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shoulder
shoulder kinesiology
175
Anatomy
Graduate
11/20/2011

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Term
what are the 4 articulations of the shoulder girdle complex?
Definition
sternoclavicular joint, acromioclavicular joint, scapulothoracic joint, glenohumeral joint
Term
what is the only articulation of the upper extremity to axial skeleton?
Definition
sternoclavicular joint
Term
what type of joint is the sternoclavicular joint?
Definition
saddle
Term
how many degrees of freedom do saddle joints usually have?
Definition
2
Term
how many degrees of freedom does the sternoclavicular joint have?
Definition
3
Term
what special thing does the sternoclavicular joint have?
Definition
disc/meniscus
Term
what are the 3 ligaments of the sternoclavicular joint?
Definition
sternoclavicular ligament, costoclavicular ligament, interclavicular ligament
Term
what joint do all forces of the arm go through ?
Definition
sternoclavicular joint
Term
what joint moves anytime you move the scapula?
Definition
sc joint
Term
what are the 2 parts of the sternoclavicular ligament?
Definition
anterior and posterior sc ligaments
Term
what is the function of the costoclavicular ligament
Definition
tether/pivot point/mechanical axis for frontal and transverse plane motions
Term
which ligament in the sternoclavicular joint acts as the mechanical axis for frontal and transverse plane motions
Definition
costoclavicular ligament
Term
is the sternoclavicular ligament stable?
Definition
yes, very
Term
is the sternoclavicular ligament prone to osteoarthritis?
Definition
no
Term
what would happen if the sternoclavicular joint dislocated?
Definition
would hit subclavian artery
Term
does the sternoclavicular joint dislocate often?
Definition
no
Term
what is the frontal plane movement of the sternoclavicular joint?
Definition
elevation/depression
Term
about what axis does the sc joint elevate/depress
Definition
anterior-posterior
Term
how far can the sternoclavicular joint elevate the shoulders?
Definition
45 deg
Term
how far can the sternoclavicular joint depress the shoulders?
Definition
15 deg
Term
what shape is the clavicle in elevation/depression at the SC joint?
Definition
convex
Term
what shape is the manubrium in elevation/depression of the SC joint?
Definition
concave
Term
what are the arthrokinematics of elevation at the SC joint?
Definition
convex clavicle rolls superiorly and slides inferiorly on concave manubrium
Term
what are the arthrokinematics of depression at the SC joint?
Definition
convex clavicle rolls inferiorly and slides superiorly on the concave mabubrium
Term
what motion happens at the SC joint in the transverse plane?
Definition
protraction/retraction
Term
how much can the SC joint protract/retract?
Definition
15 deg either way
Term
what is the shape of the clavicle in the transverse plane?
Definition
concave
Term
what is the shape of the manubrium in the transverse plane?
Definition
convex
Term
describe the arthrokinematics of protraction at the SC joint
Definition
concave clavical rolls and slides anteriorly on convex manubrium
Term
describe the arthrokinematics of retraction at the SC joint
Definition
concave clavicle rolls and slides posteriorly on convex manubrium
Term
describe the arthrokinematics of protraction at the SC joint in the up phase of a pushup
Definition
convex manubrium rolls anteriorly, slides posteriorly on concave clavicle
Term
what is the shape of clavicle/manubrium in frontal plane at SC joint?
Definition
in frontal plane, clavicle is convex, manubrium is concave
Term
what is the action of the SC joint in the sagittal plane?
Definition
posterior rotation: looks like flexing shoulder
Term
what is the arthrokinematics of posterior rotation at the SC joint?
Definition
spin
Term
how far can the sc joint posteriorly rotate?
Definition
30-45
Term
what bone moves on what at sc joint in transverse plane
Definition
concave clavicle on convex manubrium
Term
what bone moves on what at sc joint in sagittal plane?
Definition
clavicle spins on sternum/manubrium
Term
what are the functions of the SC joint?
Definition
stabilizes closed kinematic chain of shoulder complex, absorbs and distributes forces, allows movement of clavicle
Term
what are the 2 bones of the acromioclavicular joint?
Definition
scapula, clavicle
Term
what type of joint is the acromioclavicular joint?
Definition
plane joint
Term
how many degrees of freedom in AC joint?
Definition
3
Term
what 3 things suppor the AC joint
Definition
capsule, ligaments, disc (in 10% of people)
Term
describe the AC joint capsule
Definition
dense but weak
Term
what are the 2 main ligaments of the ac joint?
Definition
acromioclavicular, coracoclavicular
Term
what are the 2 parts of the coracoclavicular joint
Definition
trapezoid, conoid ligaments
Term
which is lateral, trapezoid or conoid?
Definition
trapezoid is lateral, conoid is medial
Term
what does the trapezoid ligament do?
Definition
resists posterior forces to clavicle
Term
what does the conoid ligament do?
Definition
resists inferior forces to acromion
Term
how does the conoid ligament affect the clavicle?
Definition
prevents clavicle from displacing superiorly
Term
how does the trapezoid affect the clavicle?
Definition
prevents clavicle from displacing posteriorly
Term
are the coracoacromial ligaments strong or weak?
Definition
strong
Term
are the acromioclavicular ligaments strong or weak?
Definition
weak
Term
what are the 2 acromioclavicular ligaments?
Definition
superior an dinferior ac ligaments
Term
what do the acromioclavicular ligaments do?
Definition
prevent anterior-posterior translation of the clavicle
Term
what is internal/external rotation of the scapula?
Definition
moving the glenoid cavity forward or backwards about a vertical axis
Term
what are the 3 scapular planes?
Definition
internal/external rotation, anterior/posterior tipping, upward/downward rotation
Term
movement in which plane gives scapular winging?
Definition
internal/external
Term
what is anterior/posterior tipping?
Definition
movement of acromion forward and back
Term
what is upward and downward rotation?
Definition
rotation of glenoid cavity up and down
Term
what are the functions of the AC joint?
Definition
maintain relatoinship between scapula and clavicle, allow rotation of scapula and clavicle to permit full shoulder flexion, translate forces from arm to axial structures, prevent superior dislocation of clavicle on acromion, limits clavicle rotation
Term
are AC joint sprains common?
Definition
yes
Term
is it more common to sprain AC or SC joint?
Definition
AC
Term
how is the ac joint sprained?
Definition
fall on shoulder or contact in sports
Term
how are ac sprains graded?
Definition
1 to 3
Term
what is a grade 1 ac sprain?
Definition
without deformity
Term
what is a grade 2 ac sprain
Definition
rupture of ac ligaments
Term
what is a grade 3 ac sprain
Definition
rupture of ac and coracoclavicular ligaments
Term
how are ac sprains/seprations treated?
Definition
non-surgically, with a sling. AROM exercises started after several days
Term
is it common to develop arthritis at the AC joint?
Definition
yes
Term
what can arthritis/degeneration at AC joint do?
Definition
restrict/alter shoulder moement
Term
how does horizontal adduction affect ac, sc joints
Definition
compresses them
Term
what is the scapulothoracic joint?
Definition
the "articulation" between the scapula and the thorax
Term
what type of joint is the scapulothoracic joint?
Definition
functional joint, not a true anatomical joint
Term
is the scapulothoracic joint mobile or stable?
Definition
mobile
Term
what is the bony attachment of the scapulothoracic joint
Definition
SC joint through clavicle
Term
what are the scapular roles of movement of the upper extremity?
Definition
orient glenoid, add range of motion for arm, base of support
Term
what is the position of the scapula at rest?
Definition
2.5 inches away from midline of the body
Term
where is the superior angle of the scapula?
Definition
T2
Term
where is the inferior angle of the scapula?
Definition
T7
Term
what is the scapular plane's orientation?
Definition
3-50 degrees anterior to frontal plane
Term
what is scaption
Definition
glenohumeral elevation in scapular plane
Term
what are the 3 scapulothoracic motions?
Definition
elevation/depression, protraction/retraction, downward/upward rotation
Term
what is elevation/depression at SC joint?
Definition
shrugging shouldres
Term
what is retraction/protraction at SC joint?
Definition
shoulders forward and backward
Term
what is posterior rotation at SC joint?
Definition
looks like flexing arm
Term
what is internal/external rotation at the AC joint?
Definition
moving glenoid cavity forward and backward (like protraction/retractoin)
Term
what is anterior/posterior tipping at AC joint?
Definition
moving acromion forward and backward (like flexing/extending arm)
Term
what is upward/downward rotation at AC joint?
Definition
moving glenoid cavity up and down like abducting arm
Term
what AC and SC joint movements provide elevation of scapulothoracic joint?
Definition
SC elevation, AC downward rotation
Term
what AC and SC joint movements provide depression of scapulothoracic joint?
Definition
SC depression, AC upward rotation
Term
what AC and SC movements contribute to scapulothoracic upward rotation?
Definition
SC elevation, AC upward rotation
Term
what AC and SC movements contribute to scapulothoracic downward rotation?
Definition
SC depression, AC downward rotatoin
Term
what AC and SC movements contribute to scapulothoracic protraction?
Definition
SC protraction, AC internal rotation
Term
what AC and SC joint movements contribute to scapulothoracic retraction?
Definition
SC retraction, AC external rotation
Term
what muscles elevate the scapula?
Definition
upper trap, levator scapuloae
Term
what muscles depress the scapula?
Definition
lower trap, latissimus dorsi, pectoralis minor
Term
what muscle protracts the scapula?
Definition
serratus anterior
Term
what muscles retract the scapula?
Definition
middle trap, rhomboids
Term
what muscles are upward rotators of scapula?
Definition
upper trap, lower trap, serratus anterior
Term
what muscles are downward rotators of scapula?
Definition
levator, rhomboids, assisted by gravity
Term
what is it called when the inferior border of the scapula sticks out?
Definition
tipping
Term
what is it called when the whole medial border of the scapula sticks out?
Definition
winging
Term
what type of joint is the glenohumeral joint?
Definition
ball and socket
Term
how many dof in glenohumeral joint?
Definition
3
Term
what are the articulations of the glenohumeral joint?
Definition
glenoid fossa, humeral head
Term
what are the support structures of the glenohumeral joint?
Definition
capsule, ligaments, labrum
Term
what is glenoid version?
Definition
glenoid has 5 deg of retroversion relative to scapula and 5 deg of upwards inclination relative to vertical
Term
what is the angle of inclination (up) of humeral head
Definition
130deg
Term
what is the angle of torsion of humeral head?
Definition
angle back of retroversion, 30 deg
Term
why is 30 deg retroversion of humeral head good?
Definition
aligns humeral head with glenoid, which is about 30 deg behind the thorax
Term
what is the relationship between humeral retroversion and glenohumeral external rotation?
Definition
direct: the more humeral retroversion you have, the greater your humeral external rotation
Term
what are the glenohumeral motions?
Definition
flexion/extension, adduction/abduction, horizontal adduction/abduction, internal rotation/external rotation
Term
what are the arthrokinematics of abduction?
Definition
humeral head rolls superiorly and glides inferiorly
Term
what is scapulohumeral rhythm?
Definition
movement of humerus is dependent on scapular movement
Term
what joints are needed for full shoulder flexion and abduction?
Definition
SC, AC, ST, GH
Term
in glenohumeral elevation, which joint does the first 30 deg?
Definition
glenohumeral
Term
what is the relationship of glenohumeral to scapulothoracic movement in glenohumeral elevation?
Definition
2:1, GH:ST
Term
is the glenohumeral joint stable?
Definition
no, more mobile
Term
how much surface area on the humeral head does the glenoid fossa cover?
Definition
25-30%
Term
what provides passive support to glenohumeral stability?
Definition
bones, labrum, capsule, ligaments, negative intra-articular pressure, scapular positioning
Term
what provides active support to glenohumeral stability
Definition
muscles
Term
what is the negative intra-articular pressure of the GH joint?
Definition
humeral head is sucked up against fossa, helps keep it connected
Term
what is the glenoid labrum
Definition
fibrous ring around the periphery of the glenoid
Term
what is the function of the glenoid labrum?
Definition
anchor point on the glenoid for the capsuloligamentous structures; contributes to stability by increaseing socket depth by 50%
Term
in order to dislocated your humeral head, what must be disruped?
Definition
ligaments and labrum
Term
is the glenohumeral joint capsule normally loose or tight?
Definition
loose to allow more motion
Term
what are the 3 main parts of the glenohumeral capsule?
Definition
posterior capsule, glenohumeral ligaments, coracohumeral ligament
Term
what are the 3 glenohumeral ligaments?
Definition
superior GH ligament, middle GH ligament, inferior GH ligament complex
Term
what forms the rotator cuff interval?
Definition
hole between supraspinatus and subscapularis tendons
Term
what fills the rotator cuff interval?
Definition
coracohumeral ligament, superior GH ligament
Term
what do the SGHL and coracohumeral ligaments do in the rotator cuff interval?
Definition
limit inferior translation and external rotation for the first 30 deg of abduction
Term
what does the middle GH ligament do?
Definition
primary restraint to anterior translation in 45-75 deg abduction. Also limits external rotation
Term
what are the 3 parts of the inferior glenohumeral ligament complex?
Definition
anterior band, axillary pouch, posterior band
Term
what does IGHL complex do at 90 deg abduction and neutral rotation?
Definition
supports humeral head like a sling
Term
what does IGHL complex do at 90 deg abduction and ER
Definition
forms a sling anteriorly preventing anterior dislocatoin
Term
what does IGHL complex do at 90 deg abduction and internal rotation?
Definition
form sling posteriorly preventing posterior dislocation
Term
what is the function of the posterior capsule?
Definition
limits IR and horizontal adduction
Term
what does the coracoacromial ligament do?
Definition
provides protection, prevents superior humeral translation on glenoid
Term
how does space under coracoacromial arch diminish?
Definition
with arm elevation
Term
what things can become impinged in subacromial space?
Definition
bursa, supraspinatus, biceps
Term
what are the 2 bursa in the shoulder?
Definition
subdeltoid, subacromial
Term
what do bursa do?
Definition
reduce friction, make sure things are gliding as much as possible
Term
what movement is necessary for full elevatoin?
Definition
external rotation
Term
as you go into more shoulder elevation, what movement increases in glenohumeral joint?
Definition
external rotation
Term
what muscles abduct at the glenohumeral joint?
Definition
supraspinatus, middle deltoid
Term
what muscles adduct the glenohumeral joint?
Definition
latissimus dorsi, sternal head of pectoralis major
Term
what muscles flex at the GH joint?
Definition
anterior deltoid, long head of biceps
Term
what muscles extend at GH joint?
Definition
latissimus dorsi, sternal head of pectoralis major
Term
how do internal and external rotation force productions compare at glenohumeral joint?
Definition
internal rotation much greater than external rotation
Term
what muscles externally rotate the GH?
Definition
posterior deltoid, teres minor, infraspinatus
Term
what muscles internally rotate the GH
Definition
pec major, subscapularis, latissimus dorsi, teres major, anterior deltoid
Term
what are the active GH stabilizers?
Definition
deltoid, rotator cuff
Term
what offsets the superior force of the deltoid on the GH?
Definition
infraspinatus, subscapularis, teres minor
Term
what kind of arthrokinematics does the supraspinatus provide?
Definition
rotation (very little translation_
Term
if a patient has impingement and little inferior translation, what is probably the problem?
Definition
rotator cuff weakness
Term
what is the force couple of arm elevation?
Definition
glenohumeral abduction and scapulothoracic upward rotation
Term
GH motions always require action from what?
Definition
rotator cuff
Term
what are pathomechanics of the GH joint?
Definition
adhesive capsulitis, impingement, dislocation, rotator cuff injury/deterioration, bicipital tendonitis
Term
what is the difference between subluxation and dislocation?
Definition
dislocation bone comes all the way out, subluxation = bone slips and partially dislocates but relocates right away
Term
most GH dislocations are what kind?
Definition
anterior
Term
what is the typical mechanism of injury of anterior GH dislocations?
Definition
combined elevation and external rotation
Term
what is capsular shift
Definition
surgical repair of a stretched capsule: incision along capsule, pull it tighter, sew it up again
Term
what is a bankart repair?
Definition
surgical repair of a torn capsule: torn joint capsule is trimmed, holes are drilled through the edge of the glenoid cavity, ligaments are sutured back into place
Term
what movements cause pain if you have impingement syndrome?
Definition
elevation and internal rotation
Term
what happens to cause pain in impingement syndrome?
Definition
tendons/bursa become entrapped in subacromial space
Term
what conditions are related to impingement syndrome?
Definition
bursitis, tendonitis
Term
what is tendonitis?
Definition
inflammation of at endon
Term
what tendons can cause pain in the shoulder?
Definition
biceps, rotator cuff
Term
what is calcific tendonitis?
Definition
common painful condition of shoulder due to crystaline depositis
Term
where does calcific tendonitis usually occur?
Definition
near the insertion of supraspinatus
Term
describe repetitive stress injury of shoulder
Definition
overuse of shoulder results in irritation of rotator cuff or bursa and may lead to inflammation and impingement. Happens most frequently in occupations requiring frequent overhead arm use
Term
what is the vicious cycle of tendonitis/bursitis/impingement syndrome
Definition
inflammation - less space - greater impingement - rupture/tear
Term
describe adhesive capsulitis
Definition
frozen shoulder; adhesions grow within capsular fibers, restricting motion
Term
what causes frozen shoulder
Definition
idiopathic or post trauma
Term
what part of capsule is most affected by frozen shoulder
Definition
axillary fold
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