Chapter 7: The Biomechanics of the Human Upper Extremity

Basic Biomechanics, 4th edition Susan J. Hall

Presentation Created by

TK Koesterer, Ph.D., ATC Humboldt State University

Objectives
Explain how anatomical structure affects movement capabilities on upper extremity articulations. Identify factors influencing the relative mobility and stability of upper extremity movements Identify muscles that are active during specific upper extremity movements Describe the biomechanical contributions to common injuries of the upper extremity.

Structure of the Shoulder

Most complex joint in body Separate articulations: Sternoclavicular Joint Acromioclavicular Joint Coracoclavicular Joint Glenohumeral Joint Scapulothoracic Joint Also: Bursae

Sternoclavicular Joint
Provides major axis of rotation for movement of clavicle and scapula Freely permitted frontal and transverse plane motion. Allows some forward and backward sagittal plane rotation. Rotation

Acromioclavicular Joint
Irregular diarthrodial joint between the acromion process of the scapula and the distal clavicle. allows limited motions in all three planes.
Rotation occurs during arm elevation Close-packed position with humerus abducted to 90 degrees

Coracoclavicular Joint
A syndesmosis with coracoid process of scapula bound to the inferior clavicle by the coracoclavicular ligament.
Permits little movement

Glenohumeral Joint
Most freely moving joint in human body Glenoid Labrum composed of: Joint capsule Tendon of long head of biceps brachii Glenohumeral ligaments Rotator Cuff Rotator Cuff Muscles Most stable in close-packed position, when the humerus is abducted and laterally rotated.

Scapulothoracic Joint
Region between the anterior scapula and thoracic wall. Functions of muscles attaching to scapula: Contract to stabilize shoulder region Facilitate movements of the upper extremity through appropriate positioning of the glenohumeral joint.

Bursae
Small fibrous sacs that secrete synovial fluid internally to lessen friction between soft tissues around joints. Shoulder contains: Subcoracoid bursa Subscapularis bursa Subacromial bursa

Movements of the Shoulder Complex

Humerus movement usually involves some movement at all three shoulder joints Positioning further facilitated by motions of spine Scapulohumeral Rhythm

Movements of the Shoulder Complex

Muscles of the Scapula Muscles of the Glenohumeral Joint Flexion Extension Abduction Adduction Medial and Lateral Rotation of the Humerus Horizontal Adduction and Abduction at the Glenohumeral Joint

Muscles of the Scapula

Functions: 1) stabilize the scapula when shoulder complex is loaded 2) move and position the scapula to facilitate movement at glenohumeral joint Are: Levator scapula, rhomboids, serratus anterior, pectoralis minor, subclavius, and four parts to trapezius.

Muscles of Glenohumeral Joint

Many muscles involved, some contribute more than others. Large ROM can complicate tension development with orientation of humerus. Tension development in one shoulder muscle is frequently accompanied by development of tension in an antagonist to prevent dislocation of the humeral head.

Flexion at Glenohumeral Joint

Prime flexors: Anterior deltoid Pectoralis major: clavicular portion Assistant flexors: Coracobrachialis Biceps brachii: short head

Extension at Glenohumeral Joint

Gravitational force is primary mover when shoulder extension isnt resisted. Control by eccentric contraction of flexors With resistance there is contraction of muscles posterior to the glenohumeral joint Assisted by: Posterior deltoid Biceps brachii: long head

Abduction at Glenohumeral Joint

Major abductors of humerus: Supraspinatus Initiates abduction Active for first 110 degrees of abduction Middle deltoid Active 90-180 degrees of abduction Superior dislocating component neutralized by infraspinatus, subscapularis, and teres minor

Adduction of Glenohumeral Joint

Primary adductors: Latissimus dorsi Teres major Sternocostal pectoralis Minor assistance: Biceps brachii: short head Triceps brachii: long head Above 90 degrees- coracobrachialis and subscapularis

Medial and Lateral Rotation of Humerus

Due to action of: Subscapularis Has greatest mechanical advantage for medial rotation Teres major Assisted by: Primarily: pectoralis major Also: anterior deltoid, latissimus dorsi and short head of biceps brachii

Horizontal Adduction and Abduction at the Glenohumeral Joint

Anterior to joint: Pectoralis major (both heads), anterior deltoid, coracobrachialis Assisted by short head of biceps brachi Posterior to joint: Middle and posterior deltoid, infraspinatus, teres minor Assisted by teres major, latissimus dorsi

Loads on the Shoulder

Arm segment moment arm: Perpendicular distance between weight vector and shoulder. With elbow flexion, upper arm and forearm/hand segments must be analyzed separately. Large torques from extended moment arms countered by shoulder muscles. Load reduced by half with maximal elbow flexion

Common Shoulder Injuries

Dislocations
Rotator Cuff Damage Impingement Theory Subscapular Neuropathy Rotational Injuries

Rotational Injuries
Tears of labrum Mostly in anterior-superior region Tears of rotator cuff muscles Primarily of supraspinatus Tears of biceps brachii tendon Due to forceful rotational movements Also: calcification of soft tissues, degenerative changes in articular surfaces, bursitis

Structure of the Elbow

Humeroulnar Joint
Humeroradial Joint Proximal Radioulnar Joint

Segments at the Elbow

Flexion and Extension Muscles crossing anterior side of elbow are the flexors: Brachialis, biceps brachii, brachioradialis Muscles crossing posterior side of elbow are the extensors: Triceps, anconeus muscle

Segments at the Elbow

Pronation and Supination Involves rotation of radius around ulna Articulations: Proximal and distal radioulnar joints (both pivot joints) Middle radioulnar joint (syndesmosis) Pronator quadratus Supinator

Loads on the Elbow

Large loads generate by muscles that cross elbow during forceful pitching/throwing Also in weight lifting, gymnastics Extensor moment arm shorter flexor moment arm Tricep attachment to ulna closer to elbow joint center than those of the brachialis on ulna an biceps on radius Moment arm also varies with position of elbow

Common Injuries to Elbow

Sprains Dislocations nursemaids elbow or pulled elbow Overuse Injuries Lateral Epicondylitis = tennis elbow Medial Epicondylitis = Little Leaguers Elbow Elbow injuries are more chronic than acute

Structure of the Wrist

Radiocarpal joint Reinforced by: volar radiocarpal, dorsal radiocarpal, radial collateral and ulnar collateral ligaments Retinacula Form protective passageways for tendons, nerves and blood vessel to pass through

Movements of the Wrist

Sagittal and frontal plane movements Rotary motion Flexion Extension and Hyperextension Radial Deviation Ulnar Deviation

Joint Structure of the Hand

Carpometacarpal (CM)
Metacarpophalangeal (MP) Interphalangeal (IP)

Movements of the Hand

CM Joints allow large ROM because similar to ball and socket joint Digits 2-4 constrained by ligaments MP joints allow flexion, extension, abduction, adduction and circumduction for digits 2-5 IP joints allow flexion and extension Extrinsic Muscles Intrinsic Muscles

Common Injuries of the Wrist and Hand

Sprains and strains fairly common, due to breaking a fall on hyperextended wrist Certain injuries characteristic of sport type Metacarpal fractures and football Ulnar collateral ligament and hockey Wrist fracture and skate/snowboarding Wrist in non-dominant hand for golfers Carpal Tunnel Syndrome

Summary
Shoulder is the most complex joint in the human body. Movements of the shoulder girdle contribute to optimal positioning of the glenohumeral joint for different humeral movements. Humeroulnar articulation controls flexion and extension at the elbow Pronation and supination of forearm occur at proximal and distal radioulnar joints.