending together tendinous insertions of subscapularis, supraspinatus, infraspinatus, and teres minor muscles. Keep head of humerus rotting against Glenoid fossa during joint motion. NOT medial/lateral rotation.
Rotator Cuff what does it do
Muscles Hold joint surfaces during motion
Fossa position
Anterior/lateral/upward. Upward position=stability
Joint capsule
Completely surrounds joint, creates a partial vacuum, helps hold head against fossa.
Shoulder muscles
Keep the joint from subluxing, partially dislocating.Stroke loss function involved extremity so subluxed sshoulder
Joint Subluxation/ step off
Partial separation. Common in stroke, hemiplegia. Loss function involved in extremity. Lack of deep socket for humeral head to fit into, loss of muscle tone. weight of extremity, and gravity all contribute to joint subluxation.
Acromioclavicular separation
Various amount of ligament injury at acromioclavicular join.
1st-AC ligament is stretched
2nd-AC ligament is ruptured and CC ligament is stretched.
3rd-Both Ac and CC ligaments are ruptured.
Anterior shoulder dislocations
Most common joint dislocations in shoulder. Forced shoulder abd and lateral rotation tends to dislocate motion causing humeral head to slide anteriorly out of Glenoid fossa.
Impingement syndrome
Overuse condition. Involves compression between acromial arch, humeral head, soft tissue structures such as the coracoacromial ligament, rotator cuff muscles, long head of biceps, and sub acromial bursa. Swimmer's shoulder with backstroke.
Adhesive capsulitis/Frozen shoulder
Inflammation and fibrosis of shoulder joint capsule.
Torn rotator cuff
Involves distal tendinous insertion of supraspinatus, infraspinatus, teres minor, and subscapularis on greater/lesser tubercle area of humerus. Tears can be result of acute trauma or gradual degeneration. Acromioclavicular!!
Anterior Deltoid Muscle
O:Lateral third of clavicle
I:Deltoid tuberosity
A: Shoulder abduction, flexion, medial rotation, and horizontal adduction.
N: Axillary nerve (C5,C6)
Middle Deltoid Muscle
O: Acromion Process
I: Deltoid tuberosity
A: Shoulder abduction
N: Axillary nerve (C5,C6)
Posterior deltoid muscle
O:Spine of scapula
I: Deltoid tuberosity
A: Shoulder abduction, extension, hyperextension, lateral rotation, horizontal abduction
N: Axillary Nerve (C5,C6)
Pectoralis Major Muscle, Clavicular Portion
O:Medial third of clavicle
I: Lateral lip of Biciptial groove of humerus.
A:Shoulder flexion-first 60 degrees
Pectoralis Major muscle, sternal Portion
O:Sternum, costal cartilage of first six ribs
I: Lateral lip of Biciptial groove of humerus
A: Shoulder extension- first 60 degrees.
Pectoralis Major muscle, clavicular and sternal
A:Shoulder adduction, medial rotation, and horizontal adduction
N: Lateral and medial pectoral nerve (C5-C8,T1)
Latissimus Dorsi Muscle
O:Spinous processes of T7 through L5, posterior surface of sacrum, iliac crest, and lower three ribs.
I: Medial floor of Biciptial groove of humerus
A: Shoulder extension, adduction, medial rotation, hyperextension
N: Thoracodorsal nerve (C6-C8)
Teres Major Muscle
O: Axillary border of scapula near the inferior angle
I:Crest below lesser tubercle inferior to Latissimus dorsi muscle attachment.
A: SHoulder extension, adduction, and medial rotation.
N: Lower subscapular nerve (C5-C7)
Supraspinatus Muscle
O:Supraspinous fossa of the scapula
I: Greater tubercle of humerus
A: Shoulder abduction
N: Suprascapular nerve (C5,C6)
Infraspinatus Muscle
O: Infraspinous fossa of scapula
I: Greater tubercle of humerus
A: Shoulder lateral rotation, horizontal abduction
Teres minor Muscle
O:Axillary border of scapula
I: Greater tubercle of humerus
A: Shoulder lateral rotation, horizontal abduction
N: Axillary nerve (C5,C6)
Subscapularis muscle
O: Subscapular fossa of scapula
I: Lesser tubercle of humerus
A: Shoulder medial rotation
N: Upper and lower subscapular nerve (C5,C6)
Coracobrachialis muscle
O: Coracoid process of the scapula
I: Medial surface of the humerus near the midpoint
A: Stabilizes the shoulder joint
N: Musculocutaneous nerve (C6,C7)
Shoulder girdle muscles
Attach to scapula and trunk to move or stabilize scapula.
Shoulder joint muscles
Attach mostly to scapula and humerus to move the arm. superficial. Arrangement so don't get into each other way.
Glenohumeral movement
Glide, spin and roll. As abduction occurs. Humeral head rolls across the Glenoid fossa. Head glides inferiorly, articulating with the Glenoid fossa. Rotator cuff muscles also assist. Supraspinatus muscle pulls humeral head into Glenoid fossa.
Flexion
Anterior deltoid, Pectoralis major (clavicular)
Extension
Posterior deltoid, Latissimus Dorsi, teres major, Pectoralis major (sternal)
Hyperextension
Latissimus Dorsi, posterior deltoid
Abduction
Deltoid, supraspinatus
Adduction
Pectoralis major, teres major, Latissimus Dorsi
Horizontal abduction
Posterior deltoid, infraspinatus, teres minor
Horizontal adduction
Pectoralis major, anterior deltoid
External rotation/Lateral rotation
Infraspinatus, teres minor, posterior deltoid.
internal rotation/ medial rotation
Latissimus Dorsi, teres major, subscapularis, Pectoralis major, anterior deltoid.
Biceps Long head
Together with the short head, the long head of the biceps brachii acts as a flexor of the arm at the elbow joint and a supinator of the forearm. The biceps brachii, brachialis, and brachioradialis muscles all act as flexors of the arm at the elbow, with t
Normal end feel
Soft tissue stretch
Thoracolumbar fascia
Superficial fibrous sheet that attaches to spinous processes of lower thoracic and lumbar vertebrae, supraspinal ligament and posterior part of iliac crest. Attachment for Latissimus Dorsi
Full abduction
Thumb pointed up. Full can position. Tubercle is being rotated from under acromion process, allowing full abduction. Greater tubercle in medially rotated or neutral position runs in acromion precept overhead.