KIN SHOULDER JOINT 2/11/25

SHOULDER

100

Joint motions

Flexion ROM?

hyperextension ROM?

ABD ROM?

ADD ROM?

IR ROM?

ER ROM?

H ADD ROM?

H ABD ROM?

Circumduction is a combination of what movements?

Scaption/ scapular plane ROM? 

 Flexion: 0 – 180 º
 Hyperextension: 0 - 60º
 Abduction: 0 - 180º
 Adduction: 180º-0
 Internal rotation or medial rotation: 0 - 70º
 External rotation or lateral rotation: 0 - 90º
 Horizontal adduction: 0 - 135º
 Horizontal abduction: 0 - 45º
 Circumduction: combo of all the above
 Scaption/Scapular plane: 0-180º

200

 Glenoid fossa

 Glenoid labrum

 Subscapular fossa

 Infraspinous fossa

 Supraspinous fossa

 Axillary border

 Vertebral border

 Inferior angle

 Acromion process

 Coracoid process

300

 Head
 Surgical neck
 Anatomical Neck
 Shaft
 Greater tubercle
 Lesser tubercle
 Deltoid tuberosity
 Bicipital groove
 Bicipital ridges

 

400

 Ulna
         Olecranon process
 Radius
         Radial head
         Radial tuberosity- attachment of biceps brachii

 

500

Ligaments 

Joint capsule:

Attaches what 2 bones? How many ligaments connect them?

Superior portion is tight when?

Inferior portion is tight when?

Coracohumeral ligament attaches where to where and strengthens what part of the joint capsule?

 Joint Capsule:

 Attaches around rim of glenoid fossa of

scapula and anatomical neck of humerus

 Superior, middle and inferior portions

called glenohumeral ligaments

 Arm at side: inferior portion slack, superior

portion tight

 Arm abducted: superior portion slack,

inferior portion tight

 Coracohumeral Ligament:

 Lateral coracoid process to medial greater

tubercle

 Strengthens upper joint capsule

600

The bursae Located between deltoid and capsule is called?

The bursae Below the acromion and coracoacromial ligament and above joint capsule is called?

BURESAE

 There are several bursae in shoulder joint

 Subdeltoid bursa: Located between deltoid and capsule

 Subacromial bursa: Below the acromion and

coracoacromial ligament and above joint capsule

700

END FEELS

Shoulder should have what kind of end feel?

What is the capsular pattern of the shoulder?

What is adhesive capsulitis?

 End feel= the feel of a joint at end of joint’s PROM when slight pressure is applied

 Shoulder should have a FIRM end feel, due to

 shoulder ligaments

 shoulder capsule

 Capsular pattern of shoulder (arthrokinematics & osteokinematics= joint ROM) Capsular pattern: ER→ABD→IR

 When the capsule tightens or “shrinks” as in adhesive capsulitis

 Severe loss lateral rotation

 Moderate loss abduction

 Slight loss medial rotation

800

ROTATOR CUFF:

What are the 4 muscles that make up the cuff? SITS

Keeps the head of the humerus where?

Acts as a force couple with what muscle?

If RTC is not working optimally, what would

happen to humeral head?

 4 Muscles – SITS

 Supraspinatus

 Infraspinatus

 Teres minor

 Subscapularis

 Keeps the head of the humerus “rotating” in

the glenoid fossa...Also known as humeral

head depression

 Force couple with deltoid muscle

 If RTC is not working optimally, what would

happen to humeral head? =Humeral head will go up and bump into the acromion.  

900

DELTOID 

Separated into how many section?

Where do they all insert?

 Separated into three portions

 Unique origins with common insertion on

deltoid tuberosity

1000

ANTERIOR DELT

O:

A:

I:

N:

O Lateral third of the clavicle

I Deltoid tuberosity

A Shoulder abduction, flexion, medial rotation, and horizontal adduction
Depression of the shoulder girdle when humerus is stabilized

N Axillary nerve (C5, C6)

1100

MID DELTOID: 

O:

A:

I:

N:

O Acromion process

I Deltoid tuberosity

A Shoulder abduction
Depression of the shoulder girdle when humerus is stabilized

N Axillary nerve (C5, C6)

1200

POST DELT

O:

A:

I:

N:

O Spine of scapula

I Deltoid tuberosity

A Shoulder abduction, extension, lateral rotation, horizontal abduction
Depression of the shoulder girdle when humerus is stabilized

N Axillary nerve (C5, C6)

1300

SUPRASPINATUS 

O:

A:

I:

N:

O Supraspinous fossa of the scapula

I Greater tubercle of the humerus

A Shoulder abduction Stabilizes shoulder

N Suprascapular nerve (C5, C6)

1400

INFRASPINATUS 

O:

A:

I:

N:

O Infraspinous fossa of scapula

I Greater tubercle of humerus

A Shoulder lateral rotation, horizontal abduction
Stabilizes shoulder

N Suprascapular nerve (C5, C6)

1500

TERRES MINOR 

O:

A:

I:

N:

O Axillary border of scapula

I Greater tubercle of humerus

A Shoulder lateral rotation, horizontal abduction
Stabilizes shoulder

N Axillary nerve (C5, C6)

SHOULDER

100

SUPSCAPULARIS 

O:

A:

I:

N:

O Subscapular fossa of the scapula

I Lesser tubercle of the humerus

A Shoulder adduction, medial rotation
Stabilizes shoulder

N Upper and lower subscapular nerves (C5, C6)

200

FORCE COUPLE:

What muscle pulls the humeral head up against the acromion process?

Humeral head rolls across what?

Humeral head glides in what direction during flexion?

 Deltoid alone would pull the humeral head up

against the acromion process

 Humeral head rolls across the glenoid fossa

 Humeral head glides inferiorly, keeping in contact with the glenoid fossa

300

GENOHUMERAL FORCE MOVEMENT:

What muscle abducts and pulls humeral
head into glenoid fossa?

Other RTMs do what?

What deepens the socket of the glenoid fossa?

 Supraspinatus abducts and pulls humeral
head into glenoid fossa
 Other rotator cuff muscles pull the head down
and in against the glenoid fossa
 Labrum deepens the socket of the glenoid
fossa

400

GLENOHUMERAL MOVEMENT:

Supraspinatus does what to the humeral head?

Full abd ROM requires what? 

 Glide, spin and roll keep the head in the
glenoid fossa.
 Supraspinatus pulls the head into the fossa and ABD’s the shoulder
 Other RTC muscles pull the head in and
DOWN.
 Full ABD ROM requires ER (thumb up!)

500

TERES MAJOR:

O:

A:

I:

N:

O Inferior axillary border of scapula near inferior
angle

I Medial lip of bicipital groove

A Shoulder extension, adduction, and medial
rotation

N Lower subscapular nerve (C5, C6, C7

 

600

Thoracolumbar Fascia: 

Where is it?

what does it provide attachment for?

Thoracolumbar Fascia:

 Superficial fibrous sheet

 Spinous processes of lower thoracic and lumbar vertebra, supraspinal ligament, and posterior iliac crest

 Provides attachment for Latissimus dorsi m.

700

LATISSIMUS DORSI:

O:

A:

I:

N:

O Via the thoracolumbar fascia, the spinous processes of
T7 through L5, posterior surface of iliac crest and
sacrum, lower three ribs

I Floor of bicipital groove

A Shoulder extension, adduction, medial rotation
Elevates body when upper extremities are stabilized

N Thoracodorsal nerve (C6, C7, C8)

800

PEC MAJOR: Clavicular Portion 

O:

A:

I:

N:

PEC MAJOR: Sternal Portion 

O:

A:

I:

N:

PEC MAJOR: Clavicular Portion

O Medial third of clavicle

I Lateral lip of bicipital groove of humerus (inferior to the sternal portion)

A Shoulder flexion—first 60 degrees, medial rotation, adduction
Horizontal adduction

N Lateral and medial pectoral nerves (C5, C6, C7, C8, T1)

O Sternum, costal cartilage of first six ribs

PEC MAJOR: Sternal Portion

I Lateral lip of bicipital groove of humerus (superior to the clavicular portion)

A Medial rotation, adduction, horizontal adduction
Shoulder extension from full flexion (180 degrees) when shoulder extension is resisted
Elevates body when upper extremities are stabilized

N Lateral and medial pectoral nerves (C5, C6, C7, C8, T1)

900

CORACOBRACHIALIS:

O:

A:

I:

N:

O Coracoid process of the scapula

I Medial surface of the humerus near the midpoint

A Shoulder flexion, adduction. Stabilizes shoulder.

N Musculocutaneous nerve (C5, C6, C7

1000

BICEPS:

O:

A:

I:

N:

O Long head: supraglenoid tubercle of scapula
Short head: coracoid process of scapula

I Radial tuberosity of radius

A Shoulder flexion, elbow flexion, forearm supination

N Musculocutaneous nerve (C5, C6)

1100

TRICEPS:

O:

A:

I:

N:

O Long head: infraglenoid tubercle of scapula
Lateral head: inferior to greater tubercle on posterior
humerus
Medial head: posterior surface of humerus

I Olecranon process of ulna

A Shoulder extension. Elbow extension.

N Radial nerve (C6, C7, C8)

1200

INTERESTING MUSCLE INFORMATION:

Clavicular portion of pectoralis muscle:

Vertical pull makes it an effective shoulder flexor up to how many degrees?

After how many degrees is the pull no longer vertical?

Latissimus dorsi & pec major

How can these muscles elevate the pelvis?

Teres major

 “Little helper” of the lats because they have similar actions, with the exception of hyperextension why?

 Clavicular portion of pectoralis muscle
 Vertical pull makes it an effective shoulder flexor up to 60º
- 90° after that, pull is no longer vertical and so no longer active.
 Latissimus dorsi & pec major
 Able to elevated the pelvis when the arms are stabilized
 Reversal of muscle action = Crutch Walking
 Teres major
 “Little helper” of the lats because they have similar actions,
with the exception of hyperextension. (Origin is not far
enough posteriorly to assist beyond neutral)

SHOULDER DISORDERS

100

Clavicular fractures:

commonly happens how?

How does it present?

What muscle is unable to hold up lateral side of the clavicle? 

Pectoralis major pulls the lateral fragment in what direction?

Clavicular fractures
• Common during a fall on an
outstretched hand
• Present with holding a sagging UE
• Trapezius unable to hold up the
lateral side of the bone
• Pectoralis major pulls the lateral
fragment medially

200

Cervical Rib Syndrome

Extra rib off of what vertebra?

Can exert pressure on what plexus?

Worsens with what?

Symptoms?

Cervical Rib Syndrome
• Extra rib off the C7
• Can exert pressure on the brachial plexus
• Compresses nerves
• Worsens with carrying heavy objects in
hand
• Mostly asymptomatic

300

Nerve Injuries: Long thoracic nerve

Paralysis of Serratus Anterior Causes what?

Axillary nerve

Paralysis of what?

• Long thoracic nerve

Paralysis of Serratus Anterior

Causes what?

• Axillary nerve

• Winds around surgical neck of the humerus

• Deltoid and Teres Minor paralysis and wasting

400

Arterial Injuries

Axillary artery runs through where? 

Supplies blood to where?

Arterial Injuries:

• Axillary artery
• Runs through axilla
• Can palpate it by pressing
against humerus
• Supplies blood to entire UE
• Severe bleeding if severed

500

Superior Brachial Plexus Injuries

Erb's palsy (C?-?) is caused by what?

S&S?

Superior Brachial Plexus Injuries

• C5-6
• Erb’s Palsy
• Causes
• Violent stretching of the neck during birth
• Excessive separation of neck and shoulder
• Landing on point of shoulder
• Head-on crash if shoulder hits object
• Signs & Symptoms
• Waiter’s tip position
• ABD, IR pronation, wrist flexion  

600

Inferior Brachial Plexus Injuries

 C? and T?

K________ Palsy

Caused by a forceful pull of what?

S&S?

Inferior Brachial Plexus Injuries

• C8 and T1
• Klumpke’s palsy
• Causes
• Forceful pull on the UE during birth
• Excessive stretch of UE holding onto something
• Tree limb
• Signs & Symptoms
• Ape hand
• Thumb against palm, palm flat, fingers curled  

700

Shoulder Instability and Dislocation

What's the most common type of shoulder  dislocation?

Shoulder Instability and Dislocation

• Shoulder is most common
dislocated joint in body
• Anterior > posterior dislocation  

800

Shoulder Subluxation

How is it different from a dislocation? 

How is it prevented?

Rotator cuff muscle provides support in all direction except?

Shoulder Subluxation
• Partial Dislocation
Prevented by:
• Fossa orientation
• Joint capsule with ligament
• Partial vacuum created by capsule
Contributing factors:
• Rotator cuff provides support in all
directions except inferiorly
• Lack of deep socket
• Loss of muscle tone
• Weight of extremity
• Gravity
• Ligamentous injury

900

Labral Tear

Is it painful?

Causes what to happen to the shoulder joint and why?

How is it diagnosed?

Labral Tear
• Painful
• Causes unstable shoulder
joint
• Why?
• Conclusive diagnosis via arthrogram or arthroscopic surgery

1000

Impingement
Syndrome

 Weak RTC muscles can lead to humeral _______ due to ______ pull without counter RTC depression.

Poor _______________ can contribute to humeral head contacting the acromion.

Examples of Degenerative changes?

Impingement
Syndrome

• Weak RTC muscles can lead to humeral elevation due to deltoid pull without counter RTC depression

• Poor scapulohumeral rhythm can contribute to humeral head contacting the acromion

• Degenerative changes -decreased subacromial space (anatomic crowding)

• Bony osteophytes

• Hooked acromion

• Bursal thickening

 

1100

Degenerative tendonitis of rotator cuff

Common in what age group?

Calcium deposits in what tendon usually ?

What kinds of repeated movement? 

Tendonitis leads to adherence of tendon to what? 

Degenerative tendonitis of rotator cuff
• Common in elderly
• Calcium deposits in supraspinatus
tendon
• Other tendons too
• Area just proximal to ss insertion is hypo-
vascular
• Repeated movement into
abduction/adduction
• Ultimately leads to tears
• Tendonitis leads to adherence of tendon
to underlying bursa
• Predisposes tendon to rupture

1200

Thoracic Outlet Syndrome (TOS)

Entrapment syndrome caused by pressure from what to what?

Vascular symptoms may occur due to pressure on what artery?

Thoracic Outlet Syndrome

(TOS)

• Entrapment syndrome caused by pressure

from structures in the thoracic outlet on

fibers of the brachial plexus

• Vascular symptoms may occur due to

pressure on subclavian artery

• Compression occurs between clavicle and

first rib

• Scalene muscles may contribute to TOS

1300

Complex Regional Pain Syndrome

Previously know as what?

Signs & Symptoms?

What are trophic changes ?

Can this happen with a nerve injury?

Complex Regional Pain Syndrome
• Previously known as Reflex Sympathetic Dystrophy
(RSD)
• Severe pain, swelling, autonomic disturbances,
and trophic changes of the skin on hand/arm
• Can be with/without nerve injury
• Atrophy and flexion contractures develop
• Early detection and treatment significantly
improve prognosis

1400

Scapular fractures

How common is this type of fracture?

Why do they tend to be stable?

Problems post fracture tend to be related to poor what?

Scapular fractures
• Uncommon
• Tend to be stable
• Why?
• Problems post fracture tend to be related to poor scapulothoracic mobility

1500

Frozen shoulder

What part of the shoulder does this affect?

S&S?

Usually affects who? 

What happens to the joint capsule?

What condition causes frozen shoulder?

Frozen shoulder
• Adhesive capsulitis
• Decreased shoulder ROM, pain,
inflammation, fibrous synovial adhesions,
reduced joint cavity
• Women > men, age 40-60
• Diffuse shoulder pain, positive painful arc
of motion, limited accessory motions
• Pathogenesis of capsular thickening and
adherence to humerus unknown. Usually
lasts 1-2 years and can spontaneously
resolve
• Capsular pattern of limitation

SHOULDER DISORDERS

100

Total Shoulder Arthroplasty and hemiarthroplasty

Now used for pain relief due to what 2 conditions?

Pt.s need a functioning what?

During surgery they are detaching are reattaching what muscle?

After surgery must protect against what movements?

Total Shoulder Arthroplasty and hemiarthroplasty

Needs a functioning RTC

• Used initially for repair of severe shoulder

fractures

• Now used for pain relief due to:

• OA

• RA

• Post-traumatic arthritis

• Avascular necrosis

• Must have a functional or repairable RTC

• *Subscapularis is removed and repaired during

this surgery

• Must protect against resisted IR or ER ROM

200

Reverse Total Shoulder Arthroplasty

Performed when what is not functional?

Places what on the glenoid and what on the humerus? 

Reverse Total Shoulder Arthroplasty
• Performed when the RTC is not functional or repairable
• Massive RTC tears
• Degenerative tears
• Place the “ball” on the glenoid, and the ”socket” on the humerus