
Sternoclavicular (SC), Acromioclavicular (AC), and Scapulothoracic (ST) Joint Anatomy
Integrated functional anatomy of the shoulder girdle – Bones, joints, palpation, ligaments, nerves, joint anatomy, joint actions, arthrokinematics, muscles, fascia, and range of motion of the scapula, clavicle, and acromion. Highlighting the behaviors in postural dysfunction, shoulder pain, neck pain, and common interventions for the sternoclavicular, acromioclavicular, and scapulothoracic joints.
Integrated functional anatomy of the shoulder girdle – Bones, joints, palpation, ligaments, nerves, joint anatomy, joint actions, arthrokinematics, muscles, fascia, and range of motion of the scapula, clavicle, and acromion. Highlighting the behaviors in postural dysfunction, shoulder pain, neck pain, and common interventions for the sternoclavicular, acromioclavicular, and scapulothoracic joints.
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Course Description: Shoulder Girdle Anatomy: Sternoclavicular Joint (SC), Acromioclavicular Joint (AC), and Scapulothoracic Joints (ST)
This course describes sternoclavicular joint anatomy (SC joint), acromioclavicular joint anatomy (AC Joint), and scapulothoracic joint anatomy (ST joint). These are the joints resulting from the approximation of the sternum (breastbone) with the medial clavicle (collar bone), the distal clavicle with the scapula (shoulder blade), and the scapula with the rib cage. These joints are also referred to as the shoulder girdle, and most often analyzed by referring to motion of the scapula. This course includes descriptions of the bones, synovial joints, joint actions, ligaments, bursae, relative location, the relationship between the bones of the clavicle, sternum, acromion, and thoracic spine, and the muscles that cross them. Further, this course discusses palpation and introduces sternoclavicular, acromioclavicular, and scapulothoracic joint (upper limb) specific exercises, manual techniques, and interventions for dysfunction, pain, posture, and movement impairment. The SC, AC, and ST joints often play a role in common dysfunctions and joint injuries of the shoulder including upper crossed syndrome, rounded shoulder posture, upper body dysfunction (UBD) (e.g. impingement syndrome), cervical spine dysfunction, forward head posture (e.g. chronic neck pain), thoracic spine dysfunction and thoracic kyphosis (e.g. upper back pain), sternocostal dysfunction and stiffness (e.g. costochondritis), and elbow dysfunction (e.g. lateral epicondylitis). Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) with advanced knowledge of the sternoclavicular, acromioclavicular, and scapulothoracic joints will improve their ability to analyze human movement and develop sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation/physical therapy (e.g. assessment and treatment of joint injury, joint separation/dislocation, shoulder pain, shoulder separation, rotator cuff injury, type II acromion, ac joint sprain, and upper limb pain), the effect the SC, AC, and ST joints have on upper extremity (upper limb) and cervical spine alignment (e.g. a forward head position), and active and passive exercises for the shoulder girdle, including techniques to enhance sports performance (e.g. upper limb stability, strength, hypertrophy, and power).
Pre-approved credits for:
Pre-approved for Continuing Education Credits for:
- Athletic Trainers
- Chiropractors
- Group Exercise Instructors
- Massage Therapists
- Occupational Therapists - Intermediate
- Personal Trainers
- Physical Therapists
- Physical Therapy Assistants
- Yoga Instructors
This Course Includes:
- AI Tutor
- Study Guide
- Text and Illustrations
- Audio Voice-over
- Technique Videos
- Practice Exam
- Pre-approved Final Exam
Brookbush Institute's most recommended techniques for the SC, AC, and ST joints (see videos below):
- Assess:
- Self-administered Techniques:
- Release: Levator Scapulae
- Stretch: Levator Scapula Static Stretch
- Activation: Serratus Anterior
- Manual Techniques:
- Release: Pectoralis Minor
- Mobilization: Thoracic Spine Mobilization: Posterior-to-Anterior
- Manipulation: Cervicothoracic Junction Manipulation

Study Guide: Sternoclavicular (SC), Acromioclavicular (AC), and Scapulothoracic (ST) Joint Anatomy
Introduction to Shoulder Girdle Anatomy: Sternoclavicular Joint (SC), Acromioclavicular Joint (AC), and Scapulothoracic Joints (ST)5 Sub Sections
SC, AC, & ST Joint Actions5 Sub Sections
Integrated Function
Postural Dysfunction and the Sternoclavicular, Acromioclavicular & Scapulothoracic Joints2 Sub Sections
Videos5 Sub Sections
Bibliography
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- Bones and Joint Types
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- Articular Surfaces
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- Palpation
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- Capsule, Ligaments and Menisci (Non-contractile/passive tissue)
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- Bursae
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- Nerves
- Banneheka, S. (2008) Anatomy of the ansa cervicalis: nerve fiber analysis. Anat Sci Int. 83(2):61-7. doi: 10.1111/j.1447-073X.2007.00202.x.
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- Osteokinematics
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- Ludewig, P. M., Behrens, S. A., Meyer, S. M., Spoden, S. M., & Wilson, L. A. (2004). Three-dimensional clavicular motion during arm elevation: reliability and descriptive data. Journal of Orthopaedic & Sports Physical Therapy,34(3), 140-149.
- Cynthia C. Norkin, D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry – Third Edition. © 2003 by F.A. Davis Company
- Regional Interdependence:
- Suzuki, H., Swanik, K. A., Huxel, K. C., Kelly, J. D., & Swanik, C. B. (2006). Alterations in upper extremity motion after scapular-muscle fatigue. Journal of Sport Rehabilitation, 15(1), 71
- Kwon JW, Son SM, Lee NK. (2015). Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. J Phys Ther Sci. 27: 1739-1742
- Helgadottir, H., Kristjansson, E., Einarsson, E., Karduna, A., & Jonsson, H. (2011). Altered activity of the serratus anterior during unilateral arm elevation in patients with cervical disorders. Journal of electromyography and kinesiology,21(6), 947-953
- Thigpen CA, Padua DA, Michener LA, Guskiewicz K, Giuliani C, Keener JD, Stergiou N. (2010). Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. Journal of Electromyography and Kinesiology. 20: 701-709
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- Ayhan, C., Camci, E., & Baltaci, G. (2015). Distal radius fractures result in alterations in scapular kinematics: A three-dimensional motion analysis. Clinical Biomechanics
- Day, J. M., Bush, H., Nitz, A. J., & Uhl, T. L. (2015). Scapular Muscle Performance in Individuals With Lateral Epicondylalgia. Journal of Orthopaedic & Sports Physical Therapy, (Early Access), 1-35
- Otoshi, K., Takegami, M., Sekiguchi, M., Onishi, Y., Yamazaki, S., Otani, K., Shishido, H., Shinichi, K., Shinichi, K. (2014). Association between kyphosis and subacromial impingement syndrome: LOHAS study. Journal of Shoulder and Elbow Surgery. 23. e300-e307
- Scapula and Movement
- Ha, Sung-min., Kown, Oh-yum., Cynn, Heon-seock., Lee, Won-hwee., Park, Kyue-nam., Kim, Si-hyun., & Jun, Do-young. (2012) Comparison of electromyographic activity of the lower trapezius and serratus anterior muscle in different arm-lifting scapular posterior tilt exercises. Physical Therapy in Sport, 13, 227-232
- Wong CK, Coleman D, diPersia V, Song J, Wright D. (2010). The effects of manual treatment on rounded-shoulder posture, and associated muscle strength. Journal of Bodywork & Movement Therapies. 14: 326-333
- Cools, A.M., Witvrouw, E.E., Declercq, G.A., Danneels, L.A., Cambier, D.C. (2003) Scapular muscle recruitment patterns: Trapezius muscle latency with and without impingement symptoms. The American Journal of Sports Medicine 31(4). 542-549
- Tsai NT, McClure PW, Karduna AR. (2003). Effects of muscle fatigue on 3-Dimensional scapular kinematics. Arch Phys Med Rehabil. 84: 1000-1005
- Altered Motion Scapula
- Ludewig P.M., Cook, T.M. (2000) Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Physical Therapy. 80 (3) 276-291
- Lawrence, R. L., Braman, J. P., Laprade, R. F., & Ludewig, P. M. (2014). Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. journal of orthopaedic & sports physical therapy, 44(9), 636-A8
- Fayad F, Roby-Brami A, Yazbeck C, Hanneton S, Lefevre-Colau MM, Gautheron V, Poiraudeau S, Revel M. (2008). “Three-dimensional scapular kinematics and scapulohumeral rhythm in patients with glenohumeral osteoarthritis or frozen shoulder.” 2008 Jbiomech, 41(2): 326-332
- Ayhan, C., Camci, E., & Baltaci, G. (2015). Distal radius fractures result in alterations in scapular kinematics: A three-dimensional motion analysis. Clinical Biomechanics.
- Day, J. M., Bush, H., Nitz, A. J., & Uhl, T. L. (2015). Scapular Muscle Performance in Individuals With Lateral Epicondylalgia. Journal of Orthopaedic & Sports Physical Therapy, (Early Access), 1-35
- Exercise
- Suprak DN, Bohannon J, Morales G, et al. (2013). Scapular kinematics and shoulder elevation in a traditional push-up. Journal of Athletic Training. 48(6): 826-835
- Ha, S., Kwon, O., Cynn, H., Lee, W., Kim, S., Park, K. (2013). Selective activation of the infraspinatus muscle. Journal of Athletic Training. 48(3). 346-352
- Dark A, Ginn KA, Halaki M. (2007). Shoulder muscle recruitment patterns during commonly used rotator cuff exercises: an electromyographic study. Pys Ther. 87: 1039-1046
- Kaya, E., Zinnuroglu, M., Tugeu, I. (2010) Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome. Clinical Rheumatology. (30) 201-207
- Wang, C., McClure, P., Pratt, N., Nobilini, R. Stretching and Strengthening Exercises: Their Effect on Three-Dimensional Scapular Kinematics. Arch Phys Med Rehabil. 1999 vol. 80, 923-929
- Cools, A.M., Dewitte, V., Lanszweert, F., Notebaert, D., Roets, A., Soetens, B., Cagnie, B., Witvrouw, E.E. (2007) Rehabilitation of Scapular Muscle Balance. Which Exercises to Prescribe? Am J Sports Med, 35(10), 1744-1751
- Uhl, T. L., Carver, T. J., Mattacola, C. G., Mair, S. D., & Nitz, A. J. (2003). Shoulder musculature activation during upper extremity weight-bearing exercise. Journal of Orthopaedic & Sports Physical Therapy, 33(3), 109-117
- Reed D, Cathers I, Halaki M, Ginn KA. (2015). Does load influence shoulder muscle recruitment patterns during scapular plane abduction? Journal of Science and Medicine in Sport.
- Hardwick DH, Beebe JA, McDonnell MK, Lang CE. (2006). A comparison of serratus anterior muscle activation during a wall slide exercise and other traditional exercises. Journal of Orthopaedic & Sports Physical Therapy. 36(12) 903-910
- Pectoralis Inhibition
- Wang HK, Cochorane T. 2001. Mobility impairment, muscle imbalance, muscle weakness, scapular asymmetry and shoulder injury in elite volleyball athletes. J Sport Med Phys Fitness 41(3): 403-10
- Glousman R, Jobe F, Tibone J, Moynes D, Antonelli D, Perry J. Dynamic Electromyographic analysis of the throwing shoulder with glenohumeral instability. J Bone Joint Surg 70A(2):220-226, 1988.
- Glousman R, Jobe F, Tibone J, Moynes D, Antonelli D, Perry J. Dynamic Electromyographic analysis of the throwing shoulder with glenohumeral instability. J Bone Joint Surg 70A(2):220-226, 1988
- Fascia
- Schleip R; Findley T; Chaitow L., Huijing P. Fascia: The Tensional Network of the Human Body © 2012 Elsevier Ltd.
- Texts on Postural Dysfunction
- Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani, Muscles: Testing and Function with Posture and Pain: Fifth Edition © 2005 Lippincott Williams & Wilkins
- Phillip Page, Clare Frank, Robert Lardner, Assessment and Treatment of Muscle Imbalance: The Janda Approach © 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner
- Dr. Mike Clark & Scott Lucette, “NASM Essentials of Corrective Exercise Training” © 2011 Lippincott Williams & Wilkins
- Leon Chaitow, Muscle Energy Techniques: Third Edition, © Pearson Professional Limited 2007
- Shirley A Sahrmann, Diagnoses and Treatment of Movement Impairment Syndromes, © 2002 Mosby Inc.
- Karel Lewit. Manipulative Therapy: Musuloskeletal Medicine © 2007 Elsevier
- Additional Research
- Scovazzo, M.L., Browne, A., Pink, M., Jobe, F.W., and Kerrigan, J. (1991). The painful shoulder during freestyle swimming: An electromyographic cinematographic analysis of twelve muscles. The American Journal of Sports Medicine. 19(6). 577-582
- Peolsson, A. L., Peolsson, M. N., & Jull, G. A. (2013). Cervical muscle activity during loaded arm lifts in patients 10 years postsurgery for cervical disc disease. Journal of manipulative and physiological therapeutics, 36(5), 292-299
- Falla, D., Jull, G., & Hodges, P. W. (2004). Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Experimental brain research, 157(1), 43-48. (Delayed onset of DCF with arm movement)
- Jull, G., Kristjansson, E., & Dall’Alba, P. (2004). Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. Manual therapy, 9(2), 89-94
- Falla, D., O’Leary, S., Farina, D., & Jull, G. (2011). Association between intensity of pain and impairment in onset and activation of the deep cervical flexors in patients with persistent neck pain. The Clinical journal of pain, 27(4), 309-314.
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