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Shoulder Joint (Glenohumeral Joint)
By: Nathan, Melissa, Shanik
Surface Anatomy
Anterior axillary fold
Posterior axillary fold
Anterior axillary line
Manubrium
Surface Anatomy
Clavicular Deltoid origin
Clavicle
Clavicular PectoralisMajor origin
Sternocostal head ofPectoralis Major
Clavipectoral triangle
Surface Anatomy
Descending Trapezius
Ascending Trapezius
Middle Trapezius
Acromial Deltoid origin
Scapular Spine Deltoid originTriangle of Auscultation
Anterior Deltoid
Middle Deltoid
Posterior Deltoid
Classes of Joints
There are three classes of joints in the body which are called:
Fibrous Cartilaginous Synovial
The shoulder is a Synovial Joint
Types of Synovial Joints
There are six types of synovial joints that occur in the body:
Plane or griddle Joints Saddle Joints Hinge Joints Pivot Joints Ball-and-socket Joints Ellipsoid joints The shoulder is a ball-and-socket joint
which allow for ROM in most directions
Types of Synovial Joints
Plane Joint Saddle Joint
Ball-and-Socket Joint
Movements of the Shoulder
The shoulder joint can do most ROM:
Flexion Extension Abduction Adduction Rotation Circumduction
Synovial Membrane
Synovial joints are lined with a membranes called synovial membrane that secretes synovial fluid into the joint for :
Lubrication Nourishes Smooth movements Filling all empty spaces
Articular Cartilage
Bone ends in the synovial joint are covered by hyaline cartilage called Articular Cartilage for smooth gliding movements
The humeral head articulates with the glenoid cavity of the scapula
Articular Capsule
The articular cartilage is surrounded by a joint capsule made of:
Synovial Membrane Fibrous Layer
Helps hold the bones together and allows for movement to happen
Layers of Capsule
Fibrous layer aids in covering periosteum of the bone and helps with strength and stability of the joint
Synovial membrane covers the internal portion of the joint and secretes synovial fluid
Capsule
Membrane
Fluid
Articular Cartilage
Cartilage of Shoulder
Because glenoid cavity is shallow, the head of humerus needs help to articulate with the cavity (Articular Cartilage on surface)
Glenoid Labruim –ring of fibrocartilaginous
material that attaches to the margin of the glenoid cavity
GC
GL
FL
SM
FL- Fibrous Layer, GC- Glenoid Cavity,SM- Synovial Membrane, GL- Glenoid Labruim
Bursae
In some synovial joints, bursae are found
Extension of a synovial membrane that form into a sac
Filled with synovial fluid Help cushion or protect tendons from
rubbing against bones
Bursae of the Shoulder
Subacromial bursa or Subdeltoid bursa Located between
acromion, deltoid, and coracoacromial ligament
Helps with movement of supraspinatus tendon
Subscapular Bursa
Subscapular bursa or subcoracoid bursa Located between the
tendon of the subscapularis muscle and the neck and corocoid proccess of scapula
Protects and reduces friction between the tendon where it passes inferior to the coracoid process and over the neck of the scapula
Ligaments of the Shoulder
Ligaments are fibrous tissue that connects bones to other bones. They are sometimes called articular ligaments
Coracohumeral Transverse humeral Coniod Acromioclavicular Glenohumeral Coracoclavicular Superior transverse scapular
Location of Ligaments
Acromiolclavicular ligament: Extends from the acromion to the clavicle
Coracoclavicular ligament: Anchors the clavicle to the coracoid process of scapula - Conoid: Attaches to the root of the coracoid process, base attaches to the inferior surface of the conoid tubercle of the clavicle
Glenohumeral ligaments: Part of the fibrous layer of the capsule. Consists of superior, middle, and inferior ligaments. All originate from the humerus to margin of glenoid cavity
Coracohumeral ligament: Root of the coracoid process to humeral neck
Transverse Humeral ligament: Broad fibrous band from greater to lesser tubercle. Holds the tendon from the long head of the biceps brachii muscle
Superior transverse scapular ligament: Attached by end of the coracoid process and inserts into the medial end of the scapular notch
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Posterior Musculature
Levator scapulae
Rhomboid Minor
Rhomboid Major
Serratus anterior
Middle Trapezius
Teres Minor
Teres Major
Posterior Deltoid
Infraspinatus
Posterior Musculature
Levator scapulae
Rhomboid Minor
Rhomboid Major
Serratus anterior
Middle Trapezius
Teres Minor
Teres Major
Posterior Deltoid
Infraspinatus
Upper trapezius
Lower trapezius
Posterior MusculatureTrapezius
Innervation: Spinal accessory nerve
Vascularization: Transverse cervical artery
UpperAction: Scapular elevation and upward rotation
MiddleA: Scapular retraction
LowerA: Scapular depression and upward rotation
Levator ScapulaeI: 3rd and 4th Cervical nervesV: Dorsal Scapular ArteryA: Scapular elevation and
downward rotation
Serratus anterior I: Long Thoracic Nerve V: Lateral Thoracic Artery A: Scapular protraction and upward rotation
Rhomboideus Major and Minor I: Dorsal scapular nerve V: Dorsal scapular artery A: Scapular retraction and downward rotation
Posterior Musculature
Deltoid
Latissimus Dorsi
Supraspinatus
Supraspinatus
Infraspinatus
Teres Minor
Teres Major
T1
Musculature
DeltoidsI: Axillary NerveV: Posterior circumflex artery
AnteriorA: Shoulder flexion, medial rotation, horizontal adduction
MiddleA: Shoulder abduction
PosteriorA: Shoulder extension, hyperextension, lateral rotation, horizontal abduction
Latissimus dorsi I: Thoracodorsal nerve V: Deep scapular artery A: Shoulder extension, adduction, medial rotation, hyperextension
Teres Major I: Subscapular Nerve V: Circumflex scapular artery A: Shoulder extension, adduction, medial rotation
Anterior view of Musculature
Clavicle Manubrium
Pectoralis Major
Anterior Deltoid
Subscapularis
Coracobrachialis
MusculaturePectoralis Major
I: Lateral and Medial pectoral nerveV: Lateral Thoracic arteryA: Shoulder adduction, medial rotation, horizontal adduction
Pectoralis MinorI: Medial pectoral nerveV: Axillary arteryA: Scapular depression, protraction, and downward rotation
Coracobrachialis I: Musculocutaneous nerves C6, C7 V: Brachial artery A: Weakly adducts the shoulder joint Origin: Coracoid process Insertion: Medial aspect of humerus
Internal Anatomy
Rotator Cuff
The Rotator Cuff is made up of four muscles, Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. The “SITS” muscles
The tendons of these four muscles merge with the joint capsule of the shoulder as they pass it to insert on the tubercles of the humerus. This insertion forms a partial sleeve around the proximal end of the humerus.
The Rotator Cuff reinforces the joint capsule and holds the head of the humerus in the glenoid cavity.
Rotator Cuff
Muscles of the Rotator CuffSupraspinatus
I: Subscapular nerveV: Subscapular arteryA: Shoulder abduction
Infraspinatus I: Subscapular nerveV: Subscapular arteryA: Lateral rotation, horizontal abduction
Subscapularis I: Subscapular nerve V: Subscapular artery A: Medial rotation
Teres Minor I: Axillary nerve V: Circumflex scapular artery A: Lateral rotation, horizontal abduction
Rotator Cuff TearRotator Cuff Tear
•Common in sports and recreation.
•Joint is not protected ventrally
•Supraspinatus is easily torn with: pitching (baseball) falls (skiing) hard blows from the side (hockey)
Questions?