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The Shoulder Complex

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  1. The Shoulder Complex

  2. The Shoulder Complex • General Structure & Function • Structure & Function of Specific Joints • Muscular Considerations • Specific Functional Considerations • Common Injuries

  3. The Shoulder Complex • General Structure & Function • Structure & Function of Specific Joints • Muscular Considerations • Specific Functional Considerations • Common Injuries

  4. General Structure

  5. General Function • Provides very mobile, yet strong base forhand to perform its intricate gross and skilled functions • Transmits loads from upper extremity to axial skeleton

  6. Shoulder Girdle

  7. Shoulder Complex Movements • Shoulder Girdle • Elevation & depression • Protraction & retraction • Upward & downward rotation • Upward tilt • Shoulder (glenohumeral) • FL, EXT, HyperEXT • ABD, ADD, HyperADD, HyperABD • MR, LR, HorizontalABD, HorizontalADD

  8. Abduction/Lateral Tilt (Protraction) Linear Movement Frontal Plane Angular movement Transverse Plane Adduction/Reduced Lateral Tilt (Retraction)

  9. Depression Elevation Linear Movement Frontal Plane

  10. Downward rotation Upwardrotation

  11. Shoulder Complex Movements Upward tilt Reduction of Upward Tilt Angular movement Sagittal plane

  12. Limited by capsular torsion Limited by bony impingement of greater tubercle on acromion

  13. Large ROM Due To: • Poor bony structure • Poor ligamentous restraint • Scapulohumeral cooperative action

  14. The Shoulder Complex • General Structure & Function • Structure & Function of Specific Joints • Muscular Considerations • Specific Functional Considerations • Common Injuries

  15. Structure & Function of Specific Joints • Sternoclavicular Joint • Acromioclavicular Joint • Scapulothoracic Joint • Glenolhumeral Joint • Coracoacromial Arch

  16. Sternoclavicular Joint: Bony Structure Poor Diarthrodial Biaxial

  17. Sternoclavicular Joint: Capsule Very strong

  18. Sternoclavicular Joint: Interclavicular Ligament Resists superior & anterior (posterior portion) motion

  19. Sternoclavicular Joint: Sternoclavicular Ligament Resists anterior (PSL), posterior (ASL), & superior motion

  20. Sternoclavicular Joint: Costoclavicular Ligament Resists upward and posterior motion

  21. Sternoclavicular Joint: Accessory Structures Resists medial & inferior displacement via articular contact

  22. Sternoclavicular Joint: Articular Surfaces Medial end of clavice is convex Clavicular facet is reciprocally shaped

  23. Sternoclavicular Joint: Motions Axial Rotation: 50° EL/DEP: 35° PROT/RET: 35°

  24. Sternoclavicular Joint: Motions Frontal plane Elev/Dep Sagittal plane Post Rot Horizontal plane ProT/ReT Ant/Post axis Vertical axis

  25. Acromioclavicular JointBony Structure Poor Diarthrodial Nonaxial

  26. Acromioclavicular Joint:Joint Capsule Very weak

  27. Acromioclavicular JointAcromioclavicular Ligament Resists axial rotation & posterior motion

  28. Acromioclavicular JointCoracoclavicular Ligament Resists superior motion

  29. Acromioclavicular JointAccessory Structures Articular disc

  30. Acromioclavicular Joint: Motion Little relative motion at AC joint UR/DR: 60° EL/DEP: 30° PROT/RET: 30-50°

  31. Acromioclavicular Joint: Osteokinematics Horizontal plane adjustments during scapulothoracic protraction Sagittal plane adjustment during scapulothoracic elevation

  32. Clavicle • Acts a strut connecting upper extremity to thorax • Protects brachial plexus & vascular structures • Serves as attachment site for many shoulder muscles

  33. Scapula

  34. Scapular Plane

  35. Scapulothoracic Joint • No osseous connection • SUBSCAP & SA

  36. Glenohumeral Joint: Humerus Retroversion angle: 30°

  37. Glenohumeral Joint: Humerus Inclination angle: 45°

  38. Glenohumeral Joint: Glenoid Fossa • Inclination angle: 5° • Retroversion angle: 7°

  39. Glenohumeral Joint: Glenoid Fossa • Articular cartilage thicker on periphery • Shallow fossa 1/3 diameter of humeral head

  40. Pure rotation Bony restraint poor Head 4-5X larger than fossa Close-packed position ABD with LR Glenohumeral Joint: Bony Structure

  41. Glenohumeral Joint: Joint Capsule • Inherently lax • Surface area 2X head • Provides restraint for ABD, ADD, LR, MR

  42. Glenohumeral Joint:Superior GH Ligament • Resists inferior translation in rest or adducted arm • Well-developed in 50%

  43. Glenohumeral Joint: Coracohumeral Ligament • Resists inferior translation in shoulders with less-developed SGH

  44. Glenohumeral Joint:Middle GH Ligament • Great variability in proximal attachment & morphology • Absent in 30% • Resists inferior translation in ABD & ER • Restrains anterior translation (45° ABD)

  45. Glenohumeral Joint:Inferior GH Ligament • 3 components (A,P,Ax) • Resists inferior, anterior, & posterior translation

  46. Glenohumeral Joint: Bursae • Subcoracoid • Subacromial • Subscapular

  47. Glenohumeral Joint: Accessory Structures Labrum • 50% of depth • Increases tangential stability 20%

  48. Glenohumeral Joint: Intra-articular Pressure • Synovial fluid causes adhesion • Provides ~50% restraint

  49. Coracoacromial Arch