Shoulder Biomechanics
and its clinical insights
Dr.Alagappan Thiyagarajan MPT(Sports) ,PhD
Associate professor /chief physiotherapist
chettinad academy of research and education
kelambakkam, chennai
slides
• Basic Anatomy
• Biomechanics
• Various joints of shoulder complex
• kinetics and kinematics of shoulder
complex
• Special terminologies- glenohumeral
rhythm, throwing mechanics, lifting
mechanics
• Case scenario and integration
Basic Anatomy of Shoulder complex
Synovial joint, ball and socket
variety.
Glenohumeral ligaments, ac joint
ligament, coracoacromian
ligaments, glenoid labrum,
transhumeral ligament
6 possible movements- flexion,
extension,abduction, adduction,
internal and external rotation,
circumduction
axillary artery and nerves of
brachial plexus
Anatomy
Muscles involved
4 rotator cuff muscles
• Subscapularis - internal rotator
• Supraspinatus - abduction
• Infraspinatus - external rotator
• Teres minor - external rotator
• The biceps,The triceps
• The pectoralis major
• The pectoralis minor
• The latissimus dorsi
• The serratus anterior,The serratus posterior superior
The rhomboid major,The rhomboid minor
• The upper, middle and lower trapezius
• The levator scapula
• The deltoid (anterior, middle and posterior)
• The coracobrachialis
• The subclavius
• The anterior, middle and posterior scalene (through an indirect effect)
joints of shoulder complex-
biomechanics aspects
Glenohumeral joint
• Type: True synovial joint.
• Structure: Humeral head meets
the glenoid of the scapula.
• Function: Provides extensive arm
movement but is inherently
unstable.
• Stabilization: Labrum (fibrous
cartilage) increases stability.
• Common Issues: Prone to injury
and wear and tear; labrum injuries
are common and often need
surgery or rehab.
Sterno clavicular joint
• Type: Synovial joint with fibrocartilage disk.
• Structure: Medial end of the clavicle attaches to the sternum.
• Function: Anchors the clavicle and shoulder girdle to the torso;
allows clavicle rotation for shoulder movement.
• Stability: Extremely strong with robust ligamentous support.
• Common Issues: Dysfunction (stiffness) can stress other shoulder
joints.
Acromian clavicular joint
• Type: Synovial joint.
• Structure: Lateral edge of the clavicle meets the acromion of the
scapula.
• Function: Allows scapula rotation and position adjustments;
transmits forces from the upper extremity to the clavicle.
• Stability: Supported by ligaments and muscles but lacks
congruency.
• Common Issues: Prone to sprains (falling on an outstretched hand)
and early degeneration.
Scapulo thoracic joint
• Type: Not a true synovial joint.
• Structure: Articulation of the scapula with the posterior thoracic
wall.
• Function: Essential for shoulder motion; requires synchronized
movement with the AC and SC joints.
• Motions: Anterior/posterior tilt
• Superior/inferior glide
• Protraction (gliding apart) and retraction (pinching shoulder
blades together)
• Upward/downward rotation (pivoting around the center of the
scapula)
• Common Issues: Shoulder problems can arise from disrupted
scapulothoracic rhythm.
kinetics of shoulder complex
• Force Production: Muscles generate the forces necessary for
shoulder movement.
• Joint Loading: Forces are distributed across the shoulder joints
(GH, SC, AC, ST).
• Stabilization: Dynamic stability provided by muscles (rotator cuff,
deltoids) and static stability by ligaments and joint capsules.
• Force Transmission: Forces from the arm are transmitted through
the AC and SC joints to the torso.
• Injury Risk: High forces and repetitive movements can lead to
overuse injuries and joint degeneration.
kinematics of shoulder complex
• Range of Motion: The shoulder has a wide range of motion (nearly 360
degrees) due to the GH joint.
• Joint Movements:
• GH Joint: Flexion/extension, abduction/adduction, internal/external rotation,
circumduction.
• SC Joint: Inferior/superior glide, anterior/posterior glide, axial rotation.
• AC Joint: Inferior/superior glide, internal/external rotation.
• ST Joint: Anterior/posterior tilt, superior/inferior glide, protraction/retraction,
upward/downward rotation.
• Scapulohumeral Rhythm: Coordinated movement between the scapula
and humerus, crucial for efficient shoulder function.
• Movement Patterns: Complex interactions between joints allow for fluid
and precise arm movements.
• Functional Activities: Shoulder kinematics are essential for activities like
reaching, lifting, throwing, and pushing.
Glenohumeral Rhythm
• Coordination between shoulder joint (GH joint) and shoulder
blade movement (ST joint).
• Movement Ratio: For every 3 degrees of arm movement, 2 degrees
come from the GH joint and 1 degree from the ST joint (2:1 ratio).
Phases of Arm Raising:
• 0-30 degrees: Mostly GH joint.
• 30-90 degrees: GH and ST joints both move.
• 90-180 degrees: More ST joint movement.
Scapula Movements:
• Upward Rotation: Scapula rotates up as the arm goes up.
• Posterior Tilt: Scapula tilts back.
• External Rotation: Scapula rotates outward.
Shoulder Assessment
• Patient History and Subjective
Examination
• Visual Inspection and Palpation
• Range of Motion (ROM) and Strength
Testing
• Special Tests and Functional Assessment
• Scapular and Neurological Assessment
Recognition and Management of
Injuries
Clavicle Fracture
Cause: fall on outstretched arm, fall on tip of shoulder, direct impact
S&S: supports arm; tilts head toward toward injured side; clavicle appears
a little lower, swelling, point tenderness, mild deformity
Care: sling and swath, xray, reduction followed by immobilization 6-8 wks;
sling 3-4 wks with
isometric and mobilization exercises
Humerus fracture
Cause: direct blow, dislocation, impact
received by falling on outstretched arm
S&S: may be difficult to recognize, pain,
inability to move arm, swelling point
tenderness
Care: splint with sling; prevent shock;
referral to physician; 2-6 months out of
competition
Acromioclavicular (AC) joint sprain (separated shoulder)
Cause: fall on outstretched arm, direct impact on shoulder
S&S: point tenderness, discomfort,
• Grade 1 = no deformity
• Grade 2 = definite displacement and prominence of lateral end of
clavicle; ROM,
• Grade 3 = gross deformity and prominence of distal clavicle; severe
pain, loss of movement
Care: ice and pressure;
immobilization 2-3 wks; referral ;
aggressive rehab-joint mobilization,
flexibility and strength exercises
Glenohumeral dislocations
Cause:
• Subluxations:
– excessive translation of the humeral head without
complete separation of the joint surfaces
• Anterior glenohumeral dislocation
– Forced abduction, external rotation, and extension
• Posterior glenohumeral dislocation
– Forced abduction and internal rotation of the
shoulder or a fall on an extended and internally
rotated arm
S&S: flattened deltoid contour; pain; obvious
deformity
Care: immobilization; reduction; xray; cold packs;
muscle reconditioning ASAP; sling for 3wks;
strengthening
Rotator cuff strains
Cause: usually involves supraspinatus muscle;
dynamic rotation of the arm at high velocity; long
history of shoulder impingement or instability; tears at
insertion of humerus
S&S: diffuse pain around acromion; overhead
activities increase pain; point tenderness; loss of
strength due to pain; (+) impingement and empty can
Care: RICE;
Progressive Resistive Exercise’s;
decrease activity
Shoulder bursitis
Cause: trauma or overuse; direct impact
S&S: pain with movement; tenderness to palpation
in area just under acromion
Care: ice; NSAIDs; maintaining full ROM
Biceps brachii ruptures
Cause: performing a powerful concentric or eccentric
contraction of the biceps muscle; most commonly occurs near
the origin of the muscle
S&S: a resounding snap and feels a sudden intense pain;
protruding bulge may appear near the middle of the biceps;
weakness with elbow flexion and supination of forearm
Care: ice, sling; referral to MD; surgery
• Bicipital tenosynovitis
Cause: common in overhead activities;
repeated stretching of the biceps in highly
ballistic activities causing an irritation of the
tendon and synovial sheath
S&S: tenderness in anterior upper arm;
swelling; warmth; crepitus; pain with
overhead activities
Care: rest for several days; ice; NSAIDs;
gradual strengthening and stretching of the
biceps muscle; rehab
_
Shoulder impingement
Cause: mechanical compression of supraspinatus tendon, the
subacromial bursa, and long head of biceps tendon; most common
in overhead activities
S&S: diffuse pain around the acromion in overhead position; external
rotators weaker than internal; tightness in posterior and inferior
capsules;
Care: restoring normal biomechanics; RICE;
strengthening rotator cuff muscles and
scapula muscles; modified activity
shoulder ligament /labrum tear
capsule tightness
• Glenoid Labrum Tears: Injuries to the
labrum, often requiring surgical
intervention due to poor healing capacity.
• Capsular Tightness: Restricted movement
due to a tight joint capsule, often leading
to limited range of motion and pain.
shoulder biomechanical analysis in
physiotherapy clinical practice
1.Scapulohumeral Rhythm Analysis:
• Scenario: A patient with shoulder impingement.
• Focus: Assess the coordination between scapular and humeral
movements during arm elevation. Identify disruptions in rhythm
contributing to impingement.
2. Postural Assessment
• Scenario: A patient with chronic shoulder pain.
• Focus: Evaluate overall posture, especially head, neck, and
shoulder alignment. Poor posture can lead to biomechanical
imbalances and shoulder pain.
Clinical scenarios in physiotherapy
clinical practice
3.Strength and Muscle Imbalance Testing:
• Scenario: A patient recovering from rotator cuff surgery.
• Focus: Measure the strength of rotator cuff muscles and scapular
stabilizers. Identify any imbalances or weaknesses affecting
shoulder function.
4.Range of Motion (ROM) Analysis:
• Scenario: A patient with frozen shoulder (adhesive capsulitis).
• Focus: Assess active and passive ROM in all planes. Document
restrictions to track progress and guide interventions.
clinical scenarios in physiotherapy
clinical practice
5.Kinetic Chain Evaluation:
• Scenario: An athlete with shoulder instability.
• Focus: Examine the role of the kinetic chain (e.g., legs, hips, trunk) in
shoulder mechanics. Poor kinetic chain function can lead to
compensatory shoulder movements and instability.
6.Joint Stability Testing:
• Scenario: A patient with recurrent shoulder dislocations.
• Focus: Perform stability tests (e.g., anterior drawer test, sulcus sign) to
assess ligament integrity and joint laxity.
7.Functional Movement Assessment:
• Scenario: A patient with difficulty performing overhead activities.
• Focus: Observe and analyze functional movements like reaching,
lifting, and throwing. Identify biomechanical faults that limit performance
or cause pain.
clinical scenarios in physiotherapy
clincal practice
8.Scapular Dyskinesis Evaluation:
• Scenario: A patient with non-specific shoulder pain.
• Focus: Assess scapular motion and positioning during arm
movements. Look for dyskinesis patterns that can contribute to
pain and dysfunction.
9.Pain Provocation Tests:
• Scenario: A patient with suspected rotator cuff tendinitis.
• Focus: Use specific tests (e.g., Neer’s test, Hawkins-Kennedy
test) to provoke pain and identify the involved structures.
10.Neurological Assessment:
• Scenario: A patient with numbness and weakness in the
shoulder and arm.
• Focus: Evaluate nerve function through sensory and motor
tests. Identify any neurological contributions to the patient's
symptoms.
Dr.Alagappan thiyagarajan
9865749699
[email protected]
