KINESIOLOGY

THE SHOULDER GIRDLE

Petrina Theda Philothra
Introduction
• “The Scapulohumeral Rhythm”

a smooth series of movements which

is produced by the upper extremity
attached to the skeleton of the trunk
by firmly articulation

• These articulation are collectively

called :
“The Shoulder Girdle” or
“The thoracic Scapularhumeral
articulation”
The Shoulder Complex
1. Glenohumeral joint

2. Suprahumeral joint

3. Acromioclavicular joint

4. Scapulocostal joint

5. Sternoclavicular joint

6. Costosternal joint

7. Costovertebral joint

8. Biceps Mechanism

Rene Cailliet, 1977

 BONE
Scapula Clavicle Humerus

https://www.youtube.com/watch?v=J7HfnAn_Rhc
BONE
1. THE SCAPULA
Triangular bone
3 borders : medial (vertebral), lateral (axillary),
superior
3 angles : inferior, superior, and lateral

What holds the scapula to the thorax?

• scapulothoracic muscle

holds the bone in close contact w/ the trunk &

restricts its movement against the contour of
the thoracic wall.
• Anatomic position
• Ligaments

Attached to clavicle
• the atmospheric pressure
(as principal force)
BONE
2. THE CLAVICLE
Long bone, S- shaped, roughly cylindrical
Humerus

Click icon to add picture

Smooth articular → the
humeral head
Prominence on the
anterior surface is called
the lesser tub. and more
lateral greater tub.
The surgical neck→ more
frequent fracture site.
Between the tuberosities
 bicipital groove.
The radial nerve at spiral
groove posteriorly, most
commonly compressed in
this groove → Saturday
Night Palsy.
Click icon to add picture
 THE GLENOHUMERAL JOINT
5. The 6. The
3. Synovial
1. Joint 2. Capsule 4. Bursae Muscle Joint
lining
and Nerve Movement
 GLENOHUMERAL JOINT
1. THE JOINT

• head of the humerus  half sphere, angular value of 153°

• the shallow concave glenoid fossa  angular value 75°

→because of this discrepancy, this joint is inherently

unstable.
Because it has been calculated that the atmospheric pressure
plays only a minor role in the stabilization of this joint, unlike
the hip joint.
The upward direction of the glenoid fossa & the glenoid labrum
(fibrous ring/lip at the perimeter of the fossa)  making the fossa slighty
deeper, are both clinically significant some degree of stability to the joint
2. THE CAPSULE
The GH joint is surrounded by
an extremely thin walled
capsule which is a spacious
container & attaches to the
entire glenoid rim & inserts
into the anatomical neck of
the humerus.

This redundant fibrous

capsule is reinforced
anteriorly by the superior,
middle, and inferior
glenohumeral ligaments.
2. The Capsule

• An opening exits between the superior & middle glenohumeral ligaments

which is called the FORAMEN of WEIBRECHT.
• The anterior pouch, due to capsular laxity & the presence of the foramen of
Weibrecht are both important factors in the frequency of anterior
dislocation of the shoulder.
• Thetautness of the superior capsule while the arm is at the side hanging
prevents the downward subluxation or dislocation of the arm.
• Gliding joint motion between head
of humerus and glenoid fossa
• Arm dependent with superior
portion of capsule taut, which
prevent downward movement
• arm abducted, relaxes superior
portion of capsule and causes
inferior portion to become taut.
• Half abducted, arm both superior
and inferior capsules are slack,
cause instability of GH joint
3. THE SYNOVIAL LINING
• throughout the joint, inside the
capsule.
• The long head of the biceps
attaches to the superior aspect of
the glenoid fossa, the capsule
folds& incoporates the biceps
tendon down into the
intertubercular groove of the
humerus.
4. The Bursae

There are numerous bursae about the shoulder joint, some of them
intercommunicating or simple prolongations of the synovial sac.
The subacromial, subdeltoid, and subcoracoid bursa, the names highly descriptive
of their locations.
These bursae only gains clinical significance when they become inflamed &
prevent the gliding of the muscles, giving rise to pain, this condition is called
bursitis.
 3.
2. 4.
1. Joint Synovial
Capsule Bursae
lining
5. THE MUSCLES OF
THE G-H JOINT:

1. Deltoid
2. Supraspinatus
3. Infraspinatus
4. Teres minor
5. Subscapular
6. Latissimus dorsi
7. Teres major
8. Coracobrachial
9. Pectoralis major
5. The Muscles and Nerves

These are : the D , S , I , Tm , Sc → the more important motions of the GH joint,

known as the Musculotendinous Cuff muscles or as the Rotator Cuff muscles.
The rotator cuff combines w/ the deltoid muscle to abduct the arm, the rotator
action relates to rotation around a point located in the center of the head of the
humerus in an arc at the sagittal plane.
 • Originates from the supraspinatus fossa of the scapula,
passes laterally under the coracoacromial ligament &
Supraspinatus attaches to the greater tuberosity.
• Innervated by the suprascapular nerve C4,5,6.

• Originates from the greater surface of infraspinatus

Infraspinatus fossa  insert just below attachment of supraspinatus
• Innervated by the suprascapular nerve C4,5,6.

• Originates from lateral portion of axillary border of

Teres minor scapula  insert below infraspinatus
• Innervated from the axillary nerve C5,C6.

• Originates from the anterior of scapula  insert to lesser

tuberosity of humerus
Subscapularis • Innervated from the upper & lower subscapular nerve
C5,6.

• a prime mover of shoulder arises anteriorly from the

acromioclavicle & posteriorly from spine of scapula 
Deltoid attach to anterolateral of middle third of humerus
• Innervated by the axillary nerve C5,6.
Rotator Cuff

• When tears occur in the rotator cuff muscle, they usually occur
longitudinally, in the anterior portion of the cuff → the Critical Zone.
• The Critical Zone
• Highly vascularized area
• The greatest tensile strength
• Calcium deposite

• thus is the common site for rupture

6. THE JOINT MOVEMENT

• Greater articular surface of the humerus.

• Abduction : depression of humerus to pass under coracoacromial arch.
• Glenohumeral mov. (SCAPULOHUMERAL RHYTHM):

simultaneous abduction of the arm w/ the depression of the humeral head

• Cuff muscles : motion of rotation & fix of the head of humerus into glenoid fossa
6. THE JOINT MOVEMENT --Supraspinatus

O : supraspinatus fossa
I : greater tuberosity

The Major & exclusive function is fixing the head of the humerus to the
glenoid fossa.

Disproven : supraspinatus as primarily responsible for initiation of abduction in the

first few degrees until one reaches max. at 100° of abduction
The supraspinatus acts w/ the other rotator cuff muscles during GH motion to bring
the head into the glenoid fossa.
6. THE JOINT MOVEMENT –
Infraspinatus, Teres minor, Subscapularis
• The infraspinatus, teres minor,
subscapularis :
downward rotary to depress head of
humerus (short Rotators)
• Subscapularis : assist deltoid in its
abduction action
• The active mov of the humerus at the
GH joint differs from its passive range
and influenced by rotation of the
humerus.
• Passive movement : abduction 120o
exclusively at GH joint, and blocked by
humerus impinging upon acromial
process and coracoacromial ligament
• Active abduct is possible only to 90°,
after that possible only w/ simultaneous
rotation of the humeral, greater
tuberosity pass posteriorly to
acromial process
6. THE JOINT MOV –The Scapulohumeral Rhythm

• Abduction and elevation of arm fully overhead : arc 180o, additional 60o to
active 90o and passive 120o at GH. There is rotation of scapula, adding 60o to
overhead elevation of arm
• Only 60° of abduct is possible w/ the humerus in internal rotation
due to the
fact that the humerus in internal rotation, impinges much earlier upon the
coracoacromial ligament than it does in external rotation.
 THE
SCAPULO-
HUMERAL
RHYTHM
The Scapulohumeral Movement
For every 15⁰ of
abduction of the arm,
10⁰ occur at the GH
joint, 5⁰ from the
rotation of the scapula
upon the chest wall. 2:1
ratio of humerus to
scapula exits throughout
the entire abduction
range in a smooth,
rhythmic pattern.

Scapula maintain
mechanical stability of GH
joint & efficiency of deltoid
m.
The Scapulohumeral Movement

• Full
overhead elevation requires little to no deltoid motion or support if the
scapula is fully rotated.
• Scapulohumeral rhythm at the GH & Scapulothoracic can only be possible
if there is motion in the AC & SC joint.
 THE
SUPRAHUMERAL
JOINT
Suprahumeral joint

• is
not a true joint, is more a protective articulation between the head of
the humerus and an arch formed by a broad, triangular ligament
connecting the coracoid and acromial process.
• The coracoacromial arch prevents trauma from above to the
glenohumeral joint and prevents the upward dislocation of the humerus.
 THE
SCAPULOTHORACIC
JOINT
The Scapulothoracic joint
1. Moves in gliding at distal end
of clavicle, AC joint, by virtue of
motion and rotation of clavicle
2. The muscles and nerves
the trapezius and the serratus
anterior – prime movers
the trapezius , the broad fan
shaped as three muscles :
- upper ,middle, lower fibers.
The Scapulothoracic joint –Muscles

• The Serratus anterior, is found in the

scapulothoracic joint space between the scapula
and the ribs.
• The combined action of the upper trapezius,
lower trapezius and the serratus anterior
causes rotation about the acromioclavicular
joint and the elevation of the glenoid fossa.
The Scapulothoracic Joint –
Muscles
 CV

SCAPULO-THORACIC
MOVEMENTS OF
THE SCAPULA
upper trapezius, lower trapezius and the serratus anterior
The Scapulothoracic joint –Muscles

• The other muscles, the rhomboids (major & minor), levator scapulae

→ all these muscles will elevate the medial border of the scapula & cause the glenoid
fossa to rotate downward.
innervated by the dorsal scapular nerve C5.
The Scapulothoracic joint –
Muscles

• M.latissimus dorsi→ extensor, internal rot. and adductor of the arm,

innervated by the coracodorsal nerve C7,8.
• M.Pectoralis → adducts the arm, brings it forward & medially across the
chest.
• M.Pectoralisminor → depress the shoulder minimally by virtue of its
attachment to the coracoid processs
• M. Teres major→ extensor, internal rot of arm and abductor of humerus.
THE ACROMIOCLAVICULAR
JOINT
The Acromioclavicular Joint

•A fibrocartilagenous ring exits inside joint and resembles as intraarticular

meniscus.
• Atthe age of two years, no joint space exits, age of three, a joint space
appears consisting of two synovial cavities→ at the end of the clavicula & the
acromial end w/ interposed disk between them.
• For every 10o of arm elevation, 4o of elevation occurs at clavicle
• Thescapula, is attached to clavicle through the coracoclavicular ligaments→
two portion : the lateral trapezoid & the medial conoid ligament.
• Rotation of clavicle :

Scapular elevation resulting in clavicular rotation. In overhead arm elevation

above 90o abduction of arm, first 30o occurs at SC joint, next 30o is result of
rotation of clavicle about its long axis
ACROMIO-CLAVICULAR
 THE
STERNOCLAVICULAR
JOINT
The Sternoclavicular Joint
• Rotationof the clavicula occurs primarily in the elevation of the arm
overhead, above 90⁰ abduction of the arm.

• The first 30⁰ of the clavicula elevation occurs at the SC joint, the next
30⁰ of elevation is the result of rotation of the clavicula about its along
axis.

• The SC joint is formed by the sternal end of the clavicle attaching to the
superior lateral portion of the manubrium of the sternum & the
cartilage of the first rib.

• Stability
of the joint is imparted by the costoclavicular ligament, this
ligament stabilizes the clavicula against muscle action and acts as the
fulcrum for all motions of the shoulder girdle.
CLAVICULO-STERNAL JOINT
BICEPS MECHANISM
Biceps Mechanism
• Biceps Mechanism, the biceps is anatomically & pathologically involved in
the shoulder girdle.
• The biceps brachii has two heads: short, long with insertion into
tuberosity upon inner aspect if radius
• Its action is primarily the supination of the elbow and secondarily elbow
flexion.
• Motion in the bicipital groove, only when movement in GH joint.
• Maximum downward movement → internal rotation.
• And is elevated in the forward flexion movement.
• Extended, abduction, external rotation → the biceps tendon has the
greatest upward motion within the groove.
↓
• Actually the biceps groove moves downward & the tendon glides upward

→ the bicipital mechanism is a passive mechanism.

 COMPOSITE OF
SHOULDER GIRDLE
MOVEMENT
Composite Shoulder Girdle Movements
• Movement of the shoulder girdle requires a smooth & synchronous
motion in the GH joint and all accessory joints.

• When the arm abduction→ every 15⁰ of total abduction, 10⁰occurs in

the GH joint and 5 ⁰due to scapular rotation (2:1 ratio).
• Full elevation of the overhead requires 60 ⁰of the scapula rotation.
• The coracoclavicular lig prevent scapular rotation in the coronal
plane, the scapula pivots about the AC joint from the rotation of the
clavicula & elevation of the SC joint.

• Forevery 10⁰ of the arm elevation, 4⁰ of elevation occurs in the

clavicle.
• 15⁰ of the clavicular elevation→ the first 30⁰ of the arm abduction.
• The clavicle has elevated to its final position→ 90⁰ abduction.
PATHOMECHANICS OF THE PARALYSIS
OF THE SHOULDER
Paralysis of the Serratus Anterior

→ produces a medial
winging of the scapula.
acromion elevation,
rhomboid & levator rotate
the scapula → lower angle
approaches the vertebral
spines & vertebral border is
obliquely facing down.
→ “ opening of the book “.
Paralysis of the Trapezius

→ produces a lateral winging.

The vertebral border of the scapula
moves away from the midline & slides
downward.
→ “ a sliding door “.
Paralysis of the Deltoid

→ the muscle is a prime

abductor of the shoulder,
this motion will be limited →
depends on whether the
paralysis is complete or not.
• There has been very limited successes reported w/ attempts to
transplant or transfer muscles as a subtitute for the deltoid.
• According to Steindler is :

children adult
abd 70 60
flexion 45 45
int rot 20-25 20-25
THANK YOU
Pathomechanics of the Shoulder Hand
Syndrome

• abnormal compression of the subclavian or axillary vessels which

may include the brachial plexus
• called “Thoracic Outlet Syndrome” or “Neurovascular compression
syndrome” Or “The shoulder girdle syndrome”

• The sign & symptoms: paresthesis, numbness, swelling, ulceration,

gangrene and occasionally Raynaud’s phenomenon.
1. Scalenus Anticus & cervical rib syndrome

• thecompression of the subclavian vessels

& the brachial plexus by the anterior
scalene asthese structure pass between
the anterior & middle fibers of the same
muscle.
→ Adson’s manueuver.
2. Costoclavicular Syndrome

• the neurovascular bundle

passes through the space
between the clavicle&the
first rib.
if the clavicle is depressed
or the first rib was raised,
one can easily appreciate
how the bundle can caught
between the two
uncompromosing
structures.
3. Hyperabduction Syndrome

• where the neurovascular

bundle can be tapped is under
the insertion of the pectoralis
minor in the coracoid process.