Você está na página 1de 65

Shoulder Joint Anatomy

Dr. Guna Sureshbabu.

Shoulder Girdle

Shoulder Complex is the most mobile joint in the


body.
Scapula
Clavicle
Sternum
Humerus
Rib

cage/Thorax

Shoulder Girdle Bones

Sternum-flat bone located in the midline of the


anterior thorax.
Manubrium-top
Body-Middle
Xiphoid

process
bottom triangle

Shoulder Girdle Bones

Clavicle-S shaped bone that connects upper


extremity to the axial skeleton.

Clavicle
distallyarticulateswiththe
acromionprocesstoformthe
ACjoint
Proximallyarticulateswith
thesternumtoformSCjoint

Scapula

McGraw-Hill Higher Education. All


rights reserved.

5-7

Scapula
theshoulderblade
Glenoidfossahasringof
cartilagecalledlabrumto
deepenthearticularsurface
theglenoidfossaofthe
scapulaarticulateswiththe
humerustoformthe
glenohumeraljoint(shoulder)
theacromionprocess
articulateswiththeclavicleto
fromtheacromioclavicular
joint(tipoftheshoulder)

Humerus

Humerus
proximalendarticulates
withscapulatoform
shoulder

distalendarticulateswith
bonesoftheforearmto form
elbow

Sternoclavicular Articulation
site of most movement of shoulder girdle
articulation between the
sternum and clavicle
elevation/depression (up and down, 30-40o)
a modified ball-and-socket joint
o
mobile in frontal and transverse
plane
limited sagittal movement

rotation (40-50 )
protraction/retraction (A/P, rowing, 30o)

Interclavicular
Ligament
Clavicle
Sternoclavicular
Ligament
Costoclavicular
Ligament
Sternum

Clavicle
Articular
disk
Costal
cartilage

14

Acromioclavicular
Articulation

articulation between
acromion process and
distal end of clavicle

coracoclavicular ligament
serves as axis of rotation for
associated scapular mvmts

very dense capsule +


AC ligaments
provide support

Bony Support -- WEAK!

15

AC Mvmts

3 df
protraction/retraction: acromion process
moves on meniscus, scapula rotates
about medial coracoclavicular ligament
(conoid) 30-50
upward/downward rotation: clavicle
moves on meniscus, scapula rotates
about lateral coracoclavicular
ligament (trapezoid) 60
elevation/depression: relative motion of
acromion & clavicle with no rotation
30
Note: mvmts @ AC joint will be
opposite those at SC joint
(e.g., AC elevation -- SC depression)
16

Scapulothoracic Articulation
physiological articulation (no bone-to-bone connection) between
the anterior surface of the scapula (scapular fossa) and the
thoracic wall
scapula rests on 2 muscles (serratus anterior and subscapularis)
60 ROM

17

Shoulder Joint

(aka glenohumeral)
- articulation of humerus and
glenoid fossa
- designed for mobility
(greatest ROM of any jt
in body)
- lacks bony and ligamentous
support
- shallow glenoid fossa
(1/4 size of humeral head)
-half-spherical humeral head

18

- Articulation
Between rounded head
of humerus and shallow,
pear-shaped glenoid
cavity of scapula.
Articular surface covered
by hyaline articular
cartilage.
Glenoid cavity is
deepened by glenoid
labrum
(fibrocartilaginous rim).

- Type
Synovial ball-and-socket joint.

Capsule

Surrounds joint and attached :


- Medially to the scapula beyond the
supraglenoid tubercle and the margins of
the labrum.
- Laterally to the anatomical neck of humerus.
Thin and lax, allow wide range of movement.
Strengthened by slips of tendons of subscapularis
m., supraspinatus m., infraspinatus m. & teres
minor (rotator cuff muscles).

Subacromial Arch

coracoacromial
ligament
provides a buffer
for the rotator cuff
muscle tendons

21

GlenoidLabrum

Ringofcartilagesimilartothemeniscioftheknee.
Deepensthearticularsurfaceofthegenoidfossaandaddstothestabilityoftheshoulder

Glenohumeral Joint
Glenohumeral
ligaments
provide stability
especially
anteriorly &
inferiorly
inferior
glenohumeral
ligament

5-25

Shoulder
Ligamentous Support
no ligament to prevent backward displacement
fossa angle slightly anterior
prevents backward displacement

26

Bursae Related To The


Joint

Subacromial
(Subdeltoid) bursa
Subscapularis
bursa
Infraspinatus bursa

- Relations

Superiorly
Supraspinatus m.
Subacromial bursa
Coracoacromial ligament
Deltoid m.

Inferiorly
Long head triceps brachii m.
Axillary nerve
Post. circumflex humeral vessels

Anteriorly
Subscapularis m.
Coracobrachialis
Short head of biceps brachii
Deltoid

Posteriorly
Infraspinatus
Teres minor
Deltoid

Within the joint


- Tendons of long head biceps brachii

Muscles of shoulder girdle

Trapezius- 3 lines of pull


Upper

trapezius
Middle trapezius
Lower trapezius

Muscles of shoulder girdle

Levator scapula- named for the elevation of the


scapula, its main function.

Muscles of shoulder girdle

Rhomboid- major and minor. They get their name


from Rhomboid shape, they lie under the trapezius.

Muscles of shoulder girdle

Serratus Anterior- serrated shape can be touched in


full flexion. It is a scapular protractor.

Muscles of shoulder girdle

Pectoralis minor- only shoulder girdle muscle on the


anterior side, it lies deep to the pectoralis major.

Muscles of the Shoulder


Intrinsic glenohumeral muscles
Originate on scapula & clavicle
Deltoid, Coracobrachialis, Teres major
Rotator cuff group
subscapularis, supraspinatus, infraspinatus, & teres minor

Extrinsic glenohumeral muscles


latissimus dorsi & pectoralis major

Muscles
Anterior
Pectoralis major
Coracobrachialis
Subscapularis

Superior
Deltoid
Supraspinatus

Muscles
Superior
Deltoid
Supraspinatus

Posterior

Latissimus dorsi
Teres major
Infraspinatus
Teres minor

Deltoid
themuslcethatgives
contourtotheshoulder
originatesalongthe
spineofthescapulaand
clavicle,insertsonthe
humerus
allfibersabductthe
arm
anteriorfibers:flex
andmediallyrotatearm
posteriorfibers:extend
andlaterallyrotatearm

PectoralisMajor
thechestmuscle
originatesalongthe
sternumandclavicle,
insertsonthehumerus
itfunctionsto:
~adduct
~flex
~mediallyrotate
thearm.

Biceps
thepopeyemuscle
onanterioraspectof
arm
crossesboththe
shoulderandelbow
flexesthearm

Triceps
ontheposterioraspect
ofthearm
crossesboththe
shoulderandelbow
extendsthearm

LatissimusDorsi
thelats
giveswinglike
appearancetosides
startsalongthe
thoracicvertebraeof
backandinsertsonthe
anterioraspectof
humerus
functionsextend,
adductandmedially
rotatethearm

Coracobrachialis

Coracobrachialis- attaches to the coracoid process and the


arm or Brachium. Stabalizes the humerus in the fossa.

Teres Major

Teres Major- it is the little


helper of the lats. It runs from
the axillary boarder of the
scapula to the lesser tubercle
of the humerus.

RotatorCuff
Groupoffourmusclesthatacttoholdthe
headofthehumerusintotheglenoidfossa
Supraspinatus
Infraspinatus
TeresMinor
Subscapularis

Supraspinatus:1st10degreesofabduction
Infraspinatus:externalrotation
Teresminor:externalrotation
Subscapularis:internalrotation

Rotator Cuff Muscles

The four rotator cuff muscles


cover the humeral head and
hold the head against the
glenoid fossa.

Stabilizing Influence of
Rotator Cuff
muscles have a large
stabilizing component when
active
all have a large horizontal
component
so play a significant role in
stabilizing the humerus
against the glenoid fossa

50

51

PRINCIPLE MUSCLES ACTING ON SHOULDER

MOVEMENTS

MAIN MUSCLE

ACCESSORY MUSCLE

FLEXION
0-135*

PECTORALISMAJOR(clavicular part)
DELTOID ant fibres

Coracobrachialis
Biceps short head

EXTENSION
45-60*

DELTOID post fibres


LATISSMUS DORSI

Teres major
Triceps long head
P major[sternocoastal head]

ADDUCTION

PECTORALIS MAJOR
LATISSMUS DORSI
BICEPS long head
TRICEPS short head

Teres major
coracobrachialis

ABDUCTION

SUPRASPINATUS[0-15*]
DELTOID[15*-90*]
SERRATUS ANTERIOR[90*-180*]
TRAPEZOIDupper,lower fibres[90-180]

MEDIAL ROTATION
[INTERNAL]
90*

PECTORALIS MAJOR
DELTOID ant fibres
LATISSMUS DORSI
TERES MAJOR

LATERAL ROTATION
[EXTERNAL]
70*-90*

DELTOID posterior fibres


INFRASPINATUS
TERES MINOR

subscapularis

- Blood Supply
Anterior circumflex
humeral vessels
Posterior circumflex
humeral vessels
Suprascapular
vessels
Subscapular
vessels

Nerves
All shoulder joint muscles are innervated from the brachial
plexus
Lateral pectoral nerve arising from C5, C6, & C7
Pectoralis major (clavicular head)

Medial pectoral nerve arising from C8 & T1


Pectoralis major (sternal head)

Thoracodorsal nerve arising from C6, C7, & C8


Latissimus dorsi

Nerves
Axillary nerve branching
from C5 & C6
Deltoid
Teres minor
Sensation to lateral patch of
skin over deltoid region of
arm

Upper subscapular nerves


arising from C5 & C6
Subscapularis

Nerves
Lower subscapular nerve arising from
C5 & C6
Subscapularis
Teres major

Suprascapula nerve originating from


C5 & C6
Supraspinatus
Infraspinatus

Nerves
Musculotaneous nerve
branching from C5, C6, &
C7
Coracobrachialis
Sensation to radial aspect
of forearm

Applied Anatomy
Dislocation of glenohumeral joint
Glenohumeral joint
Extremely mobile
Providing wide movement at the
expense of stability
Relatively small bony glenoid cavity

Supplemented by :
Robust fibrocartilagious glenoid labrum
Ligamentous support
Make it susceptible to dislocation
Divided into :
Anterior dislocation
Posterior dislocation

Applied Anatomy
Fractures of the clavicle and dislocations of the acromioclavicular
and sternoclavicular joints
Its relative size and the potential forces that it trasmits from the upper
limb to the trunk, it is not surprising that it is often fractured.
The typical site of fracture is the middle third.
The medial and lateral thirds are rarely fractured.
The acromial end of the clavicle tends to dislocate at the
acromioclavicular joints with trauma
The outer third of the clavicle is joined to the scapula by the conoid
and trapezoid ligaments of the coracoclavicular ligament.
Minor injury,
tends to

Tear the fibrous joint capsule and ligaments of the acromioclavicular


joint
resulting

Acromioclavicular separation on a plain radiograph

Applied Anatomy
More severe trauma
disrupt the conoid and trapezoid ligaments of coracoclavicular
ligament
results in elevation and upward subluxation of the clavicle
The typical injury at the medial end of the clavicle is an anterior or
posterior dislocation of the sternoclavicular joint.
Importantly, a posterior dislocation of the clavicle may impinge on
the great vessels of the superior mediastinum and compress or
disrupt them.

SHOULDER TIP PAIN


Irritation of the diaphragm from any surrounding pathology causes referred pain in
the shoulder
This is so because the phrenic nerve and supraclavicular nerves both arise from
spinal segment C3,C4

FROZEN SHOULDER / ADHESIVE CAPSULITIS


Is a disorder in which capsule and CT surrounding the glenohumeral joint becomes
inflamed and stiff, and grows together with abnormal bands of tissue, called
adhesions, greatly restricting motion and causing chronic pain
The patient may recover spontaneously in about 2 years

INFLAMMATION OF THE SUBACROMIAL


(SUBDELTOID) BURSA

Subacromial Bursa between supraspinatus and deltoid


muscles laterally and acromion medially
Supraspinatus tendinopathy
-this bursa may become inflamed, making movements of the
glenohumeral joint painful
Treated by injection of corticosteroid

Take Home Message


The shoulder is an extremely complicated
region of the body
Joint which has a high degree of mobility
but not without compromising stability
Involved in a variety of overhead activities
relative to sport making it susceptible to a
number of repetitive and overused type
injuries
Movement and stabilization of the
shoulder requires integrated function of
the rotator cuff muscles, joint capsule and
scapula stabilizing muscles

2010 McGraw-Hill Higher Education. All rights reserved.