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Sternoclavicular (SC) Joint
Elevation of the clavicle
Agonist muscle: Sternocleidomastoid and upper trapezius
Limited by: Pectoralis major, subclavius and costoclavicular ligament
Optimal Range of Motion (ROM): up to 48°
Depression of the clavicle
Agonist muscle: Pectoralis major and subclavius
Limited by: Sternocleidomastoid, upper trapezius, anterior & posterior capsular ligaments (superior portions) and interclavicular ligament
Optimal ROM: 10°-15°
Protraction of the clavicle
Agonist muscle: Serratus anterior, pectoralis minor
Limited by: Costoclavicular ligament (posterior portion), posterior capsular ligament and retractors(rhomboids, middle trapezius, levator scapula)
Optimal ROM: 15°-30° (1, 3)
Retraction of the clavicle
Agonist muscle: Rhomboids, middle trapezius, levator scapula
Limited by: Costoclavicular ligament (anterior portion), anterior capsular ligament and protractors (serratus anterior, pectoralis minor)
Optimal ROM: 15°-30°
*The muscles that contribute to clavicle prostration do no attach to the clavicle. It is through motion of the scapula being imparted on the clavicle via the AC joint that motion occurs
Posterior Rotation (inferior surface of the clavicle to face anterior)
Agonist muscle: Clavicular fibers of upper trapezius
Limited by: Pectoralis major, subclavius, pectoral fascia and clavipectoral fascia
Optimal ROM: 20°-50°
Anterior Rotation (clavicle return to neutral from posterior rotation)
Agonist muscle: Pectoralis major
Limited by: Sternocleidomastoid, platysma, investing layer of deep cervical fascia
Optimal ROM: <10° (return to resting position from posterior rotation)
Scapulothoracic (ST)
Elevation
Agonist muscle: Upper trapezius, levator scapulae, rhomboids
Limited by: Lower trapezius, latissimus dorsi, pectoralis minor
Optimal ROM: not typically measured
Contributing from SC joint: clavicular elevation
Contributing from AC joint: slight downward rotation, slight anterior/posterior tilt, int/ext rotation
Depression
Agonist muscle: Lower trapezius, latissimus dorsi, pectoralis minor
Limited by: Upper trapezius, levator scapulae, and rhomboids
Optimal ROM: not typically measured
Contributing from SC joint: clavicular depression
Contributing from AC joint: slight upward rotation, slight anterior/posterior tilt and internal/external rotation
Upward Rotation
Agonist muscle: Serratus anterior, upper and lower trapezius
Limited by: Rhomboids, pectoralis minor, levator scapulae, coracoclavicular ligament
Optimal ROM: up to 50-60°
Contributing from SC joint: clavicular elevation and posterior rotation
Contributing from AC joint: scapula upward rotation, posterior tilt
int/ext rotation
Downward Rotation
Agonist muscle: Rhomboids, pectoralis minor, levator scapulae
Limited by: Serratus anterior, upper and lower trapezius
Optimal ROM: return to resting position from upward rotation
Contributing from SC joint: clavicular depression and anterior rotation
Contributing from AC joint: scapula downward rotation, anterior tilt, int/ext rotation
Protraction
Agonist muscle: Serratus anterior, pectoralis minor
Limited by: Middle trapezius, rhomboids, lower trapezius and levator scapulae
Contributing from SC joint: clavicular protraction
Contributing from AC joint: scapula int rotation
Retraction
Agonist muscle: Middle trapezius, rhomboids, lower trapezius, levator scapulae
Limited by: Serratus anterior, pectoralis minor
Contributing from SC joint: clavicular retraction
Contributing from AC joint: scapula ext rotation
Acromioclavicular (AC)
Upward Rotation
(upward and outward motion of the inferior angle of the scapula)
Agonist muscle: Serratus anterior, upper and lower trapezius
Limited by: Rhomboids, pectoralis minor, levator scapulae and coracoclavicular ligament
Optimal ROM: 30°
Downward Rotation
Agonist muscle: Rhomboids, pectoralis minor, and levator scapulae
Limited by: Serratus anterior, upper and lower trapezius
Optimal ROM: 17°
Occurs actively in conjunction with shoulder extension or adduction (return to neutral); cannot occur as an isolated movement.
Internal Rotation
(glenoid fossa faces anteromedially)
Agonist muscle: Pectoralis minor
Limited by: Serratus anterior, middle trapezius and rhomboids
Optimal ROM: 20°-35°
*depending on accompanying upper extremity movement
External Rotation (glenoid fossa faces posterolaterally)
Agonist muscle: Serratus anterior, middle trapezius, and rhomboids
Limited by: Pectoralis minor
Optimal ROM: 20° – 35°
*depending on accompanying upper extremity movement
Anterior Tilt
Agonist muscle: Upper trapezius, levator scapulae and pectoralis minor
Limited by: Serratus anterior and lower trapezius
Optimal ROM: 20° – 40°
*depending on accompanying upper extremity movement
Posterior Tilt
Agonist muscle: Serratus anterior and lower trapezius
Limited by: Upper trapezius, levator scapulae and pectoralis minor
Optimal ROM: 20° – 40°
*depending on accompanying upper extremity movement