KINESIOLOGY OF THE SHOULDER

Wayan Budi Aryawan

THE SHOULDER GIRDLE

Shoulder complex dibentuk oleh 7 sendi Saling bergantung untuk menghasilkan gerakan ritmik Semua bagian bekerja sebagai tim untuk meghasilkan gerakan yg terkoordinasi Gangguan pada salah satu bagian dapat menyebabkan gangguan pada sendi-sendi yg lain

OSTEOLOGY
SCAPULA : Triangular 3 border and 3 angles Medial border: 5-6 cm dari midline Superior border: setinggi costae 2 Inferior border: setinggi costa 7-8

OSTEOLOGY
CLAVICLE : S Shaped & Roughly cylindrical Medial end fits poorly with the manubrium sterni Lateral end fits in with the acromion

OSTEOLOGY
HUMERUS: The head: permukaan articular yg halus dr humerus Lesser tuberosity: a marked prominence on the anterior surface Greater tuberosity Intertubercular grooves: memisahkan lesser and greater tuberosity Anatomical neck Surgical neck: tempat yg sering terjadinya fraktur

THE JOINTS
1. 2. 3. 4. 5. 6. 7. Glenohumeral joint Suprahumeral joint Acromioclavicular joint Scapulocostal joint Sternoclavicular joint Costosternal joint Costovertebral joint
7

3 2 1 4

5 6

Glenoumeral joint
The joint : Dibentuk oleh ball shaped of head humerus dan shallow concave glenoid fossa Triaxial joint Perbedaan yg mecolok
Angular value of the head of humerus = 153: Angular value of glenoid fossa = 75:

Tidak stabil agar lebih stabil :

Upward direction of the glenoid fossa Fibrous ring at the perimeter of the fossa glenoid labrum

Glenoumeral joint

Glenoumeral joint
The capsule : Dindingnya sangat tipis Menempel pd seluruh glenoid fossa dan berinsersi di anatomical neck of humerus Diperkuat pd sisi anterior oleh : ligament glenohumeral superior, middle dan inferior FORAMEN OF WEITBRECHT : celah antara lig. Glenohumeral superior dan medial Pada posisi lengan menggantung bag. Atas caps. Tegang dan bag. Bwh. Longgar kebalikannya bila abduksi

Glenohumeral Joint
Synovial Lining Synovial lining throughtout the joint inside the capsule Rotator cuff muscle are woven into the capsule The Bursae : Banyak bursae yg terdapat di shoulder joint, bbrp diantaranya saling berhubungan atau merupakan prolongasi dr synovial sac

Glenohumeral Joint
the bursae Subacromial, subdeltoid, subcoracoid Provide the gliding mechanism for the muscle The bursae only gains clinical significance when they become inflammed Bursitis

Glenohumeral Joint
Muscles and Nerves Prime mover :
1. 2. 3. 4. 5. M. Deltoid (n.axillary;C5,C6) M. Supraspinatus (n.suprascapular;C4,C5,C6) M. Infraspinatus (n.suprascapular;C4,C5,C6) M. Teres minor (n.axillary;C5,C6) M. Subscapularis (n.subscapular sup&inf;C5,C6)

Rotator cuff mucsle

Rotator cuff combined with deltoid arm abduction

Muscles

Glenohumeral Joint
The Movement Gliding of two incongrous surface Requires simultaneous abduction of the arm with the depression of the humeral head. The arm abduction: passively to 120:, active 90: > 120: abduction bloked by the humeral impinging upon the acromial process and the coracoaromial ligament. Full abduction (180:) results from the rotation of the scapula (60:) Scapulohumeral Rhythym

Glenohumeral Joint

Suprahumeral Joint
Not a true joint Mrp arkus yg dibentuk oleh ligament yg mengubungkan coracoid and acromial process Prevent :
1. Trauma from above glenohumerl joint 2. Upward dislocation of the humerus

Many sensitive tissue enclosed within in abd, humeral head must pass under coracoacromial process w/o pinching sensitive tissue

Scapulothoracic Joint
Scapula moves in gliding manner upon thoracic wall type of movement :
Translatory Rotatory
Usually are combination of both

Prime Mover : m. Trapezius and serratus anterior Trapezius (N. XI/N. Accesorius) 3 parts
Upper: pulls the scapula upward. Middle: fix the scapula during the abduction Lower: pull medial border of the spine down and in Upper + lower combined elevating glenoid fossa

Scapulothoracic Joint
Serratus anterior
pulls the scapula forward Long thoracic nerve of Bell (C5,C6,C7) Upper trapezius+lower trapezius+serratus anterior: rotation & elevation of the glenoid fossa

Other muscles act on scapula Levator scapulae Elevate medial border of scapula Rhomboid major Downward rotation of glenoid fossa (dorsal scapular nerve, C5) Rhomboid minor

Scapulothoracic Joint
Latissimus Dorsi
Extensor, internal rotator, adductor Thoracodorsal nerve (C7,C8) Arm adduction Upper(clavicular) portion; lateral pectoral nerve Lower(sternal) portion; medial pectoral nerve Depress the shoulder; medial pectoral nerve Extensor,internal rorator of arm, abductor of humerus Lower subscapular nerve (C5,C6)

Pectoralis Major

Pectoralis Minor
Teres major

Scapulohumeral Movement
For every 15: of abduction
10: occur at glenohumeral joint 5: from rotation of the scapula upon the chest wall
Ratio 2:1

Scapula rotation 60:; humerus 90: active, 120: passive Full overhead elevation requires little or no deltoid motion or support, if scapula fully rotated glenoid fossa direcly under humeral head Scapulohumeral rhythym only be possible if there is motion in acromioclavicular & sternocalvicuar joint

Acromioclavicular Joint
Plane joint connecting the outer end of the clavicle with to anterior medial portion of acromial process Reinforced by strong superior and inferior acromioclavicular ligaments prevent the posterior dislocation The scapula attached to clavicle through coracoclavicular ligamentprevent scapula from rotating about the acromioclavicular joint

Acromioclavicular Joint
As the scapula rotates to elevate the glenoid fossa, it rotates the clavicle through the attachment of coracoclavicular ligaments Rotation of clavicle occurs in arm elevation >90: The first 30: of clavicle elevation occurs at sternoclavicular joint The next 30: is the result of rotation of the clavicle about its long axis.

Sternoclavicular Joint
Formed by sternal end of the clavicle attaching to the superior lateral portion of manubrium of the sternum and the cartilage of the first rib. Costoclavicular ligament
Stabilize the clavicle aginst muscle action Acts as the fulcrum for all motion of the shoulder girdle.

Acts as ball and socket joint. Muscles:

Subclavius: depressing the clavicle, raising the first rib protecting subclavian vessel during fracture of clavicle Sternocleidomastoid: pull the head, flex the neck, turn the face to opposite

Sternoclavicular Joint

Biceps Mechanism
Biseps & triceps biarticular muscles Triceps : extend the shoulder Biceps :
Foreerm supination, elbow flexion Assist the anteriordeltoid in forward flexion of the shoulder

The motion of biceps tendon in bicipital groove only when there is movement of the glenohumeral joint

Shoulder Girdle Movement

Arm abduction scapulohumeral rhythym Every 15:: 10: at glenohumeral joint, 5:scapula rotation 2:1 Only 60: of humeral abduction is possible with arm internally rotated. In externally rotated:90:(active),120:(passive) Full elevation (180:) requires 60: of scapular rotation

Pathomechanics of the Paralysis of the Shoulder

Paralisis seratus anterior : Medial winging of scapula Develops especially when the arm carried forward Paralisis trapezius Lateral winging

TERIMA KASIH