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Kinesiological Concepts of the Upper Extremity

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Kinesiological Concepts of the Upper Extremity Powered By Docstoc
					Introduction
Types of Forces Generated by
Muscles at a joint
               Rotary
               Dislocating
               Stabilizing
Athrokinematics involved in
Motion
                  Roll
                      New points on one
                       surface come in
                       contact with new
                       points on the
                       opposite surface
                      Always occur in
                       same direction as
                       bone movement
                      When roll occurs
                       alone:
Athrokinematics involved in
Motion
                Roll
                Glide (Sliding)
                      One specific point
                       comes in contact
                       with new points on
                       opposing surface
                      Direction depends
                       on surface of joint
                  Combined roll and
                   glide movements
Athrokinematics involved in
Motion
                Roll
                Glide (Sliding)
                Spin
                Compression
                Distraction or
                 Traction
Convex Concave Rules
 MUST KNOW
 Convex Stationary + concave moving =
  gliding in same direction as angular
  motion
 Concave stationary = convex moving =
  gliding in opposite direction of angular
  motion
Concave-convex rule
Biomechanical Concepts of
the Shoulder Complex
Two Components in the
Shoulder Complex
 Shoulder Girdle
 Shoulder Joint
Shoulder Girdle Anatomical
Landmarks to Review
 Medial  and lateral scapular borders
 Inferior and superior scapular angles
 Supraspinatus, infraspinatus,
  subscapular and glenoid fossa
 Acromion process
 Coracoid process
Shoulder Girdle
 Articulations
   Scapulothoracic

   Sternoclavicular

   Acromioclavicular

   Glenohumeral
Scapulothoracic Articulation
                   Composed of:
                   Positions
                       30-40o to frontal plane
                       Anteriorly tipped 20-30o
                        from vertical
                   Motions
                       Elevation/depression
                       Protraction/retraction
                       Upward/downward
                        rotation
Scapular Muscles
Levator Scapulae
              O – Transverse
               processes of C1-C4
              I – Medial border of
               scapula between
               superior angle and
               root of spine of
               scapula
              N – Nerve root C3-5
             F
                    scapular elevation
                    retraction
Rhomboid Major
                O–
                     Major – T2-T5 spinous
                      processes
                     Minor – Ligamentum
                      nuchae, C7-T1 spinous
                      processes
                I–
                     Major – Medial border of
                      scapula between spine
                      and inferior angle
                     Minor – medial border at
                      root of spine of scapula
                N – Dorsal Scapular
Upper Trapezius
                 O–
                      Occiptal protuberance
                      Medial 1/3 of nuchal line
                      Upper part of ligamentum
                       nuchae
                      C7 spinous process
                 I–
                      Posterior border of lateral
                       1/3 of clavicle
                      Acromion process
                 N – spinal accessory
                 F–
                      Scapular elevation,
                       retraction
                      Rotation of head to opp.
                       Side
                      Lateral flexion of head to
                       opp. side
Middle Trapezius
                  O–
                       Inferior part of
                        ligamentum nuchea
                       T1-T5 spinous processes
                  I–
                       Medial margin of
                        acromion process
                       Superior lip of spine of
                        scapula
                  N – Spinal accessory
                  F–
                       Scapular retraction
Lower Trapezius
                O–
                     T6-T12 spinous
                      processes
                I–
                     Tubercle at apex of
                      root of spine of
                      scapula
             N – spinal accessory
             F–
                     Scapular depression,
                      retraction and upward
                      rotation
Serratus Anterior
                 O–
                      Outer surfaces and
                       superior border of ribs 1-8
                 I–
                      Ventral scapular surface on
                       medial border from
                       superior angle to inferior
                       angle
                 N–
                      Long Thoracic
                 F–
                      Scapular protraction,
                       upward rotation
                      Scapular depression (lower
                       fibers)
                      Scapular elevation (upper
                       fibers
Pectoralis Minor
                 O–
                      Superior margins and outer
                       surface ribs 3-5 near
                       cartilages
                      Fascia overlying
                       corresponding intercostal
                       muscles
                 I–
                      Medial border, superior
                       surface of coracoid process
                 N–
                      Medial Pectoral
                 F–
                      Scapular depression,
                       downward rotation,
                       protraction
Sternoclavicular Joint
                 Clavicle articulates
                  with manubrium and
                  cartilage of first rib
                 SC Articular Disk
                 Ligaments
                       Anterior and posterior
                        sternoclavicular
                       Interclavicular
                       Costoclavicular
                       Site for most
                        movements of the
                        clavicle
Sternoclavicular Joint
                   Motions
                   Elevation/Depression
                       Occurs around an
                        anterior/posterior axis
                       Arthrokinematics
                   Protraction/Retraction
                       Occurs around vertical axis
                       Arthrokinematics
                   Anterior-posterior Rotation
                    of Clavicle
                       Occurs around longutidinal
                        axis
                       Only posterior direction
Acromioclavicular Joint
                Acromion process
                 and distal end of the
                 clavicle
                Angle of Inclination
                AC Articular Disk
                Ligaments
                      Superior and Inferior
                       Acromioclavicular
                      Coracoclavicular
                           Trapezoid
                           Conoid parts
Acromioclavicular Ligament
                  Coracoclavicular
                   Ligament Functions
                      Prevent upward
                       rotation of scapula at
                       AC joint
                      Transferring medially
                       directed forces
Acromioclavicular Joint Motions
                    Medial/Lateral
                     Rotation of Scapula
                        Vertical axis via AC
                         joint
                        Bring glenoid fossa
                         anterior or posterior
                    Anterior/Posterior
                     Tipping
                        Elevation = anterior
                        Depression = posterior
Glenohumeral Joint
 Anatomical   Landmarks for Review
   Humeral   Head
   Lesser and Greater Tuberosity

   Bicipital Groove

   Deltoid Tuberosity
Glenohumeral Joint
                 Articulating Surfaces
                     Glenoid Fossa
                     Humeral Head
                          Angle of Inclination
                          Angle of Torsion
Glenohumeral Joint
                 Glenoid Labrum
                     Wedged shaped
                     Enhanced articular
                      surface
                     Loosely attached
                      superiorly
                     Firmly attached
                      inferiorly
Glenohumeral Joint
                  Capsular Ligament
                      Slack anteriorly and
                       inferiorly
                      Tight superiorly
                      Why loose?
Glenohumeral Joint
                 Glenohumeral
                  Ligament
                     Superior, middle &
                      inferior
                     Foramen of
                      Weitbrecht
                     Superior
                          Origin & insertion
                          Rotator interval
                           capsule
                          Stability
Glenohumeral Joint
                 Glenohumeral
                  Ligament
                     Superior, middle &
                      inferior
                     Foramen of
                      Weitbrecht
                     Inferior
                          Origin & insertion
                          Anterior & posterior
                           band
                          Axillary pouch
                          Stability
Glenohumeral Joint
                 Coracohumeral
                  Ligament
                     Origin & insertion
                     Function
Glenohumeral Joint
   Bursae
       Subacromial Bursa
       Subdeltoid Bursa
Glenohumeral Joint
                 Coracoacromial
                  Arch
                     Coracoacromial
                      ligament
                     Osteoligamentous
                      vault
                          Subacromial bursa
                          Supraspinatus tendon
                          Biceps brachii long
                           head
                     Function
Glenohumeral Joint Muscles
                 Flexors Prime Movers
                   Deltoid
                          anterior fibers
                     Coracobrachialis
                     Biceps brachii
                          long head
                     Pectoralis major
                          clavicular head
Glenohumeral Joint Muscles
                 Flexors Prime Movers
                   Deltoid
                          anterior fibers
                     Coracobrachialis
                     Biceps brachii
                          long head
                     Pectoralis major
                          clavicular head
Glenohumeral Joint Muscles
                 Prime Mover -- Flexors
                    Deltoid
                          anterior fibers
                     Coracobrachialis
                     Biceps brachii
                          long head
                     Pectoralis major
                          clavicular head
Glenohumeral Joint Muscles
                 Prime Mover -- Flexors
                    Deltoid
                          anterior fibers
                     Coracobrachialis
                     Biceps brachii
                          long head
                     Pectoralis major
                          clavicular head
Glenohumeral Joint Muscles
                 Extension Prime
                  Movers
                     Latissimus dorsi
                     Teres major
                     Triceps brachii
                          long head
                     Deltoid
                          posterior fibers
Glenohumeral Joint Muscles
                 Extension Prime
                  Movers
                     Latissimus dorsi
                     Teres major
                     Triceps brachii
                          long head
                     Deltoid
                          posterior fibers
Glenohumeral Joint Muscles
                 Extension Prime
                  Movers
                     Latissimus dorsi
                     Teres major
                     Triceps brachii
                          long head
                     Deltoid
                          posterior fibers
Glenohumeral Joint Muscles
                 Extension Prime
                  Movers
                     Latissimus dorsi
                     Teres major
                     Triceps brachii
                          long head
                     Deltoid
                          posterior fibers
Glenohumeral Joint Muscles
                 Abduction Prime
                  Movers
                     Deltoid
                     Supraspinatus
                     Biceps brachii
                          long head
Glenohumeral Joint Muscles
                 Abduction Prime
                  Movers
                     Deltoid
                     Supraspinatus
                     Biceps brachii
                          long head
Glenohumeral Joint Muscles
                 Abduction Prime
                  Movers
                     Deltoid
                     Supraspinatus
                     Biceps brachii
                          long head
Glenohumeral Joint Muscles
                 Adduction Prime
                  Movers
                     Pectoralis major
                     Latissmus dorsi
                     Teres major
                     Triceps brachii
                          long head
                     Deltoid
                          posterior fibers
Glenohumeral Joint Muscles
                 External Rotation
                  Prime Movers
                     Infraspinatus
                     Teres minor
                     Deltoid
                          posterior fibers
Glenohumeral Joint Muscles
                 Internal Rotation
                  Prime Movers
                     Subscapularis
                     Teres major
                     Pectoralis major
                     Latissimus dorsi
                     Deltoid
                          anterior fibers
Glenohumeral Osteokinematics
                  Flexion = 120
                  Extension = 50
                  IR/ER
                      Arm at side
                           IR = 55
                           ER = 45-50
                      90 ABD/90 elbow flexion
                           Combined = 180
                  ABD
                      IR = 60 deg
                      Neutral = 90
                      ER = 90-120
Glenohumeral Arthrokinematics
                 Roll
                 Glide
                 Ex. Abduction
                       Superior roll
                       Inferior glide
Static Stabilization of Dependent
Arm
                    Humeral head resting in
                     fossa
                    Gravity pulls humerus
                     down
                    Muscle activity
                     prevents?
                    Rotator interval capsule
                    Supraspinatus
Dynamic Stabilization of GH Joint
                   Deltoid and GH
                    Stabilization
                       Small rotary force
                       Superior translation
                       Coracoacromial arch
                       Offsetting force
                            Infraspinatus
                            Teres minor
                            subscapularis
Dynamic Stabilization of GH Joint
                    Rotator Cuff & GH
                     Stabilization
                        All have lines that
                         stabilize joint
                        Inferior pull against
                         deltoid
                        External Rotation for
                         full ABD
Dynamic Stabilization of GH Joint
                    Supraspinatus and
                     GH Stabilization
                        No use in offsetting
                         deltoid
                        Strong stabilizer
                        Rotary force enough
                         to cause ABD
                        Gravity and steering
                         humeral head
Dynamic Stabilization of GH Joint
                    Long Head of the
                     Biceps and GH
                     Stabilization
                        Traverses
                        Can contribute to
                         flexion
                        Stabilization
Integrated Function of the
Shoulder Complex
                    Scapulothoracic and
                     GH Contributions
                        Scapula upward rotation
                             60 degree arc
                        GH by itself
                             Abduction = 90-120
                             Flexion = 120
                        Combination = ~180
                        Scapulohumeral Rhythm
                             1st 60o of flexion or 1st
                              30o of ABD
                                   1:1 ratio
                             After
                                   2:1 ratio
Integrated Function of the
Shoulder Complex
                  SC and AC Contributions
                      Phase I (1st 30o of scapula
                       rotation)
                           Upper Trap
                           Lower Trap & Lower
                            Serratus Anterior
                           Coracoclavicular Ligament
                           SC Joint
                           Elevation of Clavicle
                                 Costoclavicular Lig
                           Concurrent clavicle
                            elevation and SC rotation
                      = 90-100o ABD
Integrated Function of the
Shoulder Complex
                  SC and AC Contributions
                      Phase II (2nd 30o of
                       scapula rotation)
                           Continued upward force by
                            trap and serratus
                           Restrained by CC ligament
                           Tension build in CC
                            ligament
                           Pulls posteroinferior clavicle
                           Result = posterior rotation
                                 = 30-55o
                      = 2nd 30o of scapular
                       rotation

				
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posted:12/11/2012
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