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Brunnstrom’s Clinical Kinesiology Sixth Edition
CHAPTER 5
Shoulder Complex
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Introduction
 Shoulder complex is the shoulder joint (GH joint)
and the shoulder girdle.
 Shoulder girdle has 3 joints:
 Sternoclavicular
 Acromioclavicular
 scapulo-thoracic (aka scapulo-costal)
 Only a functional joint – not a structural joint
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
General considerations:
 The shoulder maximizes mobility, but at the sake of
stability.
 Primary purpose is to position hand for function.
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Bones
 Scapula
 Flat triangular bone
 Vertebral border positioned between T2 and T7
 Provides location for glenohumeral (GH) muscles
to originate and provides stable base from which
GH joint can operate
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Bones
 Scapula
 Works in concert with clavicle to enhance total
shoulder range of motion (ROM)
 Has many unique bony prominences:
 Superior and inferior angles; spine; borders
 Glenoid fossa; acromion; coracoid process
 Supraspinatus/infraspinatus/subscapular fossas
 Supraglenoid and infraglenoid tubercles
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Bones
 Scapula
 Glenoid fossa
 Deepened 50%
 by glenoid labrum
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Joints
 Shoulder girdle movements
 Elevation/depression
 Protraction/retraction
 Upward rotation/downward rotation
 Scapular tilting—A-P; M-L
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Joints
 Sternoclavicular
 Connects upper extremity to axial skeleton
 Saddle joint with three degrees of freedom
 Elevation/depression
 Protraction/retraction
 Rotation
 Acromioclavicular
 Scapulothoracic
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Joints
 Glenohumeral joint
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Ball and socket; three degrees of freedom
Inherently unstable
Humeral head more than twice the size of glenoid
Labrum deepens socket
Large capsule; redundant inferiorly
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Joints
 Glenohumeral joint
 Capsular reinforcements
 Superior/middle/inferior GH ligaments
 Coracohumeral ligament
 Long head of biceps/triceps
 Rotator cuff tendons blend with capsule
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Rotator Cuff
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Supraspinatus
Infraspinatus
Subscapularis
Teres minor
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Joints
 Glenohumeral joint—osteokinematics
 Abduction/adduction—frontal—A-P axis
 Flexion/extension—sagittal—M-L axis
 Medial/lateral rotation—transverse—superiorinferior axis
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Joints
 Glenohumeral joint—arthrokinematics
 Flexion/extension—spin
 Abduction—superior roll; inferior glide
 Lateral rotation—posterior roll; anterior glide
 Medial rotation—anterior roll; posterior glide
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Scapulohumeral Rhythm
 Pairing of shoulder girdle movement with
shoulder joint movement
 Example: abduction of arm at shoulder joint
With
 Upward rotation of shoulder girdle (scapula)
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Muscles of the Shoulder Complex
 Glenohumeral stabilizers
 Supraspinatus
 Infraspinatus/teres minor
 Subscapularis
 Biceps/triceps brachii
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Muscles of the Shoulder Complex
 Large movers
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Deltoid
Latissimus dorsi
Teres major
Pectoralis major
Coracobrachialis
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Function of Muscles of the Shoulder Complex
 Synergistic muscle actions—force couples
 Upward scapular rotation
 Upper Trapezius—Lower Trapezius—Serratus Anterior
 Downward Scapular Rotation
 Pectoralis minor—levator scapulae—rhomboids
 Shoulder elevation
 Deltoid and rotator cuff
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Summary
 Shoulder is composed of three real joints;
one pseudojoint
 Shoulder provides extensive ROM
 GH joint is inherently unstable
 Rotator cuff and scapular muscles provide
dynamic support to GH joint and scapula
Copyright © 2012 F.A. Davis Company
Brunnstrom’s Clinical Kinesiology Sixth Edition
Summary
 Total shoulder motion is a result of:
 Intricate balance between joints of shoulder
 Proper functioning and synchronization of muscles
 Shoulder injuries are common and occur
when a “breakdown” of any one of the links
occurs
Copyright © 2012 F.A. Davis Company