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Shoulder Complex
Shoulder Complex
217
Anatomy
Graduate
09/23/2014

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Term
5 articulations of the shoulder complex
Definition
glenohumeral, acromioclavicular, sternoclavicular, scapulothoracic, suprahumeral
Term
Which articulation of the shoulder joint is a physiologic joint?
Definition
scapulothoracic
Term
full humeral elevations requires movement of what
Definition
glenohumeral, scapulothoracic, acromioclavicular, sternoclavicular, thoracic extension and/or sidebending and rotation, synchronous activity of the scapulothoracic, scapulohumeral, axiohumeral, and axioscapular musles
Term
normative ranges of movement for the shoulder: flexion
Definition
170-180
Term
normative ranges of movement for the shoulder: abduction
Definition
170-180
Term
normative ranges of movement for the shoulder: extension
Definition
45
Term
normative ranges of movement for the shoulder: adduction at 90
Definition
50
Term
normative ranges of movement for the shoulder: external rotation (arm abducted to 90, elbow flexed to 90, shoulder neutral)
Definition
90 degrees
Term
normative ranges of movement for the shoulder: internal rotation( arm abducted to 90, elbow flexed to 90, shoulder in neutral)
Definition
70 degrees
Term
those with regular int/external rotation of the shoulder can touch this approximate part of the spine with both hands individually
Definition
t3-t5
Term
normative ranges of movement for the shoulder: scaption
Definition
170-180
Term
what is scaption
Definition
motion between flexion and external rotation
Term
scaption plane of the scapula: is the resting position for what
Definition
scapula on the thorax
Term
during scaption, the scapula is ___-_____ degrees anterior to the frontal plane
Definition
30-45
Term
during scaption the scapula is 30-45 degrees anterior to the ______ plane
Definition
frontal
Term
scaption results increased ______ production of cuff musculature
Definition
torque
Term
scaption results in increased congruency and stability of what joint
Definition
glenohumeral
Term
scaption results in _______ congruency and stability of the G-H joint
Definition
increased
Term
scaption results in in increased ________ and ________ of the glenohumerla joint
Definition
congruency, stability
Term
resting position of the shoulder refers to what
Definition
position of the humerus
Term
resting position of the shoulder
Definition
55 degrees abduction, 30 degrees horizontal abduction, 30 degrees of elbow flexion
Term
close packed position of the shoulder
Definition
90 degrees of glenohumeral abduction, maximal glenohumeral external rotation
Term
how does the head of the humerus face in relation to the glenoid?
Definition
medially, posterior, and superior
Term
The head of the humerus forms a ______ angle from the longitudinal axis of the humerus
Definition
150
Term
the head of the humerus is retroverted _____ to _____ degrees
Definition
20,30
Term
the retroversion of the head of the humerus increases what in relation to the glenoid
Definition
joint stability
Term
The retroversion of the humeral head allows for normal arm swing outside of what plane
Definition
sagittal
Term
Elite baseball pitchers tend to have a greater what
Definition
humeral head retroversoin
Term
the glenoid fossa is shaped how
Definition
pear
Term
the glenoid fossa has increased concavity where
Definition
superior/inferior portions
Term
the glenoid fossa has increased ______ at superior/inferior portions
Definition
concavity
Term
the glenoid fossa has greater articular cartiage where
Definition
periphery of glenoid fossa
Term
the glenoid fossa is _/_ to _/_ of the humeral head's surface area
Definition
1/4, 1/3
Term
the glenohumeral joint is considered these types of joints (2)
Definition
diarthrodial, ball-and-socket
Term
what are the 3 degrees of freedom (motion) of teh glenohumeral joint
Definition
flex/ext, add/abd, int/ext rot
Term
the humeral head is what shape
Definition
convex
Term
the glenoid fossa is what shape
Definition
concave
Term
dr. white compared the shoulder to this sports equipment
Definition
golf ball on tee
Term
the capsulolabral ligamentous complex includes what 3 structures
Definition
joint capsule, glenoid labru, glenohumeral ligaments
Term
what is the role of the capsulolabral ligamentous complex?
Definition
provides static stability with bony anatomy to glenohumeral articulation
Term
capsulolabral ligamentous complex: joint capsule attaches to what
Definition
glenoid
Term
capsulolabral ligamentous complex: joint capsule is 2x the size of what
Definition
humeral head
Term
capsulolabral ligamentous complex: joint capsule has an axillary pouch in the inferior capsule. it is considered
Definition
redundant
Term
capsulolabral ligamentous complex: joint capsule "winds up" in the extremes of this movement
Definition
rotation
Term
capsulolabral ligamentous complex: joint capsule contains how much joint fluid
Definition
1 mL
Term
capsulolabral ligamentous complex: joint capsule provides little joint stability without what type of support
Definition
ligamentous and musclular
Term
capsulolabral ligamentous complex: joint capsule, the inferior fold is essential for what full _______ of the humerus
Definition
elevation
Term
capsulolabral ligamentous complex: joint capsule - insuffiency of anterior inferior fold is associated with what pathologies
Definition
impingement, frozen shoulder, rotator cuff tendinitis
Term
capsulolabral ligamentous complex: glenoid labrum - what is it
Definition
dense fibrocartilage ring
Term
capsulolabral ligamentous complex: glenoid labrum is attached to where
Definition
rim of glenoid of fossa
Term
capsulolabral ligamentous complex: glenoid labrum provides attachment for what
Definition
capsule and ligaments
Term
capsulolabral ligamentous complex: glenoid labrum - what is its role
Definition
increases glenohumeral stability
Term
capsulolabral ligamentous complex: how does the glenoid labrum increase glenoid-humeral stability
Definition
deepens fossa
Term
capsulolabral ligamentous complex: the glenoid labrum deepens fossa how much superiorly/inferiorly
Definition
9mm
Term
capsulolabral ligamentous complex: the glenoid labrum deepens the fossa how much anteriorly/posteriorly
Definition
5 mm
Term
capsulolabral ligamentous complex: the glenoid labrum applies negative pressure, which results in what
Definition
suction effect
Term
what are the 3 "Z" gleno-humeral ligaments
Definition
superior, middle, inferior
Term
What are the 4 glenohumeral ligaments
Definition
superior, middle, inferior, coracohumeral
Term
what are teh 3 components of the inferior glenohumeral ligament
Definition
anterior band, posterior band, axillary pouch
Term
the glenohumeral ligaments attach from the glenoid to where
Definition
neck of humerus
Term
the glenoid-humeral ligaments attach from the _____ to the neck of teh humeral head
Definition
glenoid
Term
the glenohumeral ligaments prevent ______ displacement of humeral head
Definition
anterior
Term
the coracohumeral ligament runs from base of coracoid to ______ and ______ _______
Definition
lesser, greater tubercles
Term
the coracohumeral ligament runs from base of ______ to lesser and greater tubercles
Definition
coracoid
Term
the corachumeral ligament strengthens the _____ ______
Definition
superior capsule
Term
the corachumeral ligament is taut with what motion
Definition
adductoin
Term
the corachumeral ligament resists downward pull of graivty on _______ ________ with superior capsule
Definition
humeral head
Term
Anatomic Restraints to External Rotation if Shoulder Adducted
Definition
er checked primarily by subscapularis
Term
Anatomic Restraints to External Rotation if shoulder at 45 degrees abduction
Definition
er checked by subscapularis, middle and inferior G-H ligaments
Term
Anatomic Restraints to External Rotation if shoulder is in 90 degrees of abduction
Definition
er checked by inferior g-h ligament
Term
what is the role of the shoulder bursa
Definition
reduce friction b/w mm, tendon, bones, and joint capsule
Term
clincally, which are the most involved bursa?
Definition
subscapular, subacromial, subdeltoid
Term
bursa become inflammed with excessive friction, resulting in
Definition
bursitis
Term
if chronically inflammed, the bursa will
Definition
calcify
Term
supraspinatus canal/subacromial space: borders
Definition
humeral head, acromion, AC joint, coracoacromial ligament
Term
supraspinatus canal/subacromial space: asymptomatic distance in space
Definition
9-10 mm
Term
supraspinatus canal/subacromial space: pathological space distance
Definition
<6 mm
Term
supraspinatus canal/subacromial space: structures within the space
Definition
supraspinatus, long head of the biceps, subdeltoid bursa
Term
neurology: the shoulder complex is embryologically derived from
Definition
c5-c8
Term
neurology: the shoulder complex is derived from c5-c8, except the A-C joint which is derived from
Definition
C4
Term
neurology: the sympathetic nerve supply to the shoulder orignates primarily in the thoracic region from ______ down as far as ______
Definition
t2, t8
Term
blood supply for the rotator cuff muscles
Definition
thoracoacromial, suprahumerael, suprascapular aa
Term
What is the critical zone in the shoulder
Definition
supraspinatus hypovascularity
Term
hypovascularity of the supraspinatus can lead to
Definition
avascular necrosis and joint replacement
Term
the critical zone is hypovsacular with what motion of the g/h joint
Definition
adduction
Term
the critical zone recieves adequate blood supply when the arm is in what motion
Definition
abduction
Term
axiohumeral
Definition
from axial skeleton to humerus
Term
what are the 4 ways to describe the muscles of the shoulder girdle
Definition
scapulohumeral, scapuloradial(humeral), axioscapular, axiohumeral
Term
scapulohumeral
Definition
scapula to humerus
Term
scapuloradial (humeral)
Definition
from scapula to humerus or radius
Term
axioscapular
Definition
axial skeleton to scapula
Term
what are the scapulohumeral muscles
Definition
supraspinatus, infraspinatus, teres minor, subscapularis
Term
the scapulohumeral muscles blend with what to attach to the posterior, superior,and ant humeral head
Definition
articular capsule
Term
the scapulohumeral muscles blend with the articular capsue attaching to what
Definition
post, sup, and anterior humeral head
Term
the scapulohumeral muscles are responsible for what
Definition
dynamic steering of the humeral head
Term
the scapulohumeral muscles draw the humeral heads into glenoid and resist upward shear of what?
Definition
deltoid
Term
What are the scapuloradial muscles?
Definition
biceps (longhead)
Term
The scapuoradial muscles attch to the supraglenoid tubercle and _____
Definition
ant/sup labrum
Term
the scapuloradial muscles attches to ________ _____ and ant/sup labrum
Definition
supraglenoid tubercle
Term
what is considered the 5th rotator cuff tendon?
Definition
biceps tendon
Term
What are the axioscapular muscles?
Definition
trapezius, serratus anterior, rhomboids, pectoralis minor, levator scapulae
Term
The axioscapular muscles provide stability how?
Definition
scapula against thoracic wall
Term
action of the axioscapular muscles
Definition
provide smooth upward and downward rotation of scapula
Term
which two muscles are critical to normal scapular mechanics
Definition
serratus anterior and trapezius
Term
what are the axiohumeral muscles
Definition
latissimus dorsi, pectoralis major
Term
role of the axiohumeral muscles
Definition
provide some stability to shoulder complex
Term
overdevelopment of which shoulder muscle group may contribute to muscle imbalance of the shoulder complex
Definition
axiohumeral muscles
Term
what is the average size of the acromioclavicular joint?
Definition
9x19 mm
Term
the acromioclavicular joint is considered what type of joints
Definition
diarthorodial, gliding plane joints
Term
increased axial load of the AC joint, with decreased surface area results in what
Definition
early joint failure (Osteolysis, OA)
Term
What is the distal surface of the AC joint
Definition
acromion
Term
What is the proximal surface of the AC joint?
Definition
clavicle
Term
The acromion of the AC joint has this shape
Definition
flat or slightly concave
Term
The clavicle of the AC joint has this shape
Definition
convex
Term
The AC joint has these two features
Definition
fibrocartilage disc, lax capsule
Term
What are teh AC ligaments
Definition
AC ligament, Coracoclavicular ligament
Term
Which of the AC ligaments is superior?
Definition
AC ligament
Term
WHat is the role of the coracoclavicular ligament
Definition
suspends the scapula
Term
What are the 2 parts of the coracoclavicular ligament?
Definition
conoid, trapezoid
Term
When is the conoid portion of the coracoclavicular ligament taught?
Definition
upward rotation of scapula
Term
When is the trapezoid portion of the coracoclavicular ligament taught?
Definition
downward rotation of scapula
Term
the sternoclavicular joint has this type of articulation
Definition
sellar
Term
what part of thhe sternoclavicular joint is convex
Definition
sup/inf
Term
What part of the sternoclavicular joint is concave
Definition
ant/post
Term
Which is the only true articulation b/w the UE and axial skeleton
Definition
sternoclavicular joint
Term
The dense, fibrous articular disc of the sternoclavicular joint checks what
Definition
medial displacement of clavicle
Term
What provides stability of the sternoclavicular joint?
Definition
surrounding tissues
Term
Clavicle Arthrokinematics at Sternum (referring to sternal end of clavicle): shoulder elevates
Definition
clavicle moves inferior
Term
Clavicle Arthrokinematics at Sternum (referring to sternal end of clavicle): basic
Definition
longitudinal rotation
Term
Clavicle Arthrokinematics at Sternum (referring to sternal end of clavicle): Shoulder depresses
Definition
clavicle moves superior
Term
Clavicle Arthrokinematics at Sternum (referring to sternal end of clavicle): shoulder protracts
Definition
clavicle moves anterior
Term
Clavicle Arthrokinematics at Sternum (referring to sternal end of clavicle): shoulder retracts
Definition
clavicle moves posterior
Term
scapulothoracic articulation: is not considered a true what?
Definition
joint
Term
how many muscles attach to the scapula?
Definition
17
Term
How many bursa surround the scapula?
Definition
3
Term
the scapulothoracic articulation allows increased shoulder movement beyond _____ degrees of elevation
Definition
120
Term
Scapular position on thorax: Tips Anterior (degrees)
Definition
9-20
Term
Scapular position on thorax: Superior angle of scapula is at
Definition
T2
Term
Scapular position on thorax: Inferior angle is at
Definition
T7
Term
There are 4-6 cm b/w root of spine of scapula and what
Definition
T3
Term
There are _______ between root of spine of scapula and T3
Definition
root of spine
Term
How much rotation does the scapula have?
Definition
3-5" of upward-downward rotation
Term
Winging
Definition
increased prominence of the medial border of scapula, around a superior/inferior axis
Term
Tipping
Definition
increased prominence of the inferior angle of scapula
Term
Tipping occurs in what axis
Definition
medial/lateral axis
Term
Tipping is sometimes called
Definition
anteflexion/retroflexion
Term
Abduction of the shoulder is initiated by what muscle during the inital phase of elevation
Definition
deltoid and supraspinatus
Term
At 30-60 degrees of shoulder abduction, what occurs
Definition
upward rotation of teh scapula
Term
At 30 degrees of abduction what happens to the clavicle
Definition
begins to elevate at SC joint and rotate minimally
Term
At approximately 60 degrees the rotator cuff muscles do what?
Definition
pull the humeral head distal into the capsule
Term
At 75-90 degrees of shoulder abduction, external rotation of the humerus prevents compression of teh greaterer tuberosity against what
Definition
acromion
Term
At 75-90 degrees shoulder abduction, external rotation of the _____ prevents compressio of the greater tuberosity against the acromion
Definition
humerus
Term
At 75-90 degrees of shoulder abduction, the humerus prevents compression of the ______ ______ against the acriomon
Definition
greater tuberosity
Term
at 110-135 degrees of shoulder abduction, the clavicle spins _____ a total of 50 degrees
Definition
posterior
Term
at 110-135 degrees, the clavicle spins posterior a total of 50 degrees, elevating the _______ end of the clavicle
Definition
lateral
Term
At 110-135 degrees the clavicle spins posterior a total of 50 degrees elevating the lateral end of the clavicle and allowing further ______ rotation of the ______
Definition
upward, scapula
Term
At 110-135 degrees, the clavicle spins posterior a total of 50 degrees elevating the lateral end of the clavicle and allowing further upward rotation of the scapula at what joint?
Definition
AC joint
Term
What begins to elevate with the initiation of shoulder abduction?
Definition
clavicle
Term
At 30 degrees, the clavicle spins ____ degrees with movement of what?
Definition
30, scapula
Term
At 110-135 degrees the clavicle spins posterior due to tension loading of what?
Definition
conoid ligament
Term
glenohumeral and scapulothoracic force couples with assist from what for controlled elevation of the UE in the classic 2:1 ratio
Definition
SC, AC, clavicle, thoracic spine
Term
Scapulohumeral rhythm: Explain 2:1 ration
Definition
2 degrees of motion in glenohumeral joint for every 1 degree of motion in scapula
Term
Function of the scapulohumeral rhythm: _____ range of motion
Definition
increases
Term
function of the scapulohumeral rhythm: provides ______ stability to the glenohumeral joint during _______
Definition
inferior, elevation
Term
function of the scapulohumeral rhythm: maintains optimum length tension relationship for _______ musculature
Definition
scapulohumeral
Term
What are the 2 force couples of the shoulder complex?
Definition
glenohumeral, scapulothoracic
Term
normal mechanics of teh shoulder require proper _______, _____, and ______ ______ of the muscles acting upon the glenohumeral, scapulothoracic articulatoins
Definition
strength, length, motor control
Term
force couple definition
Definition
two forces of equal magnitude but in opposite direction that produce rotation in the body
Term
force couple examples: (2)
Definition
action of axioscapular muscles during elevation of the arm
actions of RC muscles and deltoid during elevation of the arm
Term
glenohumeral abduction is initiated by what muscles
Definition
supraspinatus and deltoid muscles
Term
The resultant force of the glenohumeral joint going into 30 and 60 degrees of abduction as a result of the deltoid creates 3 mm of humeral head ______ or ______
Definition
translation, shear
Term
upward shearing forces of the glenohumeral joint peak at ___ degrees
Definition
60
Term
What counteracts the upward shearing forces of the glenohumeral joint during abduction
Definition
actions of the rotator cuff
Term
the upward shearing is counteracted by the action of the RC by what effect
Definition
concavity compression
Term
the compressive forces of the RC muscles act as dynaic stabilizers to "steer" the head of the humerus with the _______, ________, ________
Definition
latts, teres major, biceps
Term
RC muscles also act to externally roate the humerus at ____ degrees
Definition
75
Term
rotator cuff fatigue leads to what
Definition
decreased scapular posterior tilt, increased scapular elevation, limited external rotation
Term
if the deltoid were paralyzed, which muscle would take over most if not all of the range of motion for elevation
Definition
supraspinatus
Term
If the supraspinatus is paralyzed, a complete range of motion can be completed for elevation with what?
Definition
a significant loss of strength noted
Term
What is the initial phase of scapular movement (degrees)
Definition
30-60
Term
The axis of rotation for the initial movement of the scapula is
Definition
root of spine of scapula
Term
What are the primary muscles for scapulothoracic force coupled movement
Definition
upper trap, lower fibers of serratus anterior
Term
What limits elevation and abduction of scapula
Definition
lower trapezius
Term
Scapulothoracic movement: As the scapula continues to upwardly rotate, the axis of rotation shift towards
Definition
the acromion
Term
scapulothoracic movement: as the scapula continues to upwardly rotate, what functions to contribute to the upward rotation force couple
Definition
lower trapezius
Term
stability of the scapula during scapulothoracic motion is provided by what muscles
Definition
rhomboids, levator scapulae, pec minor, middle trapezius
Term
subjects with impingement demonstrated what
Definition
decreased posterior tilt during elevation, increased superior migration of scapula
Term
Trap vs Serratus Ant: Abduction: Which is more important
Definition
trapezius
Term
Trap vs Serratus Ant: Abduction: if the serratus ant is paralyzed, what happens to ROM
Definition
may be full
Term
Trap vs Serratus Ant: Abduction: if trap is paralyzed, ROM is limited to what
Definition
75
Term
Trap vs Serratus Ant: Flexion: Which is more important
Definition
serratus
Term
Trap vs Serratus Ant: flexion: if trap is paralyzed, what happens to ROM
Definition
ROM may be full
Term
Trap vs Serratus Ant: Flexion: trapezius can only produce how much upward rotation in this plane
Definition
20
Term
What are the 3 phase of elevation
Definition
initial, middle (critical) phase, final phase
Term
initial phase in degrees
Definition
0-60
Term
middle (critical) phase in degrees
Definition
60-140 degrees
Term
final phase in degrees
Definition
140-180 degrees
Term
in the inital phase, which has more mobility, glenohumeral or scapulothoracic?
Definition
glenohumeral
Term
the inital phase of elevation is considered the "_____" phase of the scapula
Definition
setting
Term
the inital phase of elevation is considered the "setting" phase for the ______
Definition
scapula
Term
Some of oscillation of the scapula during elevation is ___
Definition
WNL
Term
abduction in the initial phase is initiated by
Definition
supraspinatus, middle deltoid
Term
scapular upward rotatoin during the initial phase is accomplished through minimal rotation at what joint
Definition
SC joint
Term
Scapular upward rotation during the initial phase is accomplished through minimal rotation at the SC joint and elevation of what
Definition
the clavicle
Term
During the middle(critical) phase which has more mobility, glenohumeral or scapulothoracic motion?
Definition
scapulothoracic
Term
what counteracts the maximal upward shear force of the deltoid at 60 degrees?
Definition
rotator cuff muscles
Term
the rotator cuff muscles counteract the maximal upward shear force of the _____ at 60 degrees
Definition
deltoid
Term
the rotator cuff muscles counteract the maximal upward shear force of the deltoid at _____ degrees
Definition
60
Term
What muscles function to laterally rotate the humeral head at 75 degrees to allow for clearance of the greater tuberosity under the acromion
Definition
rotator cuff muscles
Term
What may be observed during the critical phase
Definition
painful arc
Term
Tension loading of the conoid ligament creates a posterior rotation force of teh clavicle at what angle?
Definition
110-135
Term
Tension loading of what ligament creates a posterior rotation force on the clavicle at the AC joint at 110-135
Definition
conoid ligament
Term
In the final phase which has more mobility, glenohumeral or scapulothoracic?
Definition
glenohumeral
Term
For full elevation, what needs to disassociate from what?
Definition
humerus, scapula
Term
Tightness of what muscles may restrict final phase ROM
Definition
lats, pec major, teres major, teres minor, infraspinatus, subscapularis
Term
What indicates tightness of lats, pec major, teres major, teres minor, infraspinatus or subscapularis visually
Definition
lateral bulge of teh inferior angle of the scapula
Term
What is needed for full elevation during the final pahse
Definition
thoracic extension
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