Movement assignment

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The Upper Extremity: Shoulder Region

Terry Conkle, Ed.D.

Spring 2020

The AC Joint - Right Arm (Anterior & Posterior Views)

The Acromioclavicular (AC) Joint

Articulation of

acromion & distal

end of clavicle.

AC ligament

strengthens joint superiorly.

Aponeurosis of

trapezius & deltoid strengthen joint posteriorly.

Coracoclavicular ligament further stabilizes joint.

The Sternoclavicular (SC) Joint

Proximal clavicle articulates w/ sternum and cartilage of 1st rib.

Capsule thickened by anterior & posterior sternoclavicular ligaments.

The only bony connection between the humerus and axial skeleton.

Permits limited motion of the clavicle.

Partially responsible for movements of the scapula.

Shoulder Girdle Muscles

Location:

Pectoralis minor, Serratus anterior, Subclavius

Posterior

Levator scapulae, Rhomboids, Trapezius

Fossa

Glenohumeral Joint of Shoulder

Articulation of spherical head of humerus w/ small, shallow glenoid fossa of scapula.

Glenoid labrum deepens the fossa & cushions impact of humeral head in forceful movements.

Coracohumeral

Glenohumeral

Coracoacromial

Muscular & Tendon Reinforcements

Superior:

supraspinatus & long head of biceps.

Inferior:

long head of triceps.

subscapularis, pectoralis major, & teres major.

Posterior:

infraspinatus & teres minor.

Flexion / Extension

Hyperextension

Circumduction

Abduction / Adduction

Horizontal

Diagonal

Internal / External Rotation

Internal rotation

External rotation

Shoulder Joint Movements (Appendix B)

Location:

Pectoralis major, coracobrachialis, subscapularis, biceps brachii.

Posterior:

Infraspinatus, teres minor.

Superior:

Deltoid, supraspinatus.

Inferior:

Latissimus dorsi, teres major, long head of triceps brachii.

Shoulder Joint Muscles

Movements of the arm on the trunk involve the cooperative action of the shoulder girdle

Acromioclavicular joints

Sternoclavicular joints

shoulder (glenohumeral) joint.

Basic Movement Analysis of the Arm on the Trunk

Shoulder Joint: Abduction

Deltoid & supraspinatus

Shoulder Girdle: Upward rotation of scapula

Serratus anterior; trapezius II & IV

Shoulder Joint: Adduction

Latissimus dorsi, teres major, pectoralis major (sternal), & post. deltoid.

Shoulder Girdle: reduction of upward rotation

Rhomboids & pectoralis minor.

Frontal Plane Movements

Shoulder Joint: Flexion

Anterior deltoid & pectoralis major (clavicular).

Shoulder Girdle: Upward rotation of scapula

Serratus anterior & trapezius II & IV.

Shoulder Joint: Extension

Pectoralis major (sternal), teres major, latissimus dorsi, post. deltoid.

Shoulder Girdle: Reduction of upward rotation of scapula

Relaxation of agonists

Against resistance - trapezius IV, rhomboids, pect. minor.

Shoulder Joint: Hyperextension

Teres major, latissimus dorsi, post. Deltoid.

Shoulder Girdle: Anterior tilt of scapula

Pectoralis minor.

Shoulder Joint: External Rotation

Infraspinatus & teres minor

Shoulder Girdle: Adduction of scapula

Rhomboids & trapezius III.

Shoulder Joint: Internal Rotation

Subscapularis, teres major, latissimus dorsi, ant. deltoid, pectoralis major.

Shoulder Girdle: Abduction of scapula

Serratus anterior & pectoralis minor.

Shoulder Joint: Horizontal Adduction

Pectoralis major, ant. deltoid, & coracobrachialis.

Shoulder Girdle: Abduction of scapula

Serratus anterior & pectoralis minor

Shoulder Joint: Horizontal Abduction

Post. deltoid, post middle deltoid, infraspinatus, teres minor, long head of biceps.

Shoulder Girdle: Adduction of scapula

Rhomboids & trapezius III.

Diagonal forward-downward and slightly inward movement of the arm.

AC joint forced beyond normal ROM.

Downward blow to outer end of shoulder.

Fall on outstretched hand.

Damage consists of tearing or severe stretching of AC ligaments.

Clavicle fractures have causes similar to AC sprain:

Downward blow to outer end of shoulder.

Fall on outstretched hand.

May indicate injury by supporting injured arm.

Head may be tilted toward injured side with face turned to opposite side.

May be forward, downward, or posterior.

Most likely when arm is forcefully abducted and laterally rotated.

May occur by a blow to top of shoulder .

Head of humerus is forced out of the glenoid fossa.

Arm held out from side in a position of slight abduction and lateral rotation.

Loss of normal rounded contour of deltoid muscle.

Supraspinatus (supraspinatus tendon) most often injured.

Nature of injury depends on arm kinematics.

Caused by overuse, falls, or violent, fast arm motion.

Soft tissue superior to humeral head pressed against acromion process.

Due to overuse, inflammation, trapped bursa, degeneration with aging.

Will cause pain and inflammation in shoulder.

The Elbow, Forearm, Wrist & Hand

Terry Conkle, Ed.D.

The Elbow Joint Structure

Actually 3 joints:

Humeroulnar

Hinge joint

Humeroradial

Gliding joint

Proximal Radioulnar

Pivot joint

Distal humerus - trochlea & capitulum

Ulna - semilunar notch:

Coronoid process

Olecranon process

Radial head

Radial notch of ulna

All 3 joints enveloped in a capsule, lined by synovial membrane.

Strengthened by radial & ulnar collateral ligaments (RCL & UCL).

The Annular Ligament encircles the radial head & binds it to the ulna.

Key Movements

Radio-Ulnar Joint Structure

Distal:

Pivot joint

Radius articulates w/ ulnar head

Strengthened by:

Volar radioulnar ligament

Dorsal radioulnar ligament

The radioulnar

joint

movements

Elbow & Radio-Ulnar Joint Muscles

Location:

Anterior (Elbow): Biceps brachii, brachialis, brachioradialis, pronator teres

Anterior (wrist): Pronator quadratus

Posterior: Triceps brachii, anconeus, supinator

Muscular Analysis: Basic Forearm Movements

Flexion

Biceps brachii, brachioradialis, brachialis

Brachialis active in all conditions.

Biceps brachii most active with supination, least active with pronation.

pronation

supination

Muscular Analysis: Basic Forearm Movements

Extension

Triceps & anconeus, against gravity.

Pronation

Pronator teres & pronator quadratus.

Supination

Supinator & biceps; Long head more active with greater muscle length, while short head more active with shorter muscle length.

The Wrist & Hand

Great mobility due to generous supply of joints:

Radiocarpal (wrist) joint.

Articulation between two rows of carpal bones.

Carpometacarpal joints (note the next slide).

Trapezoid

Trapezium

Hamate

Capitate

Lunate

Triquetral

Scaphoid

Radiocarpal (Wrist) Joint Structure

Condyloid joint

4 ligaments

Volar radiocarpal

Dorsal radiocarpal

Ulnar collateral

Radial collateral

Circumduction: movement at the wrist, where the fingertips describe a circle, & whole hand describes a cone.

Movements of the hand at the wrist

Mid-carpal & Inter-carpal Joints

Proximal row of 4 carpal bones articulate with four carpal bones of distal row.

Permits only a slight gliding motion.

However, the gliding adds up to a modified hinge type of movement.

Anterior surface of carpal bones are slightly concave, referred to as the carpal tunnel.

Carpometacarpal & Intermetacarpal Joints

The thumb is a prime example of a saddle joint.

Joints between bases of metacarpal bones are irregular.

All are enclosed in capsules.

Carpometacarpal Joint of the Thumb - Movements

Abduction Hyperadduction Extension

Flexion Hyperflexion Opposition (w/ another digit)

Carpometacarpal & Intermetacarpal Finger Joint Movements

Short ligaments in this region, limit motion in these joints almost to the point of being nonexistent.

Slight gliding movements only.

5th carpometacarpal joint (pinky) is slightly more mobile.

Meta-carpo-phalangeal Joint Structure

Joints at bases of the four fingers, uniting proximal phalanges with metacarpals.

Condyloid joints

Encased in capsules

Protected by collateral ligaments.

Also a dorsal ligament.

Posterior View

---------------------------------------------

Movements of

Metacarpophalangeal

Joint of the Fingers

Meta-carpo-phalangeal Joint Movements of Thumb

Flexion:

volar (anterior) surface of the thumb approaches base of thumb.

Extension:

return movement from flexion.

Interphalangeal Joints

Joints between adjacent phalanges of any of the five digits.

All are hinge joints, permitting only flexion & extension.

Hyperextension is slight, if present at all.

Each one enclosed in a capsule.

Strengthened by collateral ligaments, and in front (anteriorly) by a volar ligament.

Flexor carpi radialis,

flexor carpi ulnaris,

palmaris longus.

Posterior:

Extensor carpi radialis brevis,

extensor carpi radialis longus,

extensor carpi ulnaris.

Wrist Muscles Hand Muscles

From forearm: Extensor digiti minimi, extensor digitorum, extensor indicis, flexor digitorum profundus, flexor digitorum superficialis.

Intrinsic to Hand: Abductor digiti minimi, flexors digiti minimi brevis, interossei dorsales manus, interossei palmaris, lumbricales manus, opponens digiti minimi.

Thumb Muscles

From forearm: Abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, flexor pollicis longus.

Intrinsic to hand: Abductor pollicis brevis, adductor pollicis, flexor pollicis brevis, opponens pollicis.

Wrist

Flexion

Extension

Hyperextension

Radial deviation (Abduction)

Ulnar Deviation (adduction)

Movement Analysis of Wrist, Thumb, & Hand

Fingers

Flexion

Extension

Abduction

Adduction

Opposition

Thumb Metacarpal

Flexion

Extension

Abduction

Adduction

Opposition

Movement Analysis of the Thumb

Thumb Phalanges

Flexion

Extension

Hand Grasp Examples

Power gripping involves flexion of all fingers

Cylindrical

Spherical

Hook

Examples of Using the Hands to Grasp

Precision involves thumb & two fingers, depending on shape & size of object