ANATOMY

Shoulder Girdle: Joints,

Capsule, Ligament
By Doc Abiog
The Shoulder Girdle
Shoulder girdle consists of:
Scapula

Clavicle

Upper part of the humerus

Shoulder region
In a broad sense it includes not only the
rounded contour between the arm and the
body but also the pectoral region (front),
region of the back around the shoulder
blade and the axilla (underarm).
Skeleton of the Upper Extremities and the Lower
Extremities is divisible into the:
Girdle
Skeleton of the free limb
Scapula
Three 3s
3 borders
Superior

Medial /Vertebral

Lateral /Axillary
3 angles
Superior

Inferior

Lateral/glenoid
fossa)

(in relation to glenoid

3 surfaces/fossae
importance: attachment/origin of muscles
Separat
Supraspinous fossa - posterior
o location of supraspinatus muscleed by
Infraspinous fossa - posterior
spine of
o location of infraspinatus muscle
Subscapular fossa - anterior
o location of subscapularis muscle
Important Landmarks
1. Glenoid fossa
Lateral angel
Articular cavity
Around the articular cavity is
the glenoid labrum
2. Coracoid process
3. Acromial process summit of your
shoulder

4. Lateral end of the spine of the scapula

5. Scapular notch found in the superior
border
of
the
scapula.
A.K.A.
Suprascapular notch
3 structures located here:
o Superior transverse ligament that
forms an arch
o Suprascapular nerve
o Suprascapular artery
Clavicle
Serves as a strut
o Keeps the limb away from your
body
Only bony attachment of the upper
extremity to the rest of the skeleton
Two ends:
o Sternal
Articulates with sternum
and has an articular facet
for the first rib
o Acromial
Flat and rough
Has area for articulation
with
acromion
on
undersurface
Does not reach point of
shoulder (acromion)
Body
o Medial part
Rounded
Impression
for
the
costoclavicular
ligament
and
groove
for
the
subclavius
muscle
are
present on the inferior
surface
o Lateral
Flattened
Shows conoid tubercle and
trapezoid line
o Double curvature
Convex anteriorly, concave
posteriorly
***Clinical considerations:
Fractures of the clavicle usually occur in
the medial part, with medial and downward
displacement of the distal fragment due to the
weight of the shoulder and the pull of the
pectoralis major.
Upper End of the Humerus
Head - articulates with the glenoid fossa
Two (2) necks
o Surgical - frequent site of fracture

Anatomical - true neck; it is there

anatomically
Two (2) tubercles/tuberosities
o Greater tubercle (SIT muscles are
attached here)
o Lesser tubercle (anterior)
Intertubercular groove (A.K.A Bicipital
groove)
Separates the two tubercles
Long head tendon of the
biceps glides through this
groove
Crest of the lesser tubercle
(medial lip)
Crest of the greater tubercle
(lateral lip)
Clinical significance:
o 700-800 normal internal rotation
o 800-900 normal external rotation
o Hawkins-Kennedy Impingement
Sign -pain during rotation
o supraspinatus tendinitis - due to
calcium deposits thus raising the
arm will impinge the supraspinatus
muscle to the acromial process
o

o Between sternum and clavicle

3. Acromioclavicular
o Between end of the spine of the
scapula and the clavicle
4. Costovertebral
o Relation of the first 3 to the
vertebra
5. Costosternal
o Attachment of the first 3 to the
sternum
False joint- with the absence of articulating
cavity, synovial fluid and capsule
Scapulacostal
o (A.K.A. Scapulothoracic)
o Articulation between the scapula
and the ribs
Suprahumeral
o (A.K.A. Subacromial)
o Above the humerus but under the
acromial
process.
There
are
sensitive structures here.
***Biceps mechanism- relationship of the
biceps tendon moving along the bicipital groove
***Clinical significance: inflammation of the
tendon (bicipital tendinitis) and pain when
raising the arm. Pain will be localized in the
bicipital groove
Shoulder Joint
Type: Ball and socket (enarthodial)

Joint and Ligaments

True joints with presence of synovial cavity,
articular capsule and synovial fluid inside
1. Glenohumeral
o Between humerus and scapula
o Most important joint
When we talk about shoulder joint we
are referring to this.
2. Sternoclavicular

Degrees of Freedom of Motion:

Triaxial joint- capable of moving along 3
planes of motion
o Sagittal
o Coronal
o Transverse
Motion:
Extension/Flexion
Adduction/Abduction
Internal/External rotation
Ligaments:
Coracohumeral
o On top connecting the coracoid to
the humerus
Glenohumeral
o Has 3 ligaments
Superior
Middle
*** Between the superior and
middle ligaments, there is a recess
or
weakness
known as
the
Foramen of Weitbrecht
Inferior
***Foramen of Rouvier between
middle and inferior

Other ligaments:
Acromioclavicular - top most
Coracoacromial - crosses the acromial
process and coracoid forming an arch
(coracoacromial arch)
Coracoclavicular - compose of two
ligaments
Trapezoid
Conoid

3 famous bursae

Subacromial
Subdeltoid
subcoracoid
Identify the groove: Bicipital groove
What is inside the bicipital groove? The long head
tendon of bicep
If there is pain along the groove, you call it:
Bicipital tendinitis
What structures keep the long head tendon of
bicep in place? Transverse humeral ligament
Identify ligaments other ligaments.
o Transverse scapular ligament
o Transverse humeral ligament
- bridges bicipital groove
o Coracoclavicular ligament
True Joints
Glenohumeral Joint
Formed by the ball-shaped head of
humerus and shallow concave glenoid
fossa
Most
striking
feature
is
marked
discrepancy in both humeral head (male)
and glenoid (female)
Head angular value is 153o

Glenoid fossa is 750

Factors affecting stability of GHJ
o Negative atmospheric pressure humerus can still hang on because of
the suction effect provided by this
negative pressure
o Upward direction of the glenoid
o Static stabilizers
Glenoid labrum - makes fossa deeper by
50% of glenoid depth (cartilaginous)
Ligaments and capsule
o Dynamic stabilizers
Glenohumeral muscles - prime movers;
they initiate the motion, DSITS
Scapular stabilizers
***Range of motion of GHJ

1800- 00 to top
(-)500
hyperextension
(00
going
backwards)
Sternoclavicular joint
Type: Sellar (saddle)
It is also capable of 3 axis of motion
It is the only joint of attachment of upper
extremity to the trunk
Ligaments
o Anterior sternoclavicular - prevents
forward and lateral displacement
(bigger than posterior)
o Posterior sternoclavicular - same as
anterior
o Costoclavicular - serves as the
fulcrum
One reference says this is
the real fulcrum
o Interclavicular - prevents lateral
displacement
Acromioclavicular joint
Type: Arthrodial

Degree of freedom of motion nonaxial

o Still capable of movement by
gliding
o Rotation of scapula on clavicle
Ligaments
o Superior acromioclavicular - covers
joint cephalically
o Inferior acromioclavicular - covers
joint caudally
o Coracoclavicular- keeps clavicle
against acromion
Conoid- prevents medial displacement
o mp- medially posteriorly located
o limits dorsal rotation
o upper coracoid to oblique line
Trapezoid- prevents medial displacement
o la- laterally anteriorly located
o Limits ventral rotation
o Base of coracoid process to
coracoid tuberosity

False Joints
Scapulocostal (Scapulothoracic/ST)
False (functional) joint
2 types of motion
o Translator- a straight motion
Scapula will go up
elevation
Go down depression
Sideward
adduction/protraction;
lateral rotation
Kiss each other medial
rotation
o Rotatory

No internal/external
rotation, instead the glenoid
fossa moves
Goes up - upward rotation because the
action is behind the glenoid fossa
Goes down - downward rotation
***Any joint will have a change in fulcrum. It is
not a constant site.

Suprahumeral
False (functional) joint
A.K.A. Subacromial joint
Coracoacromial arch with head of
humerus
Function:
o Protective articulation between the
humeral head and coracoacromial
arch
o Prevents trauma from above to the
GH joint or to the head of the
humerus
o Also prevent upward dislocation of
the humerus
Pain sensitive structures:
***Can come out in the exam by
enumeration
1. Subacromial bursa
2. Subcoracoid bursa
3. Supraspinatus muscle and tendon
4. Superior portion of the glenohumeral
capsule
5. Portion of the biceps tendon
6. Interposed loose connective tissue
3 groups of muscles of the shoulder
7 muscles that are related from the trunk to the
shoulder girdle
9 muscles from the shoulder girdle to the
humerus
2 muscles from the trunk to the humerus
9 MUSCLE FORM THE SHOULDER GIRDLE TO
HUMERUS

Musculotendinous cap prime movers

(Memorize!)
1. Deltoid
2. Supraspinatus
3. Infraspinatus
4. Teres minor
5. Subscapularis
Rotator cuff muscle SITS
o Muscles sitting on the tubercles
(greater and lesser)
Short rotators
o ITS
(infraspinatus,
t.
minor,
subscapularis)
6. Teres major
7. Coracobaracialis

8. Biceps brachii
9. Triceps brachii
Nice to know:
Trapezius
o Also called the SHAWL muscle
o Early
anatomists
called
musculus cucullaris

it

Can elevate the shoulder at 90 0

and above 100