Alya Putri Khairani / 130110110220

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Kinesiology of Shoulder Complex: muscles of the shoulder region

The muscles of the shoulder region give fixation to and produce movements of the shoulder girdle and control
Scapulohumeral relationships. The muscles of the shoulder girdle also participate significantly in skilled
movements of the upper extremity, such as writing, and are essential in activities requiring pulling, pushing, and
throwing, to mention only a few of the important activities of the upper extremity
The shoulder region muscles are divided into three groups for study:

Muscles connecting the shoulder girdle with the trunk, the neck, and the skull

Muscles connecting the Scapula and the Humerus

Muscles connecting the trunk and the Humerus, having little or no attachment to the Scapula
Muscles from Trunk to Shoulder Girdle
Serratus Anterior
Proximal attachment:
By nine muscular slips from the anterolateral aspect of the thorax,
from the first to the ninth ribs-hence its name, the "saw muscle." The
lowest four or five slips interdigitate with the external oblique
abdominal muscle
Distal attachment:
The muscle passes underneath the Scapula with the distal attachment
occurring along the medial border of the Scapula. The lowest five
digitations converge on the inferior angle of the Scapula, attaching to
its costal surface. This is the strongest portion of the muscle
Innervation:
Long thoracic nerve (CS-C7)
Anatomic actions:
Abduction and upward rotation of the Scapula

Trapezius
Proximal attachment:
Occipital bone, Ligamentum Nuchae, and Spinous Processes from C7 T12
Distal attachment:
The muscle fibers converge to their distal attachments.on the Acromial end of
the Clavicle, the Acromion, and the Spine of the Scapula
Innervation:
Spinal accessory nerve (C1 C4 and spinal portion of Cranial Nerve XI)
Anatomic actions:
The Upper Trapezius performs elevation and upward rotation of the scapula,
as well as extension, lateral flexion, and contralateral rotation of the neck; the
Lower Trapezius performs upward rotation, adduction, and depression of the
scapula; the middle trapezius performs upward rotation and adduction of the
scapula
Rhomboid Major and Minor
Connect the Scapula with the vertebral column, lie underneath the Trapezius.
The upper portion is
known as Rhomboid Minor; the lower (larger) portion, as Rhomboid Major
Proximal attachment:
Ligamentum Nuchae and Spinous Processes of the lowest two Cervical and
the upper four Thoracic vertebrae
Distal attachment:
Medial border of Scapula. The Rhomboid Major also has the important
function of downward rotation of the Scapula since it attaches to the inferior
angle of the Scapula
Innervation:
Dorsal scapular nerve (C4 C5)
Anatomic actions:
Pectoralis Minor
Proximal attachment:
By four tendomuscular slips from the second to the fifth ribs

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Distal attachment:
The proximal attachment slips converge with their distal attachment into the Coracoid Process of the
Scapula. This gives the muscle a triangular shape
Innervation:
Medial Pectoral Nerve (C7 T1)
Anatomic actions:
Depression and ventral tilt of the scapula as well as elevation of ribs 2 to 5

Levator Scapulae
Proximal attachment:
Transverse processes of the upper cervical vertebrae
Distal attachment:
Medial border of the Scapula, above the spine, near the superior angle
Innervation:
Dorsal Scapular Nerve (C3 C5)
Anatomic actions:
Elevation and downward rotation of the Scapula as well as Lateral Flexion
and Ipsilateral rotation of the Cervical spine

Muscles from Shoulder Girdle to Humerus

Deltoid
A large superficial muscle consisting of three parts: anterior,
middle, and posterior. The muscle covers the Glenohumeral joint
on all sides except the axilla and comprises 40 percent of the
mass of the Scapulohumeral muscles
Proximal attachment:
The acromial end of the Clavicle, the Acromion process, and
the spine of the Scapula
Distal attachment:
Three portions of the muscle converge to have their distal
attachment onto the deltoid tuberosity, a rather rough area
about halfway down the shaft of the humerus
Innervation:
Axillary Nerve(C5 C6)
Anatomic actions:
Abduction of the Glenohumeral joint. Anterior Deltoid
performs flexion and horizontal adduction of the
Glenohumeral joint. Posterior Deltoid performs extension and
Supraspinatus
horizontal abduction of the Glenohumeral joint
Proximal attachment:
Supraspinous fossa of the scapula, which it completely fills. The muscle
fibers converge toward the tip of the shoulder to form a short tendon that
passes underneath the acromion and that adheres to the capsule of the
shoulder joint
Distal attachment:
Uppermost facet of the Greater Tubercle of the Humerus
Innervation:
Supracapsular nerve (C5 C6)
Anatomic actions:
Abduction of the Glenohumeral joint
Infraspinatus and Teres Minor
Proximal attachment:
Infraspinous fossa and lateral border of the scapula. The infraspinatus lies closest to the spine of the scapula
and occupies most of the infraspinous fossa. The teres minor is attached mainly to the lateral border of the
scapula
Distal attachment:

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Greater tubercle of the humerus, infraspinatus into its middle facet,
and teres minor into its lower (posterior) facet. The tendons of both
muscles are adherent to the capsule
Innervation:
Infraspinatus by the suprascapular nerve and teres minor by the
axillary nerve (CS-C6).
Anatomic actions:
External rotation and adduction of the Glenohumeral joint

Subcapsularis
Proximal attachment:
Costal surface of Scapula. Fiber bundles converge toward the axilla to
form a broad tendon, which passes over the anterior aspect of the
capsule of the Glenohumeral joint
Distal attachment:
Lesser tubercle of the humerus and shaft below the tubercle
Innervation:
Subcapsular nerve (C5 C6)
Anatomic actions:
Inward rotation of the Glenohumeral joint. Depending on the arm
position, the Subscapularis can flex, extend, adduct, or abduct the

Teres Major
Proximal attachment:
Inferior angle of the scapula
Distal attachment:
The muscle fibers course upward and laterally and have their distal
attachments to the crest of the lesser tubercle of the humerus by means of
a strong broad tendon
Innervation:
Subcapsular nerve (C5 C6)
Anatomic actions:
Internal rotation, adduction, and extension of the Glenohumeral joint
Coracobrachialis
Proximal attachment:
Coracoid process of Scapula
Distal attachment:
Medial surface of humerus, about halfway down the shaft of the
humerus
Innervation:
Musculocutaneous nerve (C6-C7)
Anatomic actions:
Internal rotation, adduction, and extension of the Glenohumeral joint

Biceps Brachii and Triceps Brachii

The Biceps and Triceps muscles do not belong to the Scapulohumeral group because they do not have their distal
attachments on the Humerus; however, the two heads of the Biceps and the long head of the Triceps cross the
shoulder joint and therefore act on it. The Biceps is a flexor and an abductor, and the Triceps is an extensor and an
adductor of the Glenohumeral joint. The long head of the Biceps is capable of elevating the arm when the Deltoid
and the Supraspinatus are paralyzed. The motionoccurs in a position of external rotation of the

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\ Glenohumeral joint, slightly anterior to the frontal plane and without
resistance or a tool in the hand. This motion is useful for placement of the
hand over the head, but the long head of the Biceps is not strong enough to
lift objects or to perform work in this position

Muscles from Trunk to Humerus

Latissimus Dorsi

Proximal attachment:
Spinous processes of the thoracic vertebrae from T-6 downward,
Dorsolumbar fascia, Crest of Ilium (posterior portion), and the lowest
ribs, here interdigitating with the External Oblique Abdominal muscle.
The fibers converge toward the Axilla, some fibers passing over or
near the inferior angle of the Scapula, often adhering to it
Distal attachment:
A tendon that courses in the axilla and attaches to the crest of the
lesser tubercle of the humerus, proximal to that of the teres major.
Innervation:
Thoracodorsal nerve (C6-CS)
Anatomic actions:
Internal rotation, extension and adduction of the glenohumeral joint,
scapular depression, elevation of pelvis.

Pectoralis Major
Proximal attachment:
Clavicle (sternal half), sternum, and costal cartilages of the second to
seventh ribs, and the aponeurosis over the abdominal muscles. The
muscle is described as consisting of three parts: the clavicular,
sternocostal, and abdominal
Distal attachment:
Crest of the greater tuberosity of the humerus, on an area several inches
long. Before reaching its attachment, the tendon bridges the
intertubercular (bicipital) groove
Innervation:
Medial and Lateral Pectoral nerve (C5 T1)
Anatomic actions:
Adduction and internal rotation of the Glenohumeral joint. Clavicular
Support and Dynamic Stabilization of the Shoulder
Rotator Cuff Stabilization
When a person is carrying a heavy load such as a briefcase in the hand, EMG activity has been found in the
horizontally directed rotator cuff muscles-the Supraspinatus, Infraspinatus, and Teres Minor. Contraction of these
muscles holds the Humeral/head tightly against the Glenoid to prevent subluxation when carrying a weight in the
hand
Biceps Brachii
The tendon of the long head of the Biceps Brachii courses over the Humeral head and descends in the
Intertubercular groove. When the muscle contracts; tension occurs in the tendon to produce a downward and
inward force on the head of the Humerus, compressing it against the Glenoid cavity. This force is similar to pulling
a rope around a post. Thus, when the elbow is flexed with a 'weight in the' hand, the biceps aids in preventing
subluxation of the Glenohumeral joint
The Deltoid
Attention has been focused on the deltoid in its function as an abductor of the glenohumeral joint. In the early part
of elevation, the major force of the deltoid is directed vertically, producing a shear on the glenoid and causing the
humeral head to strike the coracoacromial arch, ,This movement is prevented by the horizontal and downward
lines of action of the rotator cuff muscles. Some consider the posterior deltoid itself to be an adductor or to cause

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joint compression in the early part of the inotion and have found lines of force inferior or very close to the axis of
motion. As elevation progresses, the lever arms for abduction increase, but most of the force generated by the
deltoid is directed into the stabilizing component which compresses the head of the humerus against the glenoid.
In the position of arm elevation, the deltoid and the horizontal forces of the rotator cuff muscles provide stability
for the glenohumerai joint. In full shoulder elevation; as in
pressing upward or standing on the hands, the abducted
and upwardly rotated scapula forms a platform for the head
of the humerus. The scapula, in turn, is stabilized by the
serratus anterior and the trapezius muscles

(A)

Initiation of abduction

(B) At 90 of Glenohumeral abduction. The solid lines represent

the medial or anterior lines of action of the middle Deltoid (D),

Supraspinatus (Sup), and the Subscapularis (Sub); the dotted
lines represent the posterior lines of action of the Infraspinatus
(IS) and the Teres Minor (Tmin). The vector of the deltoid has
been resolved into a rotary component (DR) and a stabilizing

Synergistic Muscle Action

In the many motion combinations, muscles or their parts can be classified as synergists or antagonistsfor a
particular movement only. Examples are the Trapezius and the Serratus Anterior as they act together to produce
upward rotation of the scapula but act as antagonists in retraction and protraction of the scapula. Even the parts of
the- same muscle may act as .synergists or antagonists as occurs with the trapezius. The upper and lower
trapezius act synchro nously in upward rotation of the scapula but are antagonists in elevation and depression of
the scapula. Several important synergies, or force couples, occur in the shoulder. In mechanics, a force couple is
defined as two forces whose points of application occur on opposite sides of an axis and in opposite directions to
produce rotation of the body. This situation occurs during elevation of the arm. The trapezius and the serratus
anterior combine forces to produce abduction and upward rotation of the scapula. The deltoid and the Suprespintus
contract together to produce abduction (or flexion) at the Glenohumeral joint
Motion and Muscular Activity in Function
Functionally, muscles
participate in postures
and movements
according to limb and
body position in relation
to gravity, applied
resistance, and velocity
of motion rather than
by anatomic actions.
Knowledge of muscle
actions is essential in
the analysis of
muscular activity in
function as well as in
isolation of individual
muscles for evaluation
of length or strength. A
summary classification
()f muscles according to
their anatomic actions
at the shoulder joints is
presented

Muscles of Scapulothoracic Joint

Elevation

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The muscles that responsible for elevation of the Scapula and Clavicle are Upper Trapeziues, Levator Scapulae,
and to a lesser extent, Rhomboids. The Upper Trapezius, attaching to the lateral end of the Clavicle, provides
excellent leverage about the SC joint for the maintenance of this posture
Depression
Performed by Lower Trapezius, Latissimus Dorsi, Pectoralis Major, and Subclavius. The Latissimus Dorsi
depresses the shoulder girdle by pulling the Humerus and Scapula inferiorly. The forces that generated by the
depressor muscle can be directed through the Scapula and upper extremity and applied against some object,
such as spring

Retraction
The Middle Trapezoius has an optimal line-of-force to
retract the Scapula. The Rhomboids and the lower
Trapezius muscle function as secondary retractors all
the retractors are particularly active while using the
arms for pulling activities
Muscles that Elevate the arm
Placing the hand behind the head, as in
combing one's hair, requires motions of
elbow flexion; Sternoclavicular joint
elevation and upward rotation; Scapular
elevation, upward rotation, and
abduction; and Glenohumeral joint
abduction and full external rotation.
Shoulder muscles producing these
motions in the standing position are the
Biceps Brachii at the elbow; the
Trapezius and Serratus Anterior forcecouple at the Scapula; the Deltoid and
Supraspinatus couple at the
Glenohumeral joint; and the
Infraspinatus and Teres Minor. When the
arm is overhead, the Triceps Brachii
contracts to control elbow flexion for
hand placement.
contractions
of
of the Deltoid, which lengthen during movement from 0 to 60 degrees and then shorten.
When the The
extremity
is
returned to the side, the motions reverse to Sternoclavicular depression and downward rotation; Scapular
depression, downward rotation, and adduction with Glenohumeral adduction, extension, and internal rotation
With the hands in place on the overhead pulley, the pulling
motion is open chain: elbow flexion; Sternoclavicular
depression and derotation; Scapular adduction, downward
rotation, and depression; and Glenohumeral adduction and
extension with rotational changes relative to initial hand
placement close together in internal rotation or Widely
separated in external rotation. Concentric muscle activity is
required of the elbow flexors; the Glenohumeral adductors
and extensors (Latissimus Dorsi, Pectoralis Major, long head
of the Triceps Brachii, and posterior Deltoid); and the
scapular downward rotators and depressors (Pectoralis
minor and Rhomboids).
When the overhead bar is fixed and the person performs a
Pulling
chin-up to lift the body weight, closed-chain motion occurs.
The elbows flex; the Glenohumeral joint moves toward
adduction, extension, and internal rotation; and the Scapula
is adducted, downwardly rotated, and depressed. Concentric
muscle activity occurs in the same muscles used in pulling
down on the overhead bar. Both the motions and the muscle
activity are the same except that in the first instance the bar
moves down and in the second the body moves up. When
the person lowers the body from the chin-up position,
eccentric contractions of the same muscle groups occur
(elbow flexors, Glenohumeral extensors and adductors, and
the Scapular downward rotators and depressors) to extend

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Pushing
Another method used by persons with paraplegia to lift and move
their bodies is to perform wheelchair or sitting push-ups. After the
hands have been placed on the armrests of the chair, the motion is
closed chain with elbow extension, Glenohumeral adduction,
Scapular retraction, and depression. These motions require
concentric contractions of the corresponding muscle groups.
Lowering of the body then requires elbow flexion, Glenohumeral
abduction, scapular elevation, and abduction with eccentric
contractions of the same muscles (triceps brachii, pectoralis major,
latissimus dorsi, teres major, posterior deltoid, pectoralis minor,
rhomboids, and trapezius). Able-bodied subjects can lift the body
weight up to 5 to 7 inches using scapular depression alone. In the
weight-bearing phases of crutch-walking, the muscle activity is
similar to the sitting push-up: Triceps Brachii, Pectoralis Major,
Latissimus Dorsi, Teres Major, Posterior Deltoid, Pectoralis Minor,

Throwing
The overhead throwing motion is found in many types of athletics (baseball, football, racquet sports, gymnastics,
javelin, and swimming). Both the acceleration and deceleration phases frequently lead to injuries of the Glenoid
Labrum and the Rotator Cuff. In general terms, the great force imparted to the ball is gained by elevation and
rotation of the body and by transmitting this potential energy along with the kinetic energy of the large muscles of
the legs and trunk through the shoulder and elbow into kinetic energy of the hand. The motion can be divided into
phases of Cocking (wind-up), Acceleration, and Deceleration (follow through). In the shoulder and arm during the
cocking-phase motions of elbow flexion and supination, Glenohumeral abduction, horizontal abduction, and
maximal external rotation as well as Scapular retraction occur. These motions place the muscles to be used in the
acceleration phase on a stretch and increase their force: Pronators, Triceps Brachii, Pectoralis Major, Subscapularis,
Anterior Deltoid, and Serratus Anterior. In deceleration, the same muscles are active but with eccentric
contractions.

References:
Brunnstroms Clinical Kinesiology
Neumann Kinesiology of Musculoskeletal System