anatomi dan kinesiologi shoulder part 2

8/16/2019 Anatomi Dan Kinesiologi Shoulder Part 2

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SHOULDER GIRDLE

Part 2


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


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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



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The Scapulothoracic Joint


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The Scapulothoracic JointTranslatory Rotatory

GLIDING MANNER

End Result : glenoid

fossa directed upwards or

downwards



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Shoulder Girdle

Motions


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Prime Movers :•Trapezius

•Serratus Anterior

Other muscles:

•Levator Scapulae

•Rhomboids major & minor

•Latissimus Dorsi

•Pectoralis major & minor

•Teres major



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Trapezius

Lippert Lynn S. Clinical Kinesiology and Anatomy, 4th ed. E.A.Davis Company. 2006


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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



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Serratus Anterior



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Combined Movement

Upper Trapezius

Lower Trapezius

Serratus Anterior

Elevation of the

Glenoid fossa



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Levator Scapulae

Rhomboids Minor &

Major



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Combined MovementLevator Scapulae

Rhomboids

Pectoralis Minor

Downward rotation of

the Glenoid fossa



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Latissimus dorsi


Reversal action important to patient with spinalcord injury at upper thoracic level ambulate

by hip-hiking


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Teres MajorPectoralis Major & Minor



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Scapulohumeral Rhythm


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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



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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 axisReyes, Tyrone M.; Reyes Ofelia B.Luna. Kinesiology Volume Four of the Philippine

Physical Therapy. U.S.T. Printing, 1978


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sternocleidomastoid

O sternum, clavicula

I mastoid process

A Acting alone, tilts head to its ownside 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.


Subclavius Muscle

O Inferior Clavicle

I 1st Rib

A Depressing clavicleRaising 1st rib as clavicle rise

Protect Subclavian vessels

during fractures of the clavicula

N Nerve to subclavius C5-6


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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)



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Composite Shoulder Girdle

MovementAbduction 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 abducted120° passively abducted


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MovementScapular 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


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Movement


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Movement

• Elevation of the sternoclavicular joint

– 10° arm elevation 4° clavicle elevation

Elevation 30°


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MovementElevation 90°

• Elevation of the sternoclavicular joint

–10

° arm elevation

4

° clavicle elevation


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MovementElevation 180°

Rotation of the clavicle

45° clavicle external rotation the remaining 30° scapular

rotation


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PATHOMECHANICS•

Serratus anterior paralysis medial winging of

scapula (opening the book)

•Trapezius paralysis

lateral winging of scapula

(sliding door)



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PATHOMECHANICS

Deltoid paralysis Steindler procedureSurgical reconstruction,

transplant tendons and

muscles for subtitute of muscle

paralysis

Movements Children Adult

Abduction 70° 60°

ForwardFlexion 45° 45

°

Internal

Rotation

20-25° 20-25°



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Thoracic Outlet Syndrome

• Neurovascular Compression Syndrome


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TOS - Etiology


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Thoracic Outlet Syndrome

1. Scalenus Anticus

and Cervical rib

syndrome

2. Costoclavicularsyndrome

3. Hyperabduction

syndrome


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TOS - Scalenus Anticus and Cervical

Rib Syndrome

• Compression of

subclavian vessel &

brachial plexus by

anterior scalene• Adson’s manuver :

changes in radial

pulse when the neck

fully extended, chintoward same side &

holding breathPositive : Change in Radial Pulse


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TOS – Costoclavicular Syndrome• Compression in the

space between theclavicle and the first

rib

• Costoclavicular /

Military Test : pullingthe arm downwards,

patients take a deep

breath, while

monitoring radial

pulse

Positive : Change in Radial Pulse


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TOS – Hyperabduction Syndrome

• Compression under

the insertion of the

Pectoralis minor in

the coracoidprocess

• Wright test :

hyperabduct the

shoulder, whilechecking the radial

pulse

Positive : Change in Radial Pulse


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TOS – Nerve Conduction Velocity

• Reduction in NCV to

less than 85 m/s of

either the ulnar or

median nervesacross the thoracic

outlet corroborates

the clinical diagnosis.

Positive : NCV < 85 m/s


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TERIMA KASIH


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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

anatomi dan kinesiologi shoulder part 2

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