Lecture XXVI a MECHANICS OF SHOULDER-ARM COMPIZx = ° i 1. INTRODUCTION } I, ADAPTING itself Cor its high! specialized function the yy ‘ | PPE extcor jn. iC declares, would satisty high fn ie sanie time, would be oy sion. This general tread ta prog yt 'y manifest when we compo is 5, th a Targe extent, followed i in the philogenet Nature's geal was lo produce a motor unit whieh on. motility and freedom of xetion and which, at Lx anoagh ta give 15 movement fecce and peecisio an organ of Jree. mobility becames sing relay own way ship to (he trunk with that of the lower extremity Shoulder blade, the showlder-ar: cle aud shoulder jeitt form = mecianicl une ea coviples they correspond ta the combination of the 03 i ‘ the 08 ischii, the os pubis, and the hip joiit in the lawer extremity. Botnec, trast to the massive pelvle wing, only ove ilimsy articulation connects the com, plex vith the skeleton of the trunk: the sternoclaviculat joint, ‘The ciaicis Lnterposes izelf between thacas: and shoulder blade, articulating with the te in the aerantfoclavicular joint, ‘The scapu’ the humerus in the gens. * bumeral articulation; thus & summation of mobility is established by individual joins, all mutually interdependent, This makes the ultimate of the shoulder jaint itself far greater than that af te hia joint, which dees eat enjoy the benef of having its mability increased by ausillary articulations, The = clavicle rotates around the sternum, the seapela around the clevicle, and ihe humerus around the scapula, The latter, in addition, carries cut rotawry and translatery mevements against the thoracie wall in shat fs metaphorieetly called the seapulothoracic joint. Such an arrangement greatly favors the rcbilty of the shoulder-ary cunaples but if ral ara at the thorax much meze difficult, ‘the main burden of tis stabilization rests upaa the powerful musculatuce which secures the dle against the thovax Because the tone of these muscles vari with different antizedes and pasltires it is difficult te speak of 2 normal celatignsaip of the stapule Ie toe thorax without conceding rather wide physinlagical ductuations, Que might consider a8 the normal posi clavicle one in which iis retracted backward ‘and forms with, the-froptal plane an angte of 30°. Ta aS position the scapula is clesely attilched! ta tlie posterior thacacte wall (is. : tPick"). ulkders are carcied high end retracted, thy outer #6 the clavicle is elevated and paints. cbliquely backward, When the posturé 4 axes, Inuwever, the clavicle approaches mure the frontal plane oF ™¥ © t slightly forward with its acromial end three Scanned by CamScannerf i MECHANICS OF SOULE sta cong [ MPL. : H. MorpHor “ Ocy AP A. RELATION OF THE Lents plang refer to the relation of the Scapula to the thoracic wat] wal jgraic joints While this may not be corcest from in wy, it 8 8 CONVERIENL Concept re strictly sibe the movements which SL “he scopula carries out around the A 4 thoravie wall, 1C[5, DE course, abe wigs that all these movements, ccngtier rotatory ar Uanslatocy, “juce a combined movement of Sternaciavicular and acromig~ + elavicular articulation, the former eing the center of motion. But, etal, motions In the imterverte bral articulations are alsa mostly 0 SSaNer @ seaguta to tharacie wall." [Rick) gliding cvovemonts af the articulating facets sboue a center outside of onezhauld not, we believe, 5 the seapa. lod i Physical poine at She st then; 30 @ tod pedantic about using the tecm seapalothatacic jelnt inilitary posture the shoulder blades are drawn backward so that the medial border of the scapula [s less than 5-6 em, from the midline. In normal position the distance is somewhat i- creased; the upper cud of the seagula Hes at the level of the 2nd rib and the lower at the level of the 7th te ath rib. So far as the firm attachment of the scapula to the thoracic wall is concerned, a number of facts are to be considered, The principal force | which bolds the ghoulder blade to the | thorax, isthe atmospheric pressure. We assume the average size of the triangular surface of the scapula to be 15 cm, long tod 10 om. wide, an area of 7$ cm? ‘The atmospheric pressure ix 100 nf, or 760 X 14 mm, of HO, Thus the atmospheric a i? “cling upon the scapula would be 75 X 76 X 14 em, of H:0, or 79) Fic. 3, Sleenocavicular teticulation, “(Redraw from Braus) conttolled by the scapulothoracie muscles hh the trunk and which restrict veondly, the Seapular motion t ‘whieh likewise hold the bone in close contact wit its movements to the contours of the thoragic wall. i pare B. THE STERNOCLAVICULAR ARTICULATIO 1. Anatomy . This ig more a saddle than a ball-and-seck Aicular end of the clavicle 1s rounded, almost SP ne frontal plane the : In th eet tent, and artistes with herical, an ss Scanned by CamScanneriB KINESIOLOGY it 8 concavity of the sternum from which itis separated by a conetan cular meniscus (Pig, 2). While the articular surface of the Sterno ee, in the frontal plane, it is somewhat convex in the Sagittal plane a Conta, are of the clavicle is convex in the frontal but shows a. concaye re Ser < on ig the sagittal plane. The joint bas thtes degrees af freedom: of 1 intrag : f "tin, Permit rotation of the scapula on its length axis, forward and backwart ment about a perpendicular, and upward and dawwnward apr, ae aboyy 2 sagittal axis. Only the length rotatory avis goes through the cen” ences Uicular facets of the joint. This axis rung from lateral upward to mediay ee | ‘ard aporosimately th the frontal plane. ‘The perpendicular and tac axes Iie outside of the joint, somewhere in the costoclaviculay ligament, he i fre the movement about these vu sie se ging one twee ae | menisces and meniscus and stercum. The perpendicular axis toy iat and backward gliding russ (com above medi to below and tater, ta focward and backward movement the sternum furnishes the conve loud ees clavicle -the concavity of the articulation. The sagittal axis for Uprard and * dovnward mavenent also goes through the Even in upright position, without any Movement af the extremity, active suscle force is necessary fo hold the aru by the side of the body becane ' caatast to the hip joint, the atmospheric pressure alone fs unable ee dec fe this position the clavicle can still be depressed which raves that in vive the vam complex, }8, at least partially, cartied by the thoracoscapular muscles (staser"). ¢ equilibrium af the Shoulder-arm complex: in any position depends aot only upon the muscles which produce the position bust also their antagonists which stubilize ity to make the m precise depends largely upon antagenistic control sJ acromion by trapezi tor performance direct and For example, the elevatio: nd serratus lacks precision and guidance without {tie controlling and restraining influence af the eppasing chomboids and _pee- ‘shoulder girdle is able ta carry out its full movements independent of “Gose of the arm; but the full cange of arm movement requires the supple Menlary ranges of the sternoclavicular and acromiaclaviculay joints. To obtain the best abduction range in the scapulohumeral joint the scapule aligns itself with the plane of motion. The abduction feld of the humerus is greatest Ue forward oblique plane, and it is the Function of the scapulothoracic m ‘@ place and to hold the shoulder blade in this plane} in fact, Sea a Seulder joint is facilitated in any plane by the ability af the scapula [9 ‘bell to this plane. For shouléer> he je function of © : nactane muscles. f the arm, evee ag stabilizing Ss reason one may expect difficulties in Be Fomplex {rom the paralysis of almost any of the | i c2Usls of the rhombeids has an effect on the abduction though ig thi oa pass inant Hs performance the muscle plays only @ Pp Nagas, sive role thoracic 1S: ell. iy af the scapul a tl +. thee MEL, it ean be stated that the loss of ap eam tae aside from the effect it has on the move TEC8sarily in : be ition,” (™PEdes and restricts the provement © ment Scanned by CamScanner