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The Shoulder
Complex
DR TABASSUM SAHER
ASSISTANT PROFESSOR
DPSRU, SOP
General Function
 Provides very mobile, yet strong base for hand to
perform its intricate gross and skilled functions
 Transmits loads from upper extremity to axial skeleton
Shoulder Complex Movements
 Shoulder Girdle
 Elevation & depression
 Protraction & retraction
 Upward & downward rotation
 Upward tilt
 Shoulder (glenohumeral)
 FL, EXT, Hyper EXT
 ABD, ADD, Hyper ADD, Hyper ABD
 MR, LR, Horizontal ABD, Horizontal ADD
Abduction/Lateral Tilt
(Protraction)
Adduction/Reduced
Lateral Tilt
(Retraction)
Linear Movement
Frontal Plane
Angular movement
Transverse Plane
Depression
Elevation
Linear Movement
Frontal Plane
Downward rotation
Upward rotation
Shoulder Complex Movements
Upward tilt
Reduction of
Upward Tilt
Angular movement
Sagittal plane
Limited by capsular
torsion
Limited by bony
impingement of
greater tubercle on
acromion
Large ROM Due To:
 Poor bony structure
 Poor ligamentous restraint
 Scapulohumeral cooperative action
The Shoulder Complex
A. General Structure & Function
B. Structure & Function of Specific Joints
C. Muscular Considerations
D. Specific Functional Considerations
E. Common Injuries
Structure & Function of Specific
Joints
1. Sternoclavicular Joint
2. Acromioclavicular Joint
3. Scapulothoracic Joint
4. Glenohumeral Joint
Sternoclavicular Joint: Articular
Surfaces
Medial end of clavice
is convex
Clavicular facet is
reciprocally shaped
Sternoclavicular Joint: Motions
Axial Rotation: 50°
EL/DEP: 35°
PROT/RET: 35°
Sternoclavicular Joint: Motions
Frontal plane
Elev/Dep
Sagittal plane
Post Rot
Horizontal plane
ProT/ReT
Ant/Post axis
Vertical axis
Acromioclavicular Joint
Bony Structure
Poor
Diarthrodial Nonaxial
Acromioclavicular Joint:
Joint Capsule
Very weak
Acromioclavicular Joint
Acromioclavicular Ligament
Resists axial
rotation &
posterior motion
Acromioclavicular Joint
Coracoclavicular Ligament
Resists superior
motion
Acromioclavicular Joint
Accessory Structures
Articular disc
Acromioclavicular Joint: Motion
Little relative
motion at AC joint
UR/DR: 60°
EL/DEP: 30°
PROT/RET: 30-50°
Clavicle
 Acts a strut connecting upper extremity to thorax
 Protects brachial plexus & vascular structures
 Serves as attachment site for many shoulder muscles
Scapula
Scapular Plane
Scapulothoracic Joint
 No osseous
connection
 SUBSCAP & SA
Glenohumeral Joint:
Humerus
Retroversion angle: 30°
Glenohumeral Joint:
Bony Structure
 Pure rotation
 Bony restraint poor
 Head 4-5X larger than fossa
 Close-packed position
 ABD with LR
Glenohumeral Joint:
Joint Capsule
 Inherently lax
 Surface area 2X
head
 Provides restraint for
ABD, ADD, LR, MR
Glenohumeral Joint:
Coracohumeral Ligament
 Resists inferior
translation in
shoulders
Glenohumeral Joint:
Middle GH Ligament
 Great variability in
proximal attachment &
morphology
 Absent in 30%
 Resists inferior
translation in ABD &
ER
 Restrains anterior
translation (45° ABD)
Glenohumeral Joint:
Inferior GH Ligament
 Resists inferior,
anterior, & posterior
translation
Glenohumeral Joint: Bursae
 Subcoracoid
 Subacromial
 Subscapular
Glenohumeral Joint: ROM
 Flexion (167° W; 171° M)
 30° in max LR
 Extension (60°)
 Abduction (180°)
 60° in max IR
 Hyperadduction (75°)
Glenohumeral Joint: ROM
 Medial rotation (90°)
 Lateral rotation (90°)
 Horizontal abduction (45°)
 Horizontal adduction (135°)
 Total rotation
180°
 Total ROT 90° in
90° ABD
Stability Functions of Shoulder
Girdle
 Provides stable base from which shoulder muscles can
generate force
 Shoulder girdle muscles as stabilizers
 Maintain appropriate force-length relationship
 Maintain maximum congruence of shoulder joint
Specific Functional Considerations
 Stability Functions of Shoulder Girdle
 Mobility Functions of Shoulder Girdle
 Rotator Cuff Function
Mobility Functions of Shoulder
Girdle
 Permits largest ROM of any complex in the body
 Shoulder girdle increases ROM with less compromise of
stability (scapulohumeral rhythm) (4 joints vs. 1 joint)
 Facilitate movements of the upper extremity by positioning
GH favorably

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