FIG. 5.11 The sternoclavicular joints. The capsule and lateral section of the anterior bundle of the costoclavicular liga ‘ment have been removed on the left side. FIG. 5.13 ‘The osteokinematics of the right sternochvicular joint. The motions are elevation and depression in a near frontal plane (purple), protraction and retraction in a near horizontal plane (blue), and posterior clavicuar rotation in near sagital plane Green). ‘The vertical and anterior-posterior axes of rotation are color-coded with the corresponding, planes of movement. The longitudinal axis is indicated by the dashed green lineFIG. 5.14 Anterior view of a mechanical diagram of the arthrokinematics of roll and slide during elevation (A) and depression (B) of the clavicle around the right sternoclavicular joint. The axes of rotation are shown in the anterior-postetior direction near the head of the clavicle. Stretched structures are shown as thin elongated arrows: slackened structures are shown as wavy arrows. Note in (A) that the stretched costoclavicular ligament produces a downward force in the direction of the slide. CCT, costoclavicular ligament; CL, interclavicular ligament; SC superior capsule. Superior view Anterior FIG. 5.15 Superior view of a mechanical diagram of the arthrokinematics of toll and slide during retraction of the clavicle around the right sterno- davicular joint. The vertical axis of rotation is shown through the sternum. Stretched structure is shown as thin elongated arrow; slack- ened structures are shown asa wavy arrow. ACL, anterior capsular liga- ment CCL, costoclavicular ligament; PCL, posterior capsular ligaments.FIG. 5.16 ‘The right acromioclavicular joint. (A) An anterior view showing the sloping nature ofthe articulation. (B) A posterior view of the joint opened up from behind, showing the clavieular facet on the acromion and the fragmented disc. FIG. 5:20 (A) Scapulothoracic elevation shown asa summation of (B) clovation atthe stemoclaviular joint and (C) downward rotation at the actomioclavicular joint,8C Joint FIG. 5:21 (A) Scapulothoracic protacton shown asa summation of (B) protraction at the stenoclavicular joint and (©) slight invemal ouion atthe acromioclavicular joint. FIG. 5.22 (A) Scapulothoracic upward rotation shown as a summation of (B) elevation at the sternoclavicular joint and (C) upward rotation a the acromioclavicular joint.‘Transverse ligament (cut) ‘Synovial sheath for biceps tendon Biceps brachii tendon (long head) FIG. 5.23 Anterior view of a frontal section through the right glenohumeral joint, Note the fibrous capsule, synovial membrane (blue), and the long head of the biceps tendon. ‘The axillary pouch is shown as a races in the inferior caps Middle glenohumeral igament ‘Subscapularis Inferior glenohumeral ligament (anterior band) FIG. 5.27 Illustration showing a high-velocity abduction and external rotation motion of the glenohumeral joint during the cocking phase of pitching a baseball. This motion wwists and elongates the middle GH ligament and anterior band of the inferior GH ligament (depicted as thin red arrows pointed toward the rim of the glenoid fossa). ‘The humeral head has been removed to show the aforementioned stretched scructures and glenoid fossa. This active motion tends to translate the humeral head anteriorly (hick black arrow), toward the anterior glenoid labrum and subscapularis muscle. Tension in the stretched ligaments and subscapularis muscles naturally resists this anterior translation,‘Subacromial bursa ‘Supraspinatus FIG, 5.29 An anterior view of a frontal plane cross-section of the right glenchumeral joint. Note the subacromial and subdeltoid bursa within the subacromial space. Bursa and synovial lining are depicted in blue. The deltoid and supraspinatus muscles are also shown. Supraspinatus ull FIG. 5.31 The arthrokinematics of the right glenohumeral joint during active abduction. The supraspinatus is shown contracting to direct the superior roll of the humeral head. The taut inferior capsular ligament (ICL) is shown supporting the head of the humerus like a hammock (see text). Note that the superior capsular ligament (SCL) remains relatively taut because of the pull from the attached contracting supraspinacus. Sueecched tissues are depicted as long black arrows.‘mérgenes anteroinferiory patettenrdaaido mona Eliadoaterior de tubarcuiomayoc lanbinae inenscen cto nace yoalén del iorsepnct.La importancia funcional de la rotactén total hacta aniba dela amicus iO exeapylotorécica Elevar el 20 ppr encima de la cabeza a menudo se denomina informalmente flexion (cuando esta cerca del pland sagital) o abduecian —r (cuando esta cerca del plano frontal o escapular). Independiemtemente de! plana de movimiento especifico, la capacidad de levantar el brazo completamente por encima de la cabeza es un requisite previo para muchas actividades funcionales. Una escapula completamente rotada hacia arriba es un componente importante de este movimients y representa aproximadamente un tercio de Ins casi 180 grados de abduccidn o flexion del hombro. Camo ocurre con todos las movimientos escapulotoracicos, fa rotacién hacia arriba estd vinculada mecdnicamente a los movimientos de jas articulaciones estemoclavicular y acromioclavicular. La rotacion hacia arriba de la escapula que se produce durante la abduccion total del hombro cumple al menos tres funciones importantes. Primera, la escapula rotada hacia arriba proyecta la fosa glenoidea hacia arriba y anterolateralmente, proporcionando una base estructural para maximizarel alcance hacia arriba y lateral del miembro superior. En segundo lugar, la escapula rotada hacia arriba preserva la relacién Jongituc-tensian optima de los musculos abductores dela articulacién glenohumeral, como el deltoides media y el supraespinoso. En tercer lugar, la esedpula rotada hacia arriba ayuda a preservar el volumen dentra del espacie subacromial; el drea entre la superficie inferior del acromion y la cabeza humeral (ver Figs. 5.24 y 5.25) Un espacio subacromial reducide durante la abduccién puede provocar una compresién doloresa y dafiina de las tejidos residentes, como el supraespinaso, entre otras. tendén. Estd claro que la cinematica aseciada conla rotacién hacia arriba de la escdpula es esencial para la funcién ‘Sptima del hombra, especialmente para un range de abduccidn (0 flexisn) ‘completa y sin dolar.