Ch 9 Shoulder Girdle Flashcards
What is the purpose of the shoulder and the entire upper extremity?
To allow the hand to be placed in various positions to accomplish the multitude of tasks the hand is capable of performing.
What is the most mobile joint in the body?
The shoulder, or glenohumeral joint, it is capable of a great deal of motion.
Shoulder Complex
Term used to include all of the structures involved with motion of the shoulder.
Consists of the scapula, clavicle, sternum, humerus, and rib cage, and includes the sternoclavicular joint, acromioclavicular joint, glenohumeral joint, and “scapulothoracic articulation” (includes the shoulder girdle (scapula and clavicle) and the shoulder joint (scapula and humerus))
Scapulothoracic Articulation
Not a joint in the pure sense of the word. Although the scapula and thorax do not have a point of fixation, the scapula does move over the rib cage of the thorax.
The scapula and thorax are not directly attached but are connected indirectly by the clavicle and by several muscles.
-Provides increased motion to the shoulder complex.
Shoulder complex (anterior view)
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Shoulder Girdle
Term often used to discuss the activities of the scapula and clavicle and, to a lesser degree, the sternum and ribs.
- The sternoclavicular and acromioclavicular joints allow shoulder girdle motions, including elevation and depression, protraction and retraction, and upward and downward rotation.
- Five muscles attach to the scapula, the clavicle, or both, providing motion of the shoulder girdle.
Shoulder Joint
Aka the glenohumeral joint
- Consists of the scapula and humerus. The motions of the shoulder joint are flexion, extension and hyperextension, abduction and adduction, medial and lateral rotation, and horizontal abduction and adduction.
- Bc the shoulder joint is so mobile, it has few ligaments. The 9 muscles that cross the shoulder joint are the prime movers in shoulder joint motion.
Plane of the Scapula
Due to the curved shape of the rib cage, the scapula rests about 30 degrees anterior to the frontal plane in its resting position, against the posterior thorax.
Resting position of the scapula on the thorax (posterior view)
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Plane of the scapula (superior view)
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Bony landmarks of the left scapula
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Left clavicle
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Sternum (anterior view)
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Sternoclavicular (SC) Joint
Formed by the articulation between the manubrium of the sternum and the medial (sternal) end of the clavicle.
- Synovial joint that provides the shoulder girdle with its only direct attachment to the trunk.
- Shape defined as modified ball-and-socket joint, incongruent saddle joint, or plane-shaped double gliding joint. However, there is consensus that it functions as a triaxial joint, with three degrees of freedom, allowing movement in three planes of motion.
Sternoclavicular Joint Motions
Of the two bones that make up this joint, the clavicle is more movable than the sternum (motions of the SC joint will be described based on the direction in which the clavicle is moving)
- Motions include elevation and depression in the frontal plane as well as protraction and retraction in the transverse plane, and rotation occurs along the longitudinal axis of the bone (the clavicle spins on the sternum).
- Basically, the clavicle moves while the sternum remains stationary.
Ligaments of the sternoclavicular joint (left side cut away to show the disk; anterior view)
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Sternoclavicular Joint Formation
Synovial joint with a joint capsule
- 3 major ligaments and a joint disk
- The articular disk serves as a shock absorber, especially from forces generated by falls on the outstretched hand
- Joint capsule surrounds the joint and is reinforced by the anterior and posterior sternoclavicular ligaments.
- Disk and its ligamentous support are so effective that dislocation at the sternoclavicular joint is rare.
Sternoclavicular Joint Articular Disk
Has a unique attachment that contributes to the motion of this joint.
- Upper part of the disk is attached to the posterior superior part of the clavicle, while the lower part is attached to the manubrium and first costal cartilage. Double attachment is much like that of the double hinge found on doors that swing in both directions
- To summarize the double-hinge arrangement of this joint, during elevation and depression, motion occurs between the clavicle and disk, whereas during protraction and retraction, motion occurs between the disk and the sternum.
Shoulder Girdle Elevation and Depression
The convex surface of the clavicle slides inferiorly and superiorly on the concave manubrium as the clavicle’s lateral end moves up and down, respectively. This motion occurs between the clavicle and the disk.
Shoulder Protraction and Retraction
The concave portion of the clavicle slides anteriorly and posteriorly on the convex costal cartilage, respectively as the clavicle’s lateral end moves forward and backward. This motion occurs between the disk and the sternum
3 major Ligaments supporting the Sternoclavicular Joint
Sternoclavicular, Costoclavicular, and Interclavicular Ligaments
Sternoclavicular Ligament (Sternoclavicular Joint)
Connects the clavicle to the sternum on both the anterior and posterior surfaces and is therefore divided into the anterior and posterior sternoclavicular ligaments.
-These ligaments limit anterior-posterior movement of the clavicle’s medial end. The posterior sternoclavicular ligament limits anterior motion, and the anterior sternoclavicular ligament limits posterior motion. They both reinforce the joint capsule.
Costoclavicular Ligament (Sternoclavicular Joint)
A short, flat, rhomboid-shaped ligament that connects the clavicle’s inferior surface to the superior surface of the costal cartilage of the first rib. The primary purpose of this ligament is to limit the amount of clavicular elevation.
Interclavicular Ligament (Sternoclavicular Joint)
Located on top of the manubrium, connecting the superior sternal ends of the clavicles. Its purpose is to limit the amount of clavicular depression
Acromioclavicular (AC) Joint
Connects the acromion process of the scapula and the lateral (acromial) end of the clavicle. It is a plane-shaped synovial joint that allows a gliding motion to occur, contributing toward movement in three planes of motion.
Ligaments of the acromioclavicular joint (anterior view).
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Sternoclavicular Joint Motion
Allows much clavicular motion, the AC joint allows subtle movements of the scapula.
- Motions are minimal but allow continuity between the scapula and thorax during scapular motions.
- Primary motions at the AC joint are upward and downward rotation in the plane of the scapula. Bc of the curved shape of the rib cage, these motions occur more in the plane of the scapula than in the pure frontal plane.
- The scapular plane is oriented approximately 30 degrees forward of the frontal plane. The AC joint can also contribute toward scapular tilt in the sagittal plane, and when present, scapular winging in the transverse plane.
The joint capsule surrounds the articular borders of the joint and is reinforced above and below by the…
Superior and inferior acromioclavicular ligaments.
Acromioclavicular Ligaments
These ligaments support the joint by holding the acromion process to the clavicle, thus helping to prevent dislocation of the clavicle. Despite this reinforcement, the joint capsule is quite weak. This capsular weakness leaves the AC joint very susceptible to injury, especially with a fall on the outstretched hand or a blow to the outside of the shoulder.
2 accessory ligaments of the AC joint
Coracoclavicular Ligament and Coracoacromial Ligaments.
Coracoclavicular Ligament
Not directly located at the joint, it does provide stability to that joint and allows the scapula to be suspended from the clavicle. It connects the scapula to the clavicle by attaching to the inferior surface of the clavicle’s lateral end and to the superior surface of the scapula’s coracoid process
-Divided into a lateral trapezoid portion and the deeper medial conoid portion. Together they prevent backward motion of the scapula, and individually they limit the rotation of the scapula.
Coracoacromial Ligament
Does not actually cross the AC joint, but rather forms a roof over the head of the humerus and serves as a protective arch, providing support to the head when an upward force is transmitted along the humerus
-Attaches laterally on the superior surface of the coracoid process and runs up and out to the inferior surface of the acromion process.
Scapulothoracic Articulation
Not a joint in the pure sense of the word as there is no direct union between the bones, and there is no joint capsule
- Consists of the slightly concave anterior surface of the scapula resting on the convex posterior aspect of the rib cage. With the lack of a true joint structure to support the scapula in its normal resting position, stability comes from an indirect link to the trunk through the clavicle and several surrounding muscles.
- Provides motion necessary for normal function of the scapula.
Motions of the Shoulder Girdle
-Elevation and Depression
-Protraction and Retraction
-Upward and Downward Rotation
Bc these motions can be seen best by looking at the scapula, they are commonly described as either shoulder girdle or scapular motion. -At this joint, protraction and abduction are synonymous terms, as are retraction and adduction.
Shoulder girdle protraction and retraction is synonymous with…
Scapular abduction and adduction. Scapular rotation is the same as shoulder girdle rotation.
The coracoacromial ligament forms a roof over the shoulder joint.
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Scapular elevation/depression and protraction/ retraction are essentially…
Linear motions.
All points of the scapula move…
Up and down along the thorax and away from and toward the vertebral column in parallel lines.
Scapular Elevation
Occurs when the scapula moves in a superior direction
Scapular Depression
Occurs when the scapula moves inferiorly
Scapular Protraction
(scapular abduction) Occurs when the scapula moves away from the posterior midline
Scapular Retraction
(scapular adduction) Occurs when the scapula moves back toward the posterior midline.
Shoulder Girdle Motions (posterior view)
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Angular Motions of the Shoulder Girdle
-Including scapular upward/ downward rotation and scapular tilt. Because of the scapula’s triangular shape, one side moves one way while another side moves in an opposite or different direction.
Scapular Upward Rotation
The inferior angle of the scapula rotates up and away from the vertebral column,
Scapular Downward Rotation
The return to the resting anatomical position from the upwardly rotated position.
-The scapula does not move past anatomical position toward the vertebral column
Scapular Upward/Downward Rotation
It should be noted that when the inferior angle rotates up and out, the superior angle moves down, and the glenoid fossa moves up and in. Therefore, it is important to have a point of reference to define this rotation. The inferior angle is the reference point used here
Scapular Tilt
Occurs when the shoulder joint goes into hyperextension. The superior end of the scapula tilts anteriorly, and the inferior end tilts posteriorly. Examples of these combined motions are the “windup” or prerelease phase of a softball pitch, a bowling delivery, or a racing dive in swimming.
Scapular motion during upward rotation
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Scapular Winging
The posterior lateral movement of the vertebral border of the scapula in the transverse plane (the vertebral border of the scapula moves away from the rib cage) This motion occurs primarily at the AC joint but is observed most often at the scapulothoracic articulation. This can be demonstrated by asking a person with a “normal” shoulder to place his or her hand on the small of the back. The vertebral border of the scapula lifts away from the rib cage. This motion can only be done in combination with several other motions. However, pathological “winging of the scapula” also occurs when the stabilizing muscles around the scapula are weak or paralyzed. Serratus anterior weakness or paralysis is a dramatic example. When a person with that condition pushes against a wall with an outstretched hand, the involved scapula will rise away from the rib cage, standing out like a small wing. Excessive winging is considered abnormal.
Winging of the scapula (posterior view).
This person’s right serratus anterior muscle is paralyzed. When pushing against the wall with both hands, the right scapula rises away from the rib cage, standing out like a small wing.
During the linear movements of scapular elevation/ depression and scapular protraction/retraction, it is possible to move the shoulder girdle (clavicle and scapula)…
Up, down, forward, or backward without moving the humerus. However, shoulder joint motions must accompany the angular motions of scapular upward/downward rotation, and scapular tilt.
To rotate the scapula upward, you must also…
Flex or abduct the shoulder joint. Stated another way, when there is flexion or abduction of the shoulder joint, the scapula must also rotate upward.
When there is extension or adduction of the shoulder joint, the scapula…
Returns to anatomical position by rotating downward.
Scapular tilt can only happen when the shoulder joint goes into…
Hyperextension
Shoulder Joint Flexion
- Upward Rotation
- Protraction
Shoulder Joint Extension
- Downward Rotation
- Retraction
Shoulder Joint Hyperextension
Scapular Tilt