Ch. 4 Shoulder Girdle

To accomplish some of the shoulder girdle movements, the scapula MUST _______ or _____ __ ___ _____.

- To accomplish some of the aforementioned movements, the scapula MUST rotate or tilt on its axis. - The shoulder girdles' movements are NOT primary movements of the scapula but they are necessary for the scapula to move normally through them.

The scapula moves __________ the rib cage as a consequence of ____________ motion occurring at the __________________ ____________.

Joints: Scapula and Ribcage: 1. The scapula moves on the rib cage as a consequence of joint motion occurring at the sternoclavicular joint and to a much lesser extent at the acromioclavicular joint.

1. The origin of the levator scapula is the ___________ processes of _______-_______. 2. The insertion of the levator scapula is the ____________ ____________ of the ____________ from the __________________ to the __________________.

Levator Scapula: Origin and Insertion 1. Origin: Transverse processes of C1-C4. 2. Insertion: Medial border of the scapula from superior angle to the scapular spine.

Movements such as throwing a baseball, punching in boxing, and tackling in football draw the scapula ___________________________, using the __________________.

Movements such as throwing a baseball, punching in boxing, and tackling in football draw the scapula forward with a slight upward rotation, using the serratus anterior.

1. The origin of the pectoralis minor is the ________ surfaces of the __-__ ribs. 2. The insertion of the pectoralis minor ________ ________ of the ________. 3. The actions of the pectoralis minor are to a. __tract the scapula, b. _________ the scapula, c. ___________ rotate the scapula, d. assist to what?

Pectoralis Minor: Origin, Insertion, Action 1. Origin: Anterior surfaces of the 3rd-5th ribs 2. Insertion: Coracoid process of the scapula (shown in the image) 3. Action: -1. Protract the scapula (aBduction) -2. Depress the scapula -3. Downwardly rotate the scapula -4. (W/ scapula fixed): assist to elevate the thorax during forced inhalation

1. Stretching of the __________________ can be done using the same stretch of the serratus anterior. 2. In what area of the body is thoracic spine located?

Pectoralis Minor: Stretching - Stretch: the pectoralis minor is often tight and may lead to forward and rounded shoulders. Stretching can be accomplished with a wall push-up in the corner as used for stretching the serratus anterior. Additionally, lying supine with a rolled towel directly under the thoracic spine while a partner pushes each scapula into REtraction (adduction).

What is the SAID principle?

SAID principle: Specific Adaptation to Imposed Demands.

Scapular winging most commonly affects which muscle?

Scapular Winging is relatively rare; it most commonly affects the serratus anterior leading to the medial borders of the scapula protruding from the back like wings when pushing the arm forward or raising the arm.

1. The scapulothoracic is NOT a true ________ joint? 2. The scapula can be described as having _______° degrees of upward-downward rotation. 3. Scapulothoracic LACKS _______________ support since it has _____ ___________ features and is supported _______________ by its _______________.

Scapulothoracic Joint: 1. This joint is NOT a true synovial joint. - Its movement is totally dependent on the sternoclavicular AND acromioclavicular joints. 2. The scapula can be described as having a total range of: - 25° degree abduction-adduction movement 2. 60° degree upward-downward rotation c. 55° degree elevation-depression. 3. Scapulothoracic LACKS ligamentous support since it has NO synovial features and is supported dynamically by its muscles. 4. There is not a typical articulation between the anterior scapula and posterior rib cage; the serratus anterior muscle which runs just behind the rib cage posteriorly inserts on the medial border of the scapula. --> Immediately posterior to the serratus anterior is the subscapularis muscle on the anterior scapula.

Serratus anterior and ___________ are antagonists.

Serratus anterior and rhomboids are antagonists.

1. The sternoclavicular joint is a ___axial joint. 2. In relation to the __________ , the clavicle moves ___ degrees with protraction and moves ___ degrees with retraction. 3. The costoclavicular and interclavicular ligament provide stability against _________ displacement.

Sternoclavicular (SC) Joint: 1. It is classified as a multiaxial; arthrodial joint although some classify it as a sellar joint. 2. In relation to the manubrium, the clavicle moves 15 degrees with protraction and moves 15 degrees with retraction. 3. Some rotation at the clavicle results in slight rotary gliding movement at the sternoclavicular joint. 4. The costoclavicular and interclavicular ligament provide stability against superior displacement.

Movement of the shoulder girdle is not dependent on ___________________________.

Synergy with the Muscles of the Glenohumeral Joint: 1. The shoulder joint and the shoulder girdle work together in carrying out upper-extremity activities. - Movement of the shoulder girdle is NOT dependent on the shoulder joint. 2. However, the muscles of the shoulder girdle are essential in providing a scapula-stabilizing effect, so the muscles of the shoulder joint can have a stable base.

What is the bony process on the scapula that extends laterally over the glenohumeral joint?

The acromion process is the bony process on the scapula that extends laterally over the glenohumeral joint.

Which joint is rare, anomalous, and occasionally found between the coracoid process of scapula and the conoid tubercle of clavicle.

The coracoclavicular joint is the rare anomalous joint occasionally found between the coracoid process of scapula and the conoid tubercle of clavicle.

What is the short projection from the shoulder blade to which part of the biceps is attached?

The coracoid process is the short projection from the shoulder blade to which part of the biceps is attached?

What is the point of reference for the scapula?

The inferior angle of the scapula.

The main purpose of the scapula is ____________.

The main purpose of the scapula is stabilization.

The manubrium is the broad upper part of the ________ , with which the clavicle and _____ ribs articulate.

The manubrium is the broad upper part of the sternum, with which the clavicle and first ribs articulate.

The shoulder has great ________ and poor ________ and the hip has poor ________ and great ________.

The shoulder has great mobility and poor stability and the hip has poor mobility and great stability.

Rotating the head and neck to the left side uses which two shoulder girdle muscles?

We use use the left levator scapulae and the right upper traps.

What are the rotator cuff muscles?

1. Subscapularis 2. Supraspinatus 3. Infraspinatus 4. Teres Minor

Acromioclavicular (AC) Joint: 1. This joint is classified as what kind of synovial joint? 2. Which joint functions through its ligaments to greatly increase the stability of the acromioclavicular joint. 3. The AC joint has a 20° to 30° degree total __________ and __________ motion accompanying other shoulder girdle and shoulder joint movements. 4. The AC joint is ____________ injured.

Acromioclavicular (AC) Joint: 1. The AC joint is classified as an arthrodial joint. 2. The coracoclavicular joint functions through its ligaments to greatly increase the stability of the acromioclavicular. 3. It has a 20° to 30° degree total gliding and rotational motion accompanying other shoulder girdle and shoulder joint movements. - In addition to the strong support provided by the coracoclavicular ligaments: - Conoid and - Trapezoid 4. The superior and inferior acromioclavicular ligaments provide stability to this often-injured joint.

Axial Skeleton and Upper Extremity Attachment: 1. The ONLY attachment of the upper extremity to the axial skeleton is via the _________ and its attachment through the ___________. 2. What does the axial skeleton consist of?

Axial Skeleton and Upper Extremity Attachment: 1. The ONLY attachment of the upper extremity to the axial skeleton is via the scapula and its attachment through the clavicle at the sternoclavicular joint. 2. The axial skeleton consists of the skull, vertebral column, ribcage, and sternum.

1. What are the two ligaments of the coracoclavicular joint? 2. The conoid and trapezoid are major stabilizers of the _____________________ ( ______ ) joint.

Coracoclavicular Joint Ligaments: 1. Conoid i. Proximal: Superior aspect of base of coracoid process ii. Distal: Conoid tubercle on inferior surface of distal clavicle. iii. Function: Postero-Medial coracoclavicular ligament, cone shaped, and major stabilizer of AC joint. Limits anterior displacement of scapula. 2. Trapezoid: i. Proximal: Superior aspect of coracoid process (no base). ii. Distal: Inferior surface of trapezoid line of the distal clavicle. iii. Function: Antero-Lateral coracoclavicular ligament, sheet-like appearance, and major stabilizer of AC joint. Limits posterior displacement of scapula.

In doing dips, the serratus anterior is a _____-class lever.

Doing dips, the serratus anterior is a first-class lever; The serratus anterior attaches at the medial border of the spine of scapula and the axis is the scapulothoracic which is in front of the insertion and the the resistance is at the elbow/hand, making it F-A-R (first-class lever) the axis closer to the force making it more speed and range of motion.

Point to where on the body the coracoid process would be.

Image of where the coracoid process would be on the body.

With ___________________________, we don't need to strengthen, we need to stabilize. The glenohumeral is moving so you have to ____________ the ___________________________; for years, the glenohumeral joint was being stabilized but it doesn't work because the glenohumeral joint was designed to "move," getting a stable __________________ joint gives you a more powerful glenohumeral.

Impingement Syndrome: With impingement syndrome, we don't need to strengthen, we need to stabilize: the scapula is moving so you have to stabilize the scapulothoracic; for years, the glenohumeral joint was being stabilized but it doesn't work because the glenohumeral joint was designed to "move," getting a stable scapulothoracic joint gives you a more powerful glenohumeral.

The actions of the levator scapula are: 1. ________ the ______ ______ of the ________ 2. ______ ___________ rotation of the scapula 3. ______ a_ _uction 4. ... 5. ...

Levator Scapula: Actions 1. Elevate the medial border of the scapula 2. Weak downward rotation the scapula 3. Weak aDDuction (retraction) 4. Rotate head and neck to same side 5. Extend the head and neck (bilaterally)

1. The levator scapula is applied when ___________________________. 2. Fixation of the scapula by the _________ __________ allows the levator scapula bilaterally ___________________________ or unilaterally ___________________________. 3. Levator scapula is best stretched by rotating the head approximately _______° degrees to the ________ side.

Levator Scapula: Palpation, Application, Strengthening, and Flexibility - Very common site for tightness and tenderness - Palpation: Difficult to palpate due to being deep to trapezius; best palpated at insertion just medial to the superior angle of scapula, particularly during slight elevation. - Application: Shrugging the shoulders. Fixation of the scapula by the pectoralis minor allows the levator scapula bilaterally to extend the neck or unilaterally flex the neck. --> Unilateral contraction produces lateral flexion of the neck on the same side and lateral rotation of the head to the opposite side. - Stretch: Levator scapula is best stretched by rotating the head approximately 45° degrees contralaterally (opposite side) and flexing the cervical neck actively while maintaining the scapula in a relatively depressed position.

Ligaments of the Acromioclavicular (AC) Joint: 1. The superior AC ligament and inferior AC ligament function as a __________ ligament. 2. The superior AC ligament and inferior AC ligament provides ___________ stability to the AC joint.

Ligaments of the Acromioclavicular (AC) Joint: 1. Superior AC ligament: a. Proximal: Superior aspect of distal end of clavicle. b. Distal: Superior surface of acromion process of scapula. c. Function: functions (alongside inferior AC ligament) as a capsular ligament that surrounds the AC joint, provides horizontal stability to the AC joint. 2. Inferior AC ligament: a. Proximal: Inferior aspect of the distal end of the clavicle. b. Distal: Inferior surface of acromion process of scapula. c. Function: functions (alongside superior AC ligament) as a capsular ligament that surrounds the AC joint, provides horizontal stability to the AC joint.

1. What are the four ligaments of the sternoclavicular (SC) joint? 2. Which SC ligament provides stability anteriorly? 3. The _________________ ligament helps to limit excessive shoulder elevation. 4. The _______________ ligament helps resist excessive shoulder depression.

Ligaments of the Sternoclavicular Joint: 1. Anterior sternoclavicular ligament: - a. Proximal: Anteriorly on Supero-Lateral border of the manubrium of the sternum. - b. Distal: Anterior and Superior aspect of proximal clavicle - c. Function: reinforce SC joint anteriorly and assist in prevention of anterior dislocation/subluxation. 2. Posterior sternoclavicular ligament: - a. Proximal: Posterior on Supero-Lateral border of the manubrium of the sternum - b. Distal: Posterior and superior aspect of proximal clavicle - c. Function: reinforces SC joint posteriorly and assist in preventing posteriordislocation/subluxation 3. Costoclavicular ligament: - a. Proximal: Superior aspect of first costal cartilage. - b. Distal: Inferior aspect of proximal clavicle. - c. Function: resist Superior displacement of the proximal end of the clavicle and (3.) limit excessive shoulder elevation. 4. Interclavicular ligament: - a. Proximal: Superior aspect of proximal clavicle via the superior margin of manubrium to superior aspect of contra-lateral (opposite) proximal clavicle. - b. Distal: the same as proximal attachment - c. Function: Resist downward glide of proximal clavicle and excessive depression of shoulder girdle.

1. The pectoralis minor can be palpated under the ___________ _______ and just ________ to the coracoid process during resisted _____________. 2. The pectoralis minor is a synergist with the _________ ________ in true ___traction without ________. 3. In most exercises, the pectoralis minor is used in _________(ing) and ________ the scapula _________ from a __________ rotated position.

Pectoralis Minor: Palpation, Application, and Strengthening - Palpation: Difficult to palpate, but can be palpated under the pectoralis major and just inferior to the coracoid process during resisted depression (resisted depression exercise pictured). This may be enhanced by placing the subject's hand behind their back and having them actively lift the hand away, which causes downward rotation. - Application: the pectoralis minor is used, alongside the serratus anterior in TRUE protraction (aBduction) withOUT rotation. This is seen in pushup in which abduction of the scapula is necessary. The serratus anterior draws the scapula forward with a tendency to upward rotate, but the pectoralis minor pulls forward with a tendency to downward rotate counteracting the rotation. Serratus anterior and pectoralis minor are synergists and will be seen working together in most movements of pushing with the hands. - Strengthening: the pectoralis minor is most used in depressing and rotating the scapula DOWNward from a upward rotated position, as in pushing the body up during dips/dip bars.

1. What are the three posterior muscles of the shoulder girdle? 2. The three actions of the rhomboids are to a( _ _ )uct, ________ , and __________ rotate the scapula. 3. What is the origin of the levator scapula?

Posterior (1of2): 1. Rhomboids, Levator Scapula, and Trapezius. - Rhomboids: a. Origin: Spinous processes of C7-T5 b. Insertion: Medial border of scapula between inferior angle and spine of scapula. c. Action: ADDuct, elevate, and downwardly rotate the scapula. - Levator Scapulae: a. Origin: Transverse process of C1-C4. b. Insertion: Medial border of scapula from superior angle to spine of scapula (notice the angle variation from rhomboid) c. Action: Elevation, weak downward rotate and retraction (adduction) of scapula.

1. One of the actions of the trapezius upper fibers is to ________ the ________ and ________. 2. The origin for the trapezius middle fibers is the _________ _________ of ______-______. 3. All 3 fibers of the trapezius do __________________ of the scapula.

Posterior (2of2): Trapezius upper fibers: - a. Origin: Base of skull, external occipital protuberance, and posterior ligaments of neck - b. Insertion: posterior aspect of the lateral 1/3 of the clavicle - c. Action: Extend the head and neck; rotate the head and neck to the opposite side; elevate and upwardly rotate the scapula. Trapezius middle fibers: - a. Origin: Spinous process of C7-T3 - b. Insertion: Medial border of acromion process and superior border of the spine of scapula. - c. Action: Adduction, Upward rotation, and Elevation of the scapula. Trapezius lower fibers: - a. Origin: Spinous process of T4-T12 - b. Insertion: Triangular space at the base of the scapular spine - c. Action: Depress, adduct, and upwardly rotate the scapula. 3. All 3 fibers of the trapezius do upward rotation of the scapula.

1. The five muscles primarily involved in shoulder girdle movement are: - __________________ - __________________ - __________________ - __________________ (muscle connecting the scapula to the spine) - __________________ 2. All five muscles have their origin on the __________________ and their insertion on the ____________ or ____________. 3. The muscles of the shoulder girdle do NOT attach to the ____________ , nor do they cause action at the ____________ joint. 4. Which muscles are located posterior to the trunk and spine?

Primary Muscles of Shoulder Girdle Movements: - There are five muscles primarily involved in shoulder girdle movements: 1. Pectoralis minor 2. Serratus anterior 3. Trapezius 4. Rhomboid (muscle connecting the scapula to the spine). 5. Levator scapulae. -> Subclavius is also involved but is not a primary mover. - ALL five muscles have their origin on the axial skeleton and their insertion on the scapula or clavicle. 1. The muscles of the shoulder girdle do NOT attach to the humerus, nor do they cause action at the shoulder joint. 2. The pectoralis minor and subclavius are located anteriorly in relation to the trunk. 3. The serratus anterior is located anteriorly to the scapula, BUT posterior and lateral to the trunk. 4. The trapezius, rhomboid, and levator scapula are located posterior to the trunk and cervical spine.

Primary Shoulder Girdle Bones: 1. The scapula's and clavicles only bony link to the axial skeleton is provided by what joint? 2. Read through the key bony landmarks for the shoulder girdle.

Primary Shoulder Girdle Bones: - The scapula's and clavicles only bony link to the axial skeleton is provided by the sternoclavicular joint. -> The key bony landmarks for the shoulder girdle are: 1. Manubrium 2. Clavicle 3. Coracoid process 4. Acromion process 5. Glenoid fossa: 6. Lateral border of scapula 7. Inferior angle of scapula 8. Medial border of scapula 9. Superior angle of scapula 10. Spine of Scapula

1. The rhomboids ____________ the scapula in ______________ when the shoulder joint muscles ____________ or ____________ the arm. 2. The rhomboids are used powerfully in ____________. 3. The rhomboids work synergistically with the trapezius to produce ______________ with slight ______________. 4. The rhomboids can be stretched by ___________________________.

Rhomboid Major and Minor: Application, Strengthening, and Flexibility Application: 1. The rhomboids fix the scapula in retraction when the shoulder joint muscles adduct or EXtend the arm. 2. The rhomboids are used powerfully in chin-ups. - As one hangs from the horizontal bar, suspended by the hands, the scapula tends to be pulled away from the chest from the top of the chest. - When the chin-up movement begins, it is the rhomboids that rotate the medial border of the scapula down and back towards the spine. 4. The trapezius and rhomboids work together to produce aDDuction with slight Elevation; to prevent this elevation the latissimus dorsi come into play. - Strengthening: Chin-ups, dips, and bent-over rows are excellent exercises for the rhomboids. - Stretch: The rhomboids can be stretched by passively moving the scapula into full PROtraction (aBduction) while maintaining depression. Upward rotation may assist in the stretch as well.

1. What is the origin of the rhomboids? 2. What is the insertion of the rhomboids? 3. What are the actions of the rhomboids?

Rhomboid Major and Minor: Origin, Insertion, Action 1. Origin: Spinous processes of C7-T5. 2. Insertion: Medial border of the scapula, b/t the spine of scapula and inferior angle. 3. Action: - Adduct (retraction) of the scapula - Downward rotation of the scapula - Elevate the scapula.

How do you palpate for the rhomboids? - May be palpated through the relaxed trapezius during ______________ by ___________________________ which relaxes the trapezius and brings the rhomboid into action when ___________________________.

Rhomboid Major and Minor: Palpation - Difficult to palpate due to being deep to the trapezius, but may be palpated through the relaxed trapezius during retraction (aDDuction) by placing the subject's ipsilateral (same) hand behind the back (glenohumeral internal rotation and scapular downward rotation), which relaxes the trapezius (because all 3 traps upward rotate the scapula) and brings the rhomboid into action when the subject lifts the hand away from the back.

What shoulder girdle muscle is used strongly in the last 5° to 10° degrees of motion in a push-up?

Serratus Anterior

1. What is the origin of the serratus anterior? 2. The insertion of the serratus anterior is the ____________ ____________ of the __________________ of the ____________ ____________ of the ____________. 3. With the origin fixed, the actions of the serratus anterior are: - ______________ - ______________ - ______________ rotate the scapula.

Serratus Anterior: Origin, Insertion, Action 1. Origin: External surfaces of upper 8 or 9 ribs 2. Insertion: Anterior surface of the whole length of the medial border of scapula 3a. Action: W/ Origin fixed - Protraction - Depress and upwardly rotate the scapula - Hold the medial border of scapula against rib cage. 3b. Action: W/ Scapula fixed - Elevate thorax during forced inhalation. --> Best exercise for the serratus anteriors are the dumbbell pullovers.

1. Palpation of the serratus anterior is done on the _____ and ______ side of the chest below the ____ and ____ ribs just ______ to their origin during ___traction. 2. The serratus anterior is used commonly in movements with ___traction and slight _____ rotation.

Serratus Anterior: Palpation and Application - Palpation: front and lateral side of the chest below the 5th and 6th ribs just proximal to their origin during aBduction, which is best accomplished from a supine position with glenohumeral joint in 90° degree flexion. The upper area of the serratus anterior can be palpated in the same position between the lateral border of pectoralis major and latissimus dorsi in the armpit. - Application: the serratus anterior is used commonly in movements drawing the scapula FORward (protraction) with slight UPward rotation, such as throwing a baseball, punching in boxing, and tackling in football. It works alongside the pectoralis major such as throwing a baseball.

1. The serratus anterior is used strongly in doing push-ups, especially in the last __° to __° degrees of motion. 2. What are good exercises for the serratus anterior? 3. The serratus anterior can be stretched by _________ , _______ a _______ and ________ each hand __________ _____ on to the two ______.

Serratus Anterior: Strengthening and Stretch - Serratus Anterior Strengthening: the serratus anterior is used strongly in doing push-ups, especially in the last 5° to 10° degrees of motion (lifting phase not lowering phase). The bench press and head press are good exercises for this muscle. Serratus anterior weakness may result from an injury to the long thoracic nerve. - Stretch: serratus anterior can be stretched by standing, facing a corner, and placing each hand shoulder level on to the two walls. As you lean in, attempt to place your nose on the corner, both scapula are in a retracted position which stretches the serratus anterior.

1. The nerve roots for the trapezius are C_-C_ and the ____ ________ ______. 2. The nerve roots for the levator scapula are C_-C_. 3. The dorsal scapula innervates which two shoulder girdle muscles? 4. What nerve innervates the serratus anterior? 5. C8 and T1 innervate which shoulder girdle muscle?

Should Girdle Nerves: 1. Trapezius: a. Nerve root: C3-C4, 11th Cranial nerve (aka spinal accessory nerve) b. Nerve: spinal accessory nerve 2. Levator Scapula: - a. Nerve root: C3-C4, and C5 - b. Nerve: Dorsal Scapula 3. Rhomboid: - a. Nerve root: C5 - b. Nerve: Dorsal Scapula 4. Subclavius: - a. Nerve root: C5-C6 - b. Nerve: Subclavian 5. Serratus Anterior: - a. Nerve root: C5-C7 - b. Nerve: Long thoracic 6. Pectoralis Minor: - a. Nerve root: C8 and T1 - b. Nerve: Medial pectoral

Shoulder Girdle Movements: 1. Pinching the shoulder blades together is considered what type of movement?

Shoulder Girdle Movements: 1. Protraction (adduction): movement of the scapula away from the body; as in reach for an object in front of the body. 2. Retraction (adduction): movement of the scapula toward the spine; as in pinching the shoulder blades together. 3. Elevation: upward of superior movement of the scapula, as in shrugging the shoulders. 4. Depression: downward or inferior movement of the scapula, as in returning to the normal position after a shrug. 5. Upward rotation: turning the glenoid fossa upward and moving the inferior angle superiorly and laterally from the spine; as in raising the arm out to the side. 6. Downward rotation: returning the inferior angle of scapula medially and inferiorly toward the spine AND returning the glenoid fossa to its normal position; as in bringing the arm down to the side.

1. What are the four kinds of scapula tilts? 2. Lateral tilt is a consequential movement of ______________. 3. Lateral tilt results in ____________ movement of the medial border. 4. Medial tilt results in ____________ movement of the medial border.

Shoulder Girdle Movements: Tilts (Pt. 1of2) 1. Lateral, Medial, Anterior, and Posterior. -->1. Lateral tilt: outward tilt; Consequential movement during protraction in which the scapula rotates about its vertical axis; resulting in Posterior movement of the Medial border and Anterior movement of the Lateral border. a. Please note this. -->2. Medial tilt: inward tilt; consequential movement during retraction in which the scapula rotates about its vertical axis; resulting in Anterior movement of the Medial border and Posterior movement of the Lateral border.

1. Anterior tilt results in the Superior border moving ________-________ and the Inferior angle moving ________-__________. 2. Posterior tilt results in the Superior border moving ________-________ and the Inferior angle moving ________-__________. 3. _________ tilt occurs during hyperflexion. 4. _________ tilt occurs during hyperextension.

Shoulder Girdle Movements: Tilts (Pt. 2of2) 3. Anterior tilt: upward tilt; consequential rotational movement of the scapula about the frontal axis (so sagittal plane) occurring during hyperextension of the glenohumeral joint (e.g. swinging the arm going all the way back); resulting in the Superior border moving Antero-Inferiorly and the Inferior angle moving Postero-Superiorly. 4. Posterior tilt: downward tilt; consequential rotational movement of the scapula about the frontal axis during hyperflexion (swinging your arm all the way up) of the glenohumeral joint; (2.) resulting in the Superior border moving Postero-Inferiorly and the Inferior angle moving Antero-Superiorly.

1. Due to poor posture, we tend to develop a forward shoulder posture that results in the scapula ________ and depressors becoming stronger and tighter and the _________ becoming weaker. 2. To avoid poor posture, we should try to keep our shoulder girdle directly over the ____________ instead of in front of it.

Shoulder Girdle Muscles: - The shoulder girdle muscles are essential in providing dynamic stability of the scapula so that it can serve as a relative base of support for shoulder joint activities such as throwing, batting, and blocking. - The scapula muscles also play a role in spinal posture. --> (1.) Due to poor posture, we tend to develop a forward shoulder posture that results in the scapula protractors and depressors becoming stronger and tighter with the retractors becoming weaker. --> This leads to further depression and protraction, or forward shoulder posture which also contributes to increased kyphosis (hunch back) and a forward head with increased lordosis (extreme arch in the back). --> (2.) To avoid this, we should try to keep our shoulder girdle directly over the pelvis instead of in front of it. c. An additional benefit of good scapular and spinal posture is easier inspiration due to less weight and mass over the rib cage and thoracic cavity.

1. What are the anterior muscles of the shoulder girdle? 2. What is the postero-lateral muscle of the shoulder girdle? 3. Where does the subclavius have its origin? 4. The two actions of the subclavius are ____________ and ___________.

Shoulder Girdle Muscles: Anterior - 1. Pectoralis Minor: a. Origin: Anterior surfaces of the 3-5th ribs b. Insertion: Coracoid process of the scapula c. Action: ABduction, downward rotation, and depression. - 2. Subclavius: a. Origin: Costal cartilage; sternal end of 1st rib b. Insertion: inferior groove in the mid-portion of the clavicle. c. Action: Depression and aBduction. Postero-Lateral: - 1. Serratus Anterior: a. Origin: External surface of upper 8 or 9 ribs. b. Insertion: Anterior surface of the whole length of the medial border of scapula. c. Action: Abduction and upwardly rotate.

Without accompanying movement from the scapula, we could raise our humerus to around ___° - ___° degrees of shoulder abduction and flexion.

Shoulder Girdle and Shoulder Joint Synergy: 1. As the shoulder joint goes through more extreme ranges of motion, the scapular muscle contracts to move the shoulder girdle so that its glenoid fossa will be in a more appropriate position from which the humerus can move. - Without accompanying movement from the scapula, we could only raise our humerus to around 90° to 120° degrees of shoulder abduction and flexion. 2. Example: - If we want to raise our hand out to the side as high as possible, the serratus anterior and trapezius (middle and lower fibers) upward rotate the scapula as the supraspinatus and deltoid initiate glenohumeral abduction.

1. The origin of the subclavius is the _____ _______ , the ______ end of the __ rib. 2. The insertion of the subclavius is the ________ groove in the ___-portion of the ________. 3. Alongside stabilizing and protecting the SC joint, what are the other actions of the subclavius?

Subclavius: Origin, Insertion, Action 1. Origin: costal cartilage and sternal end of the 1st rib 2. Insertion: Inferior groove in the midportion of the clavicle 3. Action: -> Stabilizing and protecting the sternoclavicular (SC) joint -> Depression and protraction (aBduction).

Subclavius: Palpation, Application, Strengthening, and Flexibility

Subclavius: Palpation, Application, Strengthening, and Flexibility - Palpation: difficult to distinguish from pectoralis major, but may be palpated just inferior to the middle third of the clavicle with the subject side-lying and the scapula in a somewhat upwardly rotated position and the humerus supported in a partially passively flexed position (i.e. flexion of the shoulder). -> Slight active depression and aBduction of the scapula may enhance palpation. - Application: The subclavius pulls the clavicle Anteriorly and Inferiorly toward the sternum. - Strengthening: subclavius may be strengthened during activities in which the scapula is in active depression such as dips or aBduction such as push-ups. - Stretch: Extreme elevation and retraction (adduction) provide a stretch to the subclavius.

What is the socket of the shoulder joint and the place where the head of the humerus fits?

The glenoid fossa is the socket of the shoulder joint and where the head of the humerus fits.

The pectoralis major and the __________________ are TRUE synergists in shoulder adduction (not retraction).

The pectoralis major and the latissimus dorsi are TRUE synergists in shoulder adduction (not retraction).

The two ways in which we can improve absorbing forces are: 1. ___________________________ 2. ___________________________

The two ways in which we can improve absorbing forces are: 1. Spreading force over a greater surface area. 2. Increasing absorption rate over a greater amount of time.

Trapezius: 1. The actions of the upper fibers of the trapezius are ____________ , ____________ ____________ , ____________ _________ the head and neck to the _________ side, and ____________ of the head and neck to the ____________ side. 2. The actions of the middle fibers are a( _ _ )uction or _____________ and to __________ the scapula. 3. The actions of the lower fibers are ___________ and __________ __________ of the scapula.

Trapezius: Actions 1. Upper fibers: elevation, upward rotation, laterally flex the head and neck to the same side, and rotation of the head and neck to the opposite side. 2. Middle fibers: adduction or retraction and stabilize the scapula 3. Lower fibers: depression and upward rotation of the scapula.

1. The trapezius MUST prevent the scapula from being _______ ___________. 2. When all fibers of the trapezius are working together, they tend to _________ and _________ at the same time. 3. The trapezius is used strenuously when doing what? 4. The typical action of the trapezius is ______(ing) the scapula for _______ action.

Trapezius: Application - The upper fibers are a thin and relatively weak part of the muscle. They provide some elevation to the clavicle and assist in extending the head. - The middle fibers are stronger and thicker and provide strong elevation, upward rotation and adduction (retraction) of the scapula. Rarely are these fibers weak because it's so active in posture and shoulder function. As a result, it is often the source of tenderness and discomfort due to chronic tension. - The lower fibers are typically weak, particularly in individuals whose activities demand a significant amount of scapula abduction (protraction). -> (2.) When all fibers of the trapezius are working together, they tend to pull upward and retract at the same time. ->This can be seen in lifting the handle of a wheelbarrow. --> (4.) Typical action of the trapezius is fixating the scapula for deltoid action. Continuous action in upward rotation of the scapula permits the arms to be raised over the head. The trapezius is always used in preventing the glenoid fossa from being pulled down when lifting objects from the ground. It is also seen in holding objects overhead. --> (3.) The muscle is used strenuously when lifting with the hands, as in picking up a heavy wheelbarrow. (1.) The trapezius MUST prevent the scapula from being pulled downward.

Trapezius: 1. The insertion of the upper fibers is the ________ aspect of the _________ 1/3 of the __________. 2. The insertion of the middle fibers is the ___________ border of the _____________ ____________ and the __________ border of the _____________________. 3. The insertion of the lower fibers is what?

Trapezius: Insertions 1. Upper fibers: Posterior aspect of the Lateral 1/3 of the clavicle. 2. Middle fibers: Medial border of the acromion process and Upper border of the spine of scapula. 3. Lower fibers: triangular space at the base of the spine of scapula

1. The origin for the upper fibers of the trapezius are the ____________ of the ____________ , ____________ ____________ ______________ and ____________ ____________ of the ____________. 2. The origin for the lower fibers of the trapezius are the spinous processes of? 3. The middle fibers has its origins at the spinous processes of _____-_____.

Trapezius: Origins 1. Upper fibers: base of the skull, external occipital protuberance and posterior ligaments of the neck. 2. Middle fibers: spinous processes of C7-T3 3. Lower fibers: spinous processes of T4-T12.

Trapezius: Palpation 1. Upper fibers: between _____________ ________________ and _______ and laterally to ____________ , particularly during ____________ and ____________ of the _________. 2. Middle fibers: from _______-_______ and laterally to ____________ and ____________________ , particularly during __________________. 3. Lower fibers: from _______-_______ and ___________ aspect of ____________________ , particularly during _______________ and __________________.

Trapezius: Palpation 1. Upper fibers: between occipital protuberance and C6 and laterally to acromion, particularly during elevation and extension of the head at the neck. 2. Middle fibers: from C7-T3 and laterally to acromion process and spine of scapula, particularly during adduction (retraction). 3. Lower fibers: from T4-T12 and medial aspect of spine of scapula, particularly during depression and retraction.

Strength: 1. Carrying objects on ___________________________ calls the trapezius into play. 2. The middle and lower fibers can be strengthened through doing horizontal __________________ in a ____________ position and doing _______________ ____________. 3. The lower fibers can be emphasized with a ____-_____ ___traction exercise, attempting to place the elbows in the back pants pockets with ______________. Stretch: 4. For the upper fibers to be stretched, use one hand to ___________________________ into ___________________________ to the ____________ side while the ____________ hand is hooked under a table to maintain the scapula in ______________. 5. The middle fibers can be stretched by ___________________________ the scapula into full ______________. 6. The lower fibers are best stretched when the subject is in ___________________________ while a partner grasps the ____________ border and ____________ angle of the scapula and moves it passively into ___________________________.

Trapezius: Strengthening and Flexibility - Carrying objects on the tip of your shoulder also calls the trapezius into play 1. Strengthening of the upper AND middle fibers can be accomplished through shoulder-shrugging exercises. 2. The middle and lower fibers can be strengthened through bent-over rows and shoulder horizontal abduction exercises from a prone position. 3. The lower fibers can be emphasized with a chest-proud adduction (retraction) exercise, attempting to place the elbows in the back pants pockets with depression. To stretch the trapezius, EACH fiber needs to be addressed. 1. The upper fibers may be stretched using one hand to pull the head and neck forward into flexion or slight lateral flexion to the opposite side while the ipsilateral (same side) hand is hooked under a table to maintain the scapula in depression. 2. The middle fibers are stretched in a similar procedure to the upper fibers but can be stretched further by having a partner passively pull the scapula into full PROtraction. 3. The lower fibers are best stretched when the subject is in a side-lying position while a partner grasps the lateral border and superior angle of the scapula and moves it passively into maximal elevation and PROtraction.