The Shoulder Joint

• Shoulder joint is attached to axial skeleton

via the clavicle at SC joint
• Scapula movement usually occurs with

Chapter 5 movement of humerus

The Shoulder Joint
Manual of Structural Kinesiology
R.T. Floyd, EdD, ATC, CSCS
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– Humeral flexion & abduction require scapula
elevation, rotation upward, & abduction
– Humeral adduction & extension results in scapula
depression, rotation downward, & adduction
– Scapula abduction occurs with humeral internal
rotation & horizontal adduction
– Scapula adduction occurs with humeral external
rotation & horizontal abduction
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The Shoulder Joint Bones

• Wide range of motion of the shoulder joint in • Scapula, clavicle, & humerus serve as
many different planes requires a significant attachments for shoulder joint muscles
amount of laxity – Scapular landmarks
• Common to have instability problems • supraspinatus fossa
– Rotator cuff impingement • infraspinatus fossa
– Subluxations & dislocations • subscapular fossa
• spine of the scapula
• The price of mobility is reduced stability
• glenoid cavity
• The more mobile a joint is, the less stable it • coracoid process
is & the more stable it is, the less mobile • acromion process
• inferior angle
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New York, 2006, McGraw-Hill

Bones Bones

• Scapula, clavicle, & humerus serve as • Key bony landmarks

attachments for shoulder joint muscles – Acromion process
– Humeral landmarks – Glenoid fossa
• Head – Lateral border
• Greater tubercle
– Inferior angle
• Lesser tubercle
– Medial border
• Intertubercular groove
– Superior angle
• Deltoid tuberosity
– Spine of the scapula

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 Glenohumeral Joint Glenohumeral Joint

– Glenoid labrum
• multiaxial ball- slightly
&-socket enhances
stability
• enarthrodial

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Glenohumeral Joint Glenohumeral Joint

– Glenohumeral – Ligaments are quite lax until extreme

ligaments provide ranges of motion reached due to wide
stability range of motion involved
• especially – Stability is sacrificed to gain mobility
anteriorly &
inferiorly
• inferior
glenohumeral
ligament

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Glenohumeral Joint Glenohumeral Joint

• Determining – 90 to 95 degrees
exact range of abduction
each – 0 degrees adduction,
movement is 75 degrees anterior
to trunk
difficult due to
accompanying
shoulder girdle
movement

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 Glenohumeral Joint Glenohumeral Joint

– 40 to 60 degrees of – 70 to 90 degrees of internal & external

extension rotation
– 90 to 100 degrees of
flexion

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Glenohumeral Joint Glenohumeral Joint

– 45 degrees of • Frequently injured due to anatomical design

horizontal – shallowness of glenoid fossa
abduction – laxity of ligamentous structures
– 135 degrees of – lack of strength & endurance in muscles
horizontal
adduction – anterior or anteroinferior glenohumeral
subluxations & dislocations – common
– posterior dislocations – rare
– posterior instability problems somewhat
common
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Pairing of shoulder girdle & shoulder joint

Glenohumeral Joint
movements
Shoulder joint Shoulder girdle
• Rotator cuff is frequently injured
Abduction Upward rotation
– Subscapularis, supraspinatus, infraspinatus, &
teres minor muscles Adduction Downward rotation
– attach to the front, top, & rear of humeral head Flexion Elevation/upward rotation
– point of insertion enables humeral rotation Extension Depression/downward rotation
– vital in maintaining humeral head in correct Internal rotation Abduction (protraction)
approximation within glenoid fossa while more External rotation Adduction (retraction)
powerful muscles move humerus through its wide
Horizontal abduction Adduction (retraction)
range of motion
Horizontal adduction Abduction (protraction)

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 Movements Movements

• Abduction • Flexion
– upward lateral – movement
movement of humerus of humerus
out to the side, away straight
from body anteriorly
• Adduction • Extension
– downward movement – movement
of humerus medially of humerus
toward body from straight
abduction posteriorly

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Movements Movements

• Horizontal adduction • External rotation

(transverse flexion) – movement of
– movement of humerus in a humerus laterally
horizontal or transverse around its long axis
plane toward & across chest away from midline
• Horizontal abduction • Internal rotation
(transverse extension) – movement of
– movement of humerus in a humerus medially
horizontal or transverse around its long axis
plane away from chest toward midline

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Movements Muscles

• Diagonal abduction • Intrinsic glenohumeral muscles

– movement of humerus – Originate on scapula & clavicle
in a diagonal plane – Deltoid, Coracobrachialis, Teres major
away from midline of – Rotator cuff group
body
• subscapularis, supraspinatus, infraspinatus, &
• Diagonal adduction teres minor
– movement of humerus • Extrinsic glenohumeral muscles
in a diagonal plane – latissimus dorsi & pectoralis major
toward midline of body

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 Muscles Muscles

• Anterior • Superior
– Pectoralis major – Deltoid
– Coracobrachialis – Supraspinatus
– Subscapularis • Posterior
• Superior – Latissimus dorsi
– Deltoid – Teres major
– Supraspinatus – Infraspinatus
– Teres minor From Shier D, Butler J, Lewis R: Hole’s
essentials of human anatomy and
physiology, ed 9, New York, 2006,
McGraw-Hill.

From Shier D, Butler J, Lewis R: Hole’s essentials of human anatomy and physiology, ed 9,
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Nerves Nerves
• All shoulder joint muscles are innervated from • Axillary nerve branching
the brachial plexus from C5 & C6
• Lateral pectoral nerve arising from C5, C6, & – Deltoid
C7
– Teres minor
– Pectoralis major (clavicular head)
– Sensation to lateral patch of
• Medial pectoral nerve arising from C8 & T1
skin over deltoid region of
– Pectoralis major (sternal head) arm
• Thoracodorsal nerve arising from C6, C7, &
C8 • Upper subscapular nerves
– Latissimus dorsi arising from C5 & C6
– Subscapularis
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Nerves Nerves

• Lower subscapular nerve arising from • Musculotaneous nerve

C5 & C6 branching from C5, C6, &
– Subscapularis C7
– Teres major – Coracobrachialis
• Suprascapula nerve originating from – Sensation to radial aspect
C5 & C6 of forearm
– Supraspinatus
– Infraspinatus

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 Deltoid Muscle Pectoralis Major Muscle
Upper fibers (clavicular head):
Anterior fibers: Posterior fibers: internal rotation, horizontal
abduction, flexion, abduction, extension, adduction, flexion, abduction (once
arm is abducted 90 degrees, upper
horizontal adduction, horizontal abduction, fibers assist in further abduction), &
& internal rotation & external rotation adduction (with arm below 90
degrees of abduction)
Middle fibers:
Lower fibers (sternal
abduction head): internal
rotation, horizontal
adduction, extension,
& adduction

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Latissimus Dorsi Muscle Coracobrachialis Muscle

Adduction

Extension Flexion
Adduction
Internal rotation
Horizontal adduction
Horizontal abduction

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Rotator cuff muscles Rotator cuff muscles

• Supraspinatus
• not very large
– attach to greater tubercle from above (Abduct)
• must possess strength & muscular endurance
• Infraspinatus
• conducting repetitious overhead activities
– attach to greater tubercle posteriorly (Ext. Rot.)
(throwing, swimming, & pitching) with poor
• Teres Minor technique, muscle fatigue, or inadequate warm-
– attach to greater up & conditioning leads to failure of rotator cuff
tubercle posteriorly muscle group in dynamically stabilizing humeral
(Ext. Rot.) head in glenoid cavity
• Subscapularis • leads to further rotator cuff problems such as
– attach to lesser tendinitis & rotator cuff impingement within
tubercle anterior (Int. subacromial space
Rot.)
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 Subscapularis Muscle Supraspinatus Muscle

Internal rotation
Adduction Abduction
Extension
Stabilization of the
Stabilization of the humeral head in
humeral head in
glenoid fossa glenoid fossa

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Infraspinatus Muscle Teres Minor Muscle

External rotation External rotation

Horizontal abduction Horizontal abduction

Extension Extension

Stabilization of humeral Stabilization of humeral

head in the glenoid fossa head in the glenoid fossa

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Teres Major Muscle Glenohumeral Flexion

Extension, particularly from • Agonists
the flexed position to the – Anterior Deltoid
posteriorly extended
position – Upper Pectoralis Major
Internal rotation
Adduction, particularly from
the abducted position
down to the side &
toward midline of body

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 Glenohumeral Extension Glenohumeral Abduction
• Agonists • Agonists
– Teres – Deltoid
Major
– Supraspinatus
– Latissimus – Upper Pectoralis
Dorsi Major
– Lower
Pectoralis
Major

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Glenohumeral Adduction Glenohumeral Internal Rotation

• EX. Lat. Pull - • Agonists
pull down – Latissimus
weights Dorsi
• Agonists – Teres Major
– Latissimus – Subscapularis
Dorsi
– Pectoralis
– Teres Major Major
– Lower
Pectoralis
• All attach
Major anteromedially
on humerus
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Glenohumeral External Rotation Glenohumeral Horizontal Abduction

• Agonists • Agonists
– Infraspinatus – Posterior
– Teres Minor Deltoid
• Both attach – Middle
Deltoid
posteriorly on
greater tubercle – Infraspinatus
– Teres Minor

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 Glenohumeral Horizontal Adduction Glenohumeral Diagonal Abduction

• Agonists • Agonists
– Anterior Deltoid – Posterior Deltoid
– Pectoralis Major – Infraspinatus
– Coracobrachialis – Teres Minor
– Triceps Brachii
(Long Head)

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Glenohumeral Diagonal Adduction Web Sites

Radiologic Anatomy Browser
http://radlinux1.usuf1.usuhs.mil/rad/iong/index.html
• Agonists - both – This site has numerous radiological views of the
musculoskeletal system.
low & high University of Arkansas Medical School Gross Anatomy for Medical
– Anterior Deltoid Students
http://anatomy.uams.edu/anatomyhtml/grossresources.html
– Coracobrachialis – Dissections, anatomy tables, atlas images, links, etc.
Loyola University Medical Center: Structure of the Human Body
– Biceps Brachii www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/GA.html
(short head) – An excellent site with many slides, dissections, tutorials, etc.,
for the study of human anatomy
– Pectoralis Major - Wheeless’ Textbook of Orthopaedics
Upper & Lower www.wheelessonline.com/
– This site has an extensive index of links to the fractures,
joints, muscles, nerves, trauma, medications, medical topics,
lab tests, and links to orthopedic journals and other orthopedic
and medical news.
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Web Sites Web Sites

Premiere Medical Search Engine Lecture Topics in Kinesiology
http://www.medsite.com/Default.asp?bhcp=1 http://moon.ouhsc.edu/dthompso/namics/shoulder.htm
– This site allows the reader to enter any medical condition and – Shoulder articulations, movements, and muscles that are
it will search the net to find relevant articles. within the shoulder girdle
Arthroscopy.Com The Physician and Sportsmedicine
www.arthroscopy.com/sports.htm www.physsportsmed.com/issues/2003/0703/depalma.htm
– Patient information on various musculoskeletal problems of – Detecting and Treating Shoulder Impingement Syndrome: The
the upper and lower extremity Role of Scapulothoracic Dyskinesis
Virtual Hospital Southern California Orthopedic Institute
www.vh.org www.scoi.com/sholanat.htm
– Numerous slides, patient information, etc. – Anatomy of the Shoulder
Medical Multimedia Group FamilyDoctor.org
www.healthpages.org/AHP/LIBRARY/HLTHTOP/CTD/ http://familydoctor.org/268.xml
– A Patient's Guide to Cumulative Trauma Disorder (CTD) – Shoulder Pain
Baseball Almanac
www.baseball-almanac.com/chapters/cap-ch8.shtml
– Coaching Adult Pitchers
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 Web Sites Web Sites
MedlinePlus Orthopaedic Research Institute
www.nlm.nih.gov/medlineplus/tutorials/shoulderarthroscopy/htm/ http://www.ori.org.au/bonejoint/shoulder/contents.htm
index.htm – Several web pages, text, and graphics on glenohumeral
– Shoulder arthroscopy interactive tutorial instability
MedlinePlus American Sports Medicine Institute
www.nlm.nih.gov/medlineplus/tutorials/rotatorcuffinjuries/htm/ind www.asmi.org/asmiweb/mpresentations/mmp.htm
ex.htm – Biomechanics of the Shoulder during Throwing
– Rotator cuff injuries interactive tutorial American Sports Medicine Institute
American Physical Therapy Association http://www.asmi.org/SportsMed/throwing/thrower10.html
www.apta.org/AM/Template.cfm?Section=Home&TEMPLATE=/ – Throwers Ten Exercises
CM/HTMLDisplay.cfm&CONTENTID=20448 Washington Musculoskeletal Tumor Center
– Taking Care of Your Shoulder www.sarcoma.org/main.php?page=shoulder
American Academy of Orthopaedic Surgeons – Shoulder girdle surgery
http://orthoinfo.aaos.org/category.cfm?topcategory=Shoulder
– Patient Education Library on the Shoulder

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