Neck pain| shoulder| overhead arm elevation
March 16, 2007 9:07 amFriday, March 16, 2007
Neck pain| shoulder| overhead arm elevation
If any of the muscles listed below are in pain or discomfort, there will be an impairment of shoulder movements especially with overhead arm elevation.
Overhead arm elevation is a series of movements bringing the shoulder from the side of the body, to 60° away from the body, to 90° and then to a full overhead elevation.These movements have to be smooth and without hesitations showing that movements of the shoulder joint and movements between the shoulder blade and the chest wall is normal.
Normally, for every 2° movement at the shoulder joint , there is 1° of movement the shoulder blade on the chest wall.
Therefore, for overhead elevation of 180°, 120° of movement will occur at the shoulder joint and 60° of the movement is contributed by movements of the shoulder blade on the chest wall. The shoulder blade should not move with shoulder joint movements under 60°.
The arm can be elevated overhead by:
- lifting the arm forward (flexion)
- lifting it sideways (abduction).
Muscles that raise the arm overhead through lifting the arm forward (flexion):
- pectoralis major supplied by the lateral pectoral nerve from the lateral cord and medial pectoral nerve from the medial cord of the brachial plexus.
- infraspinatus and teres minor contract to bring the arm to 90° away from the shoulder and the activity become stronger as the arm is elevated above 90°.
- lower four slips of the serratus anterior muscle. The serratus anterior muscle is supplied by the C5, C6 and C7 nerve roots through the long thoracic nerve of Bell. The long thoracic nerve is given off from the C5-C7 nerve roots of before the formation of the brachial plexus. The serratus anterior is also helped by the rhomboid major and minor muscles and the levator scapulae which help to fix the shoulder blade to the chest wall. The serratus anterior helps to pull the shoulder blade out and up. The rhomboid muscles are important in bringing the arm down from the overhead position.
Muscles that raise the arm overhead through lifting the arm away from the side of the body:
- serratus anterior
- trapezius
- infraspinatus and teres minor
To raise the arm overhead, the shoulder must be externally rotated. If the shoulder is in internal rotation, the head of the humerus is caught under the acromion and full overhead arm elevation is not possible.
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If the shoulder is in internal rotation, the head of the humerus (shoulder bone) is caught under the acromion of the shoulder blade and full overhead arm elevation is not possible (below).
Raising the arm in external rotation can bring about full overhead elevation (below) 
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