SHOULDER JOINT

BIOMECHANICS
BY:- DR. DEEPIKA METANGE
SHOULDER COMPLEX

 Clavicle
 Scapula
 Humerus

❖ designed primarily for mobility

 Introduction
 Shoulder joint (GH joint) has more mobilitythan
stability.
 Only SC joint connects the components of shoulder
joint to the axial skeleton. This puts greater demands
on the muscles for securing the shoulder girdle on
thorax during static and dynamic conditions (dynamic
stabilization).
 Components of shoulder complex

 Clavicle, humerus and scapula are linked with 3

interdependent linkages: SC joint, AC joint & GH
joint.
 Additionally a functional joint calledscapulothoracic
joint ( ST joint) is considered as a part of shoulder
complex.
 COMPONENTS of Shoulder Complex

 Sternoclavicular joint
 Acromioclavicular joint
 Glenohumeral joint
 Scapulothoracic joint
(functional joint)

❖ Subacromial (
Suprahumeral joint)
formed by movement of
head of humerus below
coracoacromial arch
 Acromioclavicul Sternoclavicularis
aris

Clavicul Sternum
a
Scapula

Glenohumerali
s

Humerus
Scapulothorac
alis
Subacromial(Suprahumeral joint)
STERNOCLAVICULAR
JOINT
 Only structural attachment of clavicle, scapula &
upper extremity to axial skeleton.

 Movement of the clavicle at the SC joint inevitably

produces movement of the scapula under conditions
of normal function, because the scapula isattached
to the lateral end of theclavicle.

 SC joint is a plane synovial joint, with 3 rotatory

and 3 translatory degrees of freedom.
 SC articulating surface:
 The SC articulation consists of two saddle-shaped
surfaces, one at the sternal or medial end of the
clavicle and one at the notch formed by the
manubrium of the sternum and first costal cartilage.
 It is a plane synovialjoint.
 The articulating surfaces areincongruent.
 The superior portion of the clavicle does not makes
any contact with the manubrium, instead it serves as
an attachment site for SC disk and interclavicular
ligaments.
Sternoclavicular disk

 It is a fibrocartilaginous disk to increase the

congruency b/w incongruent articularsurfaces.
 Attachment: upper portion is attached to the postero-
superior clavicle and the lower portion is attached to
the manubrium and first costalcartilage.
 The disk diagonally transects the SC joint space and
divides the joint into 2 separate cavities.
 Acts like a hinge/pivot point during clavicular motion
 Elevation/depression – medial end of clavicle rolls &
slides on relatively stationary disk. Upper portion
serves as a pivot
 Protraction/retraction – S.C disk & medial clavicle
rolls & slides on manubrium facet. Lower portion
acts as a pivot.

Mobility between segments is maintained & stability is

enhanced
 The disk is considered part of the manubrium in
elevation/depression and thus the upper attachment
of the disk serves as pivot point and the disk acts as
the part of the clavicle in protraction/ retraction
with lower attachment serving as pivot point.
 The axis of motions of SC jointelevation/depression
and protraction/retraction is located lateral to the SC
joint, on the costoclavicularligament.
 The disk functions to absorb the medially directed
force transmitted along the clavicle from its lateral
end.
 Sternoclavicular joint capsule and
ligaments
 Sc joint is supported by fibrous capsule
 3 ligaments: ANTERIOR
 Sternoclavicular ligament
POSTERIOR

ANTERIOR
LAMINA
 Costoclavicular ligament
POSTERIOR
LAMINA
 Interclavicular ligaments
Sternoclavicular motions
3 rotatory degrees of freedom:
 Elevation/depression
 Protraction/retraction
 Anterior/posterior rotation of clavicle
3 degrees of translatory motion at the SC joint
(very small in magnitude):
 Anterior/posterior
 Medial/lateral
 Superior/inferior
Elevation/depression of clavicle
 Elevation/depression of
clavicle

 Occurs around an AP axis

 Between convex clavicular surface & concave surface of manubrium
and first coastal cartilage
Elevation :- downward sliding of medial clavicular surface on
manibrium
:- SC joint axis lies lateral to the joint at
costoclavicular ligament thus being a functional axis
 Clavicular elevation= upto 45degrees
 Passive clavicular depression= less than 15degrees
 These movements are associated with movements of the scapula thus
playing a significant role in increasing the range of elevation of the
arm
Protraction/retraction of clavicle
Protraction/retraction of clavicle

 Occurs at vertical axis

 Medial end of clavicle is concave and manubrium is
convex
 Protraction is anterior sliding of medial clavicle on
manubrium

 protraction= 15 degrees
 Retraction= 15 degrees

 Associated with protraction & retraction of the scapula

Anterior and Posterior Rotation of the
Clavicle
 Anterior and Posterior Rotation
of the Clavicle

▪ Occurs as a spin
▪ Clavicle rotates in only one direction from its resting position
▪ Clavicle rotates posteriorly from neutral (inferior surface of
the clavicle faces anterior)
▪ From fully rotated position back to neutral is anterior
rotation
 Posterior rotation= 30-55 degrees

 Posterior rotation of clavicle produces 30° of final

upward rotation of the scapula
 Sternoclavicular stress tolerence

 Although the SC joint is considered incongruent,the

joint does not undergo the degree of degenerative
change common to the other joints of the shoulder
complex.
 Strong force-dissipating structures such as the SC
disk and the costoclavicular ligament minimize
articular stresses and also prevent excessive intra-
articular motion that might lead to subluxation or
dislocation.
ACROMIOCLAVICULAR
JOINT
AC JOINT

 Plane synovial joint

 3 rotational and 3 translational degrees of freedom
 The primary function of the AC joint is to allow the
scapula additional range of rotation on the thorax
and allow for adjustments of the scapula (tipping
and internal/external rotation) outside the initial plane
of the scapula in order to follow the changing shape of
the thorax as arm movement occurs.
 In addition, the joint allows transmission of forces
from the upper extremity to the clavicle.
AC articulating surface

 Incongruent surfaces
 Lateral end of clavicle
and Small facet on
acromion of the
scapula
 AC joint disk
 Through 2 years of age, the AC joint is actually a
fibrocartilaginous union.
 With use of UE progressively, a joint space develops on
each articulating surface that may leave a meniscoid
fibrocartilage remnant within thejoint.
AC joint capsule and ligaments
 Superior acromioclavicularligament
 Inferior acromioclavicular ligament
TRAPEZOID
(LATERAL)
 Coracoclavicular ligament
CONOID
(MEDIAL)

❖A.C. capsule & ligaments can restrain small motions,

restrain of larger displacement is credited to coracoclavicular
ligament
 The capsule of the AC joint is weak and cannot
maintain integrity of the joint without reinforcement
of the superior and inferior acromioclavicular and
the coracoclavicular ligaments.
 Superior AC ligament is reinforced byaponeurotic
extensions from deltoid and trapezius.
 Trapezoid portion: oriented more horizontally. It
resists posterior forces on distal clavicle
 Conoid portion: oriented more vertically. Itresists
superior and inferiorforces

1. Both limit upward rotation of scapula on AC joint.

2. Prevents medial displacement of acromion on

clavicle when leaning on 1 hand
Upward rotation of the scapula at
AC joint

Upward rotation of scapula at A.C. joint

Corocoid process would drop away from

clavicle

Prevented by coraco-clavicular ligament

❖ Most important role of coraco-clavicular ligament is in

producing longitudinal rotation of clavicle which is
important for full ROM in elevation of upper extremity.
 Large external forces push humerus into glenoid fossa

Medially directed muscles of scapula would displace scapula

medially on thorax

Small A.C. joint with weak capsule & ligament cannot resist
such large forces

Clavicle would override the acromion and joint would

dislocate

Medial displacement of scapula is prevented by tension in

coraco-clavicular ligament

Tranfers medially directed force to clavicle & to strong SC jt.

 AC motions
 3 rotatory motions:
 Internal/external rotation
 Anterior and posteriortipping
 Upward and downward rotation
 3 translatory motions:
 Anterior/posterior
 Medial/lateral
 Superior/inferior
Axis and planes for AC joint motions
Medial/lateral rotation
Medial/lateral rotation
 Medial and lateral rotation bring the glenoid fossa
medial (anterior) & lateral (posterior)
 Must occur to maintain contact of the scapula with
horizontal curvature of the thorax.

Scapula would
move directly
away from
Pure translator
Protraction vertebral
movement
column&
glenoid would
face lateral
While elevating the arm

 Protraction and
retraction of the
scapula require medial
and lateral rotation,
respectively, for the
scapula to follow the
convex thorax and orient
the glenoid fossa with
the plane of elevation.
 Glenoid fossa
faces anterior By medial
Scapular
with scapula in rotation of the
protraction
contact with the scapula
ribcage
Anterior and posterior tipping
Anterior and posterior tipping

 Anterior tipping is when superior border of the

scapula move anteriorly & inferior angle posteriorly
 In order to maintain contact of the scapula with the
ribcage
 Elevation requires anterior tipping
 Anterior tipping occurs during posterior rotation of
the clavicle (as a counter rotation)
While elevating the arm
 The scapula posteriorly tips on thorax as the scapula is
upwardly rotating.
Acromioclavicular stress tolerence

 AC joint is susceptible to trauma and

degenerative changes because of Smaller
and incongruentsurfaces.
 It is commonly found in 2nd decade to 6th
decadeof life.
SCAPULOTHORACIC
JOINT
 ST JOINT
 It is not a true anatomic joint.
 The functional ST joint is part of a true closed chain
with the AC and SC joints and the thorax.
Resting position of scapula

 2 inches from midline b/w

2nd and 7th rib.
 Internally rot -30-45
degrees from coronal
plane.
 Ant tipped -10-20degrees
from frontal plane
 Upward rotated - 10-20
degrees from sagittal
plane
RESTING POSITION OF SCAPULA
 The linkage of the scapula to the AC and SC joints,
however, actually prevents scapular motions both from
occurring in isolation and from occurring as true
translatory motions.
 Eg. When the arm is abducted, scapula undergoes
upward rotation, external rotation and posterior
tipping (all movts in combination).
MOTIONS OF THE SCAPULA

 Upward/downward rotation
 Elevation/depression
 Protraction/retraction
 Medial /lateral rotation
 Anterior/posterior tipping
UPWARD ROTATION
 Approx. 60 degrees of
upward rotation of the
scapula on the thoraxis
typically available.
 Upward rotation of the
scapula is produced by
clavicular elevation
and posteriorrotation
at the SC joint and by
rotations at the AC
joint.
ELEVATION/DEPRESSION

Elevation and depression of

the scapula are produced by
elevation/depression of
the clavicle at the SC joint
and requires subtle
adjustments in
anterior/posterior tipping
and internal/external
rotation at the AC joint to
maintain the scapula in
contact with the thorax.
PROTRACTION/RETRACTION

 Protraction and
retraction of the scapula
are produced by
protraction/retraction
of the clavicle at theSC
joint, and by rotations
at the AC joint to
produce internal rot &
ant tipping.
 Medial/lateral rotation
 Medial/lateral rotation of
the scapula on the thorax
should normally accompany
protraction/ retraction of the
clavicle at the SC joint.
 Medial rotation of the
scapula on thorax which
occurs only at the AC joint,
will result in theprominence
of the vertebral border of
scapula. (WINGING OF
SCAPULA-suggestive of
impaired neuromuscular
control of ST muscles ).
Functions of scapular motions

 Orient glenoid fossa for optimal contact

 To add range to elevation of the arm
 To provide stable base for controlled
rolling & sliding of the humeral head
GLENOHUMERAL
JOINT
 GH ARTICULATING
SURFACE
 Scapula-
 Glenoid fossa is oriented/facing upwards and 6-7
degrees retroverted.
 The radius of curvature of the fossa is increased by
articular cartilage that is thinner in the middle and
thicker on the periphery, which improves congruence
with the much larger radius of curvature of the
humeral head.
 Humerus-
 The head faces medially, superiorly, and
posteriorly with regard to the shaft of the humerus
and the humeral condyles.
 ANGLES:
 Angle of inclination=130-150 degrees
 Angle of torsion=30 degrees posteriorly
 Angle of
inclination
Axis through
humeral head &
longitudinal axis
through shaft

Angle of
torsion
In transverse plane,
axis through humeral
head and condyles
 Because of the internally rotated resting position of
the scapula on the thorax, retroversion of the humeral
head increases congruence of the GH joint.
 Reduced retroversion of humeral head
(anteversion)- increases ROM for internal rotationand
decreases ROM for external rotation and has a
tendency to produce anterior GHsubluxation.
 Vice versa for increased retroversion of humeralhead.
Subluxation of shoulder
GLENOID LABRUM

 Enhance the depth or

curvature of the fossaby
50%.
 It is a redundant fold of
dense fibrous connective
tissue with little
fibrocartilage.
 It is attached to
glenohumeral ligament
and long head of biceps
brachii.
GH CAPSULE &
LIGAMENTS
 GH Capsule laxity is
required for large
excursions of shoulder
joint.
 But capsule givesless
stability alone and its
work has to be
reinforced by GH
ligaments.
➢ Capsule is taut superiorly and slack anteriorly &
inferiorly
➢ Close Packed Position:- Abduction & lateral rotation
➢ Capsule twists on itself & tightens
➢ Capsule is reinforced by GH ligaments
➢ Reinforced anteriorly by subscapularis tendon, it is a
common site of extrusion of the head- Anterior
dislocation of GH joint
➢ Thin area of capsule between superior & middle GH
ligament is a point of weakness in the capsule
GH ligament

 Superior
 Middle
 Inferior
 Coracohumeral lig
 Foramen of
weitbrecht- area of
weakness in the
capsule.
Rotator interval
capsule
 superior GH ligament,
the superior capsule,and
the coracohumeral
ligament are
interconnected
structures that bridge
the space between the
supraspinatus and
subscapularis muscle
tendons- rotator interval
capsule.
Inferior GH ligament
complex
 Inferior GH ligament has
3 parts:
 Anterior bands
 Axillary pouch
 Posterior bands
Function of GH ligament

Superior Limits ant and inferior translation in

GH Lig arm at 0 degrees of abduction

Middle GH Limits anterior translation at arm 45

Lig degrees abduction
Anterior Limits ant translation beyond 45
band of
IGHLC degrees abduction + external rotation
Posterior
band of
Limits posterior translation witharm
IGHLC 45 degrees abd+ internal rotation
 Coracohumeral
Ligament
Two bands
inserts into supraspinatous
& onto greater tubercle
where it joins sup. GH
ligament

inserts into subscapularis &

lesser
tubercle
Two bands form a tunnel through which long head
of biceps brachii passes
Coracoacromial
arch
 Coracoacromial
arch
 Forms an osteo-ligamentous vault
 Formed by corocoid, acromian & CA ligament
 Contents undercoracoacromial arch: subacromial
bursae, rotator cuff tendons and portionof long
head of biceps brachii.
 Also called as supraspinatus outlet/ subacromial space
 Normally, it is 10 mm wide, but reduces to 5mm on
elevation of arm.
 Repetitive overhead activity can cause painful
impingement syndrome.
 Bursae
 Subacromial Subacromial
bursae

 Subdeltoid
 Glenohumeral
motions
MOTIONS ROM available

Flexion 120°

Extension 50°

Abduction 90-120°

Adduction

External rotation 60° of combined motions (arm

at side)
120° of combined motions( arm at
90°abducted)
Internal rotation -
 For complete range of abduction to occur, there must
be 35-40 degrees of lateral rotation, for the
clearance of greater tubercle under the
Coracoacromial arch.
 MAXIMUM ABDUCTION IS FOUND TO OCCUR IN
SCAPULAR PLANE, i.e 30-40 degrees anterior to
frontal plane. This is due to lack of capsular tension in
scapular plane.
 Intra-articular Contribution to
Glenohumeral Motions

 The convex humeral head is a substantially larger

surface and may have a different radius of curvature
than the shallow concavefossa.
 Given this incongruence, rotations of the joint around
its three axes do not occur as pure spins but have
changing centers of rotation and shifting contact
patterns within the joint.
 Without downward
sliding of the
articular surface of
the humeral head,
the humeral head
will roll up the
glenoid fossa and
impinge upon the
coracoacromial arch.
 Slight superior
translation of the
center of the humeral
head can still occur
duringhumeral
abduction despite
inferiorsliding of
the head’s
articular surface.
(1-2mm)
 Static Stabilization of the GH Joint in
the dependent Arm- UNLOADED ARM
Bony surfaces alone cannot maintain joint contact in dependant position

Gravity acts on humerus parallel to shaft in downward direction

Requires vertical pull upwards to maintain equilibrium

Should be pulled by muscles

But, all muscles are electrically silent

Mechanism of joint stabilization appears to be passive

LOG creates downward force on
humerus

Magnitude of passive tension in

structures of rotator interval
capsule which is taut when arm
is at the side

Resultant pull of both creates a

line of force which compresses
humeral head into lower glenoid
fossa
 PASSIVE TENSION IN THE ROTATOR INTERVAL
CAPSULE
 AIR-TIGHT CAPSULE PRODUCING NEGATIVE
INTRAARTICULAR PRESSURE. RESISTS
INFERIOR TRANSLATION
 GLENOID INCLINATION-THERE IS SLIGHT
UPWARD TILT OF GLENOID FOSSA EITHER DUE
TO ANATOMICALLY OR DUE TO UPWARD
ROTATION OF THE SCAPULA. PRODUCES
PARTIAL BONY BLOCK
 LOADED ARM-STATIC
STABILIZATION

 SUPRASPINATUS
ACTIVITY STARTS
WHEN THE PASSIVE
TENSION IN
ROTATOR INTERVAL
CAPSULE IS
INSUFFICIENT AS IN
LOADED ARM.
 DYNAMIC STABILIZATION OF THE
GH JOINT
The Deltoid and Glenohumeral Stabilization
 Deltoid is a prime mover for GH abduction
 Action line of three segments of deltoid acting together
coincides with fibres of middle deltoid
 The majority of the force of contraction of the deltoid
causes the humerus and humeral head to translate
superiorly; only a small proportion of force is applied
perpendicular to the humerus and directly contributes to
rotation (abduction) of the humerus.
 The deltoid cannot independently abduct (elevate) the
arm. Another force or set of forces must be introduced to
work synergistically with the deltoid for the deltoid to work
effectively.
EFFECT OF DELTOID (ALONE) ON
ABDUCTION
 Superiorly translatory force of deltoid

If unopposed, would cause humeral head to impact the coracoacromial arch

Inferior translator pull of gravity cannot offset this force

As resultant force of deltoid must exceed that of gravity before rotation can
occur

Done by muscles of rotator cuff

 The Rotator Cuff and Glenohumeral
Stabilization

 ROTATOR OR MUSCULOTENDINOUS CUFF

MUSCLES ARE:
 Supraspinatus (S)
 Infraspinatus (I)
 Teres minor(T)
 Subscapularis(S)
➢ The infraspinatus, teres
minor, and subscapularis
muscles individually or
together have a similar line
of pull
➢ The rotatory component
(Fy) compresses as well as
rotates, and the
translatory component
(Fx) helps offset the
superior translatory pullof
the deltoid.
 Abduction without
these three muscles
would result in
substantial superior
translation
 Action of deltoid along
with these three
muscles form a “Force
Couple” which creates
a perfect spinning of
humeral head
The Supraspinatus and
Glenohumeral Stabilization
 The supraspinatus has a superiorly
directed translatorycomponent
(Fx) and a rotatory component
(Fy) that is more compressive than
that of the other rotator cuff
muscles and can independently
abduct the humerus.

 Gravity acts as a stabilizing synergist

by offsetting small upward translator
pull
The Long Head of the BicepsBrachii
and Glenohumeral Stabilization

 The long head of biceps

may produce its effectby
tightening the relatively
loose superior labrum
and transmitting
increased tension to the
superior and middle GH
ligaments.
 The long head of the biceps brachii, because of its
position at the superior capsule and its connections to
structures of the rotator interval capsule, is sometimes
considered to be part of the reinforcing cuff of the
GH joint.
 The biceps muscle is capable of contributing to the
force of flexion and can, if the humerus is laterally
rotated, contribute to the force of abduction and
anterior stabilization.
 Costs of Dynamic Stabilization of the
Glenohumeral Joint

 Supraspinatus tendon tears

 Supraspinatus impingement in
subacromialarch
 Rotator cuff tear
 AC joint degenerativechanges
 Bicipital tendinitis
 Dislocation of shoulder
AC joint degenerative
changes
Bicipital
tendinitis
Scapulohumeral
motion
 Distributes the motion between two joints
(GH & ST) thus permitting large ROM.
 Maintains glenoid fossa in optimal position,
thus increasing joint congruency
 Permits muscles acting on humerus a good
length tension relationship, thus minimizing
active insufficiency of GH joints
 Scapulothoracic and Glenohumeral
Contributions

 SCAPULAR UPWARD ROT = 60 DEGREES

 SCAPULA not only upwardly rotates but also
posteriorly tips to 30degrees.

 GLENO-HUMERAL CONTRIBUTION = 100 to 120 of

flexion and 90 to 120 of abduction.
 TOTAL MOVEMENT IN ELEVATION= OF 150-180
DEGREES
 SCAPULOHUMERAL RHYTHM
PRE-PHASE/ SETTING PHASE
During initial 60° of flexion/ 30° of abduction

Scapula seeks a position of stability in relation to the

humerus (Setting Phase)
In this phase, motion occurs primarily at the GH joint
(stressing the arm may increase the scapular contribution)
With increasing range, scapula increases its contribution (1:1
with GH joint)

In later range, GH joint increases its contribution

 The overall ratio of 2 of GH to 1 of ST motion during
arm elevation is commonly used, and the combination
of concomitant GH and ST motion most commonly
referred to as scapulohumeralrhythm.
Sternoclavicular and
Acromioclavicular Contributions

 60° arc of upward rotation

through which the scapula
moves during elevation of the
arm can be attributed to
primarily SC joint and
secondarily AC joint.
 This happens by a force couple
of trapezius & serratus anterior
(only muscles capable of upwardly
rotating the scapula)
 Upward Rotators of the Scapula

 The motions of the scapula are primarily produced by

a balance of the forces between the trapezius and
serratus anterior muscles through their
attachments on the clavicle and the scapula.
 TRAPEZIUS WITH SERRATUS Anterior-formsa
force couple for scapular upward rotation
 INITIATION Of scapular rotation- upper trap+
middle traps
 AT THE END RANGE= Lower traps
 SCAPULOHUMERAL RHYTHM
PHASE I
Upward rotation of scapula would appear to occur at AC joint

Coracoclavicular ligament prevents this

Bony surfaces alone cannot maintain joint contact in dependant position

Must produce movement at the next joint i.e. SC joint

Pull of trapezius & Serratus anterior on scapula forces the clavicle to

elevate

Clavicular elevation carries the scapula through 30° of upward rotation

Elevation is checked by the costoclavicular ligament

➢ ST upward rotation & clavicular elevation occur
concurrently with GH motion
 GH joint moves around 60°
 Arm elevates 90-100°
➢ During initial 30° of ST motion, AC joint
maintains fixed relation between scapula &
clavicle but allows 10° of medial rotation &
anterior tipping of scapula
 SCAPULOHUMERAL RHYTHM
PHASE II
As lower trapezius & serratus anterior continue to generate an upward
rotatory force on scapula

Upward rotation at AC joint is constrained by coracoclavicular ligament

& at SC joint by costoclavicular ligament

Tension at coracoclavicular ligament builds

 coracoid process gets pulled down

Draws clavicular attachment forward & down

Clavicle rotates posteriorly

Lateral end of clavicle moves up

Additional range of 30° of upward rotation

➢ AC joint absorbs varying amount of anterior/posterior
tipping & medial/lateral rotation till scapula finds its
position on ribs

➢ For clavicle to rotate, it would require motion at AC &

SC joint
But, Internal fixation of clavicle at AC joint does not
impair range of elevation

➢ Sequence of phase I & II of scapula-humeral motion

occurs regardless of plane of scapula in which the arm
elevates
Integrated movement
during elevation
 DELTOID
 Scapular plane abduction- anteriorand middle
deltoid
 Posteriordeltoid has smaller MA and thus less
effective in frontal planeabduction.
 Maintenance of appropriate length-tension
relationship of deltoid is dependent on scapular
position/movement and stabilization. For example:
when scapula cannot rotate, there is more
shortening of deltoid and thus lossof tension, which
causes elevation to upto 90 degrees only.
 Supraspinatus
 Primary function is to produce abduction with
deltoid muscle.
 It has a fairly constant MA throughout the range of
motion of abduction
 Secondary function: acts as a ‘steerer’ of humeral
head and helps to maintain stability of dependent
arm.
 Infraspinatus, teres minor and
subscapularis
 These muscle function gradually increases from-0-115
degrees of elevation after which (115-180 degrees) it
dropped.
 In the initial range of elevation, these muscles (infrasp
and t.minor) work to pull the humeral head down, and
during the middle range, these muscles act to externally
rotate for clearing greater tubercle under
coracoacromial arch.
 Subscapularis helps as internal rot when arm is at side
and during initial range
 With more abduction, its internal rot capacity decreases.
 Then it acts with other RC muscles to promote stability by
compression.
 UPPER AND LOWER TRAPEZIUS +
SERRATUS ANTERIOR
 This force couple produces upward rotationof scapula.
 When the trapezius is intact and the serratus anterior
muscle is paralyzed, active abduction of the arm can
occur through its full range, although it is weakened.
 When the trapezius is paralyzed (even though the
serratus anterior muscle may be intact), active
abduction of the arm is both weakened and limited in
range to 75, with remaining range occurring exclusively at
the GH joint.
 Without the trapezius (with or without the serratus
anterior muscle), the scapula rests in a downwardly
rotated position as a result of the unopposed effect of
gravity on thescapula.
 Serratus anterior produces upward rotation,
posterior tipping and external rotation of
scapula, which is necessary for upward elevation of
arm.
 The serratus is the primary stabilizer of the inferior
angle and medial border of the scapula to the thorax.
 How SA and trap work with
deltoid??
 The serratus anterior and trapezius muscles are prime
movers for upward rotation of the scapula. These two
muscles are also synergists for the deltoid during abduction
at the GH joint.
 The trapezius and serratus anterior muscles, as upward
scapular rotators, prevent the undesired downward
rotatory movement of the scapula by the middle and
posterior deltoid segments that are attached to the
scapula.
 The trapezius and serratus anterior muscles maintain an
optimal length-tension relationship with the deltoid and
permit the deltoid to carry its heavier distal lever through full
ROM.
 Rhomboid

 It works eccentrically to control upwardrotation

of the scapula produced by the trapezius and the
serratus anterior muscles.
 It adducts the scapula with lower traps to offset the
lateral translation component of the serratus
anterior muscle.
 Depression involves the forcefuldownward
movement of the arm in relation to the trunk.
 Latissimus Dorsi and Pectoral
Muscle Function

 When the upper extremity is free to move in space,

the latissimus dorsi muscle may produce adduction,
extension, or medial rotation of the humerus.
Through its attachment to both the scapula and
humerus, the latissimus dorsi can also adduct and
depress the scapula and shoulder complex.
 When the hand and/or forearm is fixed in weight-
bearing, the latissimus dorsi muscle will pull its
caudal attachment on the pelvis toward its cephalad
attachment on the scapula and humerus. This results
in lifting the body up as in a seated pushup.
 Pectoralis major
muscle
 Clavicular portion Flexion of shoulder

Depression of
 Sternal portion
shoulder
 Abdominal portion
Depressor
function is
assisted by
pectoralis minor
Teres Major and Rhomboid Muscle
Function

 In order for the teres

major muscle to
extend the heavier
humerus rather than
upwardly rotate the
lighter scapula, the
synergy of the
rhomboid muscles is
necessary to stabilizethe
scapula.