Treatment of the Shoulder Girdle for Functional Outcomes. Postural Alignment and it s Effect on the Shoulder Girdle. Left Anterior Rotation of Pelvis

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1 Treatment of the Shoulder Girdle for Functional Outcomes Gail Ritchie, OTR/L Postural Alignment and it s Effect on the Shoulder Girdle Floating system Relies on the alignment of the axial skeleton Left Anterior Rotation of Pelvis Pre Treatment Post Treatment 1

2 Pre and Post Treatment Pre and Post Treatment 2

3 Bony Structures Left from above Left from below Humerus (right) - anterior view Humerus (right) - posterior view Clavicle Movements: Elevation/Depression Protraction/Retraction Rotation around it s own body axis *note that movements are reliant on scapular mobility and the contour of the ribcage Left from above Left from below 3

4 Alignment Issues Faulty alignment may be indicative of muscular imbalance or structural issues Elevated/depressed Protracted SC joint immobility/hypermobility Scapula Provides a point of stability for the UE to orient in space Provides a point of stability for the UE in weight bearing Resting position is reliant on the contouring of the ribcage, spine, and pelvis Left anterior view Left posterior view Left scapula lateral view Scapular Movements Elevation/Depression Adduction/Abduction Downward/Upward Rotation *Use the glenoid fossa as a point of reference 4

5 Atypical Elevation Scapular Winging Humerus Long bone of the upper arm Primary joint of the shoulder girdle Articulates with the glenoid fossa of the scapula Humeral head is 2-3 larger than the glenoid fossa Humerus (right) - anterior view Humerus (right) - posterior view 5

6 Movements Flexion/Extension Internal/External Rotation Horizontal Adduction/Abduction Alignment Issues Humeral Internal Rotation and extension Possible Subluxation Joints of the Shoulder Girdle Complex Each joint is mechanically linked and must function in concert to allow for scapulohumeral rhythm resulting in UE function. 5 Joints: 3 True Joints 2 False Joints 6

7 True Joints Glenohumeral Joint Acromioclavicular Joint Sternoclavicular Joint Acromioclavicular Joint Glenohumeral joint Sternoclavicular Joint False Joints Scapulothoracic Joint Sub-Deltoid Joint Subdeltoid Joint Scapulothoracic Joint Scapulohumeral Rhythm 5 joints working in synchrony with each other through the synergistic activity of the musculature for all UE functions 7

8 Humeral Abduction (<90 degrees) Movement is initiated with supraspinatus and the middle deltoid The scapula moves into upward rotation (trapezius and serratus anterior) The clavicle rotates on the sternum at the SC joint Clavicle Supraspinatus Deltoid Trapezius and Serratus Anterior Humeral Abduction (>90 Degrees) Scapula continues to move into upward rotation Clavicle moves upward and rotating around it s own axis Humerus moves into external rotation to clear the acrominon process, dropping into the subdeltoid joint Full unilateral abduction is associated with lateral spreading of the ribcage on the reaching side External Rotation Spinal extension Unilateral expansion Humeral Flexion Movement is initiated via the anterior deltoid, clavicular portion of the pectoralis major and the coracobrachialis The movement of the bony structures remain the same as in abduction Full bilateral humeral flexion is associated with spinal extension and anterior ribcage expansion The last 10 degrees of humeral extension occurs with lumbar extension 8

9 Shoulder Abduction Anterior View Shoulder Flexion and Extension Lateral View Flexion Extension Lateral Flexion. Rotation 9

10 Atypical Development Minimal or no physiological flexion Weakened postural system Phasic bursts Changes in sacromere lengths Example of Transitional Links Hypermobility with Immobility Above and Below C6/C7 Hypermobility T12/L1 Hypermobility Functional Kinesiology of the Shoulder Girdle 10

11 Axioscapular Musculature Trapezius Upper fibers: elevates, upwardly rotates scap Middle fibers: adducts the scapula Lower fibers: depresses and upwardly rotates scapula Dysfunction Levator Scapulae Elevates and downwardly rotates the scapula Dysfunction: Rhomboid Major and Minor Adducts and downwardly rotates the scapula, they work in conjunction with the levator Dysfunction: 11

12 Atypical Serratus Anterior Abducts and upwardly rotates the scapula Stabilizes the scapula on the ribcage When great force is placed upon the arms the scapula needs to be fixed on the ribcage Assists with keeping the medial border close to the thoracic wall as the arm moves away from the body Dysfunction: Atypical 12