Scapula / Shoulder / Rotator Cuff

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4 BONES of the Shoulder Complex

1. Sternum 2. Clavicle 3. Scapula 4. Humerus

4 JOINTS of the Shoulder Complex

1. Glenohumeral 2. Sternoclavicular 3. Scauplothoracic 4. Acromioclavicular

Antagonist of Serratus Anterior

Rhomoids, Trapezius

Antagonist of Rhomboids

Serratus Anterior

Antagonist of Trapezius

Serratus Anterior

Antagonist of Levator Scapulae

Lower Trapezius, Serratus Anterior

Within Functional Limits

The patient could complete movement with some pain. They were still functional.

Limited / Impaired

The patient cannot do any movement.

The scapula remains stable & fixed b/c:

In order for the arm to move accurately in space, the scapula needs to stay stable and fixed to hold the arm in place. This is so the arm can move distally in a coordinated way, like a closed chain movement. Example: Push-up

Clavicle

Transmits force from arms to thorax/ chest. Most frequently broken bone in the body. allows for Flexion, Extension, Elevation, Depression & Limited Rotation. These movements usually occur in association with the scapula.

Sternoclavicular Joint (SC)

Part of the clavicle. This is a "Saddle Joint". *This joint allows for Flexion, Extension, Elevation, Depression & Limited Rotation. These movements usually occur in association with the scapula.

Acromioclavicular Joint (AC)

A loose joint is formed between the clavicle attatching laterally on the acromion process of the scapula. But this joint recieves support from coracoclavicular & acromioclavicular ligaments.

Shoulder Seperation

The Acromioclavicular ligament & Coracoclavicular ligaments tear.

Shoulder Dislocation

Gleniod humerus falls out of the "cup".

Scapulothoracic Joint (ST)

Depends on the AC & SC joints for contact with the axial skeleton. The ULTIMATE function: to provide a stable base for the humeral head's movement. Example: Dynamic Stabilization, which is being stable while moving. Protraction occurs @ this joint.

Movements of the Scapula

1. Elevation 2. Depression 3. Protraction (ABD 4. Retraction (ADD) 5. Medial or Downward Rotation 6. Lateral or Upward Rotation

Elevation of Scapula

Upward & Away from ribs. UPPER TRAPEZIUS, RHOMBOIDS, LEVATOR SCAPULAE

Depression of Scapula

Downward & Against ribs. LOWER TRAPEZIUS, LOWER SERRATUS ANTERIOR

Protraction (ABD) of Scapula

Away from spine. SERRATUS ANTERIOR

Retraction (ADD) of Scapula

Toward spine. TRAPEZIUS, RHOMBOIDS

Medial or Downward Rotation of Scapula

Medial refers to the inferior angle movement. Downward refers to the glenoid fossa, which goes down. RHOMBOIDS, LEVATOR SCAPULAE

Lateral or Upward Rotation of Scapula

Lateral refers to the inferior angle movement. Upward refers to the gleniod fossa, which goes up. SERRATUS ANTERIOR, UPPER & LOWER TRAPEZIUS

Glenohumeral Joint (GH)

Ball & Socket Joint. Articular surface of glenoid fossa lies nearly perpindicular to the humeral shaft. (Not a stable joint) Glenoid labrum deepens the fossa. Reinforced by superior, middle & inferior glenohumeral ligs & SITS muscle tendons. (Part of the joint capsule)

Relationship of Humerus & Scapula

Notice how little of the humeral head can rest in the glenoid fossa. The lack of bone provides great MOBILITY, but also POOR STABILITY.

SITS Muscles

1. Subscapularis 2. Infraspinatus 3. Teres Minor 4. Supraspinatus **Serve to provide support for the head of the humerus.

Muscles Anchoring Scapula

TRAPEZIUS, RHOMBOID MAJOR & MINOR, LEVATOR SCAPULAE, PECTORALIS MINOR, SERRATUS ANTERIOR

Scapular Upward Rotation

Shoulder Flexion & Abduction

Scapular Downward Rotation

Shoulder Extension & Adduction

Scapular Elevation

Shoulder Hyperextension

Scapular Adduction (Retraction)

Shoulder Horizontal Abduction

Scapular Abduction (Protraction)

Shoulder Horizontal Adduction

Scapulohumeral Rhythm

Synchronous movement of scapula & humerus. 2 degress of glenohumeral movement to 1 degree of scapular rotation.

Rotator Cuff Tear

Usually in the Supraspinatus, because it passed underneath the acromion process.

Most Common Dislocation

The humerus is abducted & externally rotated.

Stroke (Scapula)

When this occurs subluxation occurs, where the humerus head falls out of the glenoid fossa because of a "winged scapula". This can be due to flaccidity or low muscle tone.

Brachial Plexus

Originates from spinal levels C5 to T1. Responsible for innervation of entire UE (upper extremity).

Terminal Branches--RADIAL N.

Comes from posterior division. Creates: ARM EXT & SUP.

Terminal Branches--MEDIAN N.

Comes from medial & lateral divisions. Creates: ARM FLEXION, ABDUCTION & PRONATION.

Terminal Branches--ULNAR N.

Comes from medial division. Creates: ARM FLEXION & ADDUCTION

Terminal Branches--MUSCOLCUTAN. N

Creates: ELBOW FLEX, SUPINATION

Terminal Branches--AXILLARY N.

Creates: DELTOID, TERES MINOR CONTRACTIONS.

Brachial Plexus Injury (ERB's PALSY)

Occurs when the baby is passing through the birth canal. The baby's shoulders may become impacted, causing the brachial plexus nerves to stretch or tear. Occurs in 2 out of a 1,000 babies.

Scaption (Scapular Abduction)

Refers to the forward elevation of the internally rotated arm in the scapular plane, with the thumb pointed to the floor. This motion isolates the action of the supraspinatus muscle, which is responsible for the first 30 degrees of abduction.

Internal Rotation @ Shoulder (Rot. Cuff)

Also called Medial Rotation. This movement is created by the SUBSCAPULARIS.

Subacromial Bursa

A fluid filled sac that reduces the friction between tendons & bones. This bursa is located between the supraspinatus & acromion process.

Labrum

Joint capsule of tough fibrocartilage. This deepens the gleniod fossa.

Abduction @ Shoulder (Rot. Cuff)

This movement is created by the SUPRASPINATUS.

External Rotation @ Shoulder (Rot. Cuff)

Also called Lateral Rotation. This movement is caused by the INFRASPINATUS.

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