SHOULDER GIRDLE

Part 2

The Suprahumeral Joint

Not a true joint
Articulation between
Head humerus
Ligament connecting the
coracoid and acromial proc.

Coracoacromial arch
Prevents trauma from above to
the glenohumeral joint
Prevents upward dislocation of
the humerus

Proximity :
Obstacle abduction of arm in
coronal plane
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume
Four of the Philippine Physical Therapy. U.S.T. Printing, 1978

The Suprahumeral Joint

Small area, but contains many
sensitive tissue :
Portion subacromial bursa,
subcoracoid bursa,
supraspinatus tendon & muscle,
superior portion of the
glenohumeral capsule,
portion of biceps tendon,
connective tissue

Impairment immobility,
pain, disability

Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume

Four of the Philippine Physical Therapy. U.S.T. Printing, 1978

The Scapulothoracic Joint

The Scapulothoracic Joint

Translatory

Rotatory

GLIDING MANNER
End Result : glenoid
fossa directed upwards or
downwards

Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume

Four of the Philippine Physical Therapy. U.S.T. Printing, 1978

The Scapulothoracic Joint

Shoulder Girdle
Motions

The Scapulothoracic Joint

Prime Movers :
Trapezius
Serratus Anterior

Other muscles:
Levator Scapulae
Rhomboids major & minor
Latissimus Dorsi
Pectoralis major & minor
Teres major

Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume

Four of the Philippine Physical Therapy. U.S.T. Printing, 1978

Trapezius

Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.

Davis Company. 2006

Trapezius

Upper portion
Pulls scapula upward
Inward pivoting about
acromioclavicular
joint

Middle portion:
Fix the scapula during
arm abduction

Lower portion:
Pull medial border of
scapular spine down
and in

Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume

Four of the Philippine Physical Therapy. U.S.T. Printing, 1978

Serratus Anterior

Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.

Davis Company. 2006

Combined Movement
Upper Trapezius
Lower Trapezius
Serratus Anterior

Elevation of the
Glenoid fossa

Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.

Davis Company. 2006

Levator Scapulae

Rhomboids Minor &

Major

Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.

Davis Company. 2006

Combined Movement
Levator Scapulae
Rhomboids
Pectoralis Minor

Downward rotation of
the Glenoid fossa

Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.

Davis Company. 2006

Latissimus dorsi

Reversal action important to patient with spinal

cord injury at upper thoracic level ambulate
by hip-hiking
Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.
Davis Company. 2006

Pectoralis Major & Minor

Teres Major

Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.

Davis Company. 2006

Scapulohumeral Rhythm

Scapulohumeral Rhythm

Every 15 of abduction of the arm 10

gleohumeral joint, 5 rotation of the scapula
upon chest wall
2:1 Ratio in abduction
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume
Four of the Philippine Physical Therapy. U.S.T. Printing, 1978

The Sternoclavicular & Acromioclavicular Joint

Coracoclavicular ligament prevents scapular rotation in

coronal plane
Scapula pivots about the acromioclavicular joint from
elevation of the sternoclavicular joint
Arm elevation overhead clavicle rotation
The first 30 elevate at sternoclavicular, next 30
rotate at its long axis
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume Four of the Philippine
Physical Therapy. U.S.T. Printing, 1978

sternocleidomastoid

Subclavius Muscle

O sternum, clavicula

O Inferior Clavicle

1st Rib

Depressing clavicle
Raising 1st rib as clavicle rise
Protect Subclavian vessels
during fractures of the clavicula

Nerve to subclavius C5-6

mastoid process

A Acting alone, tilts head to its own

side and rotates it so the face is
turned towards the opposite side.
Acting together, flexes the neck,
raises the sternum and assists in
forced inspiration.

Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume

Four of the Philippine Physical Therapy. U.S.T. Printing, 1978

BICEPS MECHANISM

Passive mechanism to assist deltoid

(anterior) in forward flexing the
shoulder

Deltoid paralysis
substitute with trick motions
Abduction external rotation, fixed
elbow (weak)
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume
Four of the Philippine Physical Therapy. U.S.T. Printing, 1978

Composite Shoulder Girdle

Movement
Abduction of arm
2 : 1
Glenohumeral Joint :Scapular Rotation
Full elevation of arm :
120 GH joint + 60 Scapular Rotation
Internal rotation : only 60 humeral abduction
External rotation : 90 actively abducted
120 passively abducted

Composite Shoulder Girdle

Movement
Scapular Rotation
Coracoclavicular ligament prevents scapular rotation
in coronal plane
Scapula pivots about the acromioclavicular joint from :
Elevation of the sternoclavicular joint
10 arm elevation 4 clavicle elevation
At 90 arm elevation max 30 clavicle elevation

Rotation of the clavicle

45 clavicle external rotation the remaining 30 scapular
rotation

Composite Shoulder Girdle

Movement

Composite Shoulder Girdle

Movement
Elevation 30

Elevation of the sternoclavicular joint

10 arm elevation 4 clavicle elevation

Composite Shoulder Girdle

Movement
Elevation 90

Elevation of the sternoclavicular joint

10 arm elevation 4 clavicle elevation

Composite Shoulder Girdle

Movement
Elevation 180

Rotation of the clavicle

45 clavicle external rotation the remaining 30 scapular
rotation

PATHOMECHANICS
Serratus anterior paralysis
medial winging of
scapula (opening the book)

Trapezius paralysis
lateral winging of scapula
(sliding door)

Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume

Four of the Philippine Physical Therapy. U.S.T. Printing, 1978

PATHOMECHANICS
Deltoid paralysis

Steindler procedure
Surgical reconstruction,
transplant tendons and
muscles for subtitute of muscle
paralysis
Movements

Children

Adult

Abduction

70

60

Forward
Flexion

45

45

Internal
Rotation

20-25

20-25

Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume

Four of the Philippine Physical Therapy. U.S.T. Printing, 1978

Thoracic Outlet Syndrome

Neurovascular Compression Syndrome

TOS - Etiology

Thoracic Outlet Syndrome

1. Scalenus Anticus
and Cervical rib
syndrome
2. Costoclavicular
syndrome
3. Hyperabduction
syndrome

TOS - Scalenus Anticus and Cervical

Rib Syndrome

Compression of
subclavian vessel &
brachial plexus by
anterior scalene
Adsons manuver:
changes in radial
pulse when the neck
fully extended, chin
toward same side &
holding breath
Positive : Change in Radial Pulse

TOS Costoclavicular Syndrome

Compression in the
space between the
clavicle and the first
rib
Costoclavicular /
Military Test : pulling
the arm downwards,
patients take a deep
breath, while
monitoring radial
pulse
Positive : Change in Radial Pulse

TOS Hyperabduction Syndrome

Compression under
the insertion of the
Pectoralis minor in
the coracoid
process
Wright test :
hyperabduct the
shoulder, while
checking the radial
pulse
Positive : Change in Radial Pulse

TOS Nerve Conduction Velocity

Reduction in NCV to
less than 85 m/s of
either the ulnar or
median nerves
across the thoracic
outlet corroborates
the clinical diagnosis.
Positive : NCV < 85 m/s

TERIMA KASIH

Daftar Pustaka
Reyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume Four
of the Philippine Physical Therapy. U.S.T. Printing, 1978.
Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.
Davis Company. 2006