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Shoulder Complex

Shoulder Complex

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Published by thwiseman

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Published by: thwiseman on Nov 19, 2009
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The shoulder complex is composed of the scapula, clavicle, humerus, andthe joints that link these bones into a functional entity. These components constituteone – half of the weight of the entire upper limb. The scapula, clavicle, and humerusthat forms the shoulder complex are responsible for movement of the hand throughspace. Four interdependent linkages that control the three segments are as follows:
Scapulothoracic (ST) Joint.
Sternoclavicular (SC) Joint.
Acromioclavicular (AC) Joint.
Glenohumeral (GH) Joint.
Scapulothoracic Joint:
The scapulothoracic (ST) joint is formed by the articulation of the scapula with the thorax on which it sits.
It is not a true anatomic joint because ithas none of the usual joint characteristics (union by fibrous, cartilaginous, orsynovial tissues). In fact, the articulation of the scapula with the thorax depends onthe anatomic acromioclavicular (AC) and sternoclavicular (SC) joints. The SC andAC joints are interdependent with the ST joint because the scapula is attached byits acromion process to the lateral end of the clavicle via the AC joint; the clavicle,in turn, is attached to the axial skeleton at manubrium of the sternum via the SC joint.
 Any movement of the scapula on the thorax must result in movement ateither the AC joint, SC joint, or both.
That is, the
 functional ST joint
is part of atrue closed chain with the AC and SC joints.
Scapulothoracic Position: 
 Normally, the scapula rests at a position on the posterior thorax approximately 2 inches from the midline, between the second through seventh ribs.
The scapula also lies 30
to 40
forward of the frontal plane and is tippedanteriorly approximately 10
to 20
from vertical with a good deal of individualvariability.
Scapulothoracic Motions: 
The motions of the scapula at scapulothoracic joint are as follows:
Elevation / Depression
Protraction / Retraction
(Abduction / Adduction).
Upward Rotation / Downward Rotation
(Medial Rotation / LateralRotation).
 Elevation and depression of the scapula
are described as translatorymotions in which the scapula moves
upward (cephalad) or downward (caudally) along the rib cage from its resting position
 Protraction and 
 retraction of the scapula
are described as translatory motions of the scapula
 away from or toward the vertebral column, respectively
Upward and  downward rotations
are rotatory motions that
 tilt the glenoid fossa upward or downward, respectively
Upward and downward rotation
can also be describedby referencing movement of the
inferior angle away from the vertebral column(upward rotation) or movement of the inferior angle toward the vertebral  column (downward rotation)
Scapulothoracic Stability: 
Stability of the scapula on the thorax is provided by the structures that maintain integrity of the linked AC and SC joints. The muscles that attach to both the thorax and scapula maintain contact between these surfaces while producing the movements of the scapula.
The ultimate function of scapular motion is to orient the glenoid fossa foroptimal contact with the maneuvering arm, to add range to elevation of the arm,and to provide a stable base for the controlled rolling and sliding of the articularsurface of the humeral head.
Sternoclavicular Joint:
This occurs between the sternal end of the clavicle, themanubrium sterni, and the first costal cartilage.
Synovial double – plane joint.
This surrounds the joint and is attached to the margins of the articularsurfaces.
 Articular Disc:
This flat fibrocartilaginous disc lies within the joint and dividesthe joint’s interior into two compartments. Its circumference is attached to theinterior of the capsule, but it is strongly attached to the superior margin of thearticular surface of the clavicle above and to the first costal cartilage below.
Following are the ligaments of the sternoclavicular joint:
1) Sternoclavicular (SC) Ligaments.2) Costoclavicular Ligament.3) Interclavicular Ligament.
 The anterior & posterior SC ligaments reinforce the capsule.
The SC ligaments serve primarily to check anterior and posterior movement of the head of the clavicle.
The costoclavicular ligament is a strong ligament that runsfrom the junction of the first rib with the first costal cartilage to the inferiorsurface of the sternal end of the clavicle.
Costoclavicular ligament checkselevation of the clavicle.
Interclavicular ligament is present between the twoclavicles and
it presents excessive depression or downward glide of the clavicle.

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