Shoulder Complex

LEARNING OUTCOMES
This chapter investigates the shoulder complex. By the completion of this
chapter, you should be able to:
Identify the bones, joints, and muscles of the shoulder complex;
Discuss the relationship between each of the joints that determine
scapular motion;
Explain the relationship between movements of the scapulothoracic and
glenohumeral joints and their inter-reliability;
List muscles that stabilize the scapulothoracic joint and the glenohumeral
joint;
Discuss the influence of gravity and body position in determining muscles
acting on the shoulder complex during functional motions;
Name muscle groups that function to position and move the shoulder
complex in specific functional activities.
 The shoulder region is a complex of 20 muscles, three
bony articulations, and three soft tissue moving
surfaces (functional joints) that permit the greatest
mobility of any joint area found in the body.

The primary purpose of the shoulder is to put the

hand in a position for function.
 It also stabilizes the upper extremity for hand motions,
lifts and pushes objects, elevates the body, assists with
forced respiratory inspirations and expirations, and even
bears weight when walking with crutches or performing
handstands.
 Muscles acting on this complex structure do not act
alone but rather in concert with other muscles to
provide for its smooth function.

Support and stabilization of the shoulder are primarily

dependent on muscles and ligaments.
Bones
 The only bone that will connect the
Upper extremities to the trunk: Clavicle
Clavicle
a. Orientation of clavicle, scapula and humerus
b. Convex medially 2/3 (vascular supply and blood
vessels passes through), concave lateral 1/3( common
site of clavicle)
c. Slightly superior to horizontal plane, posterior
to frontal plane.
 Scapula T2-T7
i. Medial (5-6cm or 2-3 fingerbreadths)
ii. Lateral
iii. Superior border
iv. Rotated anteriorly to the frontal plane 35deg.
(aka Scapular plane)
v. Glenoid fossa: tilted upward 5-10deg.
1. Paralysis of upper trapezius, subluxation of
humerus
 Humerus
i. Anatomical neck
ii. Surgical neck MC site of humeral fractures
iii. Greater Tubercle palpable by Internal rotation
iv. Retroverted 20deg. posterior to frontal plane
v. Angle of inclination 125deg.
 Joints (3)
a. True joints
i. Sternoclavicular joint
1. Type: Saddle/ sellar type of joint, 3deg of
freedom
OPP: arm by the side
CPP: full elevation
CP: pain @ extremes ROM, especially
horizontal adduction and full elevation
2. Arthokinematics:
a. Sternal end of clavicle
i. Vertical: convex
ii. Horizontal: concave
 3. Ligaments:
a. SC ligaments Anterior/ posterior
b. Interclavicular ligament, - prevent depression
of the clavicle at the SC joint
c. Costoclavicular ligament prevent elevation of
clavicle
4. Movement
ii. Acromioclavicular joint
1. Plane type of joint 3o of freedom,
2. Ligaments
a. Acromioclavicular ligament
b. Coracoclavicular ligament
i. Conoid (medial/center): taut in retraction and
upward rotation
ii. Trapezoid(lateral): taut in Protraction and
Downward rotation
3. Movement
 iii. Glenohumeral joint
1. Ball and socket joint 3o of freedom
OPP: 55deg abduction 30deg. horizontal Adduction
CPP: Full abduction and lateral rotation
CP: ER>ABD>IR
 2. Ligaments
a. Coracohumeral ligament provides passive
stabilization at the GH joint
i. Prevents the downward displacement of the
head of the humerus, AP stabilization, prevent
excessive adduction
 b. Glenohumeral ligament
i. Superior
1. Prevent downward displacement, and AP movement of the humeral head.
ii. Middle
1. Becomes taut from 45-60deg abduction and External rotation, excessive anterior
displacement of humeral head
iii. Inferior
1. Taut @ 90deg. abduction
2. Prevent inferior displacement of humeral head
3. Parts:
a. Anterior band, prevent ER
b. Axillary pouch
c. Posterior band, prevent IR
iv. Points of weakness
1. Foramen of Weitbrecht between Superior
and middle
2. Foramen of Ruvier between Middle and
inferior
c. Bursae Prevents friction and allows lubrication
i. Subacromial bursa
ii. Subdeltoid bursae
iii. Subcoracoid bursa
d. Osteokinematics
i. Active abduction
1. If GH is in full IR: 60deg of abduction
a. The greater tubercle will be exposed and
hit the coracoacromial arch.
2. If GH is in 90deg of ER: 90deg abduction
ii. Passive abduction
1. Can reach up to 120deg
 False joint
i. Scapulothoracic joint motions occurring in SC and AC joint are
composite of what?
1. Movable base for the humerus
2. Increases the ROM
3. Provides stability for GH joint
4. Provide shock absorption on an outstretched hand
5. Permits elevation of the body in closed chain activities: Depression
6. Movement: protraction, retraction, elevation depression, upward
and downward rotation.
Scapulohumeral rhythm
After 30deg of abduction, there is 2:1 ratio between
glenohumeral joint and scapulothoracic joint. 0- 30deg
setting phase.>30deg
Six kinematic principles associated
with full abduction of the shoulder.
Companion motions of the shoulder
girdle and GH joints
Phases of abduction
a. 0-90
i. SC joint 25deg elevation
ii. AC joint: 5deg upward rotation
iii. GH joint: 60deg
iv. Terminated by: hitting of greater tubercle with the glenoid

b. 90-180
i. SC joint: 5deg elevation; 35deg posterior rotation of the clavicle
ii. AC joint: 25deg upward rotation
iii. GH joint: 60deg
iv. Terminated by: resistance of adductor muscles E.g. Latissimus Dorsi
Muscles
a. Responsible for movement and stabilization of the scapula
during GH joint motion
b. Originate on the thorax and on the scapula
i. Serratus anterior
ii. Trapezius
iii. Rhomboids major and minor
iv. Pectoralis minor
v. Levator Scapulae
Glenohumeral stabilizing muscles of
the shoulder
Large muscle movers of the
shoulder
Passive and dynamic stabilization of the glenohumeral
joint

a. Passive stabilizers:
i. Coracohumeral ligament
ii. Superior GH ligament
iii. Negative atmospheric pressure within the capsule

b. Dynamic stabilization
i. Rotator cuff muscles
ii. Biceps brachii
iii. Deltoid
Antagonists and synergists of
scapular upward rotation
a. Synergists
i. Upper trapezius
ii. Lower trapezius
iii. Serratus anterior
b. Antagonists
i. Rhomboids
ii. Pectoralis minor
iii. Levator scapulae
Scapular retraction
a. Synergists
i. Rhomboids
ii. Trapezius

b. Antagonists
i. Pectoralis minor
ii. Serratus anterior
Scapular protraction
a. Synergists
i. Pectoralis minor
ii. Serratus anterior

b. Antagnosists
i. Rhomboids
ii. Trapezius
Scapular elevation
a. Synergists
i. Upper trapezius
ii. Rhomboid
iii. Levator scapulae

b. Antagonists
i. Pectoralis minor
ii. Lower trapezius
iii. Lower serratus anterior
Scapular depression
a. Synergists
i. Pectoralis minor
ii. Lower trapezius
iii. Lower serratus anterior

b. Antagonist
i. Upper trapezius
ii. Rhomboids
iii. Levator scapulae
Force couple
a. Force couple is define in mechanical terms as two
forces whose points of application occur on opposite
sides of an axis and in opposite direction to produce
rotation of the body
i. Scapular upward rotation
1. Synergists
a. Upper trapezius
b. Lower trapezius
c. Serratus anterior

ii. Scapular downward rotation

1. Synergists
a. Rhomboid
b. Pectoralis minor
c. Levator scapulae
Shoulder elevation
1. Deltoid
2. Supraspinatus
3. Infraspinatus
4. Teres minor
5. Subscapularis