Functional anatomy of shoulder.ppt

Shoulder Introduction Shoulder comprises of 3 osseous (bony) segments - Humerus - Clavicle - Scapula Introduction These bones are linked through 3 joints - Glenohumeral (GH) joint - Sternoclavicular (SC) joint - Acromioclavicular (AC) joint SC Joint Capsule & Ligaments S...

Shoulder Introduction Shoulder comprises of 3 osseous (bony) segments - Humerus - Clavicle - Scapula Introduction These bones are linked through 3 joints - Glenohumeral (GH) joint - Sternoclavicular (SC) joint - Acromioclavicular (AC) joint SC Joint Capsule & Ligaments Strong fibrous capsule 3 ligaments – Sternoclavicular ligament – Costoclavicular ligament – Interclavicular ligament SC Joint Motions 3 rotary degrees of freedom – Elevation/Depression – Protraction/Retraction – Anterior/Posterior rotation SC Joint Motions 3 rotary degrees of freedom – Elevation/Depression – Protraction/Retraction – Anterior/Posterior rotation AC Joint Attaches the scapula to the clavicle Plain synovial joint Joint capsule AC Joint Capsule & Ligaments Very weak capsule, which cannot maintain joint integrity AC joint supported passively by various ligaments: – Superior acromioclavicular (AC) ligament – Inferior AC ligament – Coracoclavicular ligament Trapezoid ligament (lateral) Conoid ligament (medial) AC Joint Motions Internal/External Rotation AC Joint Motions Internal/External Rotation AC Joint Motions Depression/Elevation AC Joint Motions Upward/Downward Rotation GH Joint Capsule & Ligaments GHJ surrounded by large loose capsule that is taut superiorly & slack anteriorly/inferiorly during rest Ligaments: – Superior GH – Middle GH – Inferior GH – Coracohumeral GH Joint Motions 3 degrees of freedom – Flexion/Extension – Abduction/Adduction GH Joint Motions 3 degrees of freedom – Medial/Lateral rotation or Internal/External rotation – “Scaption” GH Joint Dynamic Stability Deltoid Rotator cuff Muscles Elevation Deltoid – Prime mover for flexion & abduction Supraspinatus – Elevation at GHJ in all 3 planes Infraspinatus/ Teres Minor/ Subscapularis – Compress & stabilize joint – Steer head of humerus Upper & Lower Trapezius – Drive scapula in humerus elevation Serratus Anterior – Stabilize scapula Rhomboids – Abduction Muscles Depression Latissimus Dorsi – Adduction/Extension/Medial rotation GHJ – Adducts/Depress Scapula Pectoralis major – Subclavicular portion Flexion of GHJ (with Deltoid) – Sternal/Abdominal portion Depresses the shoulder (Same Fx as Latissimus Dorsi)  Rotator cuff muscles Origin on Attachment Muscle Action Picture scapula on humerus Supra abducts the supraspinous f greater tube spinatus mu ossa rcle arm scle externally rot Infra greater ates infraspinous fo spinatus mu ssa tubercle the arm scle externally greater Teres minor lateral border rotates the muscle tubercle arm Subs internally rota subscapular fo lesser tuberc tes capularis m ssa le uscle the humerus  Practical – in groups Demonstrate 3 strengthening exercises for the four rotator cuff muscles  Shoulder Muscles Muscle Origin Insertion Action Picture Teres Axillary border Crest below Extension, major of scapula near lesser adduction, & inferior angle tubercle of internal humerus rotation Trapezius Occipital bone, lateral ⅓ of Scapular (Upper, the ligamentum clavicle, & Elevation, middle & nuchae, & the the acromion Upward lower) spinous & scapular Rotation, processes T01– spine of Retraction, T12 scapula Depression Lattisimus Spinous Medial Lip of Extension, Dorsi processes T7- Bicipital adduction, T12, 9th to 12th Groove internal ribs, lumbar & rotation sacral vertebrae, & post. ⅓ of the iliac crest  Shoulder Muscles Muscle Origin Insertion Function Picture Deltoid 1. Lateral end Deltoid Horizontal (Ant., of the clavicle, tuberosity of Ad- Middle, 2. Acromion of humerus &Abduction, Posterior) scapula at top Flexion, of the shoulder, Internal/Exter 3. Spine of the nal rotation, scapula. Extension, Hyperextens Rhomboids Spinous Vertebral Depression, processes of C1- Scapular Upward T5 Border Rotation Serratus Lateral Surface Vertebral Protraction, Anterior of Upper 8 ribs Border of Upward rotation- Scapula (prevents scapular winging)  Practical – in groups Demonstrate 2 strengthening exercises (using exercise machines) for the shoulder muscles (name the muscles) responsible for the following actions: Abduction & Adduction Flexion & Extension Internal & External rotation Protraction & Retraction Depression & Elevation  Practical – in groups Demonstrate 2 strengthening exercises (using own body weight, tubing, dumbells) for each shoulder muscles (name the muscles) responsible for the following actions: Abduction & Adduction Flexion & Extension Internal & External rotation Protraction & Retraction Depression & Elevation Demonstrate 3 flexibility exercises for the shoulder FLEXION Pec Major, Anterior Deltoid, Biceps Brachii, Coracobrachialis EXTENSION Posterior Deltoid, Latissimus Dorsi, Teres Major, Triceps Brachii INT. ROT Pec Major, Ant Deltoid, Subscapularis, Lats, Teres Major EXT. ROT Pos Deltoid, Infraspinatus, Teres Minor ABD Deltoid, Trapezius, Serratus Anterior, Supraspinatus ADD Pecs, Lats, Subscapularis, Infraspinatus, Teres Major, Teres Minor Triceps Brachii, Coracobrachialis PROTRACTION Pecs, Serratus Anterior RETRACTION Rhombids, Trapezius ELEVATION Levator Scapulae, Trapezius DEPRESSION Pec Minor, Trapezius, Lats