SHOULDER REGION JROOZ NPTE REVIEW

BASIC KINEMATICS

• CONVEX-CONCAVE RULE – describes the relationship between the arthrokinematics and osteokinematics

• OPEN-PACKED vs CLOSE-PACKED POSITION

• CAPSULAR PATTERN

ENDFEELS

NORMAL

• SOFT

• FIRM

• HARD

ABNORMAL

• BOGGY

• FIRM

• RUBBERY

• EMPTY

• HYPERMOBILITY

ACCESSORY JOINT MOTION

• 0

• 1

• 2

• 3 - NORMAL

• 4

• 5

• 6

Shoulder

• 5 important bones

• 3 bony articulation

• 3 other non-contractile structures

• 15 important muscles

BONES

• Sternum

• Ribs

• Scapula

• Clavicle

• Humerus

Sternum

Ribs

Clavicle

Scapula

Humerus

X-ray identification:

JOINTS

• Bony Articulation

▫ Sternoclavicular

▫ Glenohumeral

▫ Acromioclavicular

• Functional joints

▫ Scapulothoracic/Scapulohumeral

▫ Suprahumeral

▫ Bicipital groove

Sternoclavicular joint

Movements

Elevation/depression Retraction/protraction

Tilting

Transverse rotation

• Open-Pack Position: Arm at Side

• Close-Pack Position: Full Elevation

• Capsular Pattern: Pain at extremes of range of motion especially horizontal adduction and full elevation.

Acromioclavicular Joint

Acromioclavicular Joint

• Open Pack Position: Arm by Side

• Close Pack Position: 90 degrees abduction

• Capsular Pattern: Pain at extremes of range of motion, especially horizontal adduction and full elevation

Glenohumeral Joint

Glenohumeral Joint

• Open Pack Position: 55 degrees abduction, 30 degrees horizontal adduction (scapular plane)

• Close Pack Position: Full abduction, lateral rotation

• Capsular Pattern: Lateral rotation, abduction, medial rotation

Scapulothoracic/Scapulohumeral Joint

SCAPULOHUMERAL RHYTHM

DIVIDED INTO THREE PHASES

PHASE I

PHASE II

PHASE III

Suprahumeral/Coracoacromial Arch

Bicipital Groove

Transverse Humeral Ligament

Bicipital Groove

• Biceps tendon does not move in the bicipital groove but humerus moves over the fixed tendon.

Yergason vs Speeds test:

Special Test

Support & Dynamic Stabilization

of the Shoulder • The head of the humerus is maintained on the

glenoid fossa by the

▫ Coracohumeral & superior GH ligaments

▫ Negative atmospheric pressure within the capsule

• Maintenance of the normal resting position of the scapula

▫ Passive fascial forces produced by the muscles that attach to the scapula

▫ Support of the rib cage

• Support provided to the capsule by rotator cuff muscles and glenohumeral ligaments.

• Dynamic stability for the joint is afforded by the muscular dynamic stabilizers, in particular the rotator cuff, the biceps tendon, and the muscles of scapular motion

Rotator Cuff Stabilization

Holds the humeral head tightly against the glenoid to prevent subluxation when carrying weight in the hand

Supraspinatus

Infraspinatus

Teres minor

>Protraction/ Retraction 25

>Upward and Downward Rotation 60

Bursae

Muscles

• Upper limb to Thoracic wall

▫ Pectoralis Major/Minor

▫ Serratus Anterior

• Upper limb to Vertebral column

▫ Trapezius

▫ Latissimus Dorsi

▫ Levator Scapulae

▫ Rhomboids Major/Minor

• Scapula to Humerus

▫ Deltoid

▫ Teres Major

▫ Rotator Cuff Muscles

Pectoralis ( major/minor)

Serratus anterior

Trapezius

Latissimus dorsi

Levator scapulae

Rhomboids ( major/minor)

Deltoids

Supraspinatus

Infraspinatus

Teres minor

Subscapularis

Teres Major

Biceps brachii

Brachial Plexus

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