Biomechanics of Shoulder

Complex.

Dr. Faryal Zaidi

MSPT(KMU), BSPT(UHS), T-dpt*(KMU)

1
OBJECTIVES
At the end of this lecture students should be able to:
Define different terms of biomechanics
Identify different structures in shoulder complex
Explain kinetics and kinematics of shoulder joint
Describe different pathologies of shoulder complex

2
What is biomechanics? 3
Biomechanics

4
Biomechanics
The term biomechanics combines the prefix
bio, meaning life, with the field of
mechanics, which is the study of the actions of
forces, (both internal muscle forces and
external forces.) In biomechanics we analyze
the mechanical aspects of living organisms.

5
6
Why study biomechanics?

7
Subdivisions
statics: study of systems in constant motion,
(including zero motion)
dynamics: study of systems subject to
acceleration
kinematics: study of the appearance or
description of motion
kinetics: study of the actions of forces (Force
can be thought of as a push or pull acting on a
body.)
8
kinematics

What we visually observe of a body in motion

is called the kinematics of the movement.
Kinematics is the study of the size,
sequencing, and timing of movement, without
regard for the forces that cause or result from
the motion. The kinematics of an exercise or a
sport skill is known, more commonly, as form
or technique.

9
kinematics

10
Kinetics
Kinetics is the study of forces, including
internal forces (muscle forces) and external
forces (the forces of gravity).

11
Kinetics

12
Biomechanics VS kinesiology???
13
Shoulder complex

14
15
16
OSTEOLOGY

17
18
19
20
SHOULDER COMPLEX

Five Functional Joints

1. Glenohumeral Joint
2. Subacromial
3. Scapulothroasic
4. Acromioclavicular
5. Sternoclavicular

21
22
SC JOINT
Clavicle articulates with manubrium of the sternum
Weak bony structure but held by strong ligaments
Fibrocartilaginous disk between articulating
surfaces
Shock absorber and helps prevent displacement
forward
Clavicle permitted to move up and down, forward and
backward and in rotation
Clavicle must elevate 40 degrees to allow upward
rotation of scapula and thus shoulder abduction

23
SC JOINT
The only attachment of the upper extremity to axial
skeleton
Plane synovial joint with degree of freedom 6, having
joint capsule, joint disk and three major ligaments
Movement of the SC joint produces scapular
movements, if it is fused the equal amount of
movement will occur at AC joint

24
25
LIGAMENTS OF SC JOINT
LIGAMENTS:
Interclavicular Lig.
Costoclavicular Lig.
Posterior Ligament
Sternoclavicular

26
27
MOVEMENTS OF SC JOINT
Movements in horizontal plane:
Protraction (30 degree)
limited by costoclavicular and
post. capsule
Retraction (30 degree) limited
by costoclavicular and ant.
capsule

28
MOVEMENTS OF SC JOINT
Elevation (48 degree)
limited by costoclavicular
Depression (less than15 degree)
limited by first rib

Axial Rotation
Ant. Rot. (very limited 10 degree)
Post. Rot. (50 degree)

29
30
Axial rotation

31
AC JOINT
Lateral end of clavicle with
acromion process of scapula
Weak joint and susceptible
to sprain and separation
Joint capsule n two major
ligaments and disk present
or absent

32
AC JOINT
LIGAMENTS:
Coracoclavicular
Medial: Conoid
Lateral: Trapezoid
Acromioclavicular
Superior
Inferior
Coracoacromial:
Coracoids process to acromiom
process

Closed packed position is

when the humerus is abducted to
90 degree. 33
MOVEMENTS OF AC JOINT
Internal and external rotation
Bringing the glenoid fossa of the scapula
anteromedially and posterolaterally, respectively
Anterior and posterior tiping or tilting
Ant. - acromion tipping forward and the inferior
angle tipping backward
Post. - rotate the acromion backward and the
inferior angle forward.
Upward and downward rotation
Upward rotation tilts the glenoid fossa upward and
downward rotation is the opposite motion.
34
Internal/external rotation

35
Anterior/posterior tipping

36
Upward/downward rotation

37
CORACOACROMIAL ARCH
Arch over the GH joint formed by Coracoacromial
arch,acromion and coracoid process
Sub acromial space: area in between CA arch and
humeral head
Supraspinatus tendon, long head biceps tendon, and
sub acromial bursa
Subject to irritation and inflammation as a result of
excessive humeral head translation or impingement from
repeated overhead activity

38
SUBACROMIAL SPACE

39
Structures Within Suprahumeral Space

1. Long head of biceps

2. Superior capsule
3. Supraspinatus tendon
4. Upper margins of
subscapularis &
infraspinatus tendons
5. Subacromial bursa
6. Inferior surface of
the A-C joint
40
SUBACROMIAL SPACE

Clinical Relevance
Avoidance of impingement during elevation of
the arm requires
External rotation of humerus to clear greater
tuberosity
Upward rotation of scapula to elevate lateral end of
acromiom

41
SUBACROMIAL SPACE

Primary Impingement
Structural stenosis of subacromial space
Secondary Impingement
Functional stenosis of subacromial space due
to abnormal arthrokinematics

42
Glenohumeral Joint
Ball and socket, synovial joint in which round head of humerus
articulates with shallow glenoid fossa of scapula
stabilized slightly by fibrocartilaginous rim called the Glenoid Labrum
Humeral head larger than glenoid fossa
At any point during elevation of shoulder only 25 to 30% of humeral
head is in contact with glenoid Statically
stabilized by labrum and capsular ligaments Dynamically
stabilized by deltoid and rotator cuff muscles
Three degrees of freedom
Stability provided by
Passive restraints
Active restraints

43
44
GH ARTICULATING SURFACES

45
Glenoid Labrum
When the arms hang dependently at the side, the two articular
surfaces of the GH joint have little contact. The majority of the time,
the inferior surface of the humeral head rests on only a small inferior
portion of the fossa. The total available articular
surface of the glenoid fossa is enhanced by an accessory structure,
the glenoid labrum. This structure surrounds and is attached to the
periphery of the glenoid fossa enhancing the depth or curvature of
the fossa by approximately 50%.
the labrum was traditionally thought to be synoviumlined
fibrocartilage, more recently it has been proposed that it is actually a
redundant fold of dense fibrous connective tissue with little
fibrocartilage other than at the attachment of the labrum to the
periphery of the fossa.
The labrum superiorly is loosely attached, whereas the inferior
portion is firmly attached and relatively immobile.The glenoid labrum
also serves as the attachment site for the glenohumeral ligaments and
46
the tendon of the long head of the biceps brachii.
GH CAPSULE
The entire GH joint is surrounded by a large, loose capsule that is
taut superiorly and slack anteriorly and inferiorly in the resting
position (arm dependent at the side).The capsular surface area is
twice that of the humeral head.39 More than 2.5 cm of distraction of
the head from the glenoid fossa is allowed in the loose-packed
position.
The relative laxity of the GH capsule is necessary for the large
excursion of joint surfaces but provides little stability without the
reinforcement of ligaments and muscles. When the humerus is
abducted and laterally rotated on the glenoid fossa, the capsule
twists on itself and tightens, making abduction and lateral rotation
the close-packed position for the GH joint

47
48
GH LIGAMENTS
SGHL
MGHL
IGHL
Anterior band
Posterior band
Axillary band

49
50
 Restraints to External Rotation
Dependent on arm position
0 - SGHL, C-H & subscapular
45 - SGHL & MGHL
90 - anterior band IGHLC

51
 Restraints to Internal Rotation
Dependent on arm position
0 - posterior band of IGHLC
45 - anterior & posterior band of IGHLC
90 - anterior & posterior band of IGHLC

52
53
 Restraints to Inferior Translation
Dependent on arm position
0 - SGHL, C-H
90 - IGHLC

54
Glenohumeral Motion

Scapular Plane:
Flexion/extension - 120
Abduction/adduction - 120
External/internal rotation
Horizontal abduction/adduction

55
Arthrokinematics of the GH Joint

56
CONVEX-CONCAVE RULE

57
DOWNWARD GLIDE

58
Scapulo thoracic (ST) Joint

Not a true joint, but movement of scapula on thoracic

cage is critical to joint motion

Scapula capable of upward/downward rotation,

external/internal rotation & anterior/posterior tipping

In addition to rotating other motions include scapular

elevation and depression & protraction (abduction) and
retraction (adduction)

59
ST Joint

During humeral elevation (flexion, abduction

and scaption) scapula and humerus must move
in synchronous fashion
Often termed scapulohumeral rhythm
Total range 180: 120 @ GH joint, 60 of scapular
moments
Ratio of 2:1, degrees of GH movement to scapular
movement after 30 degrees of abduction and 45 to 6
degrees of flexion
Maintain joint congruency
Length-tension relationship for numerous muscles
Adequate subacromial space

60
Scapulo humeral rhythm

During humeral elevation

Scapula upwardly rotates
Posteriorly tips
Externally rotates
Elevates
& Retracts
Alterations in these movement patterns
can cause a variety of shoulder
conditions
61
MOVEMENTS OF THE SCAPULA
Upward/Downward Rotation

62