Shoulder Complex: Anatomy, Kinesiology and Beyond

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Now you are • Remember that OT is 25% difficult, hard to
set to practice understand (let alone explain) material and
based on 75% cheerleading!
where you can
demonstrate • Always keep an anatomy/kinesiology text
there is a close by.
need.
• Helpful to refresh memories sometimes
• Useful when explaining your evaluation findings

• Peer collaboration is always present in some
form or another. If you need additional help,
seek out a mentor.

• Remember, though, if you have successfully had
a mentor in the past, you should consider
returning the favor and mentoring someone
with less clinical reasoning experience than you.

Wow, I feel so smart with all
of this information. What

can I do with it?

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What’s Posture
got to do with it?

• Often caused by poor posture over
an extended period of time.

• It results in rounded shoulders, head in
front of the body, and an apparent curve
in the neck and upper back.
• While UCS is a condition routinely
suffered by the elderly, although is
becoming more common in office
workers.

• Client experiences:

• Tight upper traps, levator scapula and
pectoralis muscle

• Weak and lengthened lower traps,
rhomboids, serratus anterior and neck
flexor muscles

• Bad posture
• Hyperkyphotic curve
• Chronic pain

The muscles of the human body are interconnected.
• When one muscle becomes weak, another muscle takes over the work.
• In the condition known as UCS, mid-back muscles (serratus and lower
trapezius) become very weak.
• As a result, the pectoral and neck muscles tighten.
• This causes pain throughout the upper body, including shoulder
pain and neck pain, as well as a reduced range of motion.

• Simply put, UCS is a muscle imbalance caused by the weakening and lengthening
of the posterior upper back and neck muscles, combined with the tightening and
shortening of the opposing anterior pectoral (chest) and neck muscles. This
imbalance leads to joint dysfunction.
• Individuals with a sedentary lifestyle are most at risk for developing UCS.
• Long hours of sitting at a computer, watching television, or playing on a
smartphone can contribute to bad posture.
• This prolonged poor posture can weaken the rhomboid and neck flexor
muscles, while tightening and shortening the pectoral and upper trapezius
muscles.
• This is what’s known as the “cross” pattern where the condition gets its
name.

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Functional Assessment

• Shoulder

• Integral role in ADL (open and
close kinematic chain)

• Placing hand behind the head
(e.g., combing hair) requires full
lateral rotation

• Placing hand in small of the back
(e.g., to undo a bra) requires full
internal rotation.

ROM Necessary for Certain ADLs

• Eating

• 70-100o horizontal ADD
45-60o ABD

• Combing Hair

• 30-70o horizontal ADD
105-120o ABD
90o lateral rotation

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ROM Necessary for Certain ADLs

• Reach Perineum

• 75-90o horizontal ABD
30-45o ABD
90o+ internal rotation

• Hand Behind Head

• 10-15o horizontal ADD
110-125o forward flexion
90o lateral rotation

ROM Necessary for Certain ADLs

• Putting Something on a Shelf

• 70-80o horizontal ADD
70-80o forward flexion
45o external rotation

Slide 45 P a g e | 72

Do you have
any W’s??

Functional Activity Analysis

• Analyze the activity of placing a
plate in a cabinet and removing
the plate and placing it on the
counter. Perform those tasks and
describe the position of the
person’s scapula in the upper
and lower photos

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Functional Activity Analysis

• Describe the positions of
the shoulder joint when
the subject is:

• starting to remove
plate from the cabinet
shelf.

• placing the plate on the
counter

Lab Exercise

• Stand in the anatomical position
and hold a purse in one hand
with the elbow extended.

• The force acting on the shoulder
joint is __________

• Name the muscles acting at the
shoulder joint to counteract the
force produced by the purse

• Name the muscles acting at the
shoulder girdle to counteract the
force produced by the purse

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Occupational Therapy Interventions

• Activities of Daily Living • Environmental Adaptation • Pre-Prosthetic and
• Adaptive Equipment • Ergonomics
• AROM AAROM PROM • Exercise Prosthetic Training
• Assistive Technology • Functional Training • Prevention
• Biofeedback • Health Promotion • Problem Solving
• Body Awareness • Home Modification • Rehabilitation
• Body Mechanics • Job Modification • Relaxation Techniques
• Cogn Behavior Therapy • Job Retraining • Splint
• Compensation • Joint Protection • Stretching
• Driving Adaptations • Orthotics • Work Hardening
• Durable Medical • Caregiver/Family Education • Work Reconditioning/
• Physical Agent Modalities
Equipment • Postural Training Conditioning
• Edema Control • Many, many other
• Energy Conservation
activities and occupations

to choose from.