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Bones :
Clavicle :
-“Strut bone” or “Collar Bone”
-The only bone that connects upper trunk to axial skeleton
-Most commonly fractured bone
Orientation :
Scapula :
- Shape: flat, triangular
Scapula Resting Position:
• Superior tilted: 5 degrees
• Retroversion: 7 degrees
- “the summit of shoulder”
- (+) AC problem = 170-180 degrees
Types of Acromion :
I. Flat – MC in dislocation
II. Round/Curve – MC in population
III. Hook – MC for impingement
IV. Upturned/Convex
Humerus :
- Long bone
- Surgical neck fracture = (+) axillary nn. is affected
- Spiral Groove Fracture (above & at level)
Fracture could cause :
A. Radial nerve injury
B.(-) Triceps weakness
ORIENTATIONS
• Acromion – P, L, S
• Glenoid fossa – S, A, L
• Humerus – M, P, S
• Transverse Humeral ligament – roof of bicipital groove of humerus
JOINTS
Structural:
1. GH
2. SC
3. AC
Functional:
1. ST
2. Bicipital Groove
3. Subacromial bursa
Ligaments:
1. Interclavicular
- limits depression of distal clavicle
- protects subclavian artery
3. Sternoclavicular
- Ant: limits retraction; post translation of clavicle
- Post: limits protraction; ant translation of clavicle
SC Interarticular Disc
- Shock absorption
- During elevation & depression = AD moves towards sternum
- During protract & retract = AD moves towards clavicle
Kinematics :
Roll Slide
Protraction Anterior Anterior
Retraction Posterior Posterior
Elevation Superior Inferior
Depression Inferior Superior
Types:
- Plane joint
- 3 degrees of freedom: affected by scapular motion
Ligaments:
1. Coracoclavicular ligament:
Conoid :
- limit superior translation of distal clavicle
Trapezoid :
- Limit medial translation of scapula
2. AC ligament
Superior :
- Limit inferior translation of distal clavicle
Inferior :
- Limit superior translation of distal clavicle
Kinematics:
1. ER & IR (Horizontal curvature)
2. Upward & Downward rotation
3. Ant & Post tilting (Vertical curvature)
Glenohumeral joint :
- Ball and socket joint; universal joint
- Articulation: Humerus & scapula
- Normal shaft angle: 130-150 degrees
- Angle of torsion: 30 degrees
- Stability: Muscles, no pressure, ligaments, labrum
Ligaments:
1. Superior GH lig. (limits 0-45o) = inf & ant translation
2. Middle GH lig. (limits 45o-90o) = ant translation
3. Inferior GH lig/Hammock ligament (limits >90o) = ant & inf translation
Acromioclavicular joint :
Sternoclavicular joint :
Roll Slide
Flexion Spin Spin
Horizontal adduction Anterior Posterior
Internal rotation at 0 degrees Anterior Posterior
abduction
Extension Spin Spin
Horizontal abduction Posterior Anterior
External rotation at 0 degrees Posterior Anterior
abduction
Abduction Superior Inferior
Stability of GH joint :
1. Static
- (-) pressure (glenoid labrum)
- Passive tension ligament
2. Dynamic – muscles
a. Deltoid & supraspinatus – (Deltoid: vertical et. lat pull)
b. Rotator cuff (I,T,S)
c. Supraspinatus
Scapulohumeral Rhythm
- Happens after 30o shoulder elevation
- 2:1 = GH-ST movement
PHASE 1 = 30 degrees PHASE 2 = 60 degrees PHASE 3 90-180
degrees
Humerus Abd 30 degrees Abd 40 degrees Abd 60 degrees, ER 90
degrees
Scapula Setting phase Upward rotation of 20 Upward rotation of 30
degrees degrees
Clavicle Elevation of 5 degrees Elevation of 15 degrees Posterior rotation of 30-
50 degrees and
elevation of 15 degrees
Types of Scapular Winging
Primary – muscle pathology
Secondary – GH pathology
Dynamic – nerve pathology
Static – standard deformity
Subacromial bursa :
- Aka Suprahumeral joint
- Subacromial space
A. Arms at side = 10mm
B. Arms elevate = 5mm; provokes impingement
Bicipital groove :
-Content : long head of biceps
Lat lip: Pects major
Floor: Lats dorsi
Medial lip: Teres major
Roof: Transverse humeral
Muscles :
Supraspinatus
- MC rotator cuff impingement
- Prevents humeral heard to displace inferiorly
- Work horse of rotator cuff muscle
- Primary initiator of abduction (0-30o)
Infraspinatus
- More active: ER with no shoulder abd
Teres Minor
- More active: ER + shoulder 90o abd
Subscapularis
- Chief IR
- Prevents anterior dislocation of humerus
Deltoid
- Affected in inferior displacement of humerus
Latissimus Dorsi
- Action in CKC: elevates pelvic posteriorly
Biceps
- Substitutes for absence of supraspinatus and middle deltoids for shoulder abduction