SHOULDER COMPLEX

BIOMEHANICS
BY-PUJA KUMARI SHARMA( MPT 2ND YEAR)
 CONTENTS

*Introduction/Components of the Shoulder Complex

*Sternoclavicular Joint

*Acromioclavicular Joint

*Scapulothoracic Joint

*Glenohumeral Joint
-Static Stabilization
-Dynamic Stabilization

*Integrated Function of the Shoulder Complex

-Scapulohumeral Rhythm
INTRODUCTION

*Shoulder Complex composed of

the CLAVICLE, SCAPULA + HUMERUS

-links the UE  THORAX - Sternum

*Articular structural design – indicate

Primary Function : Wide ROM mobility

Dynamic Stabilization
 DYNAMIC STABILIZATION

Exists when a moving segment/ set of segments is limited very

little by passive forces :

articular surface configuration, capsule /ligaments

and

instead relies heavily on active forces / dynamic muscular control

Example – Shoulder Joint

COMPONENTS OF SHOULDER COMPLEX

1. Sternoclacicular joint
2. Acromioclavicular joint
3. Glenohumeral joint
4. Scapulothoracic joint – Functional joint
5. Suprahumeral joint – Functional joint
ELEVATION: OF THE UPPER EXTREMTY

The Combination of Scapular, Clavicular and Humeral motion

that occurs when arm is raises forward/ to the side
*Sagittal plane flexion
*Frontal plane abduction
*All motion in between

Total Shoulder Complex Motion – Total Elevation

= Motion of the scapula on Thorax [ 1/3 of total motion]
+Motion of the GH joint [2/3 of total motion]

INTEGRATED SHOUDLER COMPLEX FUNCTION:

SCAPULOHUMERAL RHYTHM
1. STERNOCLAVICULAR JOINT

*Connects UE to Axial Skeleton

*Type: Plane Synovial joint /3 DOF
*Has Joint capsule & Disc

*Articular Surfaces
-2 shallow saddle shaped surfaces
Medial end of clavicle
Notch of Manubrium sternum & 1st Costal cartilage
Sternoclavicular Disc –
Fibrocartilage disc

*Increases congruence b/w the

articulating surfaces

*Improve joint stability

*Absorb forces transmitted

from lateral end of clavicle to
SC joint
Sternoclavicular Joint Ligaments

1. Strong Fibrous capsule – Fairly strong

2. Anterior Sternoclavicular ligament

3. Posterior Sternoclavicular ligament
-Check Anterior & posterior translation of medial end of clavicle

4. Costoclavicular ligament – Bilaminar : Anterior/Posterior

-Limits the elevation of lateral end of clavicle

5. Interclavicular ligament
– Limits excessive depression of the distal clavicle and
Superior gliding of the medial clavicle on the manubrium
Sternoclavicular Motions:
Movements of Clavicle

*Elevation & Depression (48/15)

*Protraction & Retraction(15-20/30)

*Anterior & Posterior Rotation (10/50)

ELEVATION & DEPRESSION OF THE CLAVICLE
PROTRECTION & RETRACTION OF THE CLAVICLE
ANTERIOR & POSTERIOR ROTATION OF CLAVICLE
2. ACROMIOCLAVICULAR JOINT

-Attaches Scapula to Clavicle

Type: Plane synovial joint /3 DOF

Articular Surfaces:
Lateral end of Clavicle & Small facet on acromion of the Scapula
Acromioclavicular Joint – Ligaments

1.Joint Capsule - weak

2. Acromioclavicular Ligaments – Superior & Inferior
3. Coraco-clavicular ligaments

Limits Superior/Inferior & Anterior / posterior Stability

Acromioclavicular Motions

*Internal & External Rotation (30-60)

*Anterior & Posterior Tilting /Tipping (60)

*Upward & Downward Rotation(30/15)

INTERNAL & EXTERNAL ROTATION
Protraction & Retraction of the Scapula require Internal & External Rotation
ANTERIOR & POSTERIOR TILTING/ TIPPING
UPWARD & DOWNWARD ROTATION
3. SCAPULOTHORACIC JOINT

-Formed by the articulation of the scapula with the thorax

-Not true anatomic joint

-The SC joint + AC joint : interdependent with ST

Movement at ST joint
 AC joint movement /SC joint movement/Both
RESTING POSITION OF THE SCAPULA
Motions of the Scapula

1. Upward & Downward Rotation (50-60)

2. Elevation & Depression

3. Protraction & Retraction

4. Internal & External Rotation

5. Anterior & Posterior Tilting

UPWARD & DOWNWARD ROTATION
ELEVATION & DEPRESSION
PROTRACTION & RETRACTION
Scapular Elevation coupled
with Anterior tilting

Scapular Depression coupled

with posterior tilting

To follow the Convex Thorax

4. GLENOHUMERUAL JOINT

Most Mobile / Unstable Joint of the human body

Type: Ball-and-Socket Synovial Joint / 3 DOF

Articular Surfaces: The large head of humerus - Distal

The smaller Glenoid fossa – Proximal

Less Articular Congruency  less Joint Stability

More susceptible to Degeneration / Instability

 GLENOID FOSSA

*Orientation of Glenoid Fossa-

Slightly upward & anterior/posterior

Anteversion – GF faces anterior (10)

Retroversion – GF faces posterior (10)

*Vertical curve > Horizontal curve

*Concavity increased by
articular cartilage + GL
HEAD OF THE HUMERUS
– Anatomical resting position

Head faces medially

+
superiorly
+
posteriorly

In relation to the shaft of the humerus & the humeral condyles

When the arms hang at the side – the inferior surface of the
humeral head rests on only a small inferior portion of the
Glenoid fossa
HEAD OF THE HUMERUS – Angle of inclination

Formed by an axis through the humeral head and neck in relation

to a longitudinal axis through the shaft of the humerus (N=130-
150 in frontal plane)
HEAD OF THE HUMERUS – Angle of Torsion

Formed by an axis through the humeral head and neck in

relation to an axis through the humeral condyles(N= 30
posterior)

Posterior Torsion

Retrotorsion

Retroversion
Normal Retroversion of Head of Humerus
Reduced Retroversion / Anteversion of head of humerus
Increased Retroversion of head of humerus
GLENOID LABRUM
-Increases the total articular surface of the Glenoid fossa by
increasing the depth / concavity of the fossa by approx. 50%

FUNCTIONS

*Provides resistance to
humeral head translation

*Protects Bony edges

*Reduces joint friction

*Dissipation/spreading
of joint contact forces

*Provides attachment site for

GH ligaments & Long Head -Biceps
Shoulder Joint - Anatomy
Shoulder Joint - Anatomy
GLENOHUMERAL LIGAMENTS & JOINT CAPSULE

When arm dependent at the side

Joint Capsule - Loose

Taut superiorly

Slack anteriorly & inferiorly

---------------------------------
Tightens with

Humeral abduction + ER
(Closed packed Positon)
GLENOHUMERAL LIGAMENTS:

1. Superior Glenohumeral Ligament

2. Middle Glenohumeral Ligament
3. Inferior Glenohumeral Ligament Complex [Anterior band +
posterior band]
4. Coracohumeral Ligament
Gleno Humeral Ligaments- At Rest
GHL – At 45 Humeral Abduction + Neutral rotation
GHL – At 90 Humeral Abduction + Neutral rotation
GHL – At 90 Humeral Abduction + External rotation
GHL – 90 Humeral Abduction + Medial rotation
ROTATOR INTERVAL CAPSULE
 CORACOACROMIAL ARCH

The coracoacromial/suprahumeral arch is formed by the coracoid

process, the acromion, and the coracoacromial ligament that
spans the two bony projections
BURSAE

A fluid filled sac / thin cushions/tiny water balloon, located at

points of friction between a bone and the surrounding soft tissue
such as skin, muscles, ligaments & tendons for lubrication / to
reduce the friction

1. Subacromial Bursa
2. Subdeltoid Bursa
Glenohumeral Motions: Osteokinematics & Arthrokinematics

OSTEOKINEMATICS

3 DOF

Flexion /Extension [120/50]

Abduction/ Adduction [ 90-120]
Medial Rotation/Lateral Rotation

Scaption: Abduction in the plane of the scapula

ARTHROKINEMATICS
 COMPOSITE KINEMATIC CHANGES IN SHOULDER JOINT COMPLEX
SC JOINT AC JOINT ST JOINT GH JOINT

EARLY PHASE 25 degree of 5 degree of upward 30 degree upward 60 degree abduction

0 to 90 degrees elevation rotation rotation

Late phase 5 degree of 25degree of upward 30 degree upward 60 degree abduction

90 to 180 degrees elevation and 35 rotation rotation
degree of posterior
rotation of the
clavicle

Total 30 degree of 30degree of upward 60 degree upward 120 degree abduction

0-180 degree elevation and 35 rotation rotation
degree of posterior
rotation of the
clavicle
STATIC STABILIZATION
 In the dependent arm
*Bony geometry - articular surfaces alone can not maintain
joint stability

*With the humeral head rest on the GF:

Gravity acts caudally/downwards

*To maintain equilibrium  Cranially directed force needed

-Active contraction / passive tension in

Deltoid/ Supraspinatus/ Long head of Biceps ???- Relaxed

-RIC: Rotator Interval Capsule

*Superior Capsule
*Superior Gleno Humeral ligament
*Coracohumeral ligament

-Glenoid Inclination: Anatomical

Inadequate Static stabilization : heavily loaded arm

Supraspinatus Activation

Paralysis of Supraspinatus
 Gradual subluxation of GH joint
 DYNAMIC STABILIZATION

Muscles of Shoulder Complex- Dynamic stabilizers

*Deltoid
*Supraspinatus
*Infraspinatus
*Teres Minor
*Subscapularis
*Long Head of Biceps brachii
Shoulder Complex Anatomy - Attachments and Actions
DELTOID
*Deltoid – a prime mover for GH Abduction [+ Supraspinatus]

*Anterior Fibers  GH - Flexion

Middle Fibers  GH - Abduction
Posterior Fibers  GH – Extension

*Resolution of Deltoid muscle force vector :

-Fx Component :Parallel to long axis of the humerus
 Larger
 Stabilizer

-Fy Component: Perpendicular to long axis of the humerus

 Smaller
Mobilizer
*Fx – Parallel muscle force component of Deltoid – if unopposed

Cause the humeral head to impact the coracoacromial arch

before much abduction occurs

*Fy – perpendicular muscle force component of Deltoid

– Not effective

Not be able to cause much abduction

Until the equilibrium of the translatory forces are achieved

*Theoretically: 1

Inferiorly directed contact force of the arch

=
Fx component of the Deltoid

Impingement of Subacromial structures  PAIN

Prevent much motion

*Theoretically: 2

The Inferior pull of the Gravity

Can not offset the Fx component of the Deltoid

The Resultant Force [ Effort Force]

>>
The Gravitational Force [ Resistance Force]

Rotation
 HOW ARM ELEVATION IS BEEN ACHIVED???

The Deltoid can’t independently ELEVATE the Arm

Another Force / Set of Forces – to work synergistically with the

Deltoid

For the Deltoid to work effectively

To Produce the desires ROTATION

?????
ROTATOR CUFF
Rotator Cuff – Muscle force vectors
Resolution of RCM Force Vectors
*Fy ITS – Perpendicular force component
Cause some Humeral rotation
Compresses the head of the humerus into the Glenoid fossa

*Fx ITS – Parallel force component

Critical :
The Inferior translatory pull of ITS
Nearly Offsets
The Superior translatory pull of the Deltoid

Additional:
Teres Minor + Infraspinatus – Lateral Rotation of Humerus
Subscapularis - Medial Rotation of Humerus
 The action of the deltoid
and
the combined actions of
the Infraspinatus, Teres minor, and Subscapularis muscles
approximate a force couple

The nearly equal and opposite forces for the deltoid and these
three rotator cuff muscles acting on the humerus approximate an
almost perfect rotation of the humeral head around a relatively
stable axis of rotation
*Supraspinatus:

Fx – Parallel force component – Superior translatory

Not able to offset the upward dislocating Deltoid action

Fy – Perpendicular force component - Compressive

Effective Stabilizer of GH joint

Independent Abductor : Larger Moment Arm

Gravity : Stabilizing Synergist

*Long head of the Biceps Brachii

Force of Flexion – Neutral Humerus

Force of Abduction – Humerus LR

Reinforce Superior & Middle Glenohumeral ligaments

 Summary : Dynamic Stabilization

*FOG
*Force of the prime movers - Dynamic
*Force of the muscle stabilizers
*Articular Surface Geometry
*Passive Capsule + Ligaments Forces

*Force of Friction
*Joint Reaction Forces

9-10 Times the Weight of the UE

INTEGRATED FUNCTION OF THE SHOULDER
COMPLEX
-
SCAPULOHUMERAL RHYTHM
*The Shoulder Complex acts in a coordinated manner to provide
the smoothest & greatest ROM possible to the UE

*The GH motion alone can not achieve full range of elevation of

the humerus

*The remainder of the range is contributed by the scapula on the

thorax through the SC & AC joint motions
 Significance of Scapulo-Humeral Rhythm

1. Distributes the motions b/w the joints

Allow a large ROM with less compromise of stability

2. Maintains joint congruency

3. Maintains good muscle length - tension relationship

Prevent Active Insufficiency

 DEFINITION – Scapulo-Humeral Rhythm

An overall ratio of 2 degree of Glenohumeral motion to 1 degree

of Scapulothoracic motion during arm elevation
[ Flexion/Abduction/Scaption]

This Combination of concomitant Glenohumeral &

Scapulothoracic motion is commonly referred to as

SCAPULOHUMERAL RHYTHM
 PHASES OF SCAPULO-HUMERAL RHYTHM

PHASE – 1:[0- 30] Degree Elevation

GH Joint – 30 Degree
ST Joint [ Clavicular Motion] – Minimal 0-5 Degree

PHASE – 2: [30-90] Degree Elevation

GH Joint – 40 Degree
ST Joint – 20 Degree

PHASE – 3: [90-180] Degree Elevation

GH Joint – 50-60 Degree
ST Joint – 30-40 Degree
Scapulo Thoracic Contribution:
to ELEVATION of the Humerus
-By upward rotation of the Glenoid fossa 50-60 degree from its
resting position

Gleno-Humeral Contribution:
to ELEVATION of the Humerus
-100-120 of Flexion / 90-120 of Abduction

Maximum Range of ELEVATION : 150-180

Lateral Rotation – 50
 Sternoclavicular + Acromioclavicular Contributions

ST upward Rotation

Coupled with

Clavicular Posterior Rotation

Clavicular Elevation

At SC joint
 ST upward rotation

Coupled with

Scapula – Posterior Tilting [20-30]

+
Initially-Scapular Int. Rotation
&
End Range – Scapular Ext. Rotation [25]

At AC Joint
Integrated
movement
during
elevation
50% From SC Joint : 20 30 Degree of ST upward Rotation

50% From AC Joint : 20-30 Degree of ST upward Rotation

-------------------------------------------------

Variations in Scapulohumeral Rhythm

GH Motion : ST Motion Ratio -- 1.25:1  2.69:1

 Upward Rotators of the Scapula

The motions of the scapula are primarily produced by a balance of

the forces between the trapezius and Serratus anterior muscles
 MUSCLES
OF
ELEVATION & DEPRESSION
ELEVATORS

*Deltoid
*Supraspinatus
*Infraspinatus
*Teres Minor
*Subscapularis
*Upper & Lower trapezius
*Serratus Anterior
*Rhomboids – Minor & Major
DELTOID

*Scapular plane abduction- anterior and middle deltoid

*Posterior deltoid has smaller MA

and
thus less effective in frontal plane abduction

*Maintenance of appropriate length-tension relationship of

deltoid is dependent on scapular position/movement and
stabilization.
For example:

when scapula cannot rotate, there is more shortening of deltoid

and thus loss of tension, which causes elevation to up to 90
degrees only.
Supraspinatus

*Primary function - to produce abduction with deltoid muscle.

[MOBILIZER]

*Secondary function: acts as a ‘steerer’ of humeral head

and
helps to maintain stability of dependent arm.
[STABILIZER]
 Infraspinatus + Teres minor + Subscapularis

* These muscle function gradually increases from- 0-115 degrees of

elevation after which (115-180 degrees) it dropped.

*In the initial range of elevation, [I +T]

work to pull the humeral head down,

and
during the middle range,
act to externally rotate for clearing greater tubercle
under coracoacromial arch.

* Subscapularis helps as internal rotator when arm is at side and

during initial range and

With more abduction, its inter rot capacity decreases.

 UPPER AND LOWER TRAPEZIUS + SERRATUS ANTERIOR

*This force couple produces upward rotation of scapula.

*When the trapezius is intact and the Serratus anterior muscle is paralyzed

active abduction of the arm can occur through its full range,
although it is weakened.

*When the trapezius is paralyzed

(even though the Serratus anterior muscle may be intact),

active abduction of the arm is both weakened and limited in range

with remaining range occurring exclusively at the GH joint.

*Without the trapezius (with or without the Serratus anterior muscle),

the scapula rests in a downwardly rotated position

as a result of the unopposed effect of gravity on the scapula.
 How SA and trap work with deltoid??

The Serratus anterior and trapezius muscles are prime movers

for upward rotation of the scapula.

These two muscles are also synergists for the deltoid during
abduction at the GH joint.

The trapezius and Serratus anterior muscles,

as upward scapular rotators,

prevent the undesired downward rotatory movement of the

scapula by the middle and posterior deltoid segments that are
attached to the scapula.
Rhomboid

It works eccentrically to control upward rotation of the scapula

produced by the trapezius and the Serratus anterior muscles.

It adducts the scapula with lower traps to offset the lateral

translation component of the Serratus anterior muscle.
DEPRESSORS

*Latissimus Dorsi
*Pectorals – Major & Minor
*Teres Major
CLINICAL CONNECTION:
PATHOMECHANICS

*RCI – Rotator Cuff Injury

-Stain /tear of RC muscles
-Common in baseball pitcher/swimmers/racket sports
-Degeneration/improper lifting

*Shoulder Dislocation

*Glenoid Labrum Tear  Shoulder Dislocation

THANK YOU