Chapter 7: The Biomechanics of the Human Upper Extremity

Basic Biomechanics, 4th edition Susan J. Hall
Presentation Created by

TK Koesterer, Ph.D., ATC Humboldt State University

Objectives
• Explain how anatomical structure affects movement capabilities on upper extremity articulations. • Identify factors influencing the relative mobility and stability of upper extremity movements • Identify muscles that are active during specific upper extremity movements • Describe the biomechanical contributions to common injuries of the upper extremity.

Structure of the Shoulder
• Most complex joint in body • Separate articulations: – Sternoclavicular Joint – Acromioclavicular Joint – Coracoclavicular Joint – Glenohumeral Joint – Scapulothoracic Joint – Also: Bursae

• Rotation . • Allows some forward and backward sagittal plane rotation.Sternoclavicular Joint • Provides major axis of rotation for movement of clavicle and scapula • Freely permitted frontal and transverse plane motion.

– allows limited motions in all three planes. • Rotation occurs during arm elevation • Close-packed position with humerus abducted to 90 degrees .Acromioclavicular Joint • Irregular diarthrodial joint between the acromion process of the scapula and the distal clavicle.

Coracoclavicular Joint • A syndesmosis with coracoid process of scapula – bound to the inferior clavicle by the coracoclavicular ligament. • Permits little movement .

when the humerus is abducted and laterally rotated. .Glenohumeral Joint • Most freely moving joint in human body • Glenoid Labrum composed of: – Joint capsule – Tendon of long head of biceps brachii – Glenohumeral ligaments • Rotator Cuff • Rotator Cuff Muscles • Most stable in close-packed position.

Scapulothoracic Joint • Region between the anterior scapula and thoracic wall. • Functions of muscles attaching to scapula: – Contract to stabilize shoulder region – Facilitate movements of the upper extremity through appropriate positioning of the glenohumeral joint. .

Bursae • Small fibrous sacs that secrete synovial fluid internally to lessen friction between soft tissues around joints. • Shoulder contains: – Subcoracoid bursa – Subscapularis bursa – Subacromial bursa .

Movements of the Shoulder Complex • Humerus movement usually involves some movement at all three shoulder joints – Positioning further facilitated by motions of spine – Scapulohumeral Rhythm .

Movements of the Shoulder Complex • Muscles of the Scapula • Muscles of the Glenohumeral Joint – Flexion – Extension – Abduction – Adduction • Medial and Lateral Rotation of the Humerus • Horizontal Adduction and Abduction at the Glenohumeral Joint .

and four parts to trapezius. pectoralis minor. serratus anterior. rhomboids.Muscles of the Scapula • Functions: – 1) stabilize the scapula when shoulder complex is loaded – 2) move and position the scapula to facilitate movement at glenohumeral joint • Are: – Levator scapula. subclavius. .

. • Tension development in one shoulder muscle is frequently accompanied by development of tension in an antagonist to prevent dislocation of the humeral head.Muscles of Glenohumeral Joint • Many muscles involved. • Large ROM can complicate tension development with orientation of humerus. some contribute more than others.

Flexion at Glenohumeral Joint • Prime flexors: – Anterior deltoid – Pectoralis major: clavicular portion • Assistant flexors: – Coracobrachialis – Biceps brachii: short head .

Extension at Glenohumeral Joint • Gravitational force is primary mover when shoulder extension isn’t resisted. – Control by eccentric contraction of flexors • With resistance there is contraction of muscles posterior to the glenohumeral joint • Assisted by: – Posterior deltoid – Biceps brachii: long head .

and teres minor .Abduction at Glenohumeral Joint • Major abductors of humerus: – Supraspinatus • Initiates abduction • Active for first 110 degrees of abduction – Middle deltoid • Active 90-180 degrees of abduction • Superior dislocating component neutralized by infraspinatus. subscapularis.

Adduction of Glenohumeral Joint • Primary adductors: – Latissimus dorsi – Teres major – Sternocostal pectoralis • Minor assistance: – Biceps brachii: short head – Triceps brachii: long head – Above 90 degrees.coracobrachialis and subscapularis .

Medial and Lateral Rotation of Humerus • Due to action of: – Subscapularis • Has greatest mechanical advantage for medial rotation – Teres major • Assisted by: – Primarily: pectoralis major – Also: anterior deltoid. latissimus dorsi and short head of biceps brachii .

Horizontal Adduction and Abduction at the Glenohumeral Joint • Anterior to joint: – Pectoralis major (both heads). infraspinatus. anterior deltoid. latissimus dorsi . teres minor – Assisted by teres major. coracobrachialis – Assisted by short head of biceps brachi • Posterior to joint: – Middle and posterior deltoid.

• With elbow flexion. – Load reduced by half with maximal elbow flexion . upper arm and forearm/hand segments must be analyzed separately. • Large torques from extended moment arms countered by shoulder muscles.Loads on the Shoulder • Arm segment moment arm: – Perpendicular distance between weight vector and shoulder.

Common Shoulder Injuries • Dislocations • Rotator Cuff Damage – Impingement Theory • Subscapular Neuropathy • Rotational Injuries .

Rotational Injuries • Tears of labrum – Mostly in anterior-superior region • Tears of rotator cuff muscles – Primarily of supraspinatus • Tears of biceps brachii tendon • Due to forceful rotational movements – Also: calcification of soft tissues. bursitis . degenerative changes in articular surfaces.

Structure of the Elbow • Humeroulnar Joint • Humeroradial Joint • Proximal Radioulnar Joint .

biceps brachii. brachioradialis – Muscles crossing posterior side of elbow are the extensors: • Triceps.Segments at the Elbow • Flexion and Extension – Muscles crossing anterior side of elbow are the flexors: • Brachialis. anconeus muscle .

Segments at the Elbow • Pronation and Supination – Involves rotation of radius around ulna – Articulations: • Proximal and distal radioulnar joints (both pivot joints) • Middle radioulnar joint (syndesmosis) • Pronator quadratus • Supinator .

gymnastics • Extensor moment arm shorter flexor moment arm – Tricep attachment to ulna closer to elbow joint center than those of the brachialis on ulna an biceps on radius • Moment arm also varies with position of elbow .Loads on the Elbow • Large loads generate by muscles that cross elbow during forceful pitching/throwing – Also in weight lifting.

Common Injuries to Elbow • Sprains • Dislocations – “nursemaid’s elbow” or “pulled elbow” • Overuse Injuries – Lateral Epicondylitis = “tennis elbow” – Medial Epicondylitis = “Little Leaguer’s Elbow” • Elbow injuries are more chronic than acute .

radial collateral and ulnar collateral ligaments • Retinacula – Form protective passageways for tendons. nerves and blood vessel to pass through .Structure of the Wrist • Radiocarpal joint – Reinforced by: volar radiocarpal. dorsal radiocarpal.

Movements of the Wrist • • • • • • Sagittal and frontal plane movements Rotary motion Flexion Extension and Hyperextension Radial Deviation Ulnar Deviation .

Joint Structure of the Hand • Carpometacarpal (CM) • Metacarpophalangeal (MP) • Interphalangeal (IP) .

adduction and circumduction for digits 2-5 • IP joints allow flexion and extension • Extrinsic Muscles • Intrinsic Muscles . abduction.Movements of the Hand • CM Joints allow large ROM because similar to ball and socket joint – Digits 2-4 constrained by ligaments • MP joints allow flexion. extension.

due to breaking a fall on hyperextended wrist • Certain injuries characteristic of sport type – Metacarpal fractures and football – Ulnar collateral ligament and hockey – Wrist fracture and skate/snowboarding – Wrist in non-dominant hand for golfers • Carpal Tunnel Syndrome .Common Injuries of the Wrist and Hand • Sprains and strains fairly common.

Summary • Shoulder is the most complex joint in the human body. . • Movements of the shoulder girdle contribute to optimal positioning of the glenohumeral joint for different humeral movements. • Humeroulnar articulation controls flexion and extension at the elbow • Pronation and supination of forearm occur at proximal and distal radioulnar joints.