Shoulder Complex

Kinesiology

dr Fitri Anestherita, SpKFR

Departemen Rehabilitasi Medik RSCM-FKUI
 Introduction
• The shoulder is one of the most complicated joints of the body.
• The coordinated activity of numerous muscles working together in patterns is
required to produce this motion.
• The term “shoulder movement” describes the combined motions at both the
glenohumeral and the scapulothoracic joints.
• A weakened, painful, or unstable link anywhere along the chain significantly
decreases the effectiveness of the entire complex.

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 Shoulder Complex
• The shoulder girdle
▪ The activities of the scapula and clavicle and the sternum
▪ The sternoclavicular and acromioclavicular joints
▪ The motions : elevation and depression, protraction and retraction, and upward and downward rotation.
▪ Five muscles that attach to the scapula, the clavicle, or both.

• The shoulder joint → glenohumeral joint

▪ ball and socket joint
▪ The motions : flexion, extension and hyperextension, abduction and adduction, medial and lateral rotation,
and horizontal abduction and adduction.
▪ Nine muscles that cross the shoulder joint
4 Main joint of Shoulder Movement
 Periarticular Connective Tissue and Other
Supporting Structure
• Fibrous capsule
• Synovial membrane
• Capsular ligament
• Coracohumeral ligament
• Rotator cuff muscle
• The long head of biceps tendon
• Glenoid labrum

→ Functionally stability of the

glenohumeral joint
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 Six Kinematic Principles Associated with Full
Abduction of the Shoulder
1. Scapulohumeral rhythm
2. A simultaneous elevation at the sternoclavicular (SC) joint combined with upward
rotation at the acromioclavicular (AC) joint.
3. The clavicle retracts at the SC joint during shoulder abduction.
4. The scapula posteriorly tilts and externally rotates during full shoulder abduction.
5. The clavicle posteriorly rotates around its own axis during shoulder abduction.
6. The GH joint externally rotates during shoulder abduction

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Scapulohumeral Rhythm

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Scapulothoracic Upward Rotation

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Sternoclavicular and Acromioclavicular Joints
During Full Abduction

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The Functional Importance of Full Upward
Rotation of the Scapulothoracic Joint
A fully upward rotated scapula is an important component of the ability to raise
the arm fully overhead → accounting for approximately one third of the near
180 degrees of shoulder abduction or flexion
Function :
• projects the glenoid fossa upward and anterior-laterally
• the optimal length-tension relationship of the abductor muscles
• helps maintain the volume within the subacromial space
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Importance of Roll and Slide Arthrokinematics
at the Glenohumeral Joint

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Arthrokinematik of Shoulder Abduction

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 Action of the Shoulder Muscles
• Most of the muscles of the shoulder complex fall into one of two functional
categories: proximal stabilizers or distal mobilizers.
• The proximal stabilizers are muscles that originate on the spine, ribs, and
cranium and insert on the scapula and clavicle → serratus anterior and the
trapezius.
• The distal mobilizers consist of muscles that originate on the scapula and
clavicle and insert on the humerus or the forearm → deltoid and biceps
brachii muscles.
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 Muscles That Elevate The Arm
At The Glenohumeral Joint
1) Muscles that elevate (i.e., abduct or flex) the humerus at the GH joint;
2) Scapular muscles that control the upward rotation of the scapulothoracic
joint; and
3) Rotator cuff muscles that control the dynamic stability and
arthrokinematics at the GH joint.

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Glenohumeral Joint Muscles

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Upward Rotators At The Scapulothoracic Joint

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Function Of The Rotator Cuff Muscles During
Elevation Of The Arm

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 Regulators of Dynamic Stability at the
Glenohumeral Joint
Supraspinatus
• Drives the superior roll of the humeral head
• Compresses the humeral head firmly against the glenoid fossa
• Creates a semirigid spacer above the humeral head, restricting
excessive superior translation of the humerus
Infraspinatus, Teres Minor, and Subscapularis
• Exert a depression force on the humeral head
Infraspinatus and Teres Minor
• Externally rotate the humerus

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Internal and External Rotation of the Shoulder

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Internal and External Rotation of the Shoulder

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 Conclussion (1)
• The four joints of the shoulder complex normally interact harmoniously to
maximize the volume, stability, and ease of reach in the upper extremity.
• The scapulothoracic joint serves as an important mechanical platform for all
active movements of the humerus.
• Combined with the mechanically linked motions at the SC and AC joints, the
upwardly rotated scapula provides a stable yet mobile base for the abducting
the humeral head and maximizes the volume within the subacromial space.

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 Conclussion (2)
• Appreciating how muscles naturally interact across the shoulder prepares the
clinician to render an accurate diagnosis of the underlying pathomechanics of
abnormal shoulder posture and movement.
• This knowledge is essential to the design of effective rehabilitation and
treatment programs for the loss of normal muscle function.

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Thank You

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