Chapter 5: The Upper Extremity: The Shoulder Region

Outline

• Scapulohumeral Rhythm

• The Shoulder Girdle (Acromioclavicular and Sternoclavicular Articulations)

  Structure of Acromioclavicular Articulation

  Structure of Sternoclavicular Articulation

  Movements

• Muscles of the Shoulder Girdle

  Location

  Characteristics and Functions of Shoulder Girdle Muscles

• The Shoulder Joint (Glenohumeral Articulation)

  Structure

  Ligamentous and Muscular Reinforcements

  Movements

• Muscles of the Shoulder Joint

  Location

  Characteristics and Functions

• Joint and Muscular Analysis of the Fundamental Movements of the Arm on the Trunk

  Movements in the Frontal Plane

  Movements in the Sagittal Plane

  Movements in the Horizontal Plane

  Diagonal Movements

  Shoulder Girdle Movements Not Involving the Arm

• Common Injuries of the Shoulder Region

  Acromioclavicular Sprain

  Fracture of the Clavicle

  Dislocation of the Shoulder

  Rotator Cuff Tears

  Shoulder Impingement

• Laboratory Experiences

Objectives

At the conclusion of this chapter, the student should be able to:

1. Name, locate, and describe the structure and ligamentous reinforcements of the articulations of the shoulder region.

2. Name and demonstrate the movements possible in the joints of the shoulder region regardless of starting position.

3. Name and locate the muscles and muscle groups of the shoulder region, and name their primary actions as agonists, stabilizers, neutralizers, or antagonists.

4. Analyze the fundamental movements of the arm and trunk with respect to joint and muscle actions.

5. Describe the common injuries of the shoulder region.

6. Perform an anatomical analysis of the shoulder region in a motor skill.

Scapulohumeral Rhythm

Anatomical cooperation is beautifully illustrated in the movements of the arms on the trunk. The arm travels through a wide range of movements, and in each of these the scapula cooperates by placing the glenoid fossa in the most favorable position for the head of the humerus. This is known as scapulohumeral rhythm. When the arm is elevated sideward (abducted), for instance, the scapula rotates upward; when it is elevated forward (flexed), the scapula not only rotates upward but it tends to slide partially around the rib cage (abducted). Although occasionally movement of the scapula is deliberately repressed (as in some stylized dance movements, and in some exercises), in all natural movements, the scapula shares with the humerus in the movements of the arm on the trunk. In abduction of the arm, for instance, the movements of the scapula and humerus are continuous throughout the movement, with the humeral movement accounting for approximately two-thirds of the total movement and the scapular movement for one-third. It is important to remember, however, that this cooperative scapulohumeral rhythm is not a linear relationship. It varies with individuals and with the phase of the movement. Scapulohumeral rhythm may vary across age groups and with certain types of activity, including throwing. Load and speed of movement may also produce variations. In the normal adult, however, this cooperation is fairly predictable.

The upper extremity is suspended from the axial skeleton (head and trunk) by means of the shoulder girdle. The latter consists of the sternum and ...