The latissimus dorsi contributes to adduct and depress the scapula and shoulder complex with pectoralis major that adduct the shoulder. PMID: 10527095 DOI: 10.1016/s0003-9993 (99)90037-0 Abstract erector spinae In fact, it is the most mobile joint of the human body. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Abnormal glenohumeral translations have been linked to pathological shoulders and it has been suggested to be a contributing factor for shoulder pain and discomfort, and may also lead to the damage of encompassing structures. Systematic review of electromyography studies. These muscles include the latissimus dorsi and posterior fibres of the deltoids, with both acting as the prime mover. One small study showed that even when this muscle is completely removed, most patients encounter little difficulty with shoulder movement and can continue former activities without any problem. Internal rotation is primarily performed by the subscapularis and teres major muscles. Strengthening of surrounding supportive musculature (Biceps, triceps, latissimus dorsi, rhomboids, cervical stability muscles, dorsal spine supportive musculature). Scapula: scapula is triangular shape has three border superior and medial and lateral ,three angle inferior,superior and lateral and three surface. Effects of eccentric exercise in patients with subacromial impingement syndrome: a systematic review and meta-analysis, http://www.youtube.com/watch?v=Vez6-NTFkS8, https://www.physio-pedia.com/index.php?title=Dynamic_Stabilisers_of_the_Shoulder_Complex&oldid=323295. An agonist muscle is the source of the force needed to finish a movement and to achieve this it must contract (shorten) or relax (lengthen). The GH joint is of particular interest when understanding the mechanism of shoulder injuries because it is osteologically predisposed to instability.[1][2]. Pldoja E, Rahu, M., Kask, M.,Weyers, I., & Kolts, I. Rehabilitation should concentrate on the restoration of the normal biomechanical alignment of the shoulder complex (centralization of the GH joint, proper scapulothoracic gliding of the scapula) as well as restoring the proper force-coupling balance of the stabilizing muscles. The deltoid muscle has a significant role as a stabilizer, and is generally accepted as a prime mover for glenohumeral joint during abduction, along with the supraspinatus muscle. Kinesiology of the Hip - Brookbush Institute Using your back muscles, slowly lift the pelvis up, hold this position without experiencing pain, and gently lower the pelvis back the floor. For smooth synchronous movement of the shoulder complex we need the force couplings of the glenohumeral and scapulothoracic joints to work in a synched timing and adequate forces to offset each other. New York, Springer-Verlag. Variation in shoulder position sense at mid and extreme range of motion. As it is the agonist that produces the force, it is also referred to as the prime mover. An antagonist muscle works in an opposite way to the agonist. Full and pain free range of motion of the cervical and thoracic spine. Muscles that have their origins in the posterior (back of) shoulder joint extend the arm. The success of a coordinated movement of the humeral head with normalized arthrokinematics, avoiding an impingement situation, requires the harmonious co-contraction of the RC tendons. Struyf F, Nijs, J., Baeyens, J.P., Mottram, S., Meeusen, R. Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability. No neurological signs or symptoms from the cervical spine, throughout the upper extremities. sartorius In any pair, the agonist muscle contracts, while the antagonist muscle relaxes, allowing for the free movement of our joints and muscles. The SC joint is the only bony attachment site of the upper extremity to the axial skeleton. quadratus lumborum agonist: adductor mangus, longus & brevis [9][10], As illustrated by the force-vectors of their respected moment arms, the RC tendons collectively have been accredited with the compression of the humeral head within the glenoid fossa during movements. . These bursae allow the structures of the shoulder joint to slide easily over one another. Agonist muscles are the muscles that perform a movement, while antagonist muscles perform the opposite movements. 10.2: Interactions of Skeletal Muscles, Their Fascicle Arrangement, and 2. In: Lephart SM, Fu FH, eds. Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. Chapter 17: Shoudler Pain. Both bands stabilize the humeral head when the arm is abducted above 90. Muscles that work like this are called antagonistic pairs. doi:10.1016/0007-1226(85)90245-0. antagonist: rectus abdominus, illiopsoas GUStrength. Bushnell BD, Creighton, R.A., & Herring, M.M. The joints capsular pattern is externalrotation, followed by abduction, internal rotation and flexion. Retrieved from https://biologydictionary.net/latissimus-dorsi/. Similarly the subcoracoid bursae are found between the capsule and the coracoid process of the scapula. It relies on ligaments and muscle tendons to provide reinforcement. Milgrom C, Schaffer, M., Gilbert, S., & van Holsbeeck, M. Rotator cuff changes in asymptomatic adults. Neuromuscular Exercises Improve Shoulder Function More Than Standard Care Exercises in Patients With a Traumatic Anterior Shoulder Dislocation: A Randomized Controlled Trial. Static stabilizers include the joint labrum and capsuloligements components of the glenohumeral joint, as well as fascia tissues throughout the shoulder complex. Memorize the rotator cuff muscles using the mnemonic given below! Sports Health. The serratus anterior and trapezius (middle) muscles work as a primary force coupling to upwardly rotate the scapula. 3.1.2.1 During shoulder extension or when returning your arm beside your body, this movement is associated with scapular downward rotation, internal rotation, . gluteus medius In the image below you can see where the horizontal sheet of the latissimus dorsi just covers the bottom of the shoulder blades. The inferior glenohumeral ligament is a sling-like ligament extending between the glenoid labrum and the inferomedial part of the humeral neck. St. Louis: Elsevier Saunders. The latissimus dorsi is the largest muscle of the human body but is not the strongest at less than one centimeter in thickness. In the image you can see how one relaxes and the other contracts to produce movement in the elbow joint. \mathrm{N}T=250.N is oriented in the xxx-direction. As previously noted, due to the anatomical passage of the common RC tendon within the subacromial space, the RC tendons are particularly vulnerable to compression, abnormal friction, and ultimately an impingement (pinching) during active tasks. Lephart SM, Pincivero, D.M., Giraldo, J.L., & Fu, F.H. 1173185. Rotator cuff (RC) (collectively the following muscles: supraspinatus, subscapularis, infraspinatus, teres minor) not only abduct the shoulder, but also plays an important role as stabilizer muscles. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Extension of the Shoulder: Synergist & Antagonist Muscles To effectively rehabilitate a shoulder injury in clinical practice, it is important to have a functional knowledge of the underlying biomechanics of the shoulder complex. Neer CS. It extends to the lesser tubercle of humerus. The rotator cuff muscles help to maintain a centralized position of the head of the humerus during static postures and dynamic movements. Manual therapy, Kinesiologic considerations for targeting activation of scapulothoracic muscles: part 1: serratus anterior, Kinesiologic considerations for targeting activation of scapulothoracic musclespart 2: trapezius, http://www.youtube.com/watch?v=YbbzQs7OBoY, Scapular and rotator cuff muscle activity during arm elevation: a review of normal function and alterations with shoulder impingement, Joseph B. Myers, Ji-Hye Hwang, Maria R. Pasquale, J. Orthop Rev 23:4550. The bench press is one of the most popular exercises in the fitness and sports community and is often used as a measuring stick for evaluating upper body strength (Robbins 2012; Bianco, Paoli & Palma 2014). Another important muscle group is the rotator cuff. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Hall, S. J. There are also the periscapsular muscles[4], which are very important for homogeneous shoulder movements while avoiding biomechanical misalignments, such as a shoulder impingement. This is the strongest of the three GH ligaments, being thicker and longer than the other two. The scapulohumeral and thoracohumeral muscles are responsible for producing movement at the glenohumeral joint. The healthy movement of the scapula along the thorax during arm elevation includes protraction, posterior tilting, and lateral rotation, depending on the plane of movement (Figure 1). 2002;92(6):230918. Voight ML, & Thomson, B.C. Pectoralis major is a superficial muscle of the pectoral region and has a sternal and clavicular part. We have also learned that without this particular muscle, movement is more often than not unaffected. \mathrm{rad} / \mathrm{s})/3=1000.rad/s) are created in the string by an oscillator located at x=0x=0x=0. Identify the following term or individuals and explain their significance. Being a synovial joint, both articular surfaces are covered with hyaline cartilage. The hyperlinked article reports latissimus dorsi tears in rock climbers, rodeo steer wrestlers, golfers, skiers, body builders, baseball players, tennis players, gymnasts, volleyball players, and basketball players. The resulting waves, which travel in the positive xxx-direction, are reflected at a distant point, so there is a similar pair of waves traveling in the negative xxx-direction. It also plays a role in lumbar spine extension (straightening) and sideways bending (lateral flexion). Antagonist = Deltoid, Agonist = Deltoid Latissimus dorsi is a muscle of posterior back has an attachment to scapula and humerus. You back should be straight and your hips relaxed. Resistance Band Exercises: Best Exercises for Shoulder Rehab and Scapular Stabilzation. All rights reserved. Adductor Magnus, Bicep femoris Biologydictionary.net Editors. Therefore, it has a more superior line of pull which cannot offset the line of force emitted from the deltoid muscle. For example; weakness with the serratus anterior and lower trapezius muscle, and/or an over activation of the upper trapezius muscle, scapular downward rotators overactivity for a long time all affect the scapula upward rotation and you can find scapula on anterior tipping. agonist: QL Eccentric exercises for rotator cuff muscles in case of a suspected. Dimitrios Mytilinaios MD, PhD I would honestly say that Kenhub cut my study time in half. Reading time: 15 minutes. and prevent downward rotatory movement created by deltoid (middle/posterior) and are a synergistic muscle with deltoid regards to glenohumeral forces to abduct the G.H joint. All content published on Kenhub is reviewed by medical and anatomy experts. agonist: illiopsoas The prime flexors of the glenohumeral joint are the deltoid (anterior fibers) and pectoralis major (clavicular fibers) muscles. [19][20][21], The pathological kinematics of the ST joint include, but are not limited to:[22][23][24], These movement alterations are believed to increase the proximity of the rotator cuff tendons to the coracoacromial arch or glenoid rim,[18][25] however, there are still points of contention as to how the movement pattern deviations directly contribute to the reduction of the subacromial space.[18]. Teres major has the same action of latissimus dorsi of adduction, extension, internal rotation. This can compress the tendons and soft tissues within this space, leading to acute or chronic inflammation and dysfunction ( rotator cuff tendinopathy /shoulder impingement)[19]. Long-term shortening can lead to chronic back pain as the body will try to compensate, perhaps tilting the pelvis to one side and changing how a person walks. Full and pain free range of motion of all distal joints (digits, thumb, wrist, elbow). This shoulder function comes at the cost of stability however, as the bony surfaces offer little support. Match the term with the following definitions. Examples of analysis of movement - Observing and analysing movement These origins are: There is only one insertion point, at the intertubercular groove at the top of the humerus. And as it attaches to scapula proximally, humerus distally, for effective adduction and extension it acts to pull humerus to the scapula (stable part), and hence this movement associated with scapula downward rotation and retraction. Neuromuscular control in this context, can be understood as the unconscious activation of dynamic restraints occurring in preparation for, and in response to, joint motion and loading for the purpose of maintaining functional joint stability.[1] Dynamic restraints result from neuromuscular control over the shoulder muscles, facilitated through motor control and proprioceptive input. a. Study with Quizlet and memorize flashcards containing terms like Agonist, Antagonist, When Elbow joint action=flexion and more. [8][9], Del Maso and colleagues have estimated that a maximum of 7.5 mm of upward translation of the humeral head may occur during range of motion movements,[9] which is not an insignificant amount of migration for a large bony structure to experience within a compact space during a dynamic task. Blasier RB, Carpenter JE, Huston LJ (1994) Shoulder proprioception: effect of joint laxity, joint position and direction of motion. Together these joints can change the position of the glenoid fossa, relative to the chest wall. To prevent further latissimus dorsi strain try some of the exercises further on. Role of proprioception in pathoetiology of shoulder instability. Synergist Assists the agonist in performing its action Stabilizes and neutralizes joint rotation (prevents joint from rotating as movement is performed) [30], Further to the intricate network of passive ligatures that conjoin adjacent bones, the importance of the surrounding musculature cannot be overstated. The cross point, defined as the point where agonist and antagonist muscle torques are equal, always occurred within the fifth 15 angle subgroup (26-40) for the shoulder flexion-extension . For example; the deltoid muscle (middle fiber in particular) acts to stabilize the humeral head against the glenoid cavity during arm elevation, while the rotator cuff muscles (specifically the subscapularis, teres minor, infraspinatus muscles) control the fine-tuning movement of the humeral head. Synergists assist the agonists, and fixators stabilize a muscle's origin. Let's use an everyday example of agonist and antagonist muscle pairs to fully realise the definition of the antagonist muscle and its counterpart - the biceps and triceps. adductor mangus Vastus Medialis, SPINE - Lateral Flexion & Rotation (Agonist), SPINE - Lateral Flexion & Rotation (Antagonist), SPINE - Medial Flexion & Rotation (Agonist), SPINE - Medial Flexion & Rotation (Antagonist), The Language of Composition: Reading, Writing, Rhetoric, Lawrence Scanlon, Renee H. Shea, Robin Dissin Aufses, Ch. Antagonist= Latissimus Dorsi, When shoulder joint action = Extension/hyperextension, Agonist = Latissimus Dorsi Normative values of agonist-antagonist shoulder strength ratios of . We can therefore affirm, that the shoulder complex is among the most kinematically complex regions of the human body,[25] and requires a high level of neuromuscular stability throughout movement. You can see where this groove is located in the below image. . Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. Again, because of the floating nature of the scapula along the thorax, it too, must rely on the kinship between the cortical direction provided by the nervous system and the resulting action of the MSK system. On the scapula, the capsule has two lines of attachments. The upper sides of each triangle cross the lower regions of the scapulae or shoulder blades. Take the following custom quiz for a rotator cuff workout! external oblique [16][19][20], The stability of the ST joint relies on the coordinated activity of the 18 muscles that directly attach to the scapula. Muscle that is responsible for the movement occurring, Muscle that works in opposition to the agonist, When hip joint action = extension/hyperextension, When hip joint action = horizontal abduction, When hip joint action = Horizontal adduction, Agonist = Deltoid It is a ball-and-socket joint, formed between the glenoid fossa of scapula (gleno-) and the head of humerus (-humeral). Stretch your arms forward and point your feet. Agonists are the prime movers while antagonists oppose or resist the movements of the agonists. Latissimus dorsi muscle tears are quite rare but nearly always related to specific sporting activities. Clinically Oriented Anatomy (7th ed.). Appropriate strengthening of the shoulder dynamic stabilizer muscles and adequate neuromuscular control-patterns is crucial during rehabilitation as well as the prevention of shoulder injuries. When weakness or neuromuscular dysfunction of the scapular musculature is present, normal scapular arthrokinematics become altered,[20] and ultimately predisposes an individual to an injury of the GH joint. Postural control (neutral spine, centralization of the GH joint, proper scapular setting) during static and dynamic conditions. Antagonist = Latissimus Dorsi, A level PE- analysis of movement Contraction, The Impact Of Smoking On The Respiratory Syst, David N. Shier, Jackie L. Butler, Ricki Lewis, Andrew Russo, Cinnamon VanPutte, Jennifer Regan, Philip Tate, Rod Seeley, Trent Stephens. Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). agonist: gluteus maximus Lift both arms above your head and lean to one side until you can feel a stretch in the upper back. antagonist: lats & posterior deltoid, upper trap Available from: Hallock GG. If you have just swung your arm forward from the shoulder, bringing it back into a more neutral position is called shoulder extension. Biologydictionary.net, June 11, 2020. https://biologydictionary.net/latissimus-dorsi/. The role of the scapula. piriformis Antagonists play two important roles in muscle function: (1) they maintain body or limb position, such as holding the arm out or standing erect; and (2) they control rapid movement, as in shadow boxing without landing a punch or the ability to check the motion of a limb. Read more. The subscapular bursa sits between the capsule and the subscapularis tendon, while the coracobrachial bursa is located between the subscapularis and coracobrachialis muscles. Every muscle can be an Agonist, and every muscle has an antagonist paired muscle. As it is the agonist that produces the force, it is also referred to as the prime mover. The role of proprioception in the management and rehabilitation of athletic injuries. Agonist vs Antagonist Muscles The agonist muscle initiates the movement of the body during contraction by pulling on the bones to cause flexion or extension. When muscles from other parts of the body are needed to close large wounds as surgical free flaps, the latissimus dorsi is a good choice. What Are Antagonist Muscle Pairs? - Parallel Coaching An impingement that involves a decreased space towards the coracoacromial arch is said to be an external impingement, whereas an internal impingement involves the glenoid rim,[18] and can be associated with a GH instability. 1985;38(3):375379. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. When elbow joint action= extension. [18] The normal contribution of the ST joint is generally expressed as the ratio of ST movement with regards to that occurring simultaneously at the GH articulation. Sports medicine. Agonist, antagonist and synergist muscle control is vital for a normalized and non-pathological scapulothoracic rhythm. Jobe C. Evaluation of impingement syndromes in the overhead throwing athlete. Normative values of agonist-antagonist shoulder strength ratios of adults aged 20 to 78 years Authors R E Hughes 1 , M E Johnson , S W O'Driscoll , K N An Affiliation 1 Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA. Philadelphia: Fadavis Company. Agonist and Antagonist Muscle movements Flashcards | Quizlet Wu G, van der Helm, F.C., Veeger, H.E. clavicle deviated 20 degree with frontal plane in anatomic position. Pectoralis major, deltoid (anterior fibers) and latissimus dorsi are also capable of producing this movement. Two weak spots exist in this reinforced capsule. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Lam JH, Bordoni B. Anatomy, Shoulder and Upper Limb, Arm Abductor Muscles. > Stand with feet approximately shoulder-width apart, toes pointing straight ahead, and knees aligned over second and third toes. Muscular timing (coordinator contractions) is a key component to focus on during shoulder rehabilitation. An Imbalance of one or more of these muscles can cause biomechanical misalignments and contribute to shoulder dysfunctions such as: impingement disorders, bursitis, instabilities, scapular dyskinesia or chronic conditions associated with pathological wear and tear. The information we provide is grounded on academic literature and peer-reviewed research. Morgan R, & Herrington, L. The effect of tackling on shoulder joint positioning sense in semi-professional rugby players. Witherspoon JW, Smirnova, I.V., & McIff, T.E. It has an attachment to the coracoid process, hence it contributes to scapular downward rotation, internal rotation and anterior tipping. The shoulder joint is encircled by a loose fibrous capsule. During right arm flexion: The upper thoracic vertebrae right side flexes, right rotates and extends. Here the capsule arches over the supraglenoid tubercle and its long head of biceps brachii muscleattachment, thus making these intra-articular structures. The rotator cuff is composed of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis (SITS). Philadelphia, PA: Saunders. Muscles pairs - Agonists & Antagonists (GCSE PE) - YouTube agonist: piriformis If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. 1173185. Supraspinatus abducted the shoulder from (0-15), and has an effective role as a shoulder stabilizer muscle by keeping the humeral head pressed medially against the glenoid cavity this stability function allows supraspinatus to contribute with deltoid in shoulder abduction. The lat pulldown is a compound exercise designed to target many muscles of the back, most notably the latissimus dorsi (Figure 1). This is a stabilizing mechanism in which compression of the humerus into the concavity of glenoid fossa prevents its dislocation by translating forces. Wassinger, and S.M. gastrocnemius ", Biologydictionary.net Editors. J strength Cond Res. Extension is performed by the latissimus dorsi, teres major, pectoralis major (sternocostal fibers) and long head of triceps brachii muscles. Extending only at its medial margin, where the fibers protrude by around 1 cm. gluteus minimus If the spine is seen as the bottom of a triangle and the attachment to the humerus as the apex of this triangle, it is quite easy to picture one side of the muscle. The effect of age, hand dominance and gender. Available from: I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Exchange puzzles with a classmate. Sternum: sternum consist of manubirum where SC joint attached ,body where ribs attached and xiphoid process. [13], An imbalance in the neural activation of any one of the RC muscles could easily cause a misalignment of the humeral head thus giving rise to an impingement of the subacromial structures during movement. That is usually the journal article where the information was first stated. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. It is believed that the supraspinatus is important for movement initiation and early abduction, while the deltoid muscle is engaged from approximately 20 of abduction and carried the arm through to the full 180 of abduction. Behm DG. [12], The individualized tendons of the RC complex are directly affiliated with limiting the translation of the humeral head in specific directions. The first is on its anterior and inferior sides where the capsule inserts into the scapular neck, posterior to the glenoid labrum. . The pipeline has a constant diameter of 3.5cm3.5 \mathrm{~cm}3.5cm, and the upper end of the pipeline is open to the atmosphere. Agonist & Antagonist Muscles: Definition & Exercises 2012. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion - Part II: shoulder, elbow, wrist and hand. Kennedy JC, Alexander, I.J., & Hayes, K.C. bicepts Eshoj, H. R., Rasmussen, S., Frich, L. H., Hvass, I., Christensen, R., Boyle, E., Juul-Kristensen, B. [15] Within the scientific literature, the scapulohumeral rhythm is generally accepted to be 2:1, which represents 2 of humeral elevation for every degree of scapular upward rotation. If you keep your arm at your side and swing it backwards from the shoulder, you are performing shoulder hyperextension. Therefore, it acts as a counter to the lateral translation force of the serratus anterior muscle. Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. Muscles of the shoulder work in team to produce highly coordinated motion. Between the superior and middle glenohumeral ligaments, via which the subscapular. It's more active during arm elevation in abduction and has a gradual linear increase in activity with the increase of abduction angle. Find at least three sets of sentences you could combine by making one sentence in each set into a subordinate clause. Repeat, leaning to the opposite side. It is a common and useful practice in clinical set up to assess the relative balance of opposing muscle groups around a joint by comparing strength ratios of agonist and antagonist muscle groups (Sapeda, 1990). TFL The role of instability with resistance training. Lowe trapezius muscle assists with SA to upwardly rotate the scapula which helps to maintain subacromial space[15]. The neuromuscular control of the shoulder also requires a well-developed sense of motor control and proprioception. 2000;35(3):35163. Shoulder muscle activity and function in common shoulder rehabilitation exercises. During movements in elevation and reaching activities, it is important to consider the force-coupling which acts on the floating joint. The lower fiber of SA has a longer moment arm to maintain this scapular upward rotation. Standring, S. (2016). The anterior band limits externalrotation of the arm, while the posterior band limits internalrotation. . Shoulder joint position sense improves with elevation angle in a novel, unconstrained task. Two transverse waves of equal amplitude and with a phase angle of zero (at t=0)t=0)t=0) but with different frequencies (=3000rad/s(\omega=3000 \mathrm{rad} / \mathrm{s}(=3000rad/s and /3=1000.rad/s)\omega / 3=1000 . The movement of the scapula along the thoracic cage also directly influences the biomechanics of the shoulder complex as a whole, and can moreover predispose the development of impingement syndrome. Lephart SM, Riemann BL, Fu FH. Did you find hard to remember anatomicalstructures? It has been suggested that the tendons of the rotator cuff muscles blend with the ligaments and the glenoid labrum at their respected sites of attachments, so that the muscle contractions can provide additional stability by tightening the static structures during movement.[38]. Richardson E, Lewis JS, Gibson J, Morgan C, Halaki M, Ginn K, Yeowell G. Moghadam AN, Abdi K, Shati M, Dehkordi SN, Keshtkar AA, Mosallanezhad Z. Ortega-Castillo M, Medina-Porqueres I. Dynamic stabilizers include the contractile tissues of the shoulder complex (tendons, muscles and tendon-muscular junctions). Upper part inserts into the clavicle and has no attachment to the scapula, middle attached to the acromion and spine of the scapula, and the lower part inserts into themedial base of the scapular spine.

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