Anatomy & Biomechanics of the Shoulder

James J. Irrgang, Ph.D., PT, ATC
Department of Physical Therapy University of Pittsburgh

Shoulder Motion
Combined Movements:
• • •


• • •

Flexion - 150 - 1800 Extension - 50 - 600 Abduction - 150 - 1800 External rotation - 900 Internal rotation - 70 - 900 Horizontal abduction Horizontal adduction

Shoulder Girdle
Includes:
• • • • •

G-H joint A-C joint S-C joint S-T joint Subacromial space

Glenohumeral Motion
Controlled by:

Passive restraints Active restraints

Glenohumeral Motion
Passive Restraints:
• •


Bony geometry Labrum Capsuloligamen tous structures Negative intraarticular pressure

Capsuloligamentous Structures Glenohumeral ligaments: • • • SGHL MGHL IGHL complex • • • anterior band posterior band axillary pouch .

Capsuloligamentous Structures Glenohumeral ligaments: .

Capsuloligamentous Structures • Coracohumeral ligament • • anterior band posterior band .

SGHL & MGHL 900 .anterior band IGHLC . C-H & subscapularis 450 .SGHL.Restraints to External Rotation Dependent on arm position: • • • 00 .

anterior & posterior band IGHLC .posterior band IGHLC 450 .anterior & posterior band IGHLC 900 .Restraints to Internal Rotation Dependent on arm position: • • • 00 .

IGHLC .SGHL & C-H 900 .Restraints to Inferior Translation Dependent on arm position: • • 00 .

1200 Abduction/adduction .Glenohumeral Motion Scapular Plane: • • • • Flexion/extension .1200 External/internal rotation Horizontal abduction/ adduction .

Arthrokinematics of Glenohumeral Joint .

Glenohumeral Motion Convex .Concave Rule: .

Glenohumeral Motion Arthrokinematics: • • • • • Abduction Flexion Extension External rotation Internal rotation .

Glenohumeral Motion Arthrokinematics: Harryman et. 1990 . al.

Glenohumeral Motion Arthrokinematics: Harryman et. al. 1990 .

al. 1990 .Glenohumeral Motion Arthrokinematics: Harryman et.

Glenohumeral Motion Capsular Tightness: Results in Abnormal Arthrokinematics .

Glenohumeral Motion Normal Arthrokinematics: •Combines rotation & translation to keep humeral head centered on glenoid .

Scapulohumeral Muscles Prime Movers: • • • • • • • Deltoid Pectoralis major Latissimus dorsi Teres major Biceps Coracobrachialis Triceps .

Scapulohumeral Muscles Rotator Cuff: • • • • Subscapularis Supraspinatus Infraspinatus Teres Minor .

infraspinatus & teres minor depress humeral head .Rotator Cuff Function • • • Approximates humerus to function Supraspinatus assists deltoid in abduction Subscapularis.

JBJS 1981 . al.Subscapularis • • Effective restraint to ER with arm at side Ineffective restraint to ER with arm abducted to 900 Turkel et.

AJSM 1987 . al.Infraspinatus/Teres Minor • • Reduces strain on anterior band of IGHLC “Hamstrings” of glenohumeral joint Cain et.

Long Head of Biceps • • • Biceps tendon force increases torsional rigidity to ER No effect on strain of IGHLC Effect lost with SLAP lesion Rodosky et. AJSM 1994 . al.

JBJS 1994 & Glousman et.Biceps Becomes More Important Anterior Stabilizer as Capsuloligamentous Stability Decreases Itoi et. al. 1988 . al.

inferior RC . posterior RC Coronal plane deltoid vs.Force Couples Acting on Glenohumeral Joint • • Transverse plane anterior vs.

Rotator Cuff Tear Supraspinatus: • • Essential force couples maintained Normal strength & function possible .

Rotator Cuff Tear Supraspinatus/Posterior Cuff: • • • Essential force couples disrupted Weakness with external rotation Little active elevation possible .

Rotator Cuff Tear Massive Tear : • • • Essential force couples disrupted Weakness with internal & external rotation Little active elevation possible .

Subacromial Space .

Structures Within Suprahumeral Space • • • • • • Long head of biceps Superior capsule Supraspinatus tendon Upper margins of subscapularis & infraspinatus tendons Subacromial bursa Inferior surface of A-C joint .

Subacromial Space Clinical Relevance: • Avoidance of impingement during elevation of arm requires: • • external rotation of humerus to clear greater tuberosity upward rotation of scapula to elevate lateral end of acromion .

Subacromial Space Clinical Relevance: • • Primary impingement: • structural stenosis of subacromial space functional stenosis of subacromial space due to abnormal arthrokinematics Secondary impingement: • .

Scapulothoracic Joint .

Scapulothoracic Muscles • • • • • • Trapezius Serratus anterior Rhomboids Levator scapulae Pectoralis minor Subclavius .

Scapulothoracic Motion • • • Elevation/depression Protraction/retraction Upward/downward rotation .

Force Couple at Scapulothoracic Joint • • Serratus anterior produces anterio-lateral movement of inferior angle Upper trapezius pulls scapula medially .

Scapulohumeral Rhythm • Total elevation: • • 1200 at G-H joint 600 at S-T joint .

Force Couple at Scapulothoracic Joint • • Serratus anterior produces anterio-lateral movement of inferior angle Upper trapezius pulls scapula medially .

Acromioclavicular Joint .

Acromioclavicular Joint • • • • Joint capsule A-C ligaments Intra-articular disc Coracoclavicular ligaments • • conoid (medial) trapezoid (lateral) .

Acromioclavicular Joint Movements: • • Axial rotation of clavicle (spin) Angulation between scapula & clavicle .

Sternoclavicular Joint • • • • • Joint capsule Anterior & posterior SC ligaments Intra-articular disc Interclavicular ligament Costoclavicular ligament .

Sternoclavicular Joint Motions: • • • Protraction/retraction Elevation/depression Axial rotation (spin) .

Biomechanics of Scapular Rotation • Scapulothoracic motion occurs as part of closed kinetic chain involving: • • A-C joint S-C joint .

Scapular Rotation Phase I • • • Upper & lower portions of trapezius & serratus anterior produce upward rotatory force on scapula Motion at A-C joint prevented by coracoclavicular ligament Rotation of scapula occurs as elevation of clavicle at S-C joint .

Scapular Rotation Phase II • • • Further motion at S-C joint prevented by costoclavicular ligament Continued upward rotation of scapula pulls on costoclavicular ligament causing posterior rotation of clavicle Posterior rotation of clavicle allows further upward rotation of scapula .

Scapular Rotation Necessary to: • • • Enhance glenohumeral stability Elevate acromion to avoid impingement Maintain effective length tension relationship of scapulohumeral muscles Review this lecture .

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