Transcript Ch5 Powerpoint

CHAPTER 5:PART 1
THE UPPER EXTREMITY:
THE SHOULDER REGION
KINESIOLOGY
Scientific Basis of Human Motion, 12th edition
Hamilton, Weimar & Luttgens
Presentation Created by
TK Koesterer, Ph.D., ATC
Humboldt State University
Revised by Hamilton & Weimar
McGraw-Hill/Irwin
Copyright © 2012 by The McGraw-Hill Companies, Inc. All rights reserved.
OBJECTIVES
1. Name, locate, & describe the structure & ligamentous
reinforcements of the joints.
2. Name & demonstrate movements possible.
3. Name & locate muscles & muscle groups, and name
their primary actions.
4. Analyze the fundamental movements with respect to
joint & muscle actions.
5. Describe common injuries.
5-2
ACROMIOCLAVICULAR (AC) JOINT




Articulation of acromion &
distal end of clavicle.
Acromioclavicular ligament
strengthens joint
superiorly.
Aponeurosis of trapezius &
deltoid strengthen joint
posteriorly.
Coracoclavicular ligament
further stabilizes joint.
Fig 5.1
5-3






STERNOCLAVICULAR (SC)
JOINT
Proximal
clavicle articulates with
sternum and cartilage of 1st rib.
Capsule thickened by anterior &
posterior sternoclavicular
ligaments.
The only bony connection between
the humerus and axial skeleton.
Permits limited motion of the
clavicle.
Fig 5.2
Partially responsible for movements of the scapula.
Clavicular movements at the SC joint:
 elevation & depression,
 protraction & retraction,
 forward & backward rotation.
5-4
MOVEMENTS OF THE SHOULDER
GIRDLE
Fig 5.3 a & b
Elevation
Depression
Abduction (Protraction)
Adduction (Retraction)
5-5
MOVEMENTS OF THE SHOULDER
GIRDLE
Fig 5.3 c & d
Upward rotation
Downward rotation
Anterior tilt
Posterior tilt
5-6
MUSCLES OF THE SHOULDER GIRDLE

Location:
 Anterior
 Pectoralis
minor, Serratus anterior, Subclavius
 Posterior
 Levator
scapulae, Rhomboids, Trapezius
5-7
PECTORALIS MINOR
Function:
 Movements of scapula:
downward rotation,
anterior tilt, depression.
 Lifting effect on ribs in
forced inspiration and
posture.
Fig 5.4
5-8
SERRATUS ANTERIOR
Function:
 Abduct (protract)
scapula.
 With trapezius, upward
rotation of scapula.
 Active in reaching and
pushing.
Fig 5.4
5-9
SUBCLAVIUS
Function:
 Protect and stabilize
sternoclavicular joint.
 Depress scapula.
Fig 5.4
5-10
LEVATOR SCAPULAE
Function:
 Elevation and
downward rotation of
scapula.
Fig 5.5
5-11
RHOMBOIDS, MAJOR AND MINOR
Function:
 Downward rotation,
adduction (retraction), &
elevation of scapula.
 Works with trapezius for
maintenance of good
posture.
Fig 5.5
5-12
TRAPEZIUS
Function:
I. Elevation
II. Elevation, upward
rotation, adduction
III. Adduction
IV. Upward rotation,
depression, adduction
Fig 5.6
5-13
GLENOHUMERAL (SHOULDER)
JOINT
STRUCTURE


Articulation of spherical
head of humerus with
small, shallow glenoid
fossa of scapula.
Glenoid labrum
deepens the fossa and
cushions impact of
humeral head in
forceful movements.
Fig 5.7
Fig 5.8
5-14
LIGAMENTOUS REINFORCEMENTS
Coracohumeral
 Glenohumeral
 Coracoacromial

Fig 5.9
5-15
MUSCULAR REINFORCEMENTS
Superior: supraspinatus & long head of biceps.
 Inferior: long head of triceps.
 Anterior: subscapularis, pectoralis major, &
teres major.
 Posterior: infraspinatus & teres minor.

5-16
MOVEMENTS OF THE SHOULDER
JOINT

Flexion / Extension
 Hyperextension
Circumduction
 Abduction / Adduction

 Horizontal
 Diagonal

Internal / External
Rotation
External rotation
Internal rotation
5-17
MUSCLE OF THE SHOULDER JOINT

Location:
 Anterior:
Pectoralis major, coracobrachialis,
subscapularis, biceps brachii.
 Posterior: Infraspinatus, teres minor.
 Superior: Deltoid, supraspinatus.
 Inferior: Latissimus dorsi, teres major, long head
of triceps brachii.
5-18
PECTORALIS MAJOR
Function:
Clavicular portion – flexion,
horizontal adduction, and
internal rotation of
humerus.
Sternal portion – downward &
forward movements of arm,
& internal rotation with
adduction.
Fig 5.11
5-19
CORACOBRACHIALIS
Function:
 Horizontal adduction
 Acts like a guy wire to
stabilize the shoulder
joint.
Fig 5.12
5-20
BICEPS BRACHII
Function:
 Flexion at the elbow &
supination of forearm.
 Horizontal adduction at
shoulder.
 Short head sometimes
active in adduction &
internal rotation.
Fig 5.12
5-21
DELTOID
Function:
 Anterior – all forward
movements & internal
rotation of humerus.

Middle – abduction
 Powerful
abductor of
humerus.
 Posterior – extension,
hyperextension, horizontal
extension, adduction.
Fig 5.14
5-22
SUBSCAPULARIS
Function:
 Internal rotation of
humerus as part of
the rotator cuff.
 Contributes to
stability of shoulder
joint.
Fig 5.13a
5-23
SUPRASPINATUS
Function:
 Acts with deltoid in
abduction of the arm.
 Active in flexion &
horizontal extension.
 Contributes to stability
of shoulder joint.
 Part of the rotator cuff.
Fig 5.13b
5-24
INFRASPINATUS AND TERES MINOR
Function:
 External rotation as part
of the rotator cuff.
 With subscapularis
depresses head of
humerus.
 Contributes to stability of
shoulder joint.
Fig 5.13b
5-25
LATISSIMUS DORSI
Function:
 Extension & adduction of
arm, internal rotation.
Fig 5.14
5-26
TERES MAJOR
Function:
 Internal rotation,
extension, & adduction
of the arm.
Fig 5.15
5-27
TRICEPS BRACHII
Function:
 Long head assists in
adduction, extension,
and hyperextension of
the humerus.
Fig 5.15
5-28
JOINT AND MUSCULAR ANALYSIS OF THE
FUNDAMENTAL MOVEMENTS OF THE ARM ON
THE TRUNK

Movements of the arm on the trunk
involve the cooperative action of the
shoulder girdle
 Acromioclavicular
joints
 Sternoclavicular joints
and the shoulder (glenohumeral)
joint.
5-29
MOVEMENTS IN THE FRONTAL PLANE


Shoulder Joint: Abduction
 Deltoid & supraspinaus
Shoulder Girdle: Upward rotation of
scapula
 Serratus anterior; trapezius II & IV
Fig 5.16


Shoulder Joint: Adduction
 Latissimus dorsi, teres major,
pectoralis major (sternal), & post.
deltoid.
Shoulder Girdle: reduction of upward
rotation
 Rhomboids & pectoralis minor.
Fig 5.17
5-30
MOVEMENTS IN THE SAGITTAL PLANE

Shoulder Joint: Flexion
 Anterior
deltoid &
pectoralis major
(clavicular).

Shoulder Girdle: Upward
rotation of scapula
 Serratus
anterior &
trapezius II & IV.
Fig 5.18
5-31
MOVEMENTS IN THE SAGITTAL PLANE
Fig 5.19
 Shoulder Joint: Extension
Fig 5.20
 Pectoralis major (sternal), teres
major, latissimus dorsi, post.
deltoid.


 Shoulder Girdle: Reduction of
upward rotation of scapula
 Relaxation of agonists
 Against resistance - trapezius IV,
rhomboids, pect. minor.
Shoulder Joint: Hyperextension

Teres major, latissimus dorsi,
post. Deltoid.
Shoulder Girdle: Anterior tilt of
scapula

Pectoralis minor.
5-32
MOVEMENTS IN THE HORIZONTAL PLANE

Shoulder Joint: External
Rotation
 Infraspinatus
minor

& teres
Shoulder Girdle:
Adduction of scapula
 Rhomboids
& trapezius III.
Fig 5.22a
5-33
MOVEMENTS IN THE HORIZONTAL PLANE






Shoulder Joint: Internal Rotation
 Subscapularis, teres major, latissimus
dorsi, ant. deltoid, pectoralis major.
Shoulder Girdle: Abduction of scapula
 Serratus anterior & pectoralis minor.
Shoulder Joint: Horizontal Adduction
 Pectoralis major, ant. deltoid, &
coracobrachialis.
Shoulder Girdle: Abduction of scapula
 Serratus anterior & pectoralis minor
Fig 5.22b
Shoulder Joint: Horizontal Abduction
 Post. deltoid, post middle deltoid, infraspinatus, teres minor,
long head of biceps.
Shoulder Girdle: Adduction of scapula
 Rhomboids & trapezius III.
5-34
DIAGONAL MOVEMENTS

Diagonal forward-downward and slightly
inward movement of the arm.
Fig 5.10
Fig 5.23
5-35
COMMON INJURIES OF THE SHOULDER
REGION: ACROMIOCLAVICULAR SPRAIN

AC joint forced beyond normal ROM.
 Downward
blow to outer end of shoulder.
 Fall on outstretched hand.

Damage consists of tearing or severe
stretching of AC ligaments.
5-36
COMMON INJURIES OF THE
SHOULDER REGION: FRACTURE OF
THE CLAVICLE

Clavicle fractures have causes similar to
AC sprain:
 Downward
blow to outer end of shoulder.
 Fall on outstretched hand.

May indicate injury by supporting injured
arm.
 Head
may be tilted toward injured side with
face turned to opposite side.
5-37
COMMON INJURIES OF THE
SHOULDER REGION: DISLOCATION
OF THE SHOULDER


May be forward, downward, or posterior.
Most likely when arm is forcefully abducted and
laterally rotated.



May occur by a blow to top of shoulder .
Head of humerus is forced out of the glenoid
fossa.
Arm held out from side in a position of slight
abduction and lateral rotation.

Loss of normal rounded contour of deltoid muscle.
5-38
COMMON INJURIES OF THE
SHOULDER REGION: ROTATOR
CUFF TEARS
Supraspinatus (supraspinatus tendon)
most often injured.
 Nature of injury depends on arm
kinematics.
 Caused by overuse, falls, or violent, fast
arm motion.

5-39
COMMON INJURIES OF THE
SHOULDER REGION: SHOULDER
IMPINGEMENT
Soft tissue superior to humeral head
pressed against acromion process.
 Due to overuse, inflammation, trapped
bursa, degeneration with aging.
 Will cause pain and inflammation in
shoulder.

5-40