shoulder girdle

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shoulder girdle
2011-10-15 18:42:22
shoulder girdle

shoulder girdle
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  1. purpose
    • all the hand to be placed in various positions to accoomplish a multitude of tasks
    • do not ignore the shoulder complex when treating the distal UE
  2. Shoulder complex=
    shoulder girdle(scapula and clavicle)

    • Shoulder joint
    • (scapula and humerus)
  3. bones of shoulder complex
  4. bones of the shoulder complex
    • scapula
    • clavicle
    • sternum
    • humerus
    • rib cage
  5. articulations of the shoulder complex
    • sternoclavicular joint
    • acromioclavicular jhoint
    • glenohumeral joint
    • scapulothoracic articulation
  6. shoulder girdle
    • term used to discuss activities of the scapula
    • clavicle
    • sternum
    • sternoclavicular(SC) and acromioclavicular(AC) joints allow shoulder girdle motions
  7. shoulder girdle
    • elevation and depression
    • protraction and retraction
    • upward and downward rotation
  8. scapulothoracic articulation
    not a joint

    scapila moves over the rib cage of the thorax

    not directly attached

    connected indirectly via the clavicle and several muscles

    provides motion and also stability to the shoulder
  9. bones and landmarks

    attaches indirectly to the rib cage

    anteriorly concave and glides over the conves rib cage posteriorly

    located between the second and seventh ribs

    vertebral border 2-2 lateral from the spinous process

    spine of scapula levels with 3rd and 4th thoracic vertebrae spinous process
  10. shoulder girdle
    • 5 muscles attach to the scapula and/or clavicle and provide shoulder girdle motion
    • trapezius
    • levator scapulae
    • rhomboid muscles
    • serratus anterior
    • pectoralis minor
  11. Trapezius
    • Upper Trapezius
    • elevation
    • upward rotation
    • middle trapezius
    • adduction(retraction)
    • Lower Trapezius
    • depression
    • upward rotation
  12. levator scapulae
    • Elevation
    • downward rotation
  13. rhomboids
    • adduction
    • (retraction)

    downward rotation

    assists in elevation
  14. serratus anterior
    • abduction
    • (protraction)

    upward rotation

    underneath scapula and comes out to the ribs
  15. pectoralis minor

    downward rotation

    • abduction
    • (protraction)
  16. joint motions


    upward rotation-downward rotation

    • scapular tilt-
    • occurs with GH hyperextension
    • superior end of scapula tilts forward
    • inferior end tilts posteriorly
    • ex: wind-up or pre-release phase of softball pitching
  17. scapular rotation
    inferior angle is the point of reference for rotation

    • upward rotation
    • inferior angle moves away from the spine
    • downward rotation
    • inferior angle moves toward the spine
  18. shoulderjoint=glenohumeral joint
    Scapula and humerus motions
    flexion,extension, and hyperextension

    abduction(ABD) and adduction(ADD)

    medial and lateral rotation

    horizontal ABD and ADD

    • mobile joint, few ligaments
    • nine muscles are primary movers or the shoulder joint
  19. shoulder joint
    • ball and socket
    • humeral head articulating with glenoid fossa of scapula
    • movement in all three planes around all three axes
    • most movable joint in the body
    • one of the least stable
  20. muscles of the shoulder joint (11)
    • deltoid
    • supraspinatus
    • pectoralis major
    • latissimus dorsi
    • teres major
    • infraspinatus
    • teres minor
    • subscapularis
    • coracobrachialis
    • biceps brachii
    • triceps brachii, long head
  21. companion motions
    shoulder joint and shoulder girdle
    movement of the scapula is accompanied by movements of the glenohumeral joint and vice-versa

    • ex:shoulder flexion accompanies upward scapular rotation
    • impairment of one joint will also impair function at the other
  22. companion motions
    shoulder jt/shoulder girdle
    flexion/up rotation,protraction

    extension/dn rotation,retraction

    hyperex/scapular tilt

    abduction/up rotation

    adduction/dn rotation

    medial rotation/protraction

    lateral rotation/retraction

    horz abduction/retraction

    horz adduction/protraction
  23. scapulohumeral rhythm
    describes the movement relationship between the shoulder girdle and shoulder joint

    *****first 30 degree of shoulder joint motion is pure glenohumeral (GH) motion

    • ***after that for every 2 Degree of shoulder flexion or abduction, the scapula rotates 1 degree
    • ****2:1 ratio-scapulohumeral rhythm
  24. force couple
    upward rotation
    muscles pulling in different directions to accomplish the same motion

    Ex: upward rotation

    • upper trapezius pulls up
    • lower trapezius pulls down
    • lower serratus pulls out
    • Anterior
    • net effect upward rotation
  25. force couple
    downward rotation
    • levator scapulae pull up
    • rhomboids pulls in
    • pectoraliz minor pulls down

    • net effect
    • downward rotation
  26. shoulder stability
    shoulder joint allows a great deal of motion

    unstable joint

    many anatomical structures contribbute to the stability of the shoulder
  27. shoulder stability
    • anatomical structures that contribute to stability
    • 1. glenoid labrum-catilage
    • 2. glenoid fossa-boney part
    • 3. joint capsule reinforced by the coracohumeral and glenohumeral ligaments
    • 4. capsule completely surrounds fossa creating a partial vacuum
    • 5. rotator cuff muscles
    • 6. shoulder muscles
  28. joint capsule
    • thin-walled, spacious container
    • attaches around rim of glelnoid fossa of the scapula and anatomical neck of the humerus

    outer fibrous membrane

    inner synovial membrane-lubercates-


    • arm hanging at side, superior portion taut/tight(pulling)
    • shoulder abducted, inferior taut, superior slack

    ex: boot on a stick shift
  29. glenoid labrum (E)
    fibrous tissue surrounding glenoid fossa

    deepens the articular cavity
  30. shoulder stability
    • example of multi-support-glenohumeral subluxation(stroke) after a CVA:
    • lack of socket depth
    • loss of muscle tone
    • upper extremity weight
    • gravity
  31. other structures
    bursae(synovial sac, provides cushion)
    • subdeltoid bursa
    • large
    • located between the deltoid muscle and joint capsule
    • subacromial bursa
    • lies below the acromion and coracoacromial ligment, between them and the joint capsula
    • frequently continuous with the subbdeltoid bursa
  32. glenohumeral movement
    • A. deltoid muscle on the humeral shaft gives the muscle an upward direction of pull
    • B. deltoid muscle's isolated action is elevation, impinging the humeral head directly up under the coracoacromial arch

    always thumb UP
  33. shoulder abduction
    • as the shoulder abducts
    • humeral head rolls across the glenoid fossa
    • humeral head glides inferiorly
    • accomplished by the actions of the rotator cuff muscles

    • for full shoulder ABDuction
    • the shoulder joint must also ER(REMEMBER: this will come back to haunt you!)

    allow the greater tubercle to pass the acromion
  34. rotator cuff tendons
    • tendinous band formed by the insertions of:
    • supraspinatus(D)
    • infraspinatus(E)
    • teres minor (F)
    • subscapularis
  35. rotator cuff tear
  36. rotator cuff tear-repair
  37. rotator cuff-tendinitis
    when humerous bone is held at 90o angle to the scapula
  38. reversal of muscle action
    reversal of muscle action occurs when the more movable end becomes less move able

    • chin up as reversal of muscle action
    • typically insertion moves toward the origin
  39. referral pain
    referral zone
    • c4-5-brachial plexus
    • changes in the vertebrae can impendge and effect

    • pain in diaphram/comes from another area
    • gall bladder/pain in lower scapular
    • heart/left upper extermities-mostly men

    • women different-unusual fitigue
    • or back pain
  40. shoulder complex
    • scapula
    • clavicle
    • sternum
    • rib cage
    • humerus
  41. scapulothoracic articulation
    • scapula
    • clavicle
  42. shoulder girdle
    • scapula
    • clavicle
    • sternum
  43. shoulder joint
    • scapula
    • humerus
  44. scapulohumeral rhythm
    movement relationship between the shoulder girdle and shoulder joint
  45. sternoclavicular
    connects sternum to clavicle
  46. costoclavicular
    connects first rib to clavicle
  47. interclavicular
    connects clavicles
  48. acromioclavicular
    connects scapula to clavicle
  49. sternoclavicular ligament
    acromioclavicle ligament
    reinforces the capsule
  50. costoclavicular ligament
    limits clavicular elevation
  51. articular disk
    acts as a shock absorber
  52. interclaviculoar ligament
    limits clavicular depression
  53. coracoacromial ligament
    serves as roof over humeral head

    provides protective arch
  54. elevation
    • upper trapezius
    • rhomboids
    • levator scapula
  55. depression
    • lower trapezius
    • pectoralis minor
  56. protraction
    • serratus anterior
    • pectoralis minor
  57. retraction
    • middle trapezius
    • rhomboids
  58. upward rotation
    • upper trapezius
    • lower trapezius
    • serratus anterior
  59. downward rotation
    • rhomboids
    • pectoralis minor
    • levator scapula
  60. which plane do the motions of scapula occur?
    • saggital plane
    • frontal plane
    • transverse plane
  61. in an erect posture, scapular elevation is moving against gravity and is produced by a _____________ contraction of the __________ and ___________ muscles.
    • concentric
    • levator scapula
    • upper trapezius
  62. scapulahumeral rhythm
    "inchworm" effect
    action of the shoulder girdle and deltoid muscles (middle) during shoulder abduction. If humerus moved dduring abduction, the middle deltoid muscle would quickly run out of contractile power as it approached 90o. the middle deltoid muscle is effective throughout the entire range.

    For every 2o the shoulder joint abducrts. the shoulder girdle upwardlly roates 1o.

    with this upward rotation of the scapula, the origin of the deltoid muscle ( acromion process. the lateral eld of the clavicle, the scapular spine) moves away from thje insertion on the humerus. this motion lengthens the muscle, resoiring its contractrile potential, and allows it to continue to effedctively contract throughout its entire range.
  63. shoulder joint-motions
    • flex/enten/hyper exten
    • abduc/adduc
    • medial/lateral rotation
    • horizontal add/abduct
  64. shoulder girdle-motions
    • elevation/depression
    • protraction/retraction
    • upward/downward rotation
  65. shoulder joint
    type of joint?
    shape of joint?
    ball/socket triaxel synovial

  66. shoulder joint
    • flex/exten/hyper
    • saggital plane
    • frontal axis

    • abduc/add
    • frontal plane
    • saggital axis

    • medial/lateral rotation
    • transverse plane
    • longitunal axis
  67. shoulder joint
    closed-packet position?
    loose-packed position?
    abduc/lateral rotation-closed

    abduction/horizontal rotation-loose
  68. thoracolumbar fascia
    provides attachment for the latissimus dorsi muscle
  69. glenoid labrum
    deepens the joint
  70. rotator cuff
    keeps the humeral head rotating in contact with the glenoid fossa
  71. joint capsule
    surrounds the joint
  72. coracohumeral
    strengthens the upper part of the joint capsule
  73. subdeltoid bursa
    decreases friction between the deltoid muscle and the joint capsule
  74. subacromial bursa
    decreases friction between the acromion process, the coracoacromial ligament, and the joint capsule
  75. shoulder joint
    • pectoralis major clavicular
    • anterior deltoid
    • coracobrachalis
  76. shoulder joint muscles
    • posterior deltoid
    • pectoralis major sternal
    • latissimus dorsi
    • teres major
  77. shoulder joint muscles
    • posterior deltoid
    • latissimus dorsi
  78. shoulder joint muscles
    medial rotation
    • anterior deltoid
    • subscapularis
    • pectoralis major clavicular
    • pectoralis major sternal
    • latissimus dorsi
    • teres major
  79. shoulder joint muscles
    later rotation
    • posterior deltoid
    • teres minor
    • infraspinatus
  80. shoulder joint muscles
    • anterior deltoid
    • middle deltoid
    • posterior deltoid
    • supraspinatus
  81. shoulder joint muscles
    • coracobrachalis
    • pectoralis major clavicular
    • pectoralis major sternal
    • latissimus dorsi
    • teres major
  82. shoulder joint muscles
    horizontal adduction
    • pectoralis major clavicualar
    • pectoralis major sternal
  83. shoulder joint muscles
    Horizontal abduction
    • teres minor
    • infraspinatus
  84. function of rotator cuff muscles during shoulder flexion or abduction
    keep the head of the humerous rotating aginst the glenoid fossa during joint motion
  85. which major nerve unit is located in the axilla
    • axillary nerve
    • location in relation to the head of the humerus?

    • superior
    • posterior

    major blood vessel close?

  86. raising your hand over your head requires the combined action of which 3 shoulder girdle muscles?
    • serratus anterior
    • upper & lower trapezius

    biomechanical term for this function

    force couple
  87. starting at the inferior angle and ging clockwise, name the shoulder girdle muscles that attach to the posterior surface of the right scapula.
    • rhomboids
    • all trapezius
    • levator scapula
  88. pectoralis minor is deep to what muscle
    pectoralis major
  89. as you look at the lateral chest wall, the serratus anterior muscle is deep to what tow muscles?
    • pectoralis major
    • latissimus dorsi
  90. closing a window by pulling down
    shoulder girdle motion____________
    shoulder joint motion?
    • downward rotation
    • concentric (shorten)
    • (shoulder extension)
  91. opening a window by pulling up
    shoulder girdle motion____________
    • upward rotation
    • concentric
    • (flexion)
  92. carrying a heavy suitcase
    shoulder girdle motion___________
    shoulder joint motion____________
    • elevation
    • isometric
    • (no shoulder motion)
  93. combing your hair in the back
    shoulder girdle motion________
    shoulder joint motion___________
    • upward rotation & retraction
    • isometric
    • shoulder flexion & lateral rotation
  94. reaching across the table
    shoulder girdle motion_____
    shoulder joint motion________
    • protraction
    • concentric
    • flexion
  95. lie prone on a table with your right arm hanging onver the side of the table and holding a weight in your right hand. using only shoulder girdle motion and noshoulder motion, pull the weight straight up from the floor

    joint motion at girdle?
    muscles of girdle action
    open or closed chain?
    scapular retraction

    middle trap,rhomboids

  96. lie prone on a table with your right arm hanging over the side of the table and holding a weight in your right hand. Move youre arm up and out by doing shoulder horizontal abduction.

    what girdle motion is accompanying shoulder horizontal abduction?

    muscles of girdle motion?

    shoulder retracrtion

    rhomboids, middle trap

  97. sit in a chair that has arms; place your hands on the armrests in a postioin that puts your shoulders in hyperextension. push down on the armrests and raise your butt off the seat of the chair.

    shoulder girdle motion (shoulder flexion action from hyperextension)?

    muscles of girdle??

    concentric or eccentric
    scapular depression (upward rotation)

    lower trap, pector minor (upper trap,serratus anterior)

  98. lie in a prone position with your legs together, hands on the table next to your shulders with your fingers pointing forward. push up with your hands as far as you can while straightening your elbows, bending yoour knees, and keeping your back straight.

    shoulder girdle motion?


    open or closed chain activity?
    scapular protraction/upward rotation

    • serratus anterior
    • pect minor
    • upper/lower trap

  99. using a lat pull-down machine of the universal gym, reach up and grasp the handles. pull down while keeping your arms moving in the frontal plane.

    shoulder girdle motion?

    shoulder joint motion?

    girdle muscles?
    joint muscles?
    scapular retraction/downward rotation

    ashoulder adduction/lateral rotation

    • middle trap,
    • rhomboids
    • levator scapula
    • pectoralis manor