The glenohumeral joint Flashcards
The glenohumeral joint - Type? Degrees of freedom? Art? Features? Ligaments?
- ART - head of humerous and glenoid fossa
- Synovial ball and socket
- 3 degrees of freedom
- Hyaline cartilage (on both articulating surfaces)
- Lambrum (collagen)
- GHJ capsule
- Subacromial bursa
- Superior / Middle / Inferior glenohumeral ligaments [Reinforcing the anterior glenohumeral joint capsule]
- Transverse humeral ligament - holds long head of biceps tendon in the groove
- Coracoidacromial ligament - resisits superior translation of the head of the humerous [provides superior stability]
- Coracohumeral ligament
Trans eating hummus who then places 2 x bets in Coral
- Rotator cuff tendons (very important for dynamic stabilty)
What is the resting position of the GHJ?
0 degrees of abduction, slight lateral rotation- this is the most stable position
What is an analogy for te GHJ? What is what in the analogy?
A ball (humerous is the ball) balancing on a seal’s nose (glenoid)
Surface mark glenohumeral joint line?
Model in high sitting, identify coracoid process, move finger just laterally, joint line is represented by a line approx. 3cm long which runs downwards from this point
Notes: Acromion -> the lateral aspect of clavicle –> Just inferior is the subacromial bursa –> Rotator cuff tendns/ muscle attachment
What movements occur at the GHJ?
Flexion, extension , abduction, adduction, medial rotation, lateral rotation, horizontal abduction, horizontal extension
Flexors?
Pectoralis major (A) Deltoid (Anterior fibres) (A) Biceps brachii (long head) (A)
Extensors?
Latissimus dorsi (A) Deltoid (posterior fibres) (A) Triceps (long head) (A) Teres major [Pec major]
Abductors?
Supraspinatus (A)
Deltoid (middle fibres) (A)
Abductors? What initates the first 30 degrees?
Supraspinatus (A) - Initiates the first 0 - 30
Deltoid (middle fibres) (A)
Medial rotators?
Subscapularis (A) Latissimus dorsi (A) Pectoralis major (A) Deltoid (anterior fibres) Teres Majour B
Lateral rotators?
Teres minor (A)
Infraspinatus (A)
Deltoid (posterior fibres)
The rotator cuff muscles? What is their function?
https://www.verywellhealth.com/thmb/tPfhzs5AlWOnnrqUUois0jhKsJI=/1500x1000/filters:no_upscale():max_bytes(150000):strip_icc()/the-rotator-cuff-2696385-FINAL1-474e476cc4554dbd97995610f4402577.png
Consists of: -Supraspinatus - Infraspinatus - Subscapularis - Teres minor (assisted by long head of biceps)
Centralise head of humerus on the glenoid
Why does a mobile scapula assist this (think about optimum range)?
What is Scapulo-humeral Rhythm [SHR]?
Scapulohumeral rythm, abdormal rhythm?
2:1, humerous moves more than scapular ie 2 = Glenohumeral joint, 1 = scapulothoraccic area
As the HOH is moving in to flexion / abduction… it is rotating, the HOH and glenoid fossa always want to remain centralised.. therefore the scapula also has to move synergistically to assist with this movement of the humerus..
0-30 degrees of abduction, the supraspinatus initiates then deltoid becomes prime mover (deltoid pulls humerus up and supraspinatus pulls it horizontally) => abduction
Abnormal:
Shoulder ‘hitch’ and compensation from Tx spine
Ineffective rotator cuff so compensation with deltoid
Lack of scapula rotation
Scapulohumeral rhythm serves two purposes:
It preserves the length-tension relationships of the glenohumeral muscles. Muscles do not shorten as much as they would without the scapula's upward rotation, and so can sustain their force production through a larger portion of the range of motion. It prevents impingement between the humerus and the acromion. Subacromial impingement can occur unless relative movement between the humerus and scapula is limited because of the difference in size between the glenoid fossa and the humeral head. Simultaneous movement of the humerus and scapula during shoulder elevation limits relative (arthrokinematic) movement between the two bones
Palpate: Greater tubercle of humerus
Pt position?
Attachment for what?
https: //www.youtube.com/watch?v=weP8obvDrFM
1: 19
model in high sitting
Anatomical position, stand behind model, find lateral border of the acromion, move palpating finger laterally onto lateral aspect greater tubercle
Provides attachment for; Supraspinatus, Infrapinatus, Teres Minor [ROTATOR CUFFS]
Palpate: Lesser tubercle of humerus
Pt position?
Provides attachment for ?
model in high sitting
Palpate the greater tubercle, rotate arm laterally feel depression of intertubercular sulcus then up onto lesser tubercle. - Moving more anteriorally
Provides attachment for; Subscapularis
Palpate: Intertubercular sulcus
(intertubercular groove, or bicipital groove)
Pt position?
Attachment for what?
Palpate the greater tubercle, rotate arm laterally feel depression of intertubercular sulcus
As above Occupied by biceps tendon, provides attachment for; Pec major (lat lip), Lat dorsi (floor), Teres Maj (med lip)
Palpate: Head of humerus
Pt position?
model in high sitting
Arm in neutral, palpate rounded prominence anterior aspect of shoulder
Scapulo-humeral rhythm:
Observe your model – can you identify the relationship between movement of the GHJ and the Scapula? What is this relationship i.e. what ratio of movement occurs at the GHJ compared to shoulder girdle?
Ratio of 1:2 , ie 1 = scapular, 2 = humerous
Ie in flexion, total = 180 degrees
60 = scap
120 = humerous
Ie more movement occuring at the humerus
ROM at the shoulder
Active ROM Starting Position Flexion 0- 180 Extension 0- 30/45 Abduction 0 - 180 Adduction 0 - 45 Medial rotation 0 - 45 Lateral rotation 0 - 45 Normally more lat than medial Horiz Flexion Horiz Extension
Rotator cuff muslces - A attachement ects..
What kind of pain are they associated with?
Supraspinatus - Abduction -
Infraspinatus - Lateral rotation
Subscapularis - Medial rotation
Teres minor - Lateral rotation
Sub acromial pain / rotator cuff related sub acromial pain
PAMs : = find VIDEO
- What are they?
- Perform them..
https: //www.youtube.com/watch?v=hKjQw-blrZ4
- PA / AP - push on the HOH, hold coracoid / acromion
- Distraction (Lateral movement) - like hip pull away - pushing away under arm pit
- Longitudinal - abduct arm - tug arm at wrist / stablise other - ‘sulcus test’ ie if the space ??appears??
Deltoid
➢ suggest their functional contribution to movement,
➢ put them into action into action and identify their contraction
➢ test them for strength [ isometric and dynamic testing ]
- Resist:
forward flexion (ant. fibres)
, abduction and extension
Deltoid
➢ suggest their functional contribution to movement,
➢ put them into action into action and identify their contraction
➢ test them for strength [ isometric and dynamic testing ]
Resist:
- forward flexion (ant. fibres)
- extension (posterior fibres)
- medial roation (ant. fibres)
- lateral rotation (post. fibres)
- abduction (middle fibres)
[everything but adduction]
Infraspinatus - MORPH?
➢ suggest their functional contribution to movement,
➢ put them into action into action and identify their contraction
➢ test them for strength [ isometric and dynamic testing ]
Small triangluar?
Lateral rotator (sits on top of teres minor / infra more superfical than teres)
“make a fist, don’t let me turn your arm in”
Teres minor
➢ suggest their functional contribution to movement,
➢ put them into action into action and identify their contraction
➢ test them for strength [ isometric and dynamic testing ]
Lateral rotator so resist lat rotation (sits deeper to the infraspinatous but same place)
Palpate the infraspinatous fossa??
“make a fist.. dont let me turn your arm in”
Subscapularis
➢ suggest their functional contribution to movement,
➢ put them into action into action and identify their contraction
➢ test them for strength [ isometric and dynamic testing ]
Large triangluar
Medial rotator - so resist med rotation
Because pec major will be dominant can be good to do with pt’s hand behind their back, to put it at a bio mech disadvantage
Supraspinatus
➢ suggest their functional contribution to movement,
➢ put them into action into action and identify their contraction
➢ test them for strength [ isometric and dynamic testing ]
Abduction so resist abduction
palpate the spine of the scap and then up a bit
Measure movements at the shoulder using a goniometer: position of fulcrum? and limiting factor?
- Flexion / extension
- Abduction / adduction
- Medial / lat rotation
- Horizontal flex / extension
- Flexion / extension - fulcrum on greater tubercle [Greater tubercle of humerus model in high sitting
Anatomical position, stand behind model, find lateral border of the acromion, move palpating finger laterally onto lateral aspect greater tubercle] - Abduction / adduction - fulcrum on lesser tuberosity [Lesser tubercle of humerus model in high sitting
Palpate the greater tubercle, rotate arm laterally feel depression of intertubercular sulcus then up onto lesser tubercle] - Medial - Pt hand behind back - or fulcrum on olecrenon with arm in abduction
- lat rotation - Pt hand behind neck - or fulcrum on olecrenon then arm in abduction
- Horizontal flex like a ‘BS P.E triceps stretch’ (deltoid / supraspinatous abductor + rhomboid - protractor stretch)
- Horizontal Extension - like the T from Ys Ts Ws
Pectoralis major (A)
Morph? ect..
- position - anterior side of upper body, on chest
- morphology - fan-shaped muscle
- origin
(1) - Clavicular part: anterior surface of medial half of clavicle
(2) - Sternocostal part: anterior surface of sternum, Costal cartilages of ribs 1-6
(3) - Abdominal part: Anterior layer of rectus sheat
Insertion
(1) - Crest of greater tubercle of humerus (lat dorsi inserts inbetween pec major / teres major) - Describe the direction of fibres -
up - abdo part,
horiztonal -sternocostal part and
downwards - clavicular part - Actions - shoulder adduction / medial rotator [ Arm flexion (clavicular head), arm extension (sternocostal head)]
- functions of daily living -
- nerve supply - Lateral and medial pectoral nerves (C5-T1)
- contraction? -
Deltoid (Anterior / posterior / middle fibres) (A)
- position - on top of the shoulder joint ant / post aspect
- morphology - completely surrounds the shoulder joint (ie wraps around from back to front)
- origin [similar to trapezius]
(1) - Spine of scapular
(2) - Acromion
(3) - Lateral 1/3 of clavicle
Insertion
(1) - deltoid tuberosity of humerous - Describe the direction of fibres - down and laterally (in ant / post compartments) mid = more down
- Actions - Anterior part - flexion / med rotation
Postior part - extensor / lat rotation
Middle part - abductor - functions of daily living - putting on a tee shirt
- contraction? Resist forward flex, extension, abduction…
- nerve supply - axillary nerve (C5, C6).
Biceps brachii (long head) (A)
Biceps –> superman has big guns.. Super man..
position
Morphology - Fusiform, 2 Heads (short head and long head)
O- Supraglenoid tubercle (Long Head) Corocoid Process (Short head)
I-Radial Tuberosity
super man jumps off glencoe and catches corona virus so jumps in a radioactive tube to get rid of it
- Describe the direction of fibres, - Downwards
Action-
Flexion of elbow
Flexion of shoulder
Supinator of forearm
- functions of daily living -
Nerve - Musculocutaneous - contraction?
Teres minor (A)
- position -
- morphology -
- Describe the direction of fibres -
- functions of daily living -
- contraction?
Origin
Insertion
Action
Shoulder joint:
Innervation
- position - posterior muscle of the shoulder that extends between the scapula and the head of humerus
- morphology - small, fusiform
- Describe the direction of fibres - Up (superior) and lateral
- functions of daily living -
- contraction? - resist external rotation
Origin - Lateral border of scapula
Insertion - Greater tubercle of humerus
(Fossa fossa fossa, lat border - Terrys party with latvians at the border..)
Action Arm external rotation, arm adduction;
Stabilizes humeral head in glenoid cavity
Innervation Axillary nerve (C5, C6)
Infraspinatus (A)
- position / morphology - thick triangular muscle that occupies the majority of the dorsal surface of the scapula
- Describe the direction of fibres -
- functions of daily living -
- contraction / Action Shoulder joint: Arm external rotation;
Stabilizes humeral head in glenoid cavity
Origin Infraspinous fossa of scapula
Insertion Greater tubercle of humerus
Innervation Suprascapular nerve (C5, C6)
Supraspinatus (A)
- position - Supraspinatus is located deep to the trapezius muscle in the posterior scapular region
- morphology - small, fusiform
- Describe the direction of fibres -
- functions of daily living -
- contraction? resist abduction
Origin Supraspinous fossa of scapula
Insertion Greater tubercle of humerus
Action Shoulder joint: abduction of arm,
stabilization of the humeral head in the glenoid cavity
Innervation Suprascapular nerve (C5, C6)
Latissimus dorsi (A)
A latvian pro
Morph ect..
- position - posterior side of back - very wide
- morphology - large flat trianglular, spiralised tendon muscle
- origin
(1) - Vertebral part: Spinous processes of vertebrae T6-T12, Thoracolumbar fascia
(2) Iliac part: Posterior third of crest of ilium
(3) Costal part: Ribs 9-12
(4) Scapular part: Inferior angle of scapula
Insertion
(1) - Intertubercular sulcus of the humerus, [between pectoralis major and teres major muscles
Mnemonic: Lady between two majors (lady refers to latissimus dorsi)]
A latvian pro spills 6 / 12ths of a cup to Tea (1) onto a lump (2) by because Thor (3) closes a door on his face (3)..mixes it with a rib (+) and a angler fish (+) and then posts (4) it with cress (4) to an Inn (5) via a tube (5) full of hummus (5)
- Describe the direction of fibres - Down and medially
- Actions - Shoulder Extension, medial rotation, adduction and shoulder girdle depression
- functions of daily living - pull up (depression),
- nerve supply - Thoracodorsal nerve (C6-C8)
- contraction? - make a fist - resist abduction
Teres major B
Origins - Inferior angle and lower part of the lateral border of the scapula
Insertions - Intertubercular sulcus (medial lip) of the humerus
Function Extension and internal rotation of the humerus (arm), adductor
Subscapularis (A)
- position - morphology - trianglular think ‘sub’ so under.. it is on the front side of the scapula can be viewed through the ribcage..
‘Subscapularisfills the subscapular fossa of scapula’
- Describe the direction of fibres - up / laterally
- functions of daily living - stabilise HOH centralisation eg eating, putting on coat..
- contraction? resist internal rotation
Origin Subscapular fossa of scapula
Insertion Lesser tubercle of humerus
Action Shoulder joint: Arm internal rotation (its on the anterior side like pec major.. so think medial rotation)
Stabilizes humeral head in glenoid cavity
Innervation Upper and lower subscapular nerves (C5 - C6)
Triceps (long head) (A)
You try to send an …
Morphology - Fusiform, 3 Heads (long head, medial head & lateral head)
O- Infraglenoid tubercle (Long Head)
Lateral side (lateral head) of posterior surface of humerus
medial side (medial head) of posterior surface of humerus
I-Olecranon process
An infared beam of light shines on glencoe which prevents lattitude from happening in a medevil castle so ole has to cancel his ticket
Action-
Extension of elbow and shoulder
Nerve - Radial
Pec minor B
Origin Anterior surface, costal cartilages of ribs 3-5
Insertion Medial border and coracoid process of scapula
Function Scapulothoracic joint: draws scapula anteroinferiorly, stabilizes scapula on thoracic wall (just like seratus)
Protraction / depression - shoulder girdle
Adductors:
Pec Major
Lat dorsi
Teres major muscle
