SHOULDER

JOINT
BIOMECHANICS
BY:- DR. DEEPIKA METANGE
SHOULDER
COMPLEX

▶ Clavicle
▶ Scapula
▶ Humerus

 designed primarily for mobility

 Introductio
n
⚫ Shoulder joint (GH joint) has more
mobilitythan stability.
⚫ Only SC joint connects the components of shoulder
joint to the axial skeleton. This puts greater demands
on the muscles for securing the shoulder girdle on
thorax during static and dynamic conditions
(dynamic stabilization).
 C omponents of shoulder
c omplex
⚫ Clavicle, humerus and scapula are linked with 3
interdependent linkages: SC joint, AC joint &
GH joint.
⚫ Additionally a functional joint
calledscapulothoracic joint ( ST joint) is considered
as a part of shoulder complex.
 COMPONENTS of Shoulder
Complex
▶ Sternoclavicular joint
▶ Acromioclavicular joint
▶ Glenohumeral joint
▶ Scapulothoracic joint
(functional joint)

 Subacromial
( Suprahumeral joint)
formed by movement of
head of humerus below
coracoacromial arch
 Acromioclavicul Sternoclavicularis
ari
s

Clavic l Sternu
u m
Scapula a

Glenohumerali
s

Humerus
Scapulothorac
alis
Subacromial(Suprahumeral joint)
STERNOCLAVICULAR
JOINT
▶ Only structural attachment of clavicle, scapula
& upper extremity to axial skeleton.

⚫ Movement of the clavicle at the SC joint inevitably

produces movement of the scapula under
conditions of normal function, because the
scapula isattached to the lateral end of theclavicle.

⚫ SC joint is a plane synovial joint, with 3

rotatory and 3 translatory degrees of freedom.
 SC articulating
surface:
⚫ The SC articulation consists of two saddle-shaped
surfaces, one at the sternal or medial end of the
clavicle and one at the notch formed by the
manubrium of the sternum and first costal
cartilage.
⚫ It is a plane synovialjoint.
⚫ The articulating surfaces areincongruent.
⚫ The superior portion of the clavicle does not makes
any contact with the manubrium, instead it serves
as an attachment site for SC disk and
interclavicular ligaments.
Sternoclavicular
disk
⚫ It is a fibrocartilaginous disk to increase the
congruency b/w incongruent articularsurfaces.
⚫ Attachment: upper portion is attached to the
postero- superior clavicle and the lower portion is
attached to the manubrium and first
costalcartilage.
⚫ The disk diagonally transects the SC joint space
and
divides the joint into 2 separate cavities.
⚫ Acts like a hinge/pivot point during clavicular
motion
▶ Elevation/depression – medial end of clavicle rolls &
slides on relatively stationary disk. Upper portion
serves as a pivot
▶ Protraction/retraction – S.C disk & medial clavicle
rolls & slides on manubrium facet. Lower portion
acts as a pivot.

Mobility between segments is maintained & stability is

enhanced
⚫ The disk is considered part of the manubrium in
elevation/depression and thus the upper attachment
of the disk serves as pivot point and the disk acts as
the part of the clavicle in protraction/ retraction
with lower attachment serving as pivot point.
⚫ The axis of motions of SC jointelevation/depression
and protraction/retraction is located lateral to the SC
joint, on the costoclavicularligament.
⚫ The disk functions to absorb the medially directed
force transmitted along the clavicle from its lateral
end.
 Sternoclavicular joint ca psule
and ligaments
⚫ Sc joint is supported by fibrous
⚫ capsule
3 ligaments: ANTERIOR
⚫ Sternoclavicular
POSTERIOR
ligament
ANTERIOR
LAMINA
⚫ Costoclavicular
ligament POSTERIOR
LAMINA
⚫ Interclavicular
ligaments
 Sternoclavicular
3motions
rotatory degrees of freedom:
⚫ Elevation/depression
⚫ Protraction/retraction
⚫ Anterior/posterior rotation of clavicle
3 degrees of translatory motion at the SC
joint (very small in magnitude):
⚫ Anterior/posterior
⚫ Medial/lateral
⚫ Superior/inferior
Elevation/depression of
c lavic le
 Elevation/depression of
clavicle

⚫ Occurs around an AP axis

⚫ Between convex clavicular surface & concave surface of manubrium
and first coastal cartilage
Elevation :- downward sliding of medial clavicular surface
on manibrium
:- SC joint axis lies lateral to the joint at
costoclavicular ligament thus being a functional axis
⚫ Clavicular elevation= upto 45degrees
⚫ Passive clavicular depression= less than 15degrees
⚫ These movements are associated with movements of the scapula
thus playing a significant role in increasing the range of elevation
of the arm
Protraction/retraction of
clavicle
Protraction/retraction of
clavicle
⚫ Occurs at vertical axis
⚫ Medial end of clavicle is concave and manubrium is
convex
⚫ Protraction is anterior sliding of medial clavicle
on manubrium

⚫ protraction= 15 degrees
⚫ Retraction= 15 degrees

⚫ Associated with protraction & retraction of the

scapula
Anterior and Posterior Rotation of
the Clavicle
 Anterior and Posterior
Rotation ofthe Clavicle

 Occurs as a spin
 Clavicle rotates in only one direction from its resting
position
 Clavicle rotates posteriorly from neutral (inferior surface
of the clavicle faces anterior)
 From fully rotated position back to neutral is anterior
rotation
⚫ Posterior rotation= 30-55 degrees

⚫ Posterior rotation of clavicle produces 30° of final

upward rotation of the scapula
 Sternoclavicular stress
tolerenc e
⚫ Although the SC joint is considered
incongruent,the joint does not undergo the degree
of degenerative change common to the other joints
of the shoulder complex.
⚫ Strong force-dissipating structures such as the
SC disk and the costoclavicular ligament
minimize articular stresses and also prevent
excessive intra- articular motion that might lead to
subluxation or dislocation.
ACROMIOCLAVICULAR
JOINT
AC
JOINT
⚫ Plane synovial joint
⚫ 3 rotational and 3 translational degrees of freedom
⚫ The primary function of the AC joint is to allow the
scapula additional range of rotation on the thorax
and allow for adjustments of the scapula (tipping
and internal/external rotation) outside the initial
plane of the scapula in order to follow the changing
shape of the thorax as arm movement occurs.
⚫ In addition, the joint allows transmission of forces
from the upper extremity to the clavicle.
AC articulating
surfac e
⚫ Incongruent surfaces
⚫ Lateral end of clavicle
and Small facet on
acromion of the
scapula
 AC joint
⚫disk
Through 2 years of age, the AC joint is
actually a fibrocartilaginous union.
⚫ With use of UE progressively, a joint space develops
on each articulating surface that may leave a
meniscoid fibrocartilage remnant within the
joint.
AC joint c apsule and
ligament
⚫ Superior
acromioclavicularligament
⚫ Inferior acromioclavicular ligament TRAPEZOI
D
⚫ Coracoclavicular (LATERAL)
ligament CONOID
(MEDIAL)

 A.C. capsule & ligaments can restrain small motions,

restrain of larger displacement is credited to coracoclavicular
ligament
⚫ The capsule of the AC joint is weak and cannot
maintain integrity of the joint without reinforcement
of the superiorand inferioracromioclavicularand
the coracoclavicular ligaments.
⚫ Superior AC ligament is reinforced
byaponeurotic extensions from deltoid
andtrapezius.
⚫ Trapezoid portion: oriented more horizontally.
It resists posterior forces on distal clavicle
⚫ Conoid portion: oriented more vertically.
Itresists superior and inferior forces

1. Both limit upward rotation of scapula on AC

joint.

2. Prevents medial displacement of acromion

on clavicle when leaning on 1 hand
Upward rotation of the scapula
at AC joint

Upward rotation of scapula at A.C. joint

Corocoid process would drop away from

clavicle

Prevented by coraco-clavicular ligament

 Most important role of coraco-clavicular ligament is in

producing longitudinal rotation of clavicle which is
important for full ROM in elevation of upper extremity.
 Large external forces push humerus into glenoid fossa

Medially directed muscles of scapula would displace scapula

medially on thorax

Small A.C. joint with weak capsule & ligament cannot

resist such large forces

Clavicle would override the acromion and joint

would dislocate

Medial displacement of scapula is prevented by tension in

coraco-clavicular ligament

Tranfers medially directed force to clavicle & to strong SC jt.

 AC
motions
⚫ 3 rotatory motions:
⚫ Internal/external rotation
⚫ Anterior and posteriortipping
⚫ Upward and
downward rotation
⚫ 3 translatory motions:
⚫ Anterior/posterior
⚫ Medial/lateral
⚫ Superior/inferior
Axis and planes for AC joint
motions
Medial/lateral
rotation
Medial/lateral
rotation
▶ Medial and lateral rotation bring the glenoid fossa
medial (anterior) & lateral (posterior)
▶ Must occur to maintain contact of the scapula
with horizontal curvature of the thorax.

Scapula
would move
directly away
Pure
Protractio from vertebral
translator
n column&
movement glenoid would
face lateral
While elevating the
arm

⚫ Protraction and
retraction of the
scapula require medial
and lateral rotation,
respectively, for the
scapula to follow the
convex thorax
and orient the glenoid
fossa with the plane of
elevation.
 Glenoid fossa
faces anterior By medial
Scapular
with scapula in rotation of
protractio contact with the scapula
n the ribcage
Anterior and posterior
tipping
Anterior and posterior
tipping

▶ Anterior tipping is when superior border of the

scapula move anteriorly & inferior angle
posteriorly
▶ In order to maintain contact of the scapula with the
ribcage
▶ Elevation requires anterior tipping
▶ Anterior tipping occurs during posterior rotation of
the clavicle (as a counter rotation)
While elevating the
arm
⚫ The scapula posteriorly tips on thorax as the scapula
is upwardly rotating.
A cromioc lavic ular stress
tolerenc e

⚫ AC joint is susceptible to trauma and

degenerative changes because of
Smaller and incongruentsurfaces.
⚫ It is commonly found in 2nd decade to
6th decadeof life.
SCAPULOTHORACIC
JOINT
 ST
JOINT
⚫ It is not a true anatomic joint.
⚫ The functional ST joint is part of a true closed
chain with the AC and SC joints and the thorax.
Resting position of
scapula
⚫ 2 inches from midline
b/w
2nd and 7th rib.
⚫ Internally rot -30-45
degrees from coronal
plane.
⚫ Ant tipped -10-
20degrees from frontal
plane
⚫ Upward rotated - 10-
20 degrees from
RESTING POSITION OF
SCAPULA
⚫ The linkage of the scapula to the AC and SC joints,
however, actually prevents scapular motions both
from occurring in isolation and from occurring as
true translatory motions.
⚫ Eg. When the arm is abducted, scapula
undergoes upward rotation, external rotation
and posterior tipping (all movts in
combination).
MOTIONS OF THE
SCAPULA
⚫ Upward/downward
rotation
⚫ Elevation/depression
⚫ Protraction/retraction
⚫ Medial /lateral rotation
⚫ Anterior/posterior tipping
UPWARD
ROTATION
⚫ Approx. 60 degrees of
upward rotation of the
scapula on the
thoraxis typically
available.
⚫ Upward rotation of the
scapula is produced by
clavicular elevation
and posterior
rotation at the SC
joint and by
ELEVATION/
DEPRESSION
Elevation and depression of
the scapula are produced
by elevation/depression
of the clavicle at the SC
joint and requires subtle
adjustments in
anterior/posteriortipping
and internal/external
rotation at the AC joint to
maintain the scapula in
contact with the thorax.
PROTRACTION/
RETRACTION
⚫ Protraction and
retraction of the scapula
are produced by
protraction/retraction
of the clavicle at
theSC joint, and by
rotations at the AC
joint to produce
internal rot & ant
tipping.
 Medial/lateral
rotation
⚫ Medial/lateral rotation of
the scapula on the thorax
should normally accompany
protraction/ retraction of the
clavicle at the SC joint.
⚫ Medial rotation of the
scapula on thorax which
occurs only at the AC joint,
will result in theprominence
of the vertebral border of
scapula. (WINGING OF
SCAPULA-suggestive of
impaired neuromuscular
control of ST muscles ).
Functions of scapular
motions

▶ Orient glenoid fossa for optimal

contact
▶ To add range to elevation of the arm
▶ To provide stable base for controlled
rolling & sliding of the humeral
head
GLENOHUMERA
L JOINT
 GH
ARTIC ULATING
SURFACE
⚫Scapula-
⚫ Glenoid fossa is oriented/facing upwards and 6-
7 degrees retroverted.
⚫ The radius of curvature of the fossa is increased by
articular cartilage that is thinner in the middle and
thicker on the periphery, which improves
congruence with the much larger radius of
curvature of the humeral head.
⚫Humerus-
⚫ The head faces medially, superiorly, and
posteriorly with regard to the shaft of the
humerus and the humeral condyles.
⚫ ANGLES:
⚫ Angle of inclination=130-150 degrees
⚫ Angle of torsion=30 degrees posteriorly
 Angle of
inclination
Axis through
humeral head &
longitudinal axis
through shaft

Angle of
torsion
In transverse plane,
axis through humeral
head and condyles
⚫ Because of the internally rotated resting position of
the scapula on the thorax, retroversion of the
humeral head increases congruence of the GH
joint.
⚫ Reduced retroversion of humeral head
(anteversion)- increases ROM for internal rotationand
decreases ROM for external rotation and has a
tendency to produce anterior GHsubluxation.
⚫ Vice versa for increased retroversion of humeral
head.
Subluxation of
shoulder
GLENOID
LABRUM
⚫ Enhance the depth or
curvature of the
fossaby 50%.
⚫ It is a redundant fold of
dense fibrous
connective tissue with
little fibrocartilage.
⚫ It is attached to
glenohumeral ligament
and long head of
biceps brachii.
GH CAPSULE
& LIGAMENTS
⚫ GH Capsule laxity is
required for large
excursions of
shoulder joint.
⚫ But capsule
givesless stability
alone and its work
has to be reinforced
by GH ligaments.
 Capsule is taut superiorly and slack anteriorly
& inferiorly
 Close Packed Position:- Abduction & lateral
rotation
 Capsule twists on itself & tightens
 Capsule is reinforced by GH ligaments
 Reinforced anteriorly by subscapularis tendon, it is a
common site of extrusion of the head- Anterior
dislocation of GH joint
 Thin area of capsule between superior & middle
GH
ligament
⚫ Superior
⚫ Middle
⚫ Inferior
⚫ Coracohumeral lig
⚫ Foramen of
weitbrecht- areaof
weakness in the
capsule.
Rotator
interval
capsule ⚫ superior GH ligament,
the superior
capsule,and the
coracohumeral ligament
are interconnected
structures that bridge
the space between the
supraspinatus and
subscapularis muscle
tendons- rotator
interval capsule.
Inferior GH
ligament complex
⚫ Inferior GH ligament
has 3 parts:
⚫ Anterior bands
⚫ Axillary pouch
⚫ Posterior bands
Function of GH
ligament
Superior Limits ant and inferior translation
GH Lig in arm at 0 degrees of
abduction
Middle GH Limits anterior translation at arm
Lig 45 degrees abduction
Anterior Limits ant translation beyond 45
band
of degrees abduction + external
IGHLC
rotation
Posterior Limits posterior translation
band
IGHLC witharm 45 degrees abd+ internal
rotation
 Coracohumeral
Ligament
Two bands
inserts into supraspinatous
& onto greater tubercle
where it joins sup. GH
ligament

inserts into subscapularis &

lesser
tubercle
Two bands form a tunnel through which long
head
of biceps brachii passes
C orac oac romi
al arch
 C orac oac romi
al arch
⚫ Forms an osteo-ligamentous vault
⚫ Formed by corocoid, acromian & CA ligament
⚫ Contents undercoracoacromial arch: subacromial
bursae, rotator cuff tendons and portionof
long head of biceps brachii.
⚫ Also called as supraspinatus outlet/ subacromial
space
⚫ Normally, it is 10 mm wide, but reduces to 5mm
on elevation of arm.
⚫ Repetitive overhead activity can cause
 Bursa
e
⚫ Subacromial Subacromial
bursae

⚫ Subdeltoi
d
 Glenohumera
l motions
MOTIONS ROM available

Flexion 120°

Extension 50°

Abduction 90-120°

Adduction

External rotation 60° of combined motions (arm

at side)
120° of combined motions( arm at
90°abducted)

Internal rotation -
⚫ For complete range of abduction to occur, there
must be 35-40 degrees of lateral rotation, for the
clearance of greater tubercle under the
Coracoacromial arch.
⚫ MAXIMUM ABDUCTION IS FOUND TO OCCUR
IN SCAPULAR PLANE, i.e 30-40 degrees anterior to
frontal plane. This is due to lack of capsular tension
in scapular plane.
 Intra-articular Contribution to
Glenohumeral Motions

⚫ The convex humeral head is a substantially larger

surface and may have a different radius of
curvature than the shallow concavefossa.
⚫ Given this incongruence, rotations of the joint
around its three axes do not occur as pure spins
but have changing centers of rotation and shifting
contact patterns within the joint.
⚫ Without downward
sliding of the
articular surface
of the humeral
head, the humeral
head will roll up
the glenoid fossa
and impinge upon
the
coracoacromial arch
.
⚫ Slight superior
translation of the
center of the
humeral head can
still occur
duringhumeral
abduction despite
inferiorsliding of
the head’s
articular
surface. (1-
Static Stabilization of the GH Joint in
the dependent Arm- UNLOADED ARM
Bony surfaces alone cannot maintain joint contact in dependant
position

Gravity acts on humerus parallel to shaft in downward

direction Requires vertical pull upwards to maintain

equilibrium

Should be pulled by muscles

But, all muscles are electrically silent

 LOG creates downward force
on
humerus

Magnitude of passive tension in

structures of rotator interval
capsule which is taut when
arm is at the side

Resultant pull of both creates a

line of force which compresses
humeral head into lower
glenoid fossa
⚫ PASSIVE TENSION IN THE ROTATOR
INTERVAL CAPSULE
⚫ AIR-TIGHT CAPSULE PRODUCING NEGATIVE
INTRAARTICULAR PRESSURE. RESISTS
INFERIOR TRANSLATION
⚫ GLENOID INCLINATION-THERE IS SLIGHT
UPWARD TILT OF GLENOID FOSSA EITHER
DUE TO ANATOMICALLY OR DUE TO UPWARD
ROTATION OF THE SCAPULA. PRODUCES
PARTIAL BONY BLOCK
 LOADED ARM-
STATIC
STABILIZATION
⚫ SUPRASPINATUS
ACTIVITY STARTS
WHEN THE
PASSIVE TENSION
IN ROTATOR
INTERVAL
CAPSULE IS
INSUFFICIENT AS IN
LOADED ARM.
 DYNAMIC STABILIZATION
OF THE GH JOINT
The Deltoid and Glenohumeral Stabilization
⚫ Deltoid is a prime mover for GH abduction
⚫ Action line of three segments of deltoid acting
together coincides with fibres of middle deltoid
⚫ The majority of the forceof contraction of the
deltoid causes the humerus and humeral head to
translate superiorly; only a small proportion of force is
applied perpendicular to the humerus and directly
contributes to rotation (abduction) of the humerus.
⚫ The deltoid cannot independently abduct (elevate) the
arm. Another force or set of forces must be introduced
to work synergistically with the deltoid for the deltoid to
work effectively.
EFFEC T OF DELTOID
(ALONE) ON ABDUCTION
 Superiorly translatory force of deltoid

If unopposed, would cause humeral head to impact the coracoacromial

arch

Inferior translator pull of gravity cannot offset this

force

As resultant force of deltoid must exceed that of gravity before rotation

can
occur

Done by muscles of rotator

cuff
 The Rotator Cuff and
Glenohumeral Stabilization

⚫ ROTATOR OR MUSCULOTENDINOUS
CUFF MUSCLES ARE:
⚫ Supraspinatus (S)
⚫ Infraspinatus (I)
⚫ Teres minor(T)
⚫ Subscapularis(S)
 The infraspinatus, teres
minor, and
subscapularis muscles
individually or together
have a similar line of pull
 The rotatory component
(Fy) compresses as well as
rotates, and the
translatory component
(Fx) helps offset the
superior translatory
pullof the deltoid.
⚫ Abduction without
these three muscles
would result in
substantial superior
translation
⚫ Action of deltoid
along with these three
muscles form a “Force
Couple” which
creates a perfect
spinning of humeral
head
The Supraspinatus and
Glenohumeral Stabilization
⚫ The supraspinatus has a
superiorly directedtranslatory
component (Fx) and a rotatory
component (Fy) that ismore
compressive than that of the
other rotator cuff muscles and
can independently abduct
the humerus.

⚫ Gravity acts as a stabilizing

synergist by offsetting small
The Long Head of the
BicepsBrachii and Glenohumeral
Stabilization

⚫ The long head of biceps

may produce its
effectby tightening the
relatively loose superior
labrum and
transmitting increased
tension to the superior
and middle GH
ligaments.
⚫ The long head of the biceps brachii, because of its
position at the superior capsule and its connections
to structures of the rotator interval capsule, is
sometimes considered to be part of the reinforcing
cuff of the GH joint.
⚫ The biceps muscle is capable of contributing to
the force of flexion and can, if the humerus is
laterally rotated, contribute to the force of
abduction and anterior stabilization.
 Costs of Dynamic Stabilization of
the Glenohumeral Joint

⚫ Supraspinatus tendon tears

⚫ Supraspinatus impingement in
subacromialarch
⚫ Rotator cuff tear
⚫ AC joint degenerativechanges
⚫ Bicipital tendinitis
⚫ Dislocation of shoulder
AC joint
degenerative
changes
Bicipital
tendiniti
s
Scapulohumera
l motion
▶ Distributes the motion between two joints
(GH & ST) thus permitting large ROM.
▶ Maintains glenoid fossa in optimal position,
thus increasing joint congruency
▶ Permits muscles acting on humerus a good
length tension relationship, thus minimizing
active insufficiency of GH joints
 Scapulothoracic and
Glenohumeral Contributions

⚫ SCAPULAR UPWARD ROT = 60 DEGREES

⚫ SCAPULA not only upwardly rotates but
also posteriorly tips to 30degrees.

⚫ GLENO-HUMERAL CONTRIBUTION = 100 to 120

of flexion and 90 to 120 ofabduction.
⚫ TOTAL MOVEMENT IN ELEVATION= OF 150-
180 DEGREES
 SCAPULOHUMERAL
RHYTHM PRE-PHASE/
SETTING PHASE
During initial 60° of flexion/ 30° of abduction

Scapula seeks a position of stability in relation to

the humerus (Setting Phase)
In this phase, motion occurs primarily at the GH joint
(stressing the arm may increase the scapular
contribution)
With increasing range, scapula increases its contribution (1:1
with GH joint)

In later range, GH joint increases its contribution

⚫ The overall ratio of 2 of GH to 1 of ST motion during
arm elevation is commonly used, and the
combination of concomitant GH and ST motion
most commonly referred to as scapulohumeral
rhythm.
Sternoclavicular and
Acromioclavicular Contributions

▶ 60° arc of upward rotation

through which the scapula
moves during elevation of the
arm can be attributed to
primarily SC joint and
secondarily AC joint.
▶ This happens by a force
of trapezius & serratus anterior
couple
(only muscles capable of upwardly
rotating the scapula)
 Upward Rotators of the Scapula

⚫ The motions of the scapula are primarily produced

by a balance of the forces between the trapezius
and serratus anterior muscles through their
attachments on the clavicle and the scapula.
⚫ TRAPEZIUS WITH SERRATUS Anterior-formsa
force couple for scapular upward rotation
⚫ INITIATION Of scapular rotation- upper
trap+ middle traps
⚫ AT THE END RANGE= Lower traps
SCAPULOHUMERAL
RHYTHM PHASE I
Upward rotation of scapula would appear to occur at AC joint

Coracoclavicular ligament prevents this

Must produce movement at the next joint i.e. SC joint

Pull of trapezius & Serratus anterior on scapula forces the clavicle to

elevate

Clavicular elevation carries the scapula through 30° of upward

rotation
Elevation is checked by the costoclavicular ligament
 ST upward rotation & clavicular elevation
occur concurrently with GH motion
 GH joint moves around 60°
 Arm elevates 90-100°
 During initial 30° of ST motion, AC joint
maintains fixed relation between scapula
& clavicle but allows 10° of medial rotation
& anterior tipping of scapula
SCAPULOHUMERAL
RHYTHM PHASE II
As lower trapezius & serratus anterior continue to generate an
upward rotatory force on scapula

Upward rotation at AC joint is constrained by coracoclavicular

ligament
& at SC joint by costoclavicular ligament

Tension at coracoclavicular ligament builds

 coracoid process gets pulled down

Draws clavicular attachment forward &

down Clavicle rotates posteriorly

Lateral end of clavicle moves up

 AC joint absorbs varying amount of anterior/posterior
tipping & medial/lateral rotation till scapula finds its
position on ribs

 For clavicle to rotate, it would require motion at AC

& SC joint
But, Internal fixation of clavicle at AC joint does not
impair range of elevation

 Sequence of phase I & II of scapula-humeral motion

occurs regardless of plane of scapula in which the
arm elevates
Integrated
movement during
elevation
 DELTOI
D
⚫ Scapular plane abduction- anterior and
middle deltoid
⚫ Posteriordeltoid has smaller MA and thus
less effective in frontal planeabduction.
⚫ Maintenance of appropriate length-tension
relationship of deltoid is dependent on
scapular position/movement and stabilization. For
example: when scapula cannot rotate, there is
more shortening of deltoid and thus lossof tension,
which causes elevation to upto 90 degrees only.
 Supraspinat
us
⚫ Primary function is to produce abduction
with deltoid muscle.
⚫ It has a fairly constant MA throughout the range
of motion of abduction
⚫ Secondary function: acts as a ‘steerer’ of humeral
head and helps to maintain stability of dependent
arm.
 Infraspinatus, teres minor
and subscapularis
⚫ These muscle function gradually increases from-0-
115 degrees of elevation after which (115-180 degrees)
it dropped.
⚫ In the initial range of elevation, these muscles
(infrasp and [Link]) work to pull the humeral head
down, and during the middle range, these muscles act
to externally rotate for clearing greater tubercle
under coracoacromial arch.
⚫ Subscapularis helps as internal rotwhen arm is at
side
and during initial range
⚫ With more abduction, its internal rot capacity decreases.
⚫ Then it acts with other RC muscles to promote stability
 UPPER AND LOWER
TRAPEZIUS + SERRATUS
ANTERIOR
⚫ This force couple produces upward rotationof scapula.
⚫ When the trapezius is intact and the serratus
anterior muscle is paralyzed, active abduction of the
arm can occur through its full range, although it is
weakened.
⚫ When the trapezius is paralyzed (even though the
serratus anterior muscle may be intact), active
abduction of the arm is both weakened and limited in
range to 75, with remaining range occurring exclusively
at the GH joint.
⚫ Without the trapezius (with or without the serratus
anterior muscle), the scapula rests in a downwardly
rotated position as a result of the unopposed
⚫ Serratus anterior produces upward rotation,
posterior tipping and external rotation of
scapula, which is necessary for upward elevation
of arm.
⚫ The serratus is the primary stabilizer of the inferior
angle and medial border of the scapula to the
thorax.
 How SA and trap work
with deltoid??
⚫ The serratus anterior and trapezius muscles are prime
movers for upward rotation of the scapula. These two
muscles are also synergists for the deltoid during
abduction at the GH joint.
⚫ The trapezius and serratus anterior muscles, as
upward scapular rotators, prevent the undesired
downward rotatory movement of the scapula by the
middle and posterior deltoid segments that are
attached to the scapula.
⚫ The trapezius and serratus anterior muscles maintain an
optimal length-tension relationship with the deltoid and
permit the deltoid to carry its heavier distal lever through
full ROM.
 Rhomboid

⚫ It works eccentrically to control

upwardrotation of the scapula produced by the
trapezius and the serratus anterior muscles.
⚫ It adducts the scapula with lower traps to offset
the lateral translation component of the
serratus anterior muscle.
⚫ Depression involves the forcefuldownward
movement of the arm in relation to the
trunk.
 Latissimus Dorsi and
Pectoral Muscle Function

⚫ When the upperextremity is free to move in

space, the latissimus dorsi muscle may produce
adduction, extension, or medial rotation of the
humerus. Through its attachment to both the
scapula and humerus, the latissimus dorsi can
also adductand depress the scapula and
shoulder complex.
⚫ When the hand and/or forearm is fixed in
weight- bearing, the latissimus dorsi muscle will
pull its caudal attachment on the pelvis toward its
cephalad attachment on the scapula and humerus.
This results in lifting the body up as in a seated
 Pec toralis
major muscle
⚫ Clavicular Flexion of shoulder
portion

Depression
⚫ Sternal portion
of
⚫ Abdominal shoulder
portion
Depressor
function is
assisted by
pectoralis
Teres Major and Rhomboid
Muscle Function

⚫ In order for the teres

major muscle to
extend the heavier
humerus rather than
upwardly rotate the
lighter scapula, the
synergy of the
rhomboid muscles is
necessary to
stabilizethe scapula.