Complejo Articular del

Hombro
Complejo(Ar+cular(de(hombro(

•  Ar+culación(más(móvil(del(Cuerpo(
Humano(
•  Posee(3(grados(de(libertad(y(3(ejes(
principales*
Complejo(Ar+cular(de(hombro(

•  Complejo(ar+cular(formado(por(4*(
ar+culaciones ((
»  EsternoClavicular(
»  Acromioclavicular(
»  Escapulotorácica(
»  Glenohumeral((más(importante)(
»  *Subdeltoidea((directamente(relacionada(con(la(
glenohumeral)(
 EsternoMClavicular(

CH08-117-149.qxd 4/18/07 2:29 PM Page 128

128 Part II | KINESIOLOGY OF THE UPPER EXTREMITY

Anterior sternoclavicular
ligament Interclavicular
ligament

Intraarticular disc

Clavicle

Costoclavicular
ligament
1st rib

2nd rib
 EsternoMClavicular(

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
 EsternoMClavicular(

ElevaciónM(Descenso(
Retracción(

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
 AcromioMClavicular(

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
perior space • Superior [2]
erior space • Inferior [80]
rge dorsally • Anterior [2,84]
al border of • Retroverted [85]
width of the

EscápuloM(torácica(
Only the lateral orientation of the glenoid fossa appears
hat projects
uncontested. Although the differences in the literature
is process is
may reflect real differences in measurement or in the pop-
provides a
ulations studied, at least some of the variation is due to dif-
mion has an
ferences in reference frames used by the various investiga-
aspect of its
tors to describe the scapula’s position. The reference
th which it
frames used include one imbedded in the scapula itself
brocartilage
and one imbedded in the whole body. The scapula-fixed
medially and
reference frame allows comparison of the position of one
described as
bony landmark of the scapula to another landmark on the
hapes of the
scapula. The latter body-fixed reference frame allows com-
rocesses [4].
parison of the position of a scapular landmark to other
of acromion
regions of the body.
ement syn-
To understand the controversies regarding the orientation
gement syn-
of the glenoid fossa, it is useful to first consider the orienta-
tion of the scapula as a whole. Using a body-fixed reference
or vertebral
frame, the normal resting position of the scapula can be
uperior bor-
described in relationship to the sagittal, frontal, and transverse
g its length
planes. In a transverse plane view, the scapula is rotated
ends anteri-
inwardly about a vertical axis. The plane of the scapula is
angle, thus
oriented approximately 30–45° from the frontal plane
orax. It joins
(Fig. 8.4) [46,86]. This position directs the glenoid anteriorly
scapula that
with respect to the body. However, a scapula-fixed reference
r atrophied,
frame reveals that the glenoid fossa is retroverted, or rotated
the trapez-
posteriorly, with respect to the neck of the scapula [14,85].
uperior bor-
gerlike pro-
nd laterally
thirds of the
he coracoid
one third of
st medial to Plane of
border is the scapula
Scapula
prascapular

teral border
ntified land-
ble along its
major, teres
eral border
Clavicle
at the ante- 40°
ad gives rise
rticular sur-
Frontal plane
mewhat nar-
in a “pear-
ncreased by
EscápuloM(torácica(
 EscápuloM(Torácica(

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
 EscápuloM(Torácica(

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
EscápuloM(Torácica(
 GlenoM(Humeral(

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
 GlenoM(Humeral(

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
 GlenoM(Humeral(
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Chapter 8 | STRUCTURE AND FUNCTION OF THE BONES AND JOINTS OF THE SHOULDER COMPLEX 137

Joint cavity

Joint cavity
Joint capsule
Joint capsule
B

A
 GlenoM(Humeral(

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
 GlenoM(Humeral(
Separación(
Flexión(

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
 GlenoM(Humeral(
Rotación(

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
132 PART II Movimientos(
Clinical Kinesiology and Anatomy of the Upper Extremities

Abduction Adduction Circumduction

it is possible to move 90 degrees in each direction.

Horizontal abduction and horizontal adduction also
occur in the transverse plane around the vertical axis.
From an arbitrary starting position for these motions of
90 degrees of shoulder abduction, there would be
approximately 30 degrees of horizontal abduction
(backward motion) and approximately 120 degrees of
horizontal adduction (forward motion). Circumduction is
a term used to describe the arc or circle of motion possi-
ble at the shoulder. Because it is really only a combina-
tion ofLateral
all therotation Medial rotation
this term will Horizontal
not be abduction
Flexion Extension Hyperextension
shoulder motions,
used here.
Another term frequently seen in the literature, espe-
cially regarding therapeutic exercise for shoulder condi-
tions, is scaption. This motion is similar to flexion or
abduction but occurs in the scapular plane as opposed
to the sagittal or frontal plane. The scapular plane is
approximately 30 degrees forward of the frontal plane.
It is not quite midway between flexion and abduction.
With scaption of the shoulder, 180 degrees of up and
Horizontal adduction Scaption
Abduction Adduction Circumduction down motion is possible. Most common functional
Figure
activities 10-2.
occur in theShoulder joint motions.
scaption plane.
The normal end feel for all shoulder joint motions is
soft tissue stretch. This is due to tension from various
ligaments and muscles
adduction. andextension,
Flexion, from the andjointhyperextension
capsule. occur
Reviewing its description from Chapter 4, end feel is
Lippert,(L.((2011).(Clinical(kinesiology(and(anatomy.(Philadelphia,(PA:(F.A.(Davis.(Pag.(36( the
in the sagittal plane around the frontal axis. Flexion is
feel at the end of a joint’s passive range of motion when
 RoM(del(Complejo(Ar+cular(

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
 Ligamento(Coracoclavicular(

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
 the literature, some Inman et al. [40]. As the scapula is pulled away from the clav-
lusions to be drawn icle by upward rotation, the conoid ligament (the vertical por-
are tion of the coracoclavicular ligament) is pulled tight and pulls
on the conoid tubercle situated on the inferior surface of

Ligamento(Coracoclavicular(
al joints move simul-
the crank-shaped clavicle. The tubercle is drawn toward the
ange of shoulder ele-
coracoid process, causing the clavicle to be pulled into upward
rotation (Fig. 8.31). The crank shape of the clavicle allows the
othoracic joints con-
clavicle to remain close to the scapula as it completes its lateral
motion of flexion and
rotation, without using additional elevation ROM at the
sternoclavicular joint. The sternoclavicular joint thus elevates
systematic and coor-

apulothoracic motion
otion and the location

apulothoracic motion
Conoid ligament
d on muscle activity.
ity among individuals.
ions to help identify
help understand the
Clavicle
nts to dysfunction.

ance
PRODUCING
OME: Shoulder, or
ults from a persist-
tures within the
he acromion process Scapula
he chapter, abnor-
ute to the compres-
ther possible source Posterior surface
racic motion during of sternum
ular internal rota-
acromial space and
Movimiento(Acromioclavicular(

•  Ocurre(una(rotación(de(30º 1M(10º 2(que(se(

a ñ a d e( a( l a( d e( l a( a r + c u l a c i ó n(
esternocostoclavicular( para( permi+r( el(
movimiento( de( rotación( de( la( escapula( y(
a s í( l a( e l e v a c i ó n( d e( 1 8 0 º( d e( l a(
glenohumeral(

1(Fisiología(de(las(Ar+culaciones((Extremidades(Superiores).(6º(Ed,(Kapandji(I.A(
2(Kinesiology:(The(Mechanics(and(Pathomechanics(of(Human(Movement.(Oa+s,(C(
 Movimiento(Esternoclavicular(
•  Los(movimientos(de(la(esternocostoclavicular(se(
realizan(con(una(amplitud(de(elevación(de(10(cm(
y(3(cm(de(descenso.(Limitados(por(el(ligamento(
costoclavicular(y(músculo(subclavio(y(por(el(
ligamento(superior(y(contacto(de(clavícula(con(
cos+lla.(Corresponde(a(15M(40º2(
•  Anteposición(de(10(cm(y(retroposición(de(3(cm.(
Limitado(por(los(ligamentos(costoclavicular(y(el(
ligamento(anterior(y(posterior(respec+vamente(
•  Además(una(rotación(longitudinal(conjunta(de(
30º 1M(40º 3
1(Fisiología(de(las(Ar+culaciones((Extremidades(Superiores).(6º(Ed,(Kapandji(I.A(
2(Kinesiology:(The(Mechanics(and(Pathomechanics(of(Human(Movement.(Oa+s,(C(
3(Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(
Neumann,(D.(A.((2010).((
 Ritmo(Escapulotorácico(
•  La(rotación(o(báscula(se(efectúa(en(torno(a(un(
eje(perpendicular(al(plano(de(la(escápula,(
pasando(cerca(del(ángulo(superoexterno1(o(
bajo(la(espina(entre(borde(medial(y(lateral2.(
•  Tiene(una(amplitud(de(45º(a(60º,(el(
desplazamiento(del(ángulo(inferior(es(de(10M(
12(cm(y(el(del(superior(es(de(5(a(6(cm.(
•  Ritmo(EscapuloMTorácico(2:1?(
1(Fisiología(de(las(Ar+culaciones((Extremidades(Superiores).(6º(Ed,(Kapandji(I.A(
2(Kinesiology:(The(Mechanics(and(Pathomechanics(of(Human(Movement.(Oa+s,(C(
 Fases(de(la(Separación(

Esterno. Acromio. Escapulo. Glenohumeral*

Clavicular* clavicular* torácica*

Fase(Temprana( 25º(de( 5º(de(rotación( 30º(de(rotación( 60º(de(

0M(90º( Elevación( superior( superior( Separación(
Fase(Tardía( 5º(de(Elevación( 25º(de(rotación( 30º(de(rotación( 60º(de(
90M(180º( y(35º(de( superior( superior( separación(
rotación(
posterior(
Total( 30º(Elevación(y( 30º(de(rotación( 60º(de(rotación( 120º(de(
0M(180º( 35º(de(rotación( superior( superior( Separación(

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
used with caution to provide a perspective for the clinician shoulder. The normal function of the shoulder complex
without serving as a precise indicator of the presence or depends on the integrity of four individual joint structures
absence of pathology. The clinician must also consider the and their coordinated contributions to arm–trunk motion.

Rangos(Publicados(
contributions to the total motion made by the individual com- The glenohumeral joint is the sole contributor to medial and
ponents as well as the sequencing of those contributions. lateral rotation of the shoulder and contributes over 50% of

TABLE 8.2: Normal ROM Values from the Literature (in Degrees)
Medial Lateral Abduction
Flexion Extension Abduction Rotation Rotation in Scapular Plane
Steindler [93] 180 30–40 150
US Army/Air Force [20] 180 60 180 70 90
a
Boone and Azin [8] 165.0 ! 5.0 57.3 ! 8.1 182.7 ! 9.0 67.1 ! 4.1 99.6 ! 7.6
Hislop and Montgomery [36]b 180 45 180 80 60 170
c c c c c
Murray, et al [71] 170 ! 2 57 ! 3 178 ! 1 49 ! 3 94 ! 2
172 ! 1d 58 ! 3d 180 ! 1d 53 ! 3d 101 ! 2d
165 ! 2e 55 ! 2e 178 ! 1e 59 ! 2e 82 ! 4e
170 ! 1f 61 ! 2f 178 ! 1f 56 ! 2f 94 ! 2f
Gerhardt and Rippstein [27] 170 50 170 80 90
Bagg and Forrest [1] 168.1
Freedman and Munro [25] 167.17 ! 7.57
a
Data from 56 adult males. These values are also used as “normal” values by the American Academy of Orthopedic Surgeons.
b
Reported wide ranges from the literature.
c
Data from 20 young adult males.
d
Data from 20 young adult females.
e
Data from 20 male elders.
f
Data from 20 female elders.

Kinesiology:(The(Mechanics(and(Pathomechanics(of(Human(Movement.(Oa+s,(C(
 Tensión(Ligamentosa(

Ligamento* Inserción*Distal* Movimiento*limitado*

Glenohumeral( Cuello(anatómico,(sobre(el( Aproximación(y/o(traslación(inferior(y(

Superior( tubérculo(menor( posterior(del(húmero(
Glenohumeral( A(lo(largo(de(la(parte(anterior( Traslación(anterior(del(húmero(y/o(
Medio( del(cuello(anatómico( rotación(externa(
Glenohumeral( Como(una(banda(gruesa,(en(el( Separación.((
Inferior( borde(anteriorM(inferior(y( Banda(anterior:(+(rotación(externa(
posterior(inferior(del(cuello( Banda(posterior:+(rotación(interna(
Coracohumeral( Zona(anterior(del(tubérculo( Rotación(externa,(flexión(y(extensión.(
mayor( Traslación(inferior(de(la(cabeza(humeral((

Kinesiology(of(the(musculoskeletal(system:(Founda+ons(for(rehabilita+on.(St.(Louis,(Mo:(Mosby/Elsevier(Neumann,(
D.(A.((2010).((
How well joint surfaces match or fit is called joint congru- stability and integrity, the joint is usually placed in the
ency. The surfaces of a joint are congruent in one posi- close-packed position. By the nature of the characteristics

Tensión(Ligamentosa(
tion and incongruent in all other positions. When a
joint is congruent, the joint surfaces have maximum
contact with each other, are tightly compressed and are
difficult to distract (separate). The ligaments and cap-
of a close-packed position, a joint is often in this position
when injured. For example, a knee joint that sustains a lat-
eral force when it is extended (closed-packed position) is
much more likely to be injured than when it is in a flexed

Closed/(Loose(Packed(
sule holding the joint together are taut. This is known or semiflexed position (loose-packed position). Also,

Table 4-1 Comparison of Close-Packed and Loose-Packed Position of Joints

Joint(s) Close-Packed Position Loose Packed Position
Facet (spine) Extension Midway between flexion and extension
Temporomandibular Clenched teeth Mouth slightly open (freeway space)
Glenohumeral Abduction and lateral rotation 55° abduction, 30° horizontal
adduction
Acromioclavicular Arm abducted to 30° Arm resting by side in normal
physiological position
Ulnohumeral (elbow) Extension 70° flexion, 10° supination
Radiohumeral Elbow flexed 90°, forearm supinated 5° Full extension and supination
Proximal radioulnar 5° supination 70° flexion, 35° supination
Radiocarpal (wrist) Extension with ulnar deviation Neutral with slight ulnar deviation
Carpometacarpal N/A Midway between abduction/adduction
and flexion/extension
Metacarpophalangeal Full flexion Slight flexion
(fingers)
Metacarpophalangeal Full opposition Slight flexion
(thumb)
Interphalangeal Full extension Slight flexion
Hip Full extension and medial rotation* 30° flexion, 30° abduction and slight
lateral rotation
Knee Full extension and lateral rotation 25° flexion
of tibia
Talocrural (ankle) Maximum dorsiflexion 10° plantar flexion, midway between
maximum inversion and eversion
Metatarsophalangeal Full extension Neutral
Interphalangeal Full extension Slight flexion
*Some authors include abduction.
Adapted from Magee, DJ: Orthopedic Physical Assessment, ed 4. WB Saunders, Philadelphia, 2002, p 50, with permission.

Lippert,(L.((2011).(Clinical(kinesiology(and(anatomy.(Philadelphia,(PA:(F.A.(Davis.(Pag.(35(
 positions. This is the passive movement of one articular PIP joint slightly flexed, gently move your two hands
Bending
surface over another. Because jointand
play torsional forces
is not a volun- areopposite
in an actually a combi- motion. This motion
up-and-down
tary movement, itnation requires of forces.
relaxed Bending
muscles and theoccurs when
describes an other-than-
anterior/posterior glide of the PIP joint (a

orces demonstrate it. Tensión(Ligamentosa(

external force of vertical
a trained force is applied,
practitioner to correctly
the concave side and distraction
shearing
resulting inforce).
compression on
Bending and torsional forces are actually a combi-
on the convex
nation of forces. Bending occurs when an other-than-

Movimientos(Accesorios(
zation, three main types of side (Fig. 4-11). Rotary or torsional forces
vertical force involve
is applied, a in compression on
resulting
Accessory Motion Forces
ompression, and shearing. twisting motion. One force the is concave
trying sideto turn one
and distraction on the convex
s are the result When applying joint
of a combi- mobilization,
end three main
or part about types of side (Fig.
a longitudinal axis4-11).
whileRotary or torsional forces involve a
the other
forces are used: traction, compression, and shearing. twisting motion. One force is trying to turn one
force is fixed or turning in the opposite direction
Bending and torsional forces are the result of a combi- end or part about a longitudinal axis while the other
raction or tension, of forces. (Fig. 4-12).
nation occurs force is fixed or turning in the opposite direction
Traction,
ed on a joint, causing thealso called distraction or tension, occurs (Fig. 4-12).
when external force is exerted on a joint, causing the
Fig. 4-8). Carrying a heavy
joint surfaces to pull apart (Fig. 4-8). Carrying a heavy
n overhead bar suitcase
causes or trac-
hanging from an overhead bar causes trac-
and wrist joints. You can
tion to the shoulder, elbow, and wrist joints. You can
demonstrate
r person by grasping their this on another person by grasping their
index finger at the proximal end of the middle phalanx
end of the middle
with phalanx
one thumb and index finger. Next, grasp the dis-
finger. Next, grasp
tal endthe dis-proximal phalanx with your other thumb
of the
and index
anx with your other thumb finger. Move the proximal interphalangeal Figure 4-9. Compression force causes bone ends to move
(PIP) joint into a slightly flexed position (loose-packed toward each other.
proximal interphalangeal
position), and pullFigure 4-9.
gently in Compression
opposite force causes bone ends to move
directions. This
xed position (loose-packed toward each other.
n opposite directions. This

Figure 4-8. Traction force causes bone ends to move apart Figure 4-10. Shear force causes bone ends to move parallel
from each other. to and in opposite direction from each other.

Lippert,(L.((2011).(Clinical(kinesiology(and(anatomy.(Philadelphia,(PA:(F.A.(Davis.(Pag.(36(
ses bone ends to move apart Figure 4-10. Shear force causes bone ends to move parallel