WEEK-I

ANATOMY AND
BIOMECHANICS
SHOULDER GIRDLE
(MSPT-SPT)
Dr Riafat mehmood
Assistant professor
WHAT IS A SPORTS AND EXERCISE
PHYSIOTHERAPIST?

" The essential role of the sports physiotherapist is to

 provide evidence-based advice on safe participation in sport and
exercise.
 provide treatment and rehabilitation of injuries.
 provide support for performance .
 prevention, maintenance and recovery interventions.
SPORTS AND EXERCISE PHYSIOTHERAPY ROLES AND
CAPABILITY
 The role of the physiotherapist does vary and can depend on:
 The sport they are involved in
 Their specific role within the team
 The performance level of the sport,
 Technical (scientific and skill-based)
 Creative (adapting decision-making and techniques to clinical
situations)
 Contextual (self-awareness and the ability to adapt behaviours within
wider cultural and situational circumstances)
QUALITIES THAT ATHLETES DO NOT LIKE TO SEE IN SPORTS
PHYSIOTHERAPISTS ARE:

 Bad personal qualities

 Being unapproachable
 Not being a team player
 ATHLETES FEEL THAT THE FOLLOWING
TREATMENT TECHNIQUES ARE BENEFICIAL.
 Mobilization
 Massage
 Manipulation
 Exercise prescription
 Acupuncture
 Taping
SHOULDER
 The shoulder complex involves 3 physiological joints
and one floating joint:   
 Glenohumeral (GH) joint, 
 Acromioclavicular (AC) joint
 Sternoclavicular (SC) joint
 Scapulothoracic (ST) joint - known as a "functional
joint". is not a true joint 
 You can also consider the contributions of the
sternocostal, vertebrocostal, and sternomanubrium joints
when thinking about movement involving the shoulder
complex.
 SHOULDER JOINT
 The shoulder joint, also called the glenohumeral joint, consists of
the scapula and humerus.
 The motions of the shoulder joint are flexion, extension and
hyperextension, abduction and adduction, medial and lateral
rotation, and horizontal abduction and adduction.
 Because the shoulder joint is so mobile, it has few ligaments.
 The nine muscles that cross the shoulder joint are the prime movers
in shoulder joint motion.
 The SC joint is the only bony attachment site of the upper extremity
to the axial skeleton.
 The ST joint involves the gliding movement of the scapula along
the rib cage during upper extremity movements and does not
include a physical bone-to-bone attachment.
 The GH joint is of particular interest when understanding the
mechanism of shoulder injuries because it is osteologically
predisposed to instability.
 The GH joint is comprised of a ball and socket synovial joint,
where the head of the humerus (convex surface) articulates with the
glenoid fossa (concave surface) of the scapula.
 Because of the relatively large surface area of the humeral head in
relation to the fossa, the joint itself has limited bony congruency,
and consequentially heavily depends on surrounds soft tissues for
structural support.  
 Moreover, it is estimated that only 25% of the humeral head
articulates with the glenoid fossa at any one time during
movements.
 The surrounding passive structures (
the labrum, joint capsule, and ligaments) as well as the active
structures (the muscles and associated tendons) work
cooperatively in a healthy shoulder to maintain dynamic stability
throughout movements. 
 An area most often involved in the cases of shoulder pain is the
subacromial space, which includes the theoretical space between
the coracoacromial arch and the head of the humerus.
  More specifically, the subacromial canal lies underneath the
acromion, the coracoid process, the AC joint, and the
coracoacromial ligament.
 The space itself includes a bursa that provides lubrication for the 
rotator cuff (RC) tendons, the insertion for the long head of the 
biceps tendon, and the rotator cuff (RC) tendons themselves.
INTRODUCTION TO COMMON SPORTS
INJURIES INVOLVING THE SHOULDER
 The upper body of a human being has evolved for agility and
flexibility, rather than strength.

 Our arms, wrists, and hands are excellent at all tasks involving the
fine, delicate manipulation of lightweight objects.

 In contrast, the lower half gives our bodies durability, strength, and
endurance.
 Although lacking the refined control of the arms, our legs are
capable of safely doing the endless daily repetitive motions of
walking without wearing out.

 The legs and hips contain the body’s largest bones and strongest
muscles, capable of providing enormous lifting and locomotive
power.

 This differentiation between the upper and lower parts of the human
body may be considered the basic reason that so many sports
injuries involve the shoulders. 
WHY DO SO MANY SPORTS INJURIES
INVOLVE THE SHOULDER?
 In virtually all sports, the shoulders are disproportionately called
upon to perform feats of strength, speed, and endurance—feats for
which they are not especially well-suited.

 For example, a baseball pitcher is required to throw a five-ounce

baseball as hard as he can, as often as 300 times a day. Gymnasts
support their whole body weights by their arms for hours on end.
And football players endure the shock of repeated heavy impacts to
their shoulders (as well as heads and necks) for their whole careers.
 Such constant stress is far better suited to the thick, heavy
structures of a person’s lower body. Unfortunately, the only sport
that takes advantage of this aspect of human physiology is soccer.

 All other sports place inordinate physical demands onto the human
shoulder—which, thanks to its remarkable mobility, is an inherently
unstable structure. This makes the shoulder far more vulnerable to
injury than any other joint.
The shoulder is a ball-and-socket joint.

The upper arm bone (humerus) is topped with a ball-like structure,

which fits precisely anatomy of a shoulder into a shallow, cup-shaped
socket in the shoulder blade (scapula).

The labrum, a ring of tough cartilage, lines that socket, giving the ball
of the humerus a bit more depth in which to nestle.
 Surrounding the joint is a kind of protective sleeve of tissue called
the joint capsule, comprised in part of the ligaments connecting the
bones together and the tendons that make up the rotator cuff.

 Most sports injuries involving the shoulder result in damage to the

connective tissues: the labrum, ligaments, and tendons. Issues with
these components of the shoulder are far more common than
broken bones and bruised muscles, due to the high-force, high-
repetition activities required by athletics
 Dislocations and ACJ injuries are more common in contact sports,
such as rugby and wrestling, whilst rotator cuff tears and biceps
lesions are common in sports involving explosive heavy weight-
lifting.
 Fractures around the shoulder are seen with sports involving
crashes and falls from heights (of which there are many).
 It is often quite difficult to adequately assess the severity of a
shoulder injury and the structures damaged following sports
injuries, as simple muscle strains look very similar to more serious
injuries.
THE MOST COMMON TYPES OF
MAJOR SHOULDER INJURIES
RELATED TO SPORTS :
 Dislocations

 Rotator Cuff Tears

 Labral Tears, SLAP Lesions

 Bone Fractures
MINOR SPORTS-RELATED SHOULDER INJURIES
INCLUDE:
 Sprains

 Strains

 Inflammation

 Bursitis/Bone Spurs

 Muscular Imbalances
 DISLOCATED SHOULDER OR
DISLOCATED

ACROMIOCLAVICULAR (ACJ) JOINT.

 A dislocation is the partial or complete separation of two bones. In the
shoulder joint, these are the humerus and scapula;
 in the acromioclavicular or ACJ, it is the clavicle (collarbone) and the
scapula.

 The victim of a dislocated shoulder will feel and hear a “pop” as the ball-
shaped bone at the top of their upper arm literally “pops” out of its normal
socket in the shoulder.
 At best, the humerus can be more-or-less easily pushed back
into place inside the labrum, which lines the shallow socket in the
scapula much like a coffee filter lines the inside of a coffeemaker
basket.

 At worst, the damage caused by the bone “popping out” of its

socket will not only tear the cartilage of the labrum, but also
damage the tendons of the rotator cuff, and even the surrounding
muscles and ligaments of the shoulder joint capsule.
 This type of injury most commonly occurs in contact sports in
which athletes repeatedly fall on their shoulders, or are subjected to
hard, repeated impacts—for example, the tackling and upper-body
grappling that can occur in American football.

 Repeated dislocations will worsen the damage to the socket,

making a recurrence much more likely. They may even weaken the
already-structurally-unstable shoulder joint.
ROTATOR CUFF TEARS
 The rotator cuff is made up of several tendons; together they
provide the remarkable mobility of the shoulder. A repetitive stress
injury (RSI) or overzealous, overpowered arm swings may tear or
rip any of these important tendons, sometimes more than one.

 Any sport that requires repetitive overhand motions presents a

danger to the rotator cuff. Athletes who are particularly vulnerable
to a rotator cuff tear include swimmers (like swimmer's
shoulder), tennis players, and baseball pitchers.
 In addition, those participating in sports that require explosive,
powerful motions are also candidates for a torn rotator cuff,
including weightlifters, rock climbers, and volleyballers.
Typically, these injuries are characterized by pain, weakness in
the shoulder, reduced range of motion, and stiffness.
SLAP LESIONS OR TEARS
 Superior Labral Antero-Posterior (SLAP) tears are rips in the ring
of cartilage (labrum) that runs around the shoulder socket. Just like
rotator cuff tears, SLAP tears are more common in sports with lots
of overhead throwing, heavy lifting and tackling.

 A SLAP tear tends to develop over time from repetitive, overhead

motions, such as throwing a baseball, playing tennis or volleyball,
or swimming. It may also occur from a direct impact to the
shoulder, such as that caused by falling or being tackled to the
ground.
 symptoms include a loss of “power” in shoulder; a feeling of
looseness in the shoulder joint, almost as if it were about to slip out;
 pain accompanying overhand motions, such as throwing a
baseball;
 decrease in range of motion;
 and an unpleasant sensation (and possibly accompanying sounds)
of clicking, grinding, or popping in shoulder.
BONE FRACTURES
 However, in high-velocity crashes and falls from high heights, the
soft tissues cannot do their job of protecting the bones from
breakage.

 Fractures in the shoulder are difficult to treat, due to the position of

the bones making it hard to immobilize with hard casts in order to
heal properly.
ANATOMY AND BIOMECHANICS
SHOULDER GIRDLE
 The shoulder area is infamously known to be one of the most
complex regions of the body to evaluate and rehabilitate.

 Due to the multiple joints involved during shoulder movement.

 Muscles of the shoulder work in team to produce highly

coordinated motion. weakness of any muscle change normal
kinematic chain of the joint.
 The purpose of the shoulder and the entire upper extremity is to
allow the hand to be placed in various positions to accomplish the
multitude of tasks it is capable of performing.
 The shoulder, or glenohumeral joint, is the most mobile joint in the
body and is capable of a great deal of motion, However, in talking
about shoulder motion, we must recognize that motion also occurs
at three other joints, or areas.
 Shoulder complex is a term that is some times
used to include all of the structures involved with
motion of the shoulder.
 The shoulder complex consists of the scapula,
clavicle, sternum, humerus, and rib cage.
 includes the sternoclavicular joint,
acromioclavicular joint, glenohumeral joint, and
“scapulothoracic articulation” .
 In other words, it includes the shoulder girdle
(scapula and clavicle) and the shoulder joint
(scapula and humerus).
 the scapula and thorax do not have a point
of fixation, the scapula does move over the
rib cage of the thorax.
 The scapula and thorax are not directly
attached but are connected indirectly by the
clavicle and by several muscles.
 The scapulothoracic articulation does
provide motion and flexibility to the body
 SHOULDER GIRDLE
 Shoulder girdle is a term often used to discuss the activities of the
scapula and clavicle and, to a lesser degree, the sternum.
 The sternoclavicular and acromioclavicular joints allow
shoulder girdle motions, including elevation and depression,
protraction and retraction, and upward and downward rotation.
 Five muscles attach to the scapula, the clavicle, or both, providing
motion of the shoulder girdle.
 BONES AND
LANDMARKS
SHOULDER GIRDLE
 SCAPULA
 Scapula, a triangular-shaped bone located superficially on the
posterior side of the thorax, and the clavicle make up the
shoulder girdle.
 The scapula attaches to the trunk indirectly through its
ligamentous attachment to the clavicle.
 It is slightly concave anteriorly and glides over the convex
posterior rib cage.
 Many muscles also connect the scapula to the trunk. In the
resting position, the scapula is located between the second and
seventh ribs, with the vertebral border approximately 2 to 3
inches lateral from the spinous processes of the vertebra.
 The spine of the scapula is approximately level with the spinous
process of the third and fourth thoracic vertebrae
 Superior Angle Superior medial aspect, providing attachment for
the levator scapula muscle
 Inferior Angle Most inferior point and where vertebral and
axillary border meet. This point determines scapular rotation.
 Vertebral Border Between superior and inferior angles medially,
and attachment of the rhomboid and serratus anterior muscles
 Axillary Border The lateral side between glenoid fossa and
inferior angle
 Spine Projection on posterior surface, running from medial
border laterally to the acromion process. It provides attachment
for the middle and lower trapezius muscles.
 Coracoid Process Projection on anterior surface, providing
attachment for the pectoralis minor muscle
 Acromion Process Broad, flat area on superior lateral aspect,
providing attachment for the upper trapezius muscle
 Glenoid Fossa Slightly concave surface that articulates with
humerus on superior lateral side above the axillary border and
below the acromion pro
 CLAVICLE
 The clavicle is an S-shaped bone that connects the
upper extremity to the axial skeleton at the
sternoclavicular joint.
 position of the clavicle in relation to the sternum,
scapula, and rib cage. For shoulder girdle function,
the important bony landmarks of the clavicle are as
follows:
 Sternal End Attaches medially to sternum.
 Acromial End Attaches laterally to scapula and
provides attachment for the upper trapezius muscle.
 Body Area between the two ends.
 STERNUM
 The sternum is a flat bone located in the midline of the anterior
thorax .
 The position of the sternum in relation to the rib cage and the
clavicles is shown in Figure.
 At its superior end, the sternum provides attachment for the
clavicle, followed beneath by attachments for the costal cartilages
of the ribs.
 It is divided into three parts:
 Manubrium The superior end, providing attachment for the
clavicle and the first rib.
 Body The middle two-thirds of the sternum, providing attachment
for the remaining ribs
 Xiphoid Process Meaning “sword-shaped,” the inferior tip
JOINTS AND LIGAMENTS
SHOULDER GIRDLE
 STERNOCLAVICULAR JOINT & LIGAMENTS
 provides the shoulder girdle with its only direct attachment to the trunk.
 This plane-shaped synovial joint has a double gliding motion.
 Sternoclavicular joint motions include elevation and depression, protraction
and retraction, and rotation.
 Because these motions occur in three planes, the joint has three degrees of
freedom.
 Sternoclavicular joint motions accompany the motions of the shoulder girdle.
Although these motions are more subtle than those at most other joints, they
are even so important.
 Basically, the clavicle moves while the sternum remains stationary.
 Being a synovial joint, the sternoclavicular joint has a joint capsule.
 It also has three major ligaments and a joint disk.
 The joint capsule surrounds the joint and is reinforced by the anterior and posterior sternoclavicular
ligaments.
 The articular disk has a unique attachment that contributes to the motion of this joint.
 The upper part of the disk is attached to the posterior superior part of the clavicle, while the lower part
is attached to the manubrium and first costal cartilage.
 This double attachment is much like that of the double hinge found on doors that swing in both
directions.
 During shoulder girdle elevation and depression, motion occurs between the clavicle and the disk.
 During protraction and retraction, motion occurs between the disk and the sternum.
 The articular disk also serves as a shock absorber, especially from forces generated by falls on the
outstretched hand.
 The disk and its ligamentous support are so effective that dislocation at the sternoclavicular joint is rare.
sternoclavicular ligament connects the clavicle to the
sternum on both the anterior and posterior surfaces. These
ligaments limit anterior-posterior movement of the clavicle’s
medial end. They both reinforce the joint capsule.
costoclavicular ligament is a short,flat, rhomboid-shaped
ligament that connects the clavicle’s inferior surface to the
superior surface of the costal cartilage of the first rib. The
primary purpose of this ligament is to limit the amount of
clavicular elevation.
interclavicular ligament is located on top of the
manubrium, connecting the superior sternal ends of the
clavicles. Its purpose is to limit the amount of clavicular
depression
 ACROMIOCLAVICULAR JOINT &
LIGAMENTS
connects the acromion process of the scapula with the
lateral end of the clavicle.
 It is a plane-shaped synovial joint with three planes of
motion. The motions are minimal but important to
normal shoulder motion.
 The joint capsule surrounds the articular borders of
the joint. It is quite weak and is reinforced above and
below by the superior and inferior acromioclavicular
ligaments.
 The coracoclavicular ligament and coracoacromial ligaments are two
accessory ligaments of the acromioclavicular joint.
 coracoclavicular ligament is not directly located at the joint, it does
provide stability to that joint and allows the scapula to be suspended
from the clavicle.
 It connects the scapula to the clavicle by attaching to the inferior
surface of the clavicle’s lateral end and to the superior surface of the
scapula’s coracoid process
 The ligament is divided into a lateral trapezoid portion and the
deeper medial conoid portion. Together they prevent backward
motion of the scapula, and individually they limit the rotation of the
scapula.
 coracoacromial ligament
does not actually cross the
acromioclavicular joint, but rather forms a
roof over the head of the humerus and
serves as a protective arch, providing
support to the head when an upward force
is transmitted along the humerus .
It attaches laterally on the superior surface
of the coracoid process and runs up and
out to the inferior surface of the acromial
process.
1.Identify the structures that make up .
a.shoulder girdle,
b.shoulder joint,
c.shoulder complex.?

2.What are the Sports and Exercise Physiotherapy Roles and

Capability.?
3. Given that the scapula is shaped somewhat like a triangle,
a. what landmark is commonly used to determine the direction the scapula is rotating?
b. what direction is the landmark moving if the scapula is rotating upwardly?
c. what direction is the landmark moving if the scapula is rotating downward?

Identify the shoulder girdle motions that occur with the following actions. Accompanying
shoulder joint motions have been provided in parentheses.
1.Closing a window by pulling down Shoulder girdle motion ______________
2.Opening a window by pulling up Shoulder girdle motion ________________
3.Combing your hair in the back Shoulder girdle motion __________________
SHOULDER GIRDLE JOINT
MOTIONS
Elevation/depression and protraction/retraction
are essentially linear motions. All points of the scapula
move up and down along the thorax and away from and
toward the vertebral column in parallel lines. Angular
motion occurs during upward and downward rotation
of the scapula. Because of the scapula’s triangular shape,one side moves
one way while another side moves in an opposite or different direction.

upward rotation,
the inferior angle of the scapula rotates up and away from the vertebral
column, while downward rotation is the return to the resting anatomical
position.

Scapular tilt occurs when the shoulder joint goes into hyperextension.
The superior end of the scapula tilts anteriorly, and the inferior end tilts
posteriorly. Examples of these combined motions are the “windup” or
prerelease phase of a softball pitch, a bowling delivery, or a racing dive
in swimming.
 Because of the complexity of joint shapes and joint
interaction in the shoulder complex, some very subtle
motions occur.
 such movement is worthy of mention so as to clarify
normal versus abnormal motion. Scapular winging is the
posterior lateral movement of the vertebral border of the
scapula in the transverse plan.
 This motion occurs primarily at the acromioclavicular
joint but is seen most often at the scapulothoracic
articulation.
 However, pathological “winging of the scapula” also
occurs when the stabilizing muscles around the scapula are
weak or paralyzed. A serratus anterior muscle weakness or
paralysis
COMPANION MOTIONS
OF THE SHOULDER
JOINT AND SHOULDER
GIRDLE
SCAPULOHUMERAL RHYTHM
 Scapulohumeral rhythm is a concept that
further describes the movement relationship
between the shoulder girdle and the shoulder
joint.
 The first 30 degrees of shoulder joint motion
is pure shoulder joint motion.
 However, after that, for every 2 degrees of
shoulder flexion or abduction that occurs, the
scapula must upwardly rotate 1 degree.
 This 2:1 ratio is known as scapulohumeral
rhythm
ANGLE OF PULL SHOULDER
GIRDLE
 In the case of the shoulder girdle, muscles with a greater
vertical angle of pull will be effective in pulling the
scapula up or down (elevating or depressing the scapula).
 Muscles with a greater horizontal pull will be more
effective in pulling the scapula in or out (protracting or
retracting).
 Muscles with a more equal horizontal and vertical pull
will have a role in both motions.
 For example,
 the levator scapula has a stronger vertical component,
 the middle trapezius has a stronger horizontal component,
 and the rhomboids have a more equal pull in both
directions.
MUSCLES OF THE SHOULDER
GIRDLE
 Muscle Descriptions There are five muscles primarily responsible
for moving the scapula. Each muscle will be discussed with
particular emphasis on its location and function,
 Trapezius
 Levator scapula
 Rhomboids
 Serratus anterior
 Pectoralis minor
 1.Trapezius
 large, superficial muscle that appears
diamond-shaped when looking at both right
and left sides.
 Functionally, it is usually divided into three
parts:
 upper, middle, and lower.
 The reason for this separation is that there
are three different lines of pull (upward,
inward, downward)
 2.levator scapula
 muscle is named for its function of scapular
elevation. It is covered entirely by the
trapezius muscle.
 Its diagonal line of pull is mostly vertical.
Therefore, it is a prime mover in scapular
elevation and only an assisting mover in
retraction. It is also a prime mover in
downward rotation.
 3.Rhomboids
 rhomboids are actually two muscles:
rhomboid major and rhomboid minor.
 The rhomboids derive their name from their
shape.
 The rhomboid muscles lie under the trapezius
muscle and can be palpated when the trapezius
muscle is relaxed.
 Because their oblique line of pull has a good
horizontal and vertical component, they are a
prime mover in retraction and elevation. Like
the levator scapula muscle, the rhomboids
rotate the scapula downward
 4.serratus anterior
 This muscle gets its name from the serrated, or sawtooth,
pattern of attachment on the anterior, lateral side of the
thorax. It is superficial at this point and can be palpated
when the arm is overhead.
 horizontal line of pull outward, it is a prime mover in
scapular protraction.
 Its lower fibers pulling outward on the lower part of the
scapula are effective in rotating the scapula upward.
 These fibers join with the upper and lower trapezius
muscles to form a force couple that rotates the scapula
upward.
 Another function of the serratus anterior muscle is to
keep the vertebral border of the scapula against the rib
cage
 5.Pectoralis minor
 pectoralis minor muscle lies deep to the pectoralis
major muscle and is the only shoulder girdle
muscle located entirely on the anterior surface of
the body.
 Its downward diagonal line of pull is mostly
vertical, making it a prime mover in scapular
depression, downward rotation, and scapular tilt.
 Although it is rather easy to see the depression
action, the downward rotation is less obvious,
because the muscle is on the anterior surface while
the scapula moves on the posterior surface.
ANATOMICAL RELATIONSHIPS
SHOULDER GIRDLE
FORCE COUPLES SHOULDER
GIRDLE
 In the case of the shoulder girdle,
 the upper trapezius muscle pulls up,
 the lower trapezius muscle pulls down,
 and the lower fibers of the serratus anterior muscle pull
outward in a horizontal direction.
 The net effect is that the scapula rotates upward
 Downward rotation is another example of a force
couple.
 The combined effect of the pectoralis minor muscle
pulling down,
 the rhomboid muscles pulling in,
 and the levator scapular muscle pulling up is downward
rotation of the scapula
1.Lie prone on a table with your right arm hanging over the side of
the table and holding a weight in your right hand .Using only
shoulder girdle motion and no shoulder joint motion, pull the weight
straight up from the floor.
 a. What joint motion is occurring at the shoulder girdle?
 b. What muscles are prime movers of this shoulder girdle action?
 c. Is this an open-chain or closed-chain activity?
2.Sit in a chair that has arms; place your hands on the armrests in a
position that puts your shoulders in hyperextension. Push down on
the armrests and raise your buttocks off the seat of the chair.
a. What shoulder girdle motion is accompanying the shoulder
flexion action (from hyperextension to neutral)?
b. b. What muscles are prime movers in this shoulder girdle motion?
c. c. Is this a concentric or eccentric activity?
3.Lie in a prone position with your legs together, hands on the table
next to your shoulders with your fingers pointing forward . Push up
with your hands as far as you can while straightening your elbows,
bending your knees, and keeping your back straight.
a. What shoulder girdle motion is occurring?
b. b. What muscles are prime movers in this shoulder girdle
motion?
c. c. Is this an open-chain or closed-chain activity?
 4.Using a lat pull-down machine of the Universal Gym (or some
other comparable apparatus), reach up and grasp the handles. Pull
down while keeping your arms moving in the frontal plane.
 a. What shoulder girdle motions are accompanying shoulder
adduction and lateral rotation?
 b. What muscles are prime movers in these shoulder girdle
motions?
 c. Is this a concentric or eccentric activity?