MODERN VIEWS ON THE FUNCTIONAL ANATOMY AND BIOMECHANICS OF THE MUSCLES OF THE SHOULDER GIRDLE

  2. 2026
  3. MODERN VIEWS ON THE FUNCTIONAL ANATOMY AND BIOMECHANICS OF THE MUSCLES OF THE SHOULDER GIRDLE

Khmara T. V., Osypenko Ye. Ye., Koval O. A., Kulbida M. I., Skrypnyk V. M.

MODERN VIEWS ON THE FUNCTIONAL ANATOMY AND BIOMECHANICS OF THE MUSCLES OF THE SHOULDER GIRDLE

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About the author:

Khmara T. V., Osypenko Ye. Ye., Koval O. A., Kulbida M. I., Skrypnyk V. M.

Heading:

LITERATURE REVIEWS

Type of article:

Scientific article

Annotation:

The shoulder girdle is a unique biomechanical structure that combines maximum amplitude of movement and high stability. In this study, this system is considered as the result of the complex interaction of four joints: the ster noclavicular, acromioclavicular, shoulder, and scapulothoracic joint. It should be noted that the functionality of this structure primarily depends on the accuracy of the neuromuscular apparatus, which acts as an active stabiliser. The study analyses how classical anatomy is being transformed today under the influence of in vivo imaging, electromyography, and kinematic analysis methods. A deep understanding of the morphology of the muscles that control the scapula and clavicle is important for the clinical training of professionals in all specialties. This is the basis for the diagnosis and treatment of a wide range of pathologies: from impingement syndrome to degenerative rota tor cuff tears that necessitate complex reconstructions. Particular attention is paid to scientific research of the last ten years, which has detailed the structure of muscle fibres, their innervation and force vectors. We have considered the prospects of surgical tendon transfer for func tional recovery in this article. The introduction of this latest data allows for significant improvements in diagnostic algorithms, rehabilitation protocols, and surgical intervention strategies.

Tags:

functional anatomy, rehabilitation, scapula, scapular dyskinesis, shoulder girdle, shoulder joint, upper limb muscles

Bibliography:

  1. Li H, Chen J, Wang J, Zhang T, Chen Z. Review of rehabilitation protocols for brachial plexus injury. Front. Neurol. 2023;14:1084223. DOI: 10.3389/fneur.2023.1084223.
  2. Jeon IH, Kholinne E. Advancements in the Management of Irreparable Rotator Cuff Tears. Indian J Orthop. 2025;59(6):731-742. DOI: 10.1007/s43465-024-01322-0.
  3. Jildeh TR, Ference DA, Abbas MJ, Jiang EX, Okoroha KR. Scapulothoracic Dyskinesis: A Concept Review. Curr Rev Musculoskelet Med. 2021;14(3):246-254. DOI: 10.1007/s12178-021-09705-8.
  4. Teixeira DC, Alves L, Gutierres M. The role of scapular dyskinesis on rotator cuff tears: a narrative review of the current knowledge. EFORT Open Rev. 2021;6(10):932-940. DOI: 10.1302/2058-5241.6.210043.
  5. Mendez-Rebolledo G, Araya-Quintanilla F, Guzmán-Muñoz E, Salazar-Mendez J, Cruz-Montecinos C, Berckmans KR, et al. Comparative electromyographic study of scapular stabilizing muscles during five main rehabilitation exercises. Am J Phys Med Rehabil. 2024;103(6):502 509. DOI: 10.1097/PHM.0000000000002394.
  6. Wey A, Dunn JC, Kusnezov N, Waterman BR, Kilcoyne KG. Improved external rotation with concomitant reverse total shoulder arthroplasty and latissimus dorsi tendon transfer: A systematic review. J Orthop Surg (Hong Kong). 2017;25(2):2309499017718398. DOI: 10.1177/2309499017718398.
  7. Lee A, Lassiter EM, De Silva V, Gerber C, McHugh M, Yatsonksy D, et al. Anatomical and surgical considerations of the pectoralis muscle. Orthop Rev (Pavia). 2024;16:121397. DOI: 10.52965/001c.121397.
  8. Abro AA, Aziz N, Memon K, Fatima T. Return to Functional Activity After Pectoralis Major Surgical Treatment: A Comprehensive Review. Cureus. 2025;17(2):e79283. DOI: 10.7759/cureus.79283.
  9. López-Vivancos A, González-Gálvez N, Orquín-Castrillón FJ, Vale RGDS, Marcos-Pardo PJ. Electromyographic activity of the pectoralis major muscle during traditional bench press and other variants of pectoral exercises: a systematic review and meta-analysis. Appl Sci. 2023;13(8):5203. DOI: 10.3390/app13085203.
  10. Stronska-Garbien K, Golas A, Roczniok R, Terbalyan A, Drozd M. Neuromuscular Repatterning of the Pectoralis Major During the Bench Press Exercise Following a 10-week Targeted Resistance Training Intervention. J Musculoskelet Neuronal Interact. 2024;24(3):276-283.
  11. Noteboom L, Belli I, Hoozemans MJM, Seth A, Veeger HEJ, Van Der Helm FCT. Effects of bench press technique variations on musculoskeletal shoulder loads and potential injury risk. Front Physiol. 2024;15:1393235. DOI: 10.3389/fphys.2024.1393235.
  12. Fischer J, Burger C, Manieu Seguel JA, Rodoplu C. Acute muscle excitation response across various bench press ranges of motion. Sci Rep. 2025;15(1):14105. DOI: 10.1038/s41598-025-98354-9.
  13. Siva Jyothi N, Senthil Selvam P, Ahmedullah M, Yatheendra KG, Subramanian SS, Paul J. Effectiveness of PNF stretch of pectoralis major muscle on pulmonary function in COPD patients. Int J Health Sci. 2022;6(S1):13332-13341. DOI: 10.53730/ijhs.v6nS1.
  14. Ahmed AS, Graf AR, Karzon AL, Graulich BL, Egger AC, Taub SM, et al. Pectoralis minor syndrome - review of pathoanatomy, diagnosis, and management of the primary cause of neurogenic thoracic outlet syndrome. JSES Rev Rep Tech. 2022;2(4):469-488. DOI: 10.1016/j. xrrt.2022.05.008.
  15. Kim A, Yi C, Ji M, Hwang UJ, Lim JY, Myung Y, et al. Pectoralis minor length index at 1 month postoperative can predict homolateral neuropathic pain 4 months after mastectomy with lymph node resection. PLoS One. 2025;20(6):e0326119. DOI: 10.1371/journal. pone.0326119.
  16. Aktaş İ, Ünlü Özkan F. Pectoralis minor syndrome. Turk J Phys Med Rehabil. 2022;68(4):447-455. DOI: 10.5606/tftrd.2023.12037.
  17. Richards JA, Munshi MH, Woodard DR, DeFroda SF, Nuelle CW, Richard Ma SY. Arthroscopic Pectoralis Minor Release. Arthrosc Tech. 2024;14(5):103335. DOI: 10.1016/j.eats.2024.103335.
  18. Saini S, Chandra N, Palekar T, Patole K. Effect of passive pectoralis minor stretching on scapular kinematics in scapular dyskinesia. Clin Pract. 2022;19(3):1925-1936. DOI: 10.37532/fmcp.2022.19(3).1925-1936.
  19. Servasier L, Jeudy J, Raimbeau G, Bigorre N. Arthroscopic release of the pectoralis minor tendon as an adjunct to acromioplasty in the treatment of subacromial syndrome associated with scapular dyskinesia. Orthop Traumatol Surg Res. 2022;108(2):103211. DOI: 10.1016/j.otsr.2022. 103211.
  20. Kuniki M, Iwamoto Y, Konishi R, Kuwahara D, Yamagiwa D, Kito N. Neural Drive and Motor Unit Characteristics of the Serratus Anterior in Individuals With Scapular Dyskinesis. J Musculoskelet Neuronal Interact. 2024;24(2):148-158.
  21. Lee SH, Kim JH, Kwon OY. Comparison of serratus anterior and abdominal muscle activity during push-up plus exercise with hip adduction and the abdominal drawing-in maneuver. Phys Ther Korea. 2024;31(1):24-31. DOI: 10.12674/ptk.2024.31.1.24.
  22. Hernández Rovira E, Alonso-Aubin DA, Cañabate Ortiz D, Torrents Martín C, Rial Rebullido T. Serratus Anterior and Latissimus Dor si Muscle Activation in Hypopressive Exercises Performed in Open Versus Closed Kinetic Chain: A Cross-Sectional Study. Muscles. 2025;4(3):20. DOI: 10.3390/muscles4030020.
  23. Tsuruike M, Ellenbecker TS. Serratus anterior and lower trapezius muscle activities during multi-joint isotonic scapular exercises and iso metric contractions. J Athl Train. 2015;50(2):199-210. DOI: 10.4085/1062-6050-49.3.80.
  24. Jung EY, Roh SY, Mun WL. Electromyographic Patterns of Scapular Muscles During Four Variations of Protraction-Retraction Exercises. Life (Basel). 2025;15(12):1840. DOI: 10.3390/life15121840.
  25. Sciascia A, Kibler WB. Current views of scapular dyskinesis and its possible clinical relevance. Int J Sports Phys Ther. 2022;17(2):117-130. DOI: 10.26603/001c.31727.
  26. Hwang B, Jeon I. Correlation Analysis between Shoulder Abduction Angles and Normalized Muscle Activity of Scapular Muscles during Y-Raise Exercise with Elastic Resistance. J Musculoskelet Sci Technol. 2025;9(1):44-50. DOI: 10.29273/jmst.2025.9.1.44.
  27. Yadav R, Sharma S. Efficacy of Myofascial Release Therapy and Positional Release Therapy in Patients with Upper Trapezius Trigger Points: Study Protocol of a Double-blinded Randomized Clinical Trial. Int J Ther Massage Bodywork. 2024;17(4):49-57. DOI: 10.3822/ ijtmb.v17i4.1041.
  28. Rokri P, Kumar P, Gupta N. Effectiveness of dry needling and positional release technique on myofascial trigger points of upper trapezius in mechanical neck pain. J Neonatal Surg. 2025;14(32S):7425-7433. DOI: 10.47316/jns.v14i32S.8845.
  29. Mahdizadeh M, Bagheri R, Taghizadeh Delkhoush C, Tohidast SA. The effect of upper trapezius trigger points dry needling on postural control in patients with chronic neck pain. J Bodyw Mov Ther. 2024;40:1079-1085. DOI: 10.1016/j.jbmt.2024.07.015.
  30. Farrell C, Kiel J. Anatomy, Back, Rhomboid Muscles. Treasure Island (FL): StatPearls Publishing; 2023. Available from: .
  31. Fennell J, Phadke CP, Mochizuki G, Ismail F, Boulias C. Shoulder Retractor Strengthening Exercise to Minimize Rhomboid Muscle Activity and Subacromial Impingement. Physiother Can. 2016;68(1):24-28. DOI: 10.3138/ptc.2014-83.
  32. Sheth M, Ko JWK, Namdari S. Reverse shoulder arthroplasty and latissimus dorsi tendon transfer. Am J Orthop. 2017;46(4):E287-E292.
  33. Anastasopoulos PP, Alexiadis G, Spyridonos S, Fandridis E. Latissimus dorsi transfer in posterior irreparable rotator cuff tears. Open Orthop J. 2017;11:77-94. DOI: 10.2174/1874325001711010077.
  34. Hones KM, Rakauskas TR, Wright JO, King JJ, Wright TW, Werthel JD, et al. Outcomes of Reverse Total Shoulder Arthroplasty with Latissimus Dorsi Tendon Transfer for External Rotation Deficit: A Systematic Review and Meta-Analysis. JBJS Rev. 2023;11(6):e23.00048. DOI: 10.2106/JBJS.RVW. 23.00048.
  35. Velasquez Garcia A, Nieboer MJ, de Marinis R, Morrey ME, Valenti P, Sanchez-Sotelo J. Mid- to long-term outcomes of latissimus dorsi tendon transfer for massive irreparable posterosuperior rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2024;33(4):959-974. DOI: 10.1016/j.jse.2023.10.002.
  36. Paksoy A, Akgün D, Gebauer H, Karczewski D, Lacheta L, Tokish JM, et al. The latissimus dorsi creates a dynamic track for the inferior angle of the scapula during arm abduction in humans. J Orthop Surg Res. 2024;19(1):193. DOI: 10.1186/s13018-024-04659-2.
  37. Varol U, Valera-Calero JA, Sánchez-Jiménez E, Fernández-de-Las-Peñas C, Ortega-Santiago R, Kobylarz MD, et al. Levator Scapulae Stiffness Measurement Reliability in Individuals with and without Chronic Neck Pain by Experienced and Novel Examiners. Sensors (Basel). 2024;24(1):277. DOI: 10.3390/s24010277.
  38. Iliopoulos F, Dimitriadis Z, Koumantakis GA. Electromyographic Activity of Sternocleidomastoid Muscle in Individuals With Neck Pain and Healthy Volunteers: A Reliability and Between-Group Differences Examination. J Manipulative Physiol Ther. 2022;45(6):459-468. DOI: 10.1016/j.jmpt.2022. 09.001.
  39. Figas G, Hadamus A, Błażkiewicz M, Kujawa J. Symmetry of the neck muscles’ activity in the electromyography signal during basic motion patterns. Sensors (Basel). 2023;23(8):4170. DOI: 10.3390/s23084170.
  40. Epperson TN, Black AC, Varacallo MA. Anatomy, Shoulder and Upper Limb, Sternoclavicular Joint. StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://pubmed.ncbi.nlm.nih.gov/ 30725943/.
  41. Karanasios S, Korakakis V, Whiteley R. Swimmers’ shoulder pain and scapula dyskinesis: a narrative review. Int J Sci Res. 2021;10(2):1-3. DOI: 10.36106/ijsr/7634479.
  42. Apostolakos JM, Jildeh TR, Dey Hazra RO, Dey Hazra ME, Chang PS, Geissbuhler AR, et al. Sternoclavicular Joint Reconstruction With Gracilis Tendon Autograft. Arthrosc Tech. 2023;12(8):e1281-e1288. DOI: 10.1016/j.eats.2023.03.019.
  43. Ciatti C, Masoni V, Maniscalco P, Asti C, Puma Pagliarello C, Caggiari G, et al. Management options for traumatic posterior sternoclavicular joint dislocation: a narrative review with a single institution’s experience. J Clin Med. 2024;13(18):5428. DOI: 10.3390/jcm13185428.
  44. Cogar AC, Johnsen PH, Potter HG, Wolfe SW. Subclavius posticus: an anomalous muscle in association with suprascapular nerve com pression in an athlete. Hand (N Y). 2015;10(1):76-79. DOI: 10.1007/s11552-014-9652-8.
  45. Balthillaya MG, H S, Reddy I, Velingkar K, Chettiar E, S D, et al. Comparison of Scapulohumeral rhythm in individuals with and without Forward Shoulder Posture. F1000Res. 2024;13:1421. DOI: 10.12688/f1000research.158183.1.
  46. Joo SY, Kim YK. Scapular Dyskinesis and Associated Factors in Adult Elite Swimmers. Medicina (Kaunas). 2025;61(10):1885. DOI: 10.3390/medicina 61101885.
  47. Standoli T, Fratalocchi F, Standoli J. Swimmers’ shoulder pain and scapula dyskinesis: a narrative review. Int J Sci Res. 2021;10(2):1-3.
  48. Costa E Silva Cabral AL, Marques JP, Dionisio VC. Scapular dyskinesis and overhead athletes: A systematic review of electromyography studies. J Bodyw Mov Ther. 2024;39:606-614. DOI: 10.1016/j.jbmt.2024.03.014.
  49. Pascoal A, Ribeiro G, Infante A. Scapular resting posture and scapulohumeral rhythm adaptations in volleyball players: implications for clinical shoulder assessment in athletes. Sports (Basel). 2023;11(6):114. DOI: 10.3390/ sports11060114.
  50. Henning L, Plummer H, Oliver GD. Comparison of scapular muscle activations during three overhead throwing exercises. Int J Sports Phys Ther. 2016;11(1):108-114.

Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 1, 180, 131-142 pages, index UDC 611.737.1:612.766

DOI:

10.29254/2077-4214-2026-1-180-131-142

2026 Issue 1, 180
functional anatomy rehabilitation scapula scapular dyskinesis shoulder girdle shoulder joint upper limb muscles
29.03.2026
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