Transcript Scapula

The Shoulder Girdle
Shoulder Girdle Bones
• Clavicle and Scapula
– Move as a unit
Scapula Key Bony Landmarks (Palpate)
• Glenoid Fossa
• Acromion Process- continuation of the spine of
scapula and located at the lateral end of the clavicle
• Coracoid Process- located just below the lateral end
of the clavicle
• Spine of Scapula
• Lateral Border
• Medial Border-vertebral border
• Inferior Angle
• Supraspinous Fossa- located superior to the spine of
the scapula
• Infraspinous Fossa- located inferior to the spine of the
scapula
Scapula Key Bony Landmarks
Clavicle and Sternum Key Bony
Landmarks
• Clavicle:
–Sternal End-located proximal to sternum
–Acromial End-located proximal to
scapula
• Sternum:
–Manubrium
–Body
–Xiphoid Process
Scapulothoracic Joint
• Not a true synovial
joint
• No ligamentous
support
• Supported
dynamically and
moves on the rib
cage by two
muscles; serratus
anterior and
subscapularis
Sternoclavicular Joint
• Clavicle
articulates with
sternum
• Synovial joint
• Very strong
joint and
dislocation is
rare
Acromioclavicular Joint
• Acromion process of
scapula articulates
with clavicle
• Sustains great forces
• Commonly injured by
collision sports such
as hockey, football,
rugby, horseback
riding, mountain biking
Glenohumeral Joint
• Scapula articulates
with head of
humerus
• The joint contains
a shallow socket
called the glenoid
fossa
• The glenoid fossa
is only one-fourth
the size of the
humeral head
Movements of the Shoulder Girdle
•
•
•
•
•
•
•
Protraction (Abduction)
Retraction (Adduction)
Upward Rotation
Downward Rotation
Elevation
Depression
Anterior Tilt
Movements
• Focus on specific
bony landmarks
–inferior angle
–glenoid fossa
–acromion process
• Shoulder girdle
movements =
scapula movement
• Protraction
(abduction)
–scapula moves
laterally away from
spinal column
• Retraction
(adduction)
–scapula moves
medially toward
spinal column
• Upward Rotation
– turning glenoid
fossa upward &
moving inferior
angle
superolaterally away
from spinal column
• Downward Rotation
– returning inferior
angle inferomedially
toward spinal
column & glenoid
fossa to normal
position
• Elevation
–upward or
superior
movement, as in
shrugging
shoulders
• Depression
–downward or
inferior
movement, as in
returning to
normal position
Anterior Tilt
• Rotational movement of scapula
occurring during glenohumeral
hyperextension
• Superior border moving
anteroinferiorly & inferior angle
moving posterosuperiorly
Scapulohumeral Rhythm
• The coordinated movements of the
scapula, clavicle, and humerus
• Shoulder joint and shoulder girdle work
together in carrying out upper
extremity activities
• Glenohumeral movement requires the
scapulothoracic, acromioclavicular,
and sternoclavicular joints to also
move
Scapulohumeral Rhythm
• Scapula rotates 1o for every
2o movement of the humerus
(Overall 2:1 ratio of
glenohumeral to
scapulothoracic
movement)
• The scapula rotates 60
degrees, the humerus
abducts 120 degrees ,
totaling 180 degrees of
abduction at the GH joint
Shoulder Joint Shoulder Girdle
Flexion
Upward Rotation and Elevation
Extension
Downward Rotation and
Depression
Abduction
Upward Rotation
Adduction
Downward Rotation
Horizontal Adduction Protraction
Horizontal Abduction
Retraction
Medial Rotation
Protraction
Lateral Rotation
Retraction
Muscles that Move the Shoulder Girdle
• 5 muscles primarily involved in shoulder
girdle movements
– All originate on axial skeleton and insert on
scapula and/or clavicle
– Do not attach to humerus and do not
cause shoulder joint actions
– Essential in providing dynamic stability of
the scapula so it can serve as a relative
base of support for shoulder joint activities
such as throwing, batting, and blocking
Muscles that Move the Shoulder Girdle
• Posterior:
–Trapezius (upper, middle, and
lower)
–Levator Scapula
–Rhomboids (minor and major)
• Anterior:
–Serratus Anterior
–Pectoralis Minor
Trapezius Origins
• Upper Fibers:
Occipital Bone
(skull) and Spinous
Process of C7
• Middle Fibers:
Spinous Process of
T1-T5
• Lower Fibers:
Spinous Process of
T6-T12
Trapezius Insertions
• Upper Fibers:
– Lateral 1/3 of
clavicle
• Middle Fibers:
– Acromion Process
of Scapula
• Lower Fibers:
– Root of the Spine
of Scapula
Trapezius Actions
• Upper Fibers:
– Elevation of Scapula
• Middle Fibers:
– Retraction
– Upward Rotation of Scapula
• Lower Fibers:
– Depression
– Upward rotation of Scapula
Trapezius Integrated Functions
• Upper Fibers:
– Provide dynamic stability to the cervical spine
and shoulder
• Middle Fibers:
– Eccentrically decelerates scapular protraction
– Assists in dynamically stabilizing the scapula
• Lower Fibers:
– Eccentrically decelerates scapular elevation
– Assists in dynamically stabilizing the scapula
Levator Scapula
•
Origin:
– Transverse
Process of C1-C4
• Insertion:
– Medial Border of
Scapula
• Actions:
– Elevation of
Scapula
– Downward Rotation
of Scapula
– Extension of Head
and Neck
Levator Scapula Integrated
Functions
• Assists in eccentric deceleration of
depression and upward rotation of
scapula
• Assists in eccentric deceleration of
flexion of head and neck
• Assists in dynamic stabilization of the
cervical spine and scapula
Rhomboids Minor and Major
Origin:
• Minor: Spinous
Process of C7-T1
• Major: Spinous
Process of T2-T5
Insertion:
• Minor: Root of the
Spine of the Scapula
• Major: Between the
Root of the Spine of the
Scapula and the Inferior
Angle of the Scapula
Rhomboids Minor and Major Actions
• Retraction of
Scapula
• Downward
Rotation of
Scapula
Rhomboids Minor and Major Integrated
Functions
• Assists in
eccentric
deceleration of
scapular
protraction and
upward rotation
of scapula
• Assists in
stabilization of
scapula
Serratus Anterior
• Origin:
– Ribs 1-9
• Insertion:
– Anterior surface
of the medial
border of
scapula
• Actions:
– Protraction of
Scapula
– Upward Rotation
of Scapula
Serratus Anterior Integrated
Functions
• Assists in eccentric deceleration of
retraction of scapula
• Assists in stabilization of the
scapula
• Helps to hold the scapulothoracic
joint along the medial border of the
scapula
Pectoralis Minor
• Origin:
– Ribs 3-5
• Insertion:
– Coracoid Process of
Scapula
• Actions:
• Protraction of Scapula
• Depression of Scapula
• Downward Rotation of
Scapula
Pectoralis Minor Integrated
Functions
• Assists in
eccentric
deceleration of
retraction of
scapula
• Assists in dynamic
stabilization of the
scapula
Putting It All Together
• Scapular
Elevation:
–Upper Trapezius
–Levator Scapula
• Scapular
Depression:
–Lower Trapezius
–Pectoralis Minor
• Scapular
Protraction:
–Serratus Anterior
–Pectoralis Minor
• Scapuluar
Retraction:
–Middle Trapezius
–Rhomboids
Putting It All Together
• Scapular Upward Rotation:
–Serratus Anterior
–Upper and Lower Trapezius
• Scapular Downward Rotation:
–Rhomboids
–Levator Scapula
–Pectoralis Minor
Scapular Winging
• A winged scapula is a shoulder
condition in which the scapula
sticks out at the back, particularly
when performing pushing
exercises like the push up
• Common symptoms of a winged
scapula include the following:
– Pain and limited shoulder
elevation
– Difficulty in lifting weights
– Pressure on the scapula
from a chair when sitting
Scapular Winging
• A winged scapula can be caused by one of two
reasons:
– Damage to the long thoracic nerve of the
shoulder. It may cause paralysis of the serratus
anterior. Medical clearance is necessary before
engaging in any exercise
– General weakness of the serratus anterior
muscle. In this case, the winging scapula can be
improved with corrective exercises designed to
build strength in the weak serratus anterior
muscle.
Scapular Winging
• Three corrective exercises may
strengthen serratus anterior:
–Hand Walks, Arm Shuffle, Push Up
Plus
• Pay careful attention to
scapulohumeral rhythm and
symmetry
• Maintain a stable pelvis and neck
Hand Walks
The pattern is one hand up, next hand up,
one hand down, other hand down, repeat.
Arm Shuffle
Begin with your hands very wide. Shift your
weight back and forth while simultaneously
touching one hand on top of the other as
shown
Push Up Plus
Once you have completed a push up, add the
“plus” motion by protracting your scapula as
much as possible without changing your spinal
alignment. Hands should be shoulder width
apart.
Rounded Shoulders
• A common postural condition in which
the scapula are protracted and
depressed and the humeri are
medially rotated
• When the trapezius muscles are weak
they contribute to rounded shoulders
because they are unable to efficiently
oppose protraction of the scapula
(especially if protractors pectoralis
minor and serratus anterior are tight)
Trapezius Tightness
• Whenever a phone is crimped between head
and shoulder, it may cause tightness of the
upper trapezius
• Whenever a purse or book bag is carried
upon the shoulder, people subconsciously
elevate the scapula on the side which it is
carried. This causes the elevators to
isometrically contract for long periods of time
• This is another common posture that may
cause tightness of the upper trapezius
Rhomboids and Pectoralis Minor
• When rhomboids are weak they
can contribute to rounded
shoulders because they cannot
oppose protraction and depression
of the scapula
• When pectoralis minor is tight,
they can contribute to rounded
shoulders
Scapular Depression on Bench
• This is an exercise for
individuals who need
to work the lower
traps, rhomboids, and
serratus anterior
muscles
• Maintain a tall posture
throughout the
exercise and good
stability through the
abdominal complex.
Supine Row
• Lie under bar so that the bar
is at mid-sternum level
• Activate core by drawing in
• Perform row and lift body
towards the bar
• The bar should meet the
mid-sternum.
• Lower slowly
• AVOID retracting the
scapula before pulling
yourself up, it should be a
smooth action through the
scapulothoracic joint as you
lift yourself towards the bar.
Levator Scapula Stretch
• In the proper posture sit on a ball or chair with a
minimum of 90 degrees bend at the hips and knees
• Draw your belly button inward toward your spine
• Tuck your chin in and rotate the head in right direction
of your opposite pocket while retracting and
depressing shoulder of the side being stretched
• Hold for 20-30 seconds, repeat for 2-3 reps
Upper Trapezius Stretch
• In optimal posture sit on the ball or bench with a
minimum of 90 degree bend at the hips and
knees.
• Draw your belly button inward toward your
spine
• Tuck your chin in and slowly draw your left ear
to your left shoulder until tension is felt
• Hold for 20-30 seconds, repeat for 2-3 reps
•
Foam Roll Rhomboids
• Draw your belly button inward toward your
spine
• Stabilize the head in “neutral”
• Roll mid-back area on the foam roll
• If a “tender point” is located, stop rolling, and
rest on the tender point until pain decreases