Shoulder jointShoulder joint

Mazyad AlotaibiMazyad Alotaibi

SCAPULA

1. Scapula Abduction and Upward Rotation

2. Scapula Elevation

3. Scapula Adduction

4. Scapula Depression and Adduction

5. Scapula Adduction and Downward Rotation

Scapular motionsScapular motions

Scapula Abduction and Upward Rotation

1- Prime mover/agonist: Serratus anterior

Synergist/ Accessory muscles: Pectoralis minor.

2- Range of motion: measure the distance between spine process and medial border of scapula

Scapula Abduction and Upward Rotation

3-Fixation: a. in strong scapular abduction, by pull of obliqus externus abdominis on same side.

b. By weight of thorax.

4- Effect of weakness/contracture/shortening: Effect of weakness result in:

- Winging of Scapula - In ability to raise the arm overhead.

5- Factor limited range of motion: a. Tension of trapezoid ligament. b. Tension of trapezius and rhomboid major and rhomboid minor muscles.

6- Substitution: None.

Scapula Abduction and Upward Rotation7- Procedures:

a- Position of Patient: b- Position of Therapist : inner hand, Outer hand,

Direction of Resistance c- Test

d- Instruction to patient

Patient Position :

Patient should be supine with shoulder flexed to 90. The shoulder should be raised off the table,

hand in a fist .

Therapist and Patient Instructions :

Therapist stands over the patient, resistance is given over the hand in a downward direction. The

stabilizing hand is placed around the wrist .

 

Scapula Elevation

1- Prime mover/agonist: --Trapezius (superior fibers(

- Levator scapulae

Synergist/ Accessory muscles: Rhomboids major and minor

2- Range of motion: measure the distance between top of the shoulder and loops of ear..

Scapula Elevation3- Fixation: a. flexor muscles of cervical spine..

b. weight of head. 4-Effect of weakness/contracture/shortening: Effect of weakness result in:Effect of weakness result in: Inability to raise shoulder upwards; either

bilateral or unilateral weakness. 5-Factor limited range of motion:

a. Tension of costoclavicular ligament.

b. Tension of scapular depression muscle and clavicle: pectoralis minor,

subclavius, and trapezius (lower fibers) muscles. 6-Substitution: by Rhomboids (scapula adduction and downward rotation) inferior angle will move medially.

Scapula Elevation7- Procedures:a- Position of Patient:

b- Position of Therapist : inner hand, Outer hand, Direction of Resistance

c- Test d- Instruction to patient

Scapula Adduction (Retraction) Scapula Adduction (Retraction)

1- Prime mover/agonist: TrapeziusTrapezius) (middle fibers)

Synergist/ Accessory muscles: Rhomboid major and minor, and Trapezius (upper and lower fibers)

2- Range of motion: measure the distance between transverse process and medial border of scapula

Scapula Adduction (Retraction)

3- Fixation:- weight of thorax.

4- Effect of weakness/contracture/shortening: - Inability to adduct the scapula.

5- Factor limited range of motion: a. Tension of conoid ligament. b. Tension of pectoralis major and minor, and serratus anterior muscles.

c. Contact of vertebral border of scapula with spinal musculature. 6- Substitution: - Rhomboids (scapula adduction and downward rotation) inferior angle will move medially.- Post. Deltoid if the scapular muscles are absent (horizontal adduction of

shoulder will occur).

Scapula Adduction (Retraction)7- Procedures:a- Position of Patient:

b- Position of Therapist : inner hand, Outer hand, Direction of Resistance

c- Test d- Instruction to patient

Scapula Depression and Adduction

1- Prime mover/agonist: 1- Prime mover/agonist: TrapeziusTrapezius (lower fibers) Synergist/ Accessory muscles:

latissimus dorsi.

2- Range of motion: measure the distance between spine

process and inferior angle of scapula

Scapula Depression and Adduction

3- Fixation: a. By contraction pf spinal extensor muscles.

b. By weight of thorax. 4- Effect of weakness/contracture/shortening: Effect of weakness result in:Effect of weakness result in:

- In ability to raise the arm overhead.

5- Factor limited range of motion: a. Tension of inter clavicular ligament and articular disk of sternoclavicular

joint. b. Tension of trapezius muscle.

6- Substitution: None. None.

Scapula Depression and Adduction

7- Procedures: a- Position of Patient:

b- Position of Therapist : inner hand, Outer hand, Direction of Resistance

c- Test d- Instruction to patient

Scapula Adduction and Downward Rotation

1- Prime mover/agonist: Rhomboid major and minorRhomboid major and minor

Synergist/ Accessory muscles: Levator scapulae.

2- Range of motion: The distance between the vertebral The distance between the vertebral border of scapula and vert sp. border of scapula and vert sp.

Scapula Adduction and Downward Rotation

3- Fixation:By weight of thorax.By weight of thorax. 4- Effect of weakness/contracture/shortening:

- The scapula will abduct and the inferior angle rotate outward. - Inability to adduct & downward rotate the scapula.

5- Factor limited range of motion: a. Tension of conoid ligament.b. Tension of pectoralis major and minor, serratus anterior muscles.

c. Contact of vertebral border of scapula with spinal musculature. 6- Substitution: by middle trapezius (only adduct the scapula without downward rotation).

Scapula Adduction and Downward Rotation7- Procedures:a- Position of Patient:

b- Position of Therapist : inner hand, Outer hand, Direction of Resistance

c- Test d- Instruction to patient

Shoulder flexion1- Prime mover/agonist: Anterior DeltoidAnterior DeltoidCoracobrachialisCoracobrachialis

Synergist/ Accessory muscles: Synergist/ Accessory muscles: Pectoralis minor (upper), deltoid (middle), serratus Pectoralis minor (upper), deltoid (middle), serratus

anterior anterior

2- Range of motion: 0 to 80-900 to 80-90

Shoulder flexionShoulder flexion3- Fixation: 3- Fixation: a. By Contraction of trapezius and serratus anterior muscles. a. By Contraction of trapezius and serratus anterior muscles.

4- Effect of weakness/contracture/shortening: 4- Effect of weakness/contracture/shortening: Effect of weakness result in: Effect of weakness result in:

- Decrease the strength of shoulder flexors.- Decrease the strength of shoulder flexors. 5- Factor limited range of motion: 5- Factor limited range of motion: a. Contact of greater tubercle and humerus with anterior surface of acromion.a. Contact of greater tubercle and humerus with anterior surface of acromion.

b. Tension of shoulder extensor muscles. b. Tension of shoulder extensor muscles.

6- Substitution: 6- Substitution: by:by:

a. in the absence of a Deltoid the patient may attempt to flex the shoulder with a. in the absence of a Deltoid the patient may attempt to flex the shoulder with the Biceps brachii by first externally rotating the shoulder then flex it.the Biceps brachii by first externally rotating the shoulder then flex it.

b. the upper Trapezius results in shoulder elevation.b. the upper Trapezius results in shoulder elevation. c. the Pectoralis major results in horizontal adduction. c. the Pectoralis major results in horizontal adduction. d. the patient may lean backward or try to elevate the shoulder girdle to assist in d. the patient may lean backward or try to elevate the shoulder girdle to assist in

flexion. flexion.

Shoulder flexionShoulder flexion

7- Procedures:7- Procedures:a- Position of Patient:

b- Position of Therapist : inner hand, Outer hand, Direction of Resistance

c- Test d- Instruction to patient

Shoulder extensionShoulder extension1- Prime mover/agonist:

Latissimus dorsiLatissimus dorsi))DeltoidDeltoid

Teres majorTeres major

Synergist/ Accessory muscles: Triceps brachii (long head). Triceps brachii (long head).

2-Range of motion: from 90 to 0 from prone lying position is shoulder extension.from 90 to 0 from prone lying position is shoulder extension.from 0 to 45 up to 60 is hyperextension from 0 to 45 up to 60 is hyperextension

Shoulder extensionShoulder extension3-Fixation: a. By contraction of rhomboideus major and minor, and trapezius muscles. a. By contraction of rhomboideus major and minor, and trapezius muscles.

b. By weight of trunk.b. By weight of trunk. 4-Effect of weakness/contracture/shortening: : Effect of weakness result in: Effect of weakness result in: - Weakness of latissimus dorsi result in: diminishing the strength of shoulder - Weakness of latissimus dorsi result in: diminishing the strength of shoulder

extension and lateral trunk flexion.extension and lateral trunk flexion. - Weakness of teres major result in: diminishing the strength shoulder extension - Weakness of teres major result in: diminishing the strength shoulder extension

and medial rotation. and medial rotation.

5-Factor limited range of motion: a. Tension of shoulder flexor muscles.a. Tension of shoulder flexor muscles. b. Contact of greater tubercle and humerus with acromion posteriorly. b. Contact of greater tubercle and humerus with acromion posteriorly.

6-Substitution: by Rhomboids (scapula adduction and downward rotation)by Rhomboids (scapula adduction and downward rotation) inferior angle will move medially.inferior angle will move medially.

Shoulder extensionShoulder extension7- Procedures:a- Position of Patient:

b- Position of Therapist : inner hand, Outer hand, Direction of Resistance

c- Test d- Instruction to patient

Shoulder abductionShoulder abduction1- AnatomyPrime mover/agonist:

DeltoidDeltoid (medial fibers)(medial fibers)

SupraspinatusSupraspinatus))

Synergist/ Accessory muscles: Deltoid ( Ant& Pos fibers)Deltoid ( Ant& Pos fibers)

2- Range of motion: from 0 to 170 (0 to 90 is pure abduction-

then surgical neck will impact with glenoid cavity so to do up to 180 the arm must lateral rotate.

Shoulder abductionShoulder abduction3- Fixation:

a. By contraction of trapezius and serratus anterior muscles. a. By contraction of trapezius and serratus anterior muscles.

4- Effect of weakness/contracture/shortening:

Effect of weakness result in:

- inability to lift arm in abduction.

- Paralysis of Deltoid tends to sublax the shoulder downward.

- Weakness of supraspinatus or rupture of its tendon: decreases the shoulder joint stability.

5- Factor limited range of motion:

a. Contact of greater tubercle and humerus with lateral surface of acromion.a. Contact of greater tubercle and humerus with lateral surface of acromion.

b. Tension of shoulder adductor muscles. b. Tension of shoulder adductor muscles.

6- Substitution:

None. None.

Shoulder abductionShoulder abduction7- Procedures:

a- Position of Patient: b- Position of Therapist : inner

hand, Outer hand, Direction of Resistance

c- Test d- Instruction to patient