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Many patients with shoulder pain, many people will have limited abduction, some people think that can not be abduction is shoulder inflammation, indeed, the shoulder joint capsule limited mode is very affecting shoulder abduction. A simple outreach action requires a lot of cooperation. It is possible that the shoulder joint cannot be abducted, not the periarthritis of the shoulder, but the poor coordination of the rest of the movement. Today, let's talk about the composition of the outreach.
The complete shoulder joint includes the scapular joint, the scapular chest wall joint, the sterno-lock joint and the acromioclavicular joint. The movement of the shoulder joint is coordinated by the four joints according to certain rules.
Shoulder abduction is clinically defined as the rotation of the humerus around the anteroposterior axis in the frontal plane. The normal activity is above 160°, and many people can reach 180°. A normal healthy person's scapular joint abduction can reach 120°, which is 60 degrees worse than the normal shoulder joint activity? What parts of the remaining activities need to be provided?
This is to say the scapular rhythm. In fact, during our shoulder abduction, the complete abduction of the shoulder complex requires the scapula to perform an upward rotation of about 60° at the same time. According to the general 2:1 scapular rhythm, a 120° scapular abduction and a 60° scapular upper wall joint of the scapular chest joint will result in a 180° active abduction of the shoulder joint.
Scapular rhythm
When the shoulder joint is normally abducted or flexed, there is a natural 2:1 ratio of the scapular and scapular chest wall joints. This ratio means that every 2 degrees of scapular abduction is accompanied by an external scapula of about 1 degree. . The normal and complete shoulder joint has a 180 degree abduction, about 120 degrees from the abduction of the scapular joint, and the other 60 degrees from the external rotation of the scapula.
Although in general, the scapula has an abduction or flexion of 120 degrees, the shoulder blade should be rotated 60 degrees to achieve a full abduction or flexion of the shoulder joint 180 degrees, but during the shoulder abduction or flexion The cooperative interaction of the scapular and scapular chest wall joints is different.
When the shoulder joint is abducted, during the 0-30 degree period, only the acromioclavicular joint abduction, there is no movement of the shoulder and chest wall joint; during 30-90 degrees, the scapular rhythm is 1:1, that is, the shoulder joint abduction 30 Shoulder scapular wall joint external rotation 30 degrees; during 90-180 degrees, the scapular rhythm is 2:1, that is, the shoulder joint abduction 60 degrees scapular chest wall joint joint external rotation 30 degrees. Therefore, the total ratio of joint activity of the scapula and chest wall is 2:1.
The scapular rhythm is not only the movement of the scapular and scapular chest wall joints, but also the movement of the sterno-lock joint and the acromioclavicular joint.
The shoulder blade in the scapular rhythm is rotated 60°, which is inseparable from the joint movement of the sterno-lock joint and the acromioclavicular joint. After the scapula is raised, the acromioclavicular joint is also moving, so the position of the clavicle is also rising. The upswing of the clavicle is inseparable from the movement of the sterno-lock joint. Therefore, during the whole exercise, the 60-degree upper maneuver of the scapula was completed by lifting the clavicle at the chest joint for 25 degrees and the shoulder blade at the acromioclavicular joint for 35 degrees.
At the same time, the aerodynamics of the abduction involves the upward and downward sliding of the humerus. This type of exercise can effectively prevent the humeral head from hitting the underside of the shoulder.
It is worth noting that while the clavicle is uplifting, the clavicle itself is rotated 20 degrees to 35 degrees along the long axis, with a retraction of 15 degrees (the clavicle rotates backwards because the scapula is rotated over the acromioclavicular joint and pulled to the ankle). The locking ligament causes the crank-shaped clavicle to rotate backwards; and the shoulder blade itself also has a 20 degree back tilt and a 10 degree abduction, which helps maintain the space under the shoulder; while the shoulder joint is abducted, Can not be separated from the external rotation of the humerus, the external rotation of the humerus 22-55 degrees, this accompanying external rotation may make the large nodules of the humerus avoid the space under the shoulder, can avoid the cardia of the greater sacral and subacromial space Pressure, especially the supraspinatus and biceps long head. If the humeral head cannot be effectively externally rotated, then our outreach activity is limited. It may be that we have no problem with abduction in the external rotation of the humerus. In the normal state, the exhibition will cause pain and even limited mobility. .
to sum up
The state of motion during shoulder abduction is:
1. The ankle joint is abducted 120 degrees, and the shoulder and chest wall joint movement is 60 degrees (including the tibia movement including upward scrolling and downward sliding). The movement of the shoulder and chest wall joints includes a 25 degree chest lock joint rise and a 35 degree acromioclavicular joint rise.
2, the clavicle itself 20 degrees - 35 degrees after the rotation, with 15 degrees retraction
3, the scapula itself also has a 20 degree backward tilt and a 10 degree abduction 4, the external rotation of the tibia itself 22 degrees - 55 degrees
If there is a problem in any of the above-mentioned movements, it may cause problems in the abduction of the shoulder joint, resulting in limited activity or pain.
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