MSK Shoulder

- The shoulder complex can be divided into two main components:

Shoulder girdle which includes the sternoclavicular, AC and scapulothoracic joint:
Shoulder joint (glenohumeral joint) is a ball and socket joint formed by the concave
glenoid cavity and convex humeral head
- Static stabilisers of the shoulder joint include:
Superior, middle and inferior glenohumeral ligaments when the shoulder is abducted
the main static stabilisers of the shoulder are the anterior & posterior inferior GH
ligaments which attach to the labrum. The glenoid labrum attaches directly to the the
margin of the glenoid fossa
Glenoid capsule
Glenoid labrum expands and increases the depth of the glenoid cavity
- Dynamic stabilisers of the shoulder joint:
Rotator cuff muscles:
Supraspinatus: O Supraspinous fossa I greater tubercle A- abduction of shoulder
Innervation suprascapular nerve (C5-C6)
Infraspinatus: A lateral rotation
Teres minor: O superior lateral border of scapula A- lateral rotation of shoulder
Innervation Axillary nerve
Subscapularis: internally rotates shoulder, Innervation upper and lower subscapular
nerves
The rotator cuff muscles act to stabilise the humeral in the glenoid fossa. Whilst the
deltoid muscle acts to elevate the humeral head when the arm is elevated, the rotator
cuff muscles acts to depress the humeral head to prevent the impingement of
subacromial structures (tendon of supraspinatus, subacromial bursa) which could occur
due to superior translation of the humeral head.
Imbalance in strength between these two muscles, can result in excessive superior
translation of the humeral head and lead to subacromial impingement syndrome and
subsequent pain during elevation of the arm
- Scapulohumeral rhythm is the kinematic interaction between the scapula and the humerus
It involves combined articulation of the scapulothoracic and glenohumeral joint
Normal scapulohumeral rhythm:
Enhances joint stability at shoulder abduction of 90 degrees where the glenoid fossa is
underneath the humeral head stability of the shoulder joint is assisted by the deltoid
muscle.
Correct scapulohumeral rhythm ensure a stable scapula which is the site of origin for the
rotator cuff muscles. This allows the muscles to maintain an optimal length tension
relationship
Abnormal scapulohumeral rhythm (scapular dyskinesia) can occur due to:
Weakness of scapular stabilisers trapezius, serratus anterior, rhomboids and levator
scapula

Scapular movements:

- Upward rotation of scapula (required during elevation of arm): assisted by force coupling of
upper trapezius and serratus anterior/lower trapezius
- Anterior tilt pectoralis minor, posterior tilt serratus anterior
 - Adequate strengthening of scapular stabilisers is required for adequate rotator cuff muscle
strengthening

History of shoulder pain:

- Predisposing factors: previous shoulder injury, age, occupation, training factors during sport,
-