Shoulder girdle

Ahmed ramadan
SCJ
• Joint type:
 True Joint plane synovial, stability > mobility, slight movement ex: gliding
 articular cartilage the intervertebral discs is Fixed to the sternum in protractio
n & retraction (Fixed)
 move with the clavicle in elevation & depression (movable)

• arthrology:
 Articulated between two bone ends with intraarticular cartilage and synovial
fluid, plus ligaments and capsule.
 Clavicle connects upper limb to axial skeleton.
 Fixed to the sternum in protraction, retraction (Fixed).
 Moves with the clavicle in elevation & depression (movable).
SCJ
1.Articulation Surfaces:
1. Clavicle Surface: Convex vertically and concave horizontally.
2. Sternum Surface: Concave vertically and convex horizontally.

2.Movement Interactions:
1. Elevation/Depression:
1. The convex clavicular surface glides on the concave surface of the sternum.
2. Elevation results in the clavicle rolling superiorly, and the medial end gliding do
wnward.
3. Depression results in the clavicle rolling inferiorly, and the medial end gliding up
ward.
2. Protraction/Retraction:
1. The concave clavicular surface glides on the convex surface of the sternum.
2. Protraction involves anterior roll, and the medial end glides forward.
3. Retraction involves posterior roll, and the medial end glides backward.
SCJ
• It is the only joint that connects the axial skeleton.
• Its capsule is strong and tough.
• The joint has wide mobility.
• The clavicle is the only bone that connects the upper limb to the axial
skeleton.
SCJ
• Stability:
• Sternoclavicular Ligament:
• Anterior:
Prevent post translation of medial end of clavicle.
• Posterior:
Prevent ant translation of medial end of clavicle.
 Binder Clavicular Ligament
• Bridging between 2 clavicles
• Prevent inferior glide of clavicle
 Costoclavicular Ligament
• Clavicle and ribs connected
• The rib cage is mobile for respiration
• Prevent superior glide of clavicle
• Glide + translation
SCJ
• Degree of Freedom
1.Elevation & Depression
2.Protraction & Retraction
3.Anterior & Posterior Rotation
 SCJ
• Kinematics:
 osteokinematics: Elevation | arthrokinematics: inferior glide
(medial side)
 osteokinematics: depression | arthrokinematics: superior glide
(medial side)
 osteokinematics: protraction | arthrokinematics: anterior glide
(medial side)
 osteokinematics: retraction | arthrokinematics: posterior glide
(medial side)
 osteokinematics: ant rotation around long axis |
arthrokinematics: spinning
 osteokinematics: post rotation around long axis |
arthrokinematics: spinning
ACJ
• Type of joint:
 Plane synovial joint

• arthrology :
 Angle of Inclination: 16°-36°
• Weak capsule
• 2 bone ends: clavicle + acromion
• Interarticular cartilage
• Synovial fluid
ACJ
• Stability
 Ligaments
 Acromioclavicular Ligament:
 Superior (sup) + Inferior (inf)
 Prevents anterior and posterior translation of clavicle
 Superior Support of Joint:
 Superior acromioclavicular ligament
 Origin of deltoid
 Insertion of trapezius
 Prevents superior translation of humerus
 Coracoclavicular Ligament:
 Consist of Conoid & Trapezoid ligaments
 Prevents superior translation of clavicle
STJ
• Joint type:
 False joint, Because there is no true articulation between the scapula and
the thorax Plus all the movements or the scapula is caused by movements of
other joints (mainly SCJ and GHJ )

• arthrology :
 Angle of inclination 5-10 degrees
 Closed chain movement

• Degree of Freedom:
 Upward Rotation & Downward Rotation (ACJ)
 Elevation & Depression (SCJ)
 Protraction & Retraction (SCJ)
STJ
• Kinematics:
 1. Scapular Elevation
• Sternoclavicular Joint: The clavicle undergoes
superior roll and inferior glide.
• Acromioclavicular Joint: Minor adjustments
occur here, mainly involving a slight downward
glide to accommodate scapular movement.
 2. Scapular Depression
• Sternoclavicular Joint: The clavicle experiences
an inferior roll and superior glide.
• Acromioclavicular Joint: Slight upward glide
to allow full depression of the scapula.
STJ
• Kinematics:
 3. Scapular Protraction (Abduction)
• Sternoclavicular Joint: Anterior roll and
anterior glide of the clavicle.
• Acromioclavicular Joint: Internal rotation at the
AC joint, with a slight anterior glide to keep the
scapula flush with the rib cage.
 4. Scapular Retraction (Adduction)
• Sternoclavicular Joint: Posterior roll and
posterior glide of the clavicle.
• Acromioclavicular Joint: External rotation, with a
slight posterior glide to fine-tune scapular
alignment.
STJ
• Kinematics:
 5. Scapular Upward Rotation
• Sternoclavicular Joint: Posterior spin of the
clavicle and a superior glide.
• Acromioclavicular Joint: Upward rotation with
a small degree of inferior glide to fully allow
upward rotation of the scapula.
 6. Scapular Downward Rotation
• Sternoclavicular Joint: Anterior spin of the
clavicle with inferior glide.
• Acromioclavicular Joint: Downward rotation of
the scapula is facilitated with a minor superior
glide.
GHJ
• Type of joint:
 Plane synovial joint
• Arthrology:
 Articulation between the shallow glenoid fossa
and convex head of humorous
 Glenoid fossa: Retroversion = 7° |
Inclination = 5°
 Humeral Head: Retroversion = 30° |
Inclination = 130-150°
GHJ
• Stability:
 Static Stability: Against inferior translational gravity
• Passive Tension:
1. Capsule + Ligament + LabrumStability 20% ↑ depth
 Rotator Interval Capsule: 50%

I. Superior GH ligament
II. coracohumeral ligament
III. Superior capsule
2. Negative intra-capsular pressure
3. Scapulo-humeral positions:
*Glenoid fossa upward rotation*
 GHJ
 Static Stability with External Load:
Active assistance by Supraspinatus

 Dynamic Stability:
1.Friction Force + Joint Reaction Force
2.Deltoid -> Superior Translator
3.Rotator Cuff
1.Supraspinatus -> compression and superior tension
2.“the rest” -> compression and inferior tension
 Teres minor & infraspinatus -> external rotation
 subscapularis-> internal rotation -
> prevent greater tubercle from Subacromial arch.
4.Gravity
5.Long head Biceps -> Centralization of head of humerus into glenoid
 GHJ
• GH ligaments
 Superior CH ligament -> Taut in inferior + ant. Translation (external
rotation) at 0 abduction (when the arm at the side).
 Middle CH lig -> Resist ant. translation (External Rotation) from 0 -
> 60 Abduction
 Inferior:
 Anterior band -> 90 Abduction + extreme External Rotation
 Posterior band -> 90 Abduction + extreme Internal Rotation
 Axillary pouch -> 90 Abduction + Inferior Translation.

• coracohumeral ligament: limits flexion (90( and extension (40-60)

•
GHJ
• Kinematics
 Elevation (Abduction, Flexion)
 Scapulohumeral rhythm (2:1 Ratio)(starts after 30°) :
1. AC upward rotation + SC elevation (scapula upward rotation)
2. Retraction of clavicle
3. ER and posterior tilt of scapula
4. ER of clavicle
5. ER of humeral head
 Muscles
 Arthrokinematics
• Upward Rotators: Abduction 60-70°, Load on deltoid increases
• Rotator cuff: shrugging abduction 40°
 Extension + Adduction: LD + posterior deltoid + pec major + teres major
 Internal rotation: LD + pec major + teres major + ant. Deltoid + subscapularis
 External rotation: teres minor + infra + post. deltoid
pathology
• Shoulder subluxation
 Shoulder subluxation is a partial dislocation of the shoulder joint, where the
head of the humerus partially slips out of the glenoid downward
 Cause: supraspinatus weakness

• Impingement:
• Ex, Subacromial impingement and Painful arc syndrome
• Tendinitis
• Abnormal scapular position
• Rotator Cuff
• Abnormal Acromion
• Slouch position