© McGraw-Hill Higher Education. All rights reserved. 4-1 Chapter 4 The Shoulder Girdle Manual of...

© McGraw-Hill Higher Education. All rights © McGraw-Hill Higher Education. All rights reserved. reserved. 4-4-11

Chapter 4Chapter 4The Shoulder GirdleThe Shoulder Girdle

Manual of Structural KinesiologyManual of Structural KinesiologyR.T. Floyd, EdD, ATC, CSCSR.T. Floyd, EdD, ATC, CSCS


BonesBones

• Scapula & Scapula & clavicleclavicle– Move as a unitMove as a unit– Clavicle’s Clavicle’s

articulation with articulation with sternum is only sternum is only bony link to bony link to axial skeletonaxial skeleton


BonesBones

• Key bony landmarksKey bony landmarks– ManubriumManubrium– ClavicleClavicle– Coracoid processCoracoid process– Acromion processAcromion process– Glenoid fossaGlenoid fossa– Lateral borderLateral border– Inferior angleInferior angle– Medial borderMedial border


BonesBones

• Key bony landmarksKey bony landmarks– Acromion processAcromion process– Glenoid fossaGlenoid fossa– Lateral borderLateral border– Inferior angleInferior angle– Medial borderMedial border– Superior angleSuperior angle– Spine of the scapula Spine of the scapula

From Seeley RR, Stephens TD, Tate P; anatomy and physiology, ed 7, New York, 2006, McGraw-Hill


JointsJoints

• Shoulder girdle (scapulothoracic)Shoulder girdle (scapulothoracic)– scapula moves on the rib cagescapula moves on the rib cage– joint motion occurs at sternoclavicular joint joint motion occurs at sternoclavicular joint

& to a lesser amount at the & to a lesser amount at the acromioclavicular jointacromioclavicular joint


JointsJoints

• Sternoclavicular (SC)Sternoclavicular (SC)– (multiaxial) arthrodial classification(multiaxial) arthrodial classification– MovementsMovements

• anteriorly 15 degrees with protractionanteriorly 15 degrees with protraction• posteriorly 15 degrees with retractionposteriorly 15 degrees with retraction• superiorly 45 degrees with elevation superiorly 45 degrees with elevation • inferiorly 5 degrees with depressioninferiorly 5 degrees with depression


JointsJoints

• Sternoclavicular (SC)Sternoclavicular (SC)– Ligamentous supportLigamentous support

• anteriorly by the anterior SC ligamentanteriorly by the anterior SC ligament• posteriorly by the posterior SC ligamentposteriorly by the posterior SC ligament• costoclavicular & interclavicular costoclavicular & interclavicular

ligaments provide stability against ligaments provide stability against superior displacementsuperior displacement


JointsJoints

• Acromioclavicular (AC)Acromioclavicular (AC)– arthrodial classificationarthrodial classification– 20- to 30-degree total gliding & rotational motion 20- to 30-degree total gliding & rotational motion

accompanying other shoulder girdle & shoulder accompanying other shoulder girdle & shoulder joint motionsjoint motions

– supported bysupported by• Coracoclavicular ligamentsCoracoclavicular ligaments• Superior acromioclavicular ligamentSuperior acromioclavicular ligament• Inferior acromioclavicular ligamentInferior acromioclavicular ligament

– often injuredoften injured


JointsJoints

• ScapulothoracicScapulothoracic– not a true synovial jointnot a true synovial joint– does not have regular synovial featuresdoes not have regular synovial features– movement depends on SC & AC joints movement depends on SC & AC joints

which allows the scapula to move which allows the scapula to move • 25-degrees abduction-adduction25-degrees abduction-adduction• 60-degrees upward-downward rotation60-degrees upward-downward rotation• 55-degrees elevation-depression55-degrees elevation-depression

– supported dynamically by its musclessupported dynamically by its muscles– no ligamentous supportno ligamentous support


MovementsMovements

• Focus on specific Focus on specific bony landmarksbony landmarks– inferior angle inferior angle – glenoid fossa glenoid fossa – acromion processacromion process

• Shoulder girdle Shoulder girdle movements = scapula movements = scapula movementsmovements


MovementsMovements

• Abduction Abduction (protraction)(protraction)– scapula moves scapula moves

laterally away from laterally away from spinal columnspinal column

• Adduction (retraction)Adduction (retraction)– scapula moves scapula moves

medially toward spinal medially toward spinal columncolumn


MovementsMovements

• Downward rotationDownward rotation– returning inferior angle returning inferior angle

inferomedially toward inferomedially toward spinal column & glenoid spinal column & glenoid fossa to normal positionfossa to normal position

• Upward rotationUpward rotation– turning glenoid fossa turning glenoid fossa

upward & moving inferior upward & moving inferior angle superolaterally angle superolaterally away from spinal columnaway from spinal column


MovementsMovements

• DepressionDepression– downward or inferior downward or inferior

movement, as in movement, as in returning to normal returning to normal positionposition

• ElevationElevation– upward or superior upward or superior

movement, as in movement, as in shrugging shouldersshrugging shoulders


MovementsMovements

• Shoulder joint & shoulder girdle work Shoulder joint & shoulder girdle work together in carrying out upper extremity together in carrying out upper extremity activitiesactivities

• Shoulder girdle movement is not Shoulder girdle movement is not dependent upon the shoulder joint & its dependent upon the shoulder joint & its musclesmuscles


MovementsMovements

• Shoulder girdle musclesShoulder girdle muscles– Stabilize scapula so the shoulder joint Stabilize scapula so the shoulder joint

muscles will have a stable base from which muscles will have a stable base from which to exert force for moving the humerusto exert force for moving the humerus

– Contract to maintain scapula in a relatively Contract to maintain scapula in a relatively static position during shoulder joint actionsstatic position during shoulder joint actions

– Contract to move shoulder girdle & to Contract to move shoulder girdle & to enhance movement of upper extremity enhance movement of upper extremity when shoulder goes through extreme when shoulder goes through extreme ranges of motionranges of motion


MovementsMovements

• For some shoulder girdle movements, For some shoulder girdle movements, scapula must rotate or tilt on its axisscapula must rotate or tilt on its axis

• Lateral tilt (outward tilt)Lateral tilt (outward tilt)– during abduction during abduction – scapula rotates about its vertical axis resulting in scapula rotates about its vertical axis resulting in

posterior movement of medial border & anterior posterior movement of medial border & anterior movement of lateral bordermovement of lateral border

• Medial tilt (return from lateral tilt, inward tilt)Medial tilt (return from lateral tilt, inward tilt)– during extreme adductionduring extreme adduction– scapula rotates about its vertical axis resulting in scapula rotates about its vertical axis resulting in

anterior movement of medial border & posterior anterior movement of medial border & posterior movement of lateral bordermovement of lateral border


MovementsMovements

• Anterior tilt (upward tilt)Anterior tilt (upward tilt)– rotational movement of scapula about frontal axis rotational movement of scapula about frontal axis

occurring during glenohumeral hyperextensionoccurring during glenohumeral hyperextension– superior border moving anteroinferiorly & inferior superior border moving anteroinferiorly & inferior

angle moving posterosuperiorlyangle moving posterosuperiorly

• Posterior tilt (downward tilt)Posterior tilt (downward tilt)– rotational movement of scapula about frontal axis rotational movement of scapula about frontal axis

occurring during glenohumeral hyperflexionoccurring during glenohumeral hyperflexion– superior border moving posteroinferiorly & inferior superior border moving posteroinferiorly & inferior

angle moving anterosuperiorly angle moving anterosuperiorly


MovementsMovements

• Synergy with muscles of glenohumeral jointSynergy with muscles of glenohumeral joint– As shoulder joint goes through more extreme As shoulder joint goes through more extreme

ranges of motion, scapular muscles contract to ranges of motion, scapular muscles contract to move shoulder girdle so that its glenoid fossa will move shoulder girdle so that its glenoid fossa will be in a more appropriate position from which the be in a more appropriate position from which the humerus can movehumerus can move

– Without the accompanying scapula movement Without the accompanying scapula movement humerus can only be raised into approximately 90 humerus can only be raised into approximately 90 degrees of total shoulder abduction & flexiondegrees of total shoulder abduction & flexion


MovementsMovements

• Synergy with muscles of glenohumeral jointSynergy with muscles of glenohumeral joint– This works through the appropriate muscles of This works through the appropriate muscles of

both joints working in synergy to accomplish the both joints working in synergy to accomplish the desired action of the entire upper extremitydesired action of the entire upper extremity

– Ex. to raise our hand out to the side laterally as Ex. to raise our hand out to the side laterally as high as possible, the serratus anterior & trapezius high as possible, the serratus anterior & trapezius (middle & lower fibers) muscles upwardly rotate (middle & lower fibers) muscles upwardly rotate scapula as supraspinatus & deltoid initiate scapula as supraspinatus & deltoid initiate glenohumeral abductionglenohumeral abduction

– This synergy between scapula & shoulder joint This synergy between scapula & shoulder joint muscles enhances movement of entire upper muscles enhances movement of entire upper extremityextremity


Shoulder Shoulder

GirdleGirdleMovemeMoveme

ntsnts

ElevationElevation

DepressionDepression

AbductionAbductionAdductionAdduction

UpwardUpward

RotationRotation

Downward

DownwardRotation

Rotation


MusclesMuscles

• 5 muscles primarily involved in 5 muscles primarily involved in shoulder girdle movementsshoulder girdle movements– All originate on axial skeleton & insert All originate on axial skeleton & insert

on scapula and/or clavicleon scapula and/or clavicle– Do not attach to humerus & do not Do not attach to humerus & do not

cause shoulder joint actionscause shoulder joint actions– Essential in providing dynamic stability Essential in providing dynamic stability

of the scapula so it can serve as a of the scapula so it can serve as a relative base of support for shoulder relative base of support for shoulder joint activities such as throwing, joint activities such as throwing, batting, & blockingbatting, & blocking


Shoulder Girdle MusclesShoulder Girdle Muscles

• 5 muscles primarily 5 muscles primarily involved in shoulder involved in shoulder girdle movementsgirdle movements– Trapezius - upper, Trapezius - upper,

middle, lowermiddle, lower– Rhomboid - deepRhomboid - deep– Levator scapulaLevator scapula– Serratus anteriorSerratus anterior– Pectoralis minor - Pectoralis minor -

deepdeep



• Location & actionLocation & action– AnteriorAnterior

• Pectoralis minor – abduction, downward rotation, & Pectoralis minor – abduction, downward rotation, & depressiondepression

• Subclavius – depressionSubclavius – depression

– Posterior & laterallyPosterior & laterally• Serratus anterior – abduction & upward rotationSerratus anterior – abduction & upward rotation



• Location & actionLocation & action– PosteriorPosterior

• TrapeziusTrapezius

• Upper fibers – elevation & extension of the headUpper fibers – elevation & extension of the head

• Middle fibers – elevation, adduction, & upper rotationMiddle fibers – elevation, adduction, & upper rotation

• Lower fibers – adduction, depression, & upper Lower fibers – adduction, depression, & upper rotationrotation

• Rhomboid – adduction, downward rotation, & Rhomboid – adduction, downward rotation, & elevationelevation

• Levator scapulae – elevationLevator scapulae – elevation


NervesNerves• Shoulder girdle muscles primarily Shoulder girdle muscles primarily

innervated by innervated by cervicalcervical & brachial & brachial plexusplexus

From Seeley RR, Stephens TD, Tate P: Anatomy and physiology, ed 6, Dubuque, IA, 2003, McGraw-Hill


NervesNerves• Shoulder girdle muscles primarily Shoulder girdle muscles primarily

innervated by cervical & innervated by cervical & brachialbrachial plexusplexus

From Seeley RR, Stephens TD, Tate P: Anatomy and physiology, ed 6, Dubuque, IA, 2003, McGraw-Hill


NervesNerves

• Branches of C3 & C4Branches of C3 & C4– Trapezius Trapezius – Levator scapulaLevator scapula

• Spinal accessory nerve Spinal accessory nerve – Trapezius Trapezius


NervesNerves

• Dorsal scapula nerveDorsal scapula nerve– Levator scapulaLevator scapula– RhomboidRhomboid

• Long thoracic nerve originating Long thoracic nerve originating from C5, C6, & C7from C5, C6, & C7– Serratus anteriorSerratus anterior

• Medial pectoral nerve originating Medial pectoral nerve originating from C8 & T1from C8 & T1– Pectoralis minorPectoralis minor


Trapezius muscleTrapezius muscle

Lower fibers: Lower fibers: depression, depression, adduction, & adduction, & upward rotationupward rotation

Upper fibers: elevation Upper fibers: elevation of scapula, extension of scapula, extension & rotation of head& rotation of head

Middle fibers: elevation, Middle fibers: elevation, upward rotation, & upward rotation, & adductionadduction


Levator scapulae muscleLevator scapulae muscleElevates the medial Elevates the medial

margin of the margin of the scapulascapula


Rhomboid muscles - major & Rhomboid muscles - major & minorminor

Downward rotation: Downward rotation: from upward rotated from upward rotated position they draw position they draw scapula in scapula in downward rotationdownward rotation

Elevation: slight Elevation: slight upward movement upward movement accompanying accompanying adductionadduction

Rhomboid major & minor muscles Rhomboid major & minor muscles work togetherwork together

Adduction (retraction): draw Adduction (retraction): draw scapula toward spinal columnscapula toward spinal column


Serratus anterior muscleSerratus anterior muscle

Upward rotation: Upward rotation: longer, lower longer, lower fibers tend to fibers tend to draw inferior draw inferior angle of angle of scapula farther scapula farther away from away from vertebrae, thus vertebrae, thus rotating rotating scapula upward scapula upward slightlyslightly

Abduction (protraction): draws medial Abduction (protraction): draws medial border of scapula away from vertebraeborder of scapula away from vertebrae


Pectoralis minor musclePectoralis minor muscle Abduction (protraction): draws Abduction (protraction): draws

scapula forward & tends to tilt scapula forward & tends to tilt lower border away from ribslower border away from ribs

Depression: when Depression: when scapula is rotated scapula is rotated upward, it assists upward, it assists in depressionin depression

Downward rotation: as it Downward rotation: as it abducts, it draws abducts, it draws scapula downwardscapula downward


Subclavius muscleSubclavius muscle

Stabilization & protection of Stabilization & protection of sternoclavicular jointsternoclavicular joint

AbductionAbduction

DepressionDepression


Scapula AbductionScapula Abduction• Scapula move laterally away from Scapula move laterally away from

spinous processes without rotationspinous processes without rotation

• EX. Push-up & bench pressEX. Push-up & bench press

• AgonistsAgonists– PectoralisPectoralis

minor minor– SerratusSerratus

anterior anterior


Scapula AdductionScapula Adduction

• Return from Return from abductionabduction

• Occurs with Occurs with retractionsretractions

• AgonistsAgonists– Middle TrapeziusMiddle Trapezius– RhomboidsRhomboids


Scapula Upward RotationScapula Upward Rotation

• Lateral & Lateral & upward upward movementmovement

• AgonistsAgonists– Middle Middle

TrapeziusTrapezius– Lower Lower

TrapeziusTrapezius– Serratus Serratus

anterioranterior


Scapula Downward RotationScapula Downward Rotation

• Downward & Medial MovementDownward & Medial Movement• Glenoid Fossa is rotated downward when downward Glenoid Fossa is rotated downward when downward

movement of shoulder joint occursmovement of shoulder joint occurs• EX. Lat Pulls - EX. Lat Pulls -

pulling wt. downpulling wt. down• AgonistsAgonists

– Pectoralis MinorPectoralis Minor– RhomboidRhomboid


Scapula ElevationScapula Elevation

• Lifting scapula without rotation in anatomic positionLifting scapula without rotation in anatomic position• Shoulder ShrugShoulder Shrug

• AgonistsAgonists– LevatorLevator

ScapulaScapula– UpperUpper

TrapeziusTrapezius– RhomboidRhomboid


Scapula DepressionScapula Depression

• EX. DipEX. Dip

• AgonistsAgonists– Lower Lower

TrapeziusTrapezius– Pectoralis Pectoralis

MinorMinor


Web SitesWeb SitesRadiologic Anatomy Browser

http://radlinux1.usuf1.usuhs.mil/rad/iong/index.html – This site has numerous radiological views of the musculoskeletal

system.University of Arkansas Medical School Gross Anatomy for Medical

Studentshttp://anatomy.uams.edu/anatomyhtml/grossresources.html– Dissections, anatomy tables, atlas images, links, etc.

Loyola University Medical Center: Structure of the Human Bodywww.meddean.luc.edu/lumen/MedEd/GrossAnatomy/GA.html– An excellent site with many slides, dissections, tutorials, etc., for the

study of human anatomyWheeless’ Textbook of Orthopaedics

www.wheelessonline.com/– This site has an extensive index of links to the fractures, joints,

muscles, nerves, trauma, medications, medical topics, lab tests, and links to orthopedic journals and other orthopedic and medical news.


Web SitesWeb SitesScapulothoracic Positions and Motion

www.orthop.washington.edu/uw/scapulothoracic/tabID__3376/ItemID__212/Articles/Default.aspx

– Scapula movements and movies The Physician and Sportsmedicine

www.physsportsmed.com/issues/2003/0703/depalma.htm – Detecting and Treating Shoulder Impingement Syndrome: The

Role of Scapulothoracic DyskinesisThe Physician and Sportsmedicine

www.physsportsmed.com/issues/2001/11_01/johnson.htm– Acromioclavicular Joint Injuries: Identifying and Treating

'Separated Shoulder' and Other ConditionsThe Physician and Sportsmedicine

www.physsportsmed.com/issues/1999/02_99/williams.htm– Posterior Sternoclavicular Joint Dislocation


Web SitesWeb SitesBaseball Almanac

www.baseball-almanac.com/chapters/cap-ch8.shtml– Coaching Adult Pitchers

Lecture Topics in Kinesiologyhttp://moon.ouhsc.edu/dthompso/namics/shoulder.htm– Shoulder articulations, movements, and muscles that are

within the shoulder girdle.Premiere Medical Search Engine

www.medsite.com– This site allows the reader to enter any medical condition and

it will search the net to find relevant articles.Virtual Hospital

www.vh.org– Numerous slides, patient information, etc.

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