•

Shoulder Problem Spine of the scapula

Evaluation 6 Articulations or Joints

Shoulder assessment
• Second most common musculoskeletal
complaint
Difficult joint to examine
• Multidirectional range of
UNIQUE!
• Shoulder injury can affect nearly every
sport and many daily activities
1. Coraco Clavicular
2. Sterno Clavicular
3. Acromio Clavicular
4. Gleno Humeral
5. Scapulo Thoracic
6. Sub Acromial Space
Separation- sternoclavicular separation/
motion-
dislocation
a) Sternoclavicular- common anterior
dislocation
b) Acromion – superior dislocation
c) Shoulder – anterior dislocation

Dislocations and separations are protected by

Bony Anatomy both “static” and “dynamic” stabilizers
Anterior a) Static – ligament (not moving)
b) Dynamic – provided by muscles
(moving)
Glenohumeral Joint
• Shallow (“golf ball sitting on a tee”)
Bones Scapula & -Inherently unstable (maximizes ROM)
clavicle
• Static stabilizers
-Move as a unit
-glenohumeral ligaments, glenoid labrum
-Clavicle’s articulation and capsule
with sternum is only
bony link to axial ➢ Dynamic stabilizers
skeleton
-Predominantly rotator cuff muscles
Bones -Also scapular stabilizers (Trapezius,
leavator scapulae, serratus anterior,
Key bony landmarks
rhomboids )
• Manubrium
• Clavicle The Rotator Cuff Muscles: SITS
• Coracoid process ✓ Supraspinatus ABD (rotate externally)
• Acromion process
✓ Infraspinatus ER (rotates externally)
• Glenoid fossa
✓ Teres minor ER ( rotates externally)
• Lateral border
• Inferior angle ✓ Supscapularis IR ( do internal rotation)
• Medial border -Depress humeral head against glenoid to
• Acromion process allow full abduction
• Glenoid fossa
• Lateral border
• Inferior angle
• Medial border
• Superior angle
 • Rotation of head to opp. Side
Shoulder Complex Muscles
• Lateral flexion of head to opp. Side
Scapular Muscles Middle Trapezius
Levator Scapulae O-
• Inferior part of ligamentum
O– Transverse processes of C1-C4 nuchea
I – Medial border of scapula between • T1-T5 spinous processes
superior angle and root of spine of I–
scapula
• Medial margin of acromion
N – Nerve root C3-5
process
F- (scapular elevation, retraction)
• Superior lip of spine of scapula
Rhomboid Major (OIN)
N – Spinal accessory
O-
F –Scapular retraction
• Major – T2-T5 spinous processes
Lower Trapezius
• Minor – Ligamentum nuchae, C7- O-T6-T12 spinous processes
T1 spinour processes I –Tubercle at apex of root of spine of
I– scapula
• Major – Medial borde of scapula N – spinal accessory
between spine and inferior angle F –Scapular depression, retraction
• Minor – medial border at root of and upward rotation
spine of scapula Serratus Anterior
N– O-
Dorsal Scapular Outer surfaces and superior border of
Upper Trapezius (OINF) ribs 1-8
O- I–
• Medial 1/3 of nuchal line Ventral scapular surface on medial
• Upper part of ligamentum nuchae border from superior angle to inferior
• C7 spinous process angle
I– N–
• Posterior border of lateral 1/3 of Long Thoracic
clavicle F–
• Acromion process Scapular protraction, upward rotation
N – spinal accessory Scapular depression (lower fibers)
F– Scapular elevation (upper fibers
• Scapular elevation, retraction
Pectoralis Minor Pectoralis Major
O- O-
• Superior margins and outer • Sternal – anterior surface of sternum,
surface ribs 3-5 near cartilages cartilages of ribs 1-6 or7
• Fascia overlying corresponding • Clavicular – anterior surface of sternal
intercostal muscles ½ clavicle
I– I – crest of humerus’s greater tuberosity
Medial border, superior surface of N–
coracoid process • Sternal – medial pectoral
N– • Clavicular – lateral pectora
Medial Pectoral F – GH ADD, H. ADD and IR
F– Anterior Deltoid
Scapular depression, downward O- Anterior border, superior surface of
rotation, protraction lateral third of clavicle
Biceps Brachii I –Deltoid tuberosity
O- N – Axillary
• Short head – coracoid process F–
• Long head – supraglenoid tubercle • GH H. ADD, flexion
of scapula • IR when in supine position
I– Middle Deltoid
• Radial tuberosity O -Lateral margin and superior
• Biceps brachii aponeurosis surface of acromion
N – Musculocutaneous I –Deltoid Tuberosity
F– N –Axillary
• Shoulder – flexion F –GH ABD
• Elbow – flexion, forearm Posterior Deltoid
supination O- Inferior lip of posterior border of
Coracobrachialis spine of scapula
O – Coracoid process I –Deltoid tuberosity
I- Medial surface of mid-humerus, N – Axillary
opposite to deltoid tuberosity F–
N –Musculocutaneous • GH extension, H. ABD,
F – GH flexion, adduction, Hor. • ER when in prone position
Adduction
Triceps Brachii Supraspinatus
O– O -Medial 2/3 supraspinatus fossa
• Long Head – infraglenoid tubercle I–
• Lateral Head – lateral and Superior portion of greater tuberosity
posterior surface of proximal ½ of N – Suprascapular
body of humerus F–
• Medial Head – distal 2/3 of medial • Intiates shoulder ABD
and posterior surfaces of humerus • Humeral head stabilization
below radial groove
I – Posterior surface of olecranon process Infraspinatus
N – Radial O – Medial 2/3 infraspinatus fossa
F– I – Middle portion of greater tuberosity
• Shoulder – long head – Ext and N – Suprascapular
ADD F–
• Elbow -- extension • GH ER
Latissimus Dorsi • Humeral head stabilization
O-
• Posterior layer of lumbodorsal Teres Minor
fascia, then attaching to the T6- O –Upper 2/3 dorsal surface of lateral
T12, lumbar and sacral vertabrae border of scapula
• External lip of iliace creast lateral I -- Lowest portion of greater tuberosity
to erector spinae N –Axillary
• Ribs 9-12 F–

• Slip from inferior angle of scapula • GH ER

I – Intertubercular groove (distal aspect) • Humeral head stabilization
N – Thoracodorsal
F – GH IR, ADD, Ext, Subscapularis
Teres Major (Lat’s Little Helper) O – Subscapular Fossa
O- I-
• Dorsal surface of inferior angle Lesser tuberosity

• Lower 1/3 of scapula lateral border Anterior capsule of GH joint

I –Crest of lesser tuberosity N –Upper and lower subscapular

N – Lower Subscapular F–

F –GH IR, ADD, Ext • GH IR

• Humeral head stabilization