SHOULDER (GLENOHUMERA

L) JOINTHeather, Riley, Tonia, and Jo

SURFACE ANATOMYAnterior axillary fold - The inferior border of the pectoralis major muscle forms the anterior axillary fold

Clavicular head of pectoralis major - The clavicular head is the smaller top section of the bare-chested upper-torso

Clavipectoral triangle - The clavipectoral triangle (deltopectoral triangle) is the depressed area just inferior to the lateral part of the clavicle, bounded by the clavicle superiorly, the deltoid laterally, and the clavicular head of the pectoralis major medially.

Sternocostal head of pectoralis major - The sternal-costal head consists of more muscle mass. It originates at the sternum and six sternum costal cartilages

Clavicle - can be felt from end to end (subcutaneous) since they produce horizontal ridges visible at the junction of the neck to the thorax

Manubrium – the upper segment of the sternum in which the clavicles and upper two ribs articulate

Surface Anatomy

SURFACE ANATOMYParts of the Deltoid :•clavicular part ( or anterior): originates on the lateral third of the clavicle•acromial part (or middle): originates on the acromion process•spinal part (or posterior): originates on the scapular spine

Surface Anatomy Posterior Axillary Fold – formed by the latissimus dorsi winding around the lateral border of the teres major muscle

Triangle of auscultation - The space bounded by the lower border of the trapezius, the latissimus dorsi, and the medial margin of the scapula, used to listen to (auscultate) the lungs because the stethoscope can be placed close to the thoracic wall at this location

Three areas of the Trapezius Muscle :1. Descending Part of Trapezius (the

superior region or Upper fibers) - which functions to support the weight of the arm

2. Ascending Part of Trapezius (the inferior region or Lower Fibers) - which function to rotate and or lower the scapulae.

3. Middle Part of the Trapezius (the intermediate region or middle fibers) - which function to draw or pull the scapulae  inwards closer to the spine

BONES OF THE SHOULDER JOINT

Made up of three bones:

1.Clavicle2.Humerus3.Scapula

CLAVICLE1. Sternal end

2. Acromial end

3. Conoid tubercle

HUMERUS Greater Tubercle

Lesser Tubercle

Intertubercular Sulcus

Head

Anatomical Neck

Surgical Neck

Deltoid Tuberosity

SCAPULA•Acromion Process

•Coracoid Process

•Borders (superior, vertebral, and axillary

•Angles (Superior and Inferior)

•Subscapular Fossa

•Infraspinatous Fossa

•Supraspinatous Fossa

•Spine

•Glenoid Fossa (Cavity)

Coracohumeral ligament

Transverse humeral ligament

Acromioclavicular ligament

Glenohumeral ligaments - superior - middle - inferior

ShoulderLigaments

Coracoclavicular ligament - Trapezoid ligament - Conoid ligament

Superior transverse scapular ligament

Shoulder

BursaeA bursa is a sac between two moving surfaces that contains a small amount of lubricating fluid, and they reduce friction where two body parts are moving against one another and there is no joint.

CARTILAGE

Labrum: is a type of cartilage found in the shoulder, found only around the socket where it is attached. This cartilage is more fibrous and rigid

Articulating Cartilage: white cartilage found on the ends of bones, which allows the bones to glide and move on each other. When this type of cartilage starts to wear out you get arthritis.

ARTICULAR CAPSULE

Synovial Membrane:Layer of connective tissue that lines the joints, tendon sheaths, and bursae and makes synovial fluid, which has a lubricating function.

THE ROTATOR CUFF:

•Group of muscles and tendons that surround the shoulder joint

•Keep the head of your upper arm bone firmly within the shallow socket of the shoulder. 

ROTATOR CUFF MUSCLES

Supraspinatus

Infraspinatous

Teres Minor

Subscapularis

CLINICAL CONCERNSROTATOR CUFF INJURY

http://link.brightcove.com/services/player/bcpid1709592238001?bckey=AQ~~,AAABjg7u0WE~,1M0n70-zc746ABCoBjqsbGI_EgtRkuwu&bctid=2549400139001

•Dull ache deep in the shoulder

•Disturb sleep, particularly if you lie on the affected side

•Difficult to comb your hair or reach behind your back

•Arm weakness

SYMPTOMS:

ROTATOR CUFF INJURYTYPES:•Partial tear: damages the soft tissues but does not completely sever it

•Full thickness tear or a complete tear: splits the soft tissue into two pieces.

CAUSE:•Injury: Falling on an outstretched hand or lifting something too heavy are two common injuries associated with rotator cuff tears.

•Degeneration: Repetitive stress, lack of blood supply, and bone spurs are factors that contribute to degeneration.

CLINICAL CONCERNS

OTHER COMMONINJURIESTO THE

SHOULDER

Labrum Tear

Instability- One shoulder joint moves or is forced out of its normal position. This condition can result in a dislocation of one of the joints in the shoulder.

Impingement-Caused by excessive rubbing of the shoulder muscles against the top part of the shoulder blade (acromion)

Cervical Plexus

Accessory (Spinal) Nerve

• Medial Cord• Lateral Cord• Posterior

Cord

• Lateral Pectoral • Medial Pectoral• Long Thoracic• Dorsal Scapular• Musculocutaneo

us• Thoracodorsal• Axillary• Subscapular• Suprascapular

Nerves

Brachial Plexus

• Subclavian• Axillary• Transverse

Cevical• Dorsal

Scapular• Lateral

Thoracic• Posterior

Circumflex• Deep

Scapular• Suprascapula

r• Circumflex

Scapular• Subscapular• Brachial

Arteries

UPPER TRAPEZIUS Origin: Superior line of the occipital bone,

ligamentum nuchae, and cervical vertebrae Insertion: Lateral 1/3 of clavicle and acromion process Action: Scapular elevation and upward rotation Innervation: Spinal Accessory nerve Roots C3 and C4 Synergists: -Elevation : Levator Scapulae-Upward Rotation: Upper and Lower Trapezius Antagonists:-Adduction: Rhomboids Major and Minor, Middle Trapezius-Downward Rotation: Levator Scapula, Rhomboids Major and Minor.

MIDDLE TRAPEZIUS Origin: Spinous Processes of C7 to T3 Insertion: Scapular Spine Action: Scapular Adduction (retraction) Innervation: Spinal Accessory Nerve Roots C3 and C4 Synergists: Adduction: Rhomboids Major

and Minor Antagonists: Serratus Anterior, Pectoralis

Minor

LOWER TRAPEZIUS Origin: Spinous Processes of Middle and Lower

Thoracic Vertebrae Insertion: Base of the scapular Spine Action: Scapular depression and upward rotation Innervation: Spinal Accessory Nerve Roots C3 and C4 Synergists:

-Depression: Pectoralis Minor

-Upward Rotation: Upper Trapezius, Serratus Anterior Antagonists:

-Elevation: Levator Scapulae, Upper Trapezius, Rhomboids Major and Minor

-Downward Rotation: Rhomboids Major and Minor, Levator Scapulae

LEVATOR SCAPULAE: Origin: Transverse process of first four

cervical vertebrae Insertion: Vertebral border of scapula

between the superior angle and the spine Action: Scapular elevation and downward

rotation (Inferior rotation of Glenoid Cavity) Innervation: Dorsal Scapular and Cervical

nerves and Dorsal scapular artery Roots: Dorsal Scapular C5 -Cervical C3 and C4 Synergists: -Elevation: Upper Trapezius, Rhomboids Major and Minor-Inferior Rotation: Rhomboid Major and Minor, Pectoralis Major Antagonists: -Depression: Lower Trapezius, Pectoralis Minor-Superior Rotation: Upper and Lower Trapezius, Serratus Anterior

PECTORALIS MINOR Origin: Anterior Surface, third

through fifth Ribs Insertion: Coracoid process of the

scapula Action: Ribs Fixed: Draws scapula

forward (abducts) and rotates scapula downward against the thoracic wall

Scapula fixed: Elevates the rib cage.

Innervation: Medial pectoral nerve, Axillary artery

Synergists: Abduction: Serratus Anterior

Respiration: Sternocleidomastoid, Scalenes

Antagonists: Adduction: Rhomboids major and minor, Middle Trapezius

Respiration: Rectus Abdominus

SERRATUS ANTERIOR: Origin: Lateral Surface of the

Upper eight ribs Insertion: Anterior surface of the

vertebral border of the scapula Action: Scapular protraction and

Upward Rotation, holds scapula against thoracic wall

Innervation: Long thoracic nerve, Lateral thoracic artery

Roots C5-C7 Synergists: -Abduction: Pectoralis Minor-Upward Rotation: Upper and lower Trapezius Antagonists: -Adduction: Rhomboids Major and Minor, Middle Trapezius-Downward Rotation: Levator Scapulae, Rhomboids Major and Minor

RHOMBOID MAJOR: Origin: Spinous processes of T2 - T5 Insertion: Vertebral border of the

scapula between the spine and inferior angle

Action: Adducts (retracts) Scapula, Depresses Glenoid Cavity, Stabilizes scapula

Innervation: Dorsal Scapular Nerve and Dorsal Scapular Artery

Synergists:

-Adduction: Middle Trapezius

-Downward Rotation: Levator Scapulae, Pectoralis Minor Antagonists:

-Abduction: Serratus anterior, Pectoralis Minor

-Upward Rotation: Upper and lower Trapezius, Serratus Anterior

RHOMBOID MINOR: Origin: Nuchal Ligament and

spinous process of C7 and T1 Insertion: Vertebral border of

scapula superior to spine Action: Adducts (retracts)

Scapula, Depresses Glenoid Cavity, Stabilizes scapula

Innervation: Dorsal Scapular Nerve and Dorsal Scapular Artery

Synergists: -Adduction: Middle Trapezius-Downward Rotation: Levator Scapulae, Pectoralis Minor Antagonists: -Abduction: Serratus anterior, Pectoralis Minor-Upward Rotation: Upper and lower Trapezius, Serratus Anterior

DELTOIDS Anterior (Clavicular) Origin: Lateral 1/3 of Clavicle Action: Shoulder Abduction, Flexion, Medial rotation, Horizontal

Adduction

Middle (Acromial) Origin: Acromion process Action: Shoulder Abduction

  Posterior (Spinal) Origin: Scapular Spine Action: Shoulder Abduction, Extension, Hyperextension, Lateral

Rotation, Horizontal Adduction

All 3 Deltoids Insert on the Deltoid Tuberosity and are Innervated

by the Axillary Nerve with Roots C5-C6 All 3 Deltoids have the Supraspinatus as a Synergist when

performing Abduction

PECTORALIS MAJOR Origin: (clavicular head) Medial third of the clavicle,

(sternal head) sternum, costal cartilage of first six ribs and the aponeurosis of the External Oblique

Insertion: Lateral lip of bicipital groove of humerus Action: Shoulder Adduction, Medial Rotation, Draws

Scapula anteriorly and inferiorly, Clavicular Head Flexes Humerus, Sternal Head Extends Humerus

Innervation: Lateral and Medial Pectoral Nerve Roots: Clavicular C5-C6, Sternocostal C7-C8 Synergists:

-Adduction: Latisumus Dorsi, Teres Major

-Medial Rotation: Latissumus Dorsi, Anterior Deltoid, Teres Major

-Extension: Posterior Deltoid, Latissimus Dorsi, Teres Major Antagonists:

-Abduction: Deltoids, Supraspinatus

-Lateral Rotation: Infraspinatus, Teres Minor, Posterior Deltoid

-Flexion: Anterior Deltoid

LATISSIMUS DORSI Origin: Spinous Processes of T7 through L5 (via

dorsolumbar fascia), posterior surface of sacrum, iliac crest, and lower 3 ribs

Insertion: Medial lip of Intertubercular sulcus of humerus Action: Shoulder extension, adduction, medial rotation,

hyperextension Innvervation: Thoracodorsal nerve Roots: C6-C8 Synergists: -Extension: Posterior Deltoid, Teres Major, Pectoralis Major-Adduction: Teres Major, Pectoralis Major-Medial Rotation: Teres Major, Petoralis Major, Subscapularis, Anterior Deltoid Antagonists: -Flexion: Anterior Deltoid, Pectoralis Major-Abduction: Deltoids, Supraspinatus-Lateral Rotation: Infraspinatus, Teres Minor, Posterior Deltoid

SUPRASPINATUS: Origin: Supraspinous fossa of the

scapula

Insertion: Greater Tubercle of the humerus

Action: Initiates and Assists the Deltoid Abduct the arm

Innervation: Suprascapular nerve Root: C5 and C6

Synergist-Abduction: Deltoids

Antagonist-Adduction: Pectoralis Major, Teres Major and Latissimus Dorsi

TERES MAJOR Origin: Dorsal surface of inferior

angle of the scapula Insertion: Medial lip of

intertubercular groove of humerus Action: Adducts and medially rotates Innervation: Lower subscapular

nerve Root: C6 and C7 Synergist

-Adduction: Pectoralis Major, Teres Major, Latissimus Dorsi

-Medial Rotation: Latissimus Dorsi, Teres Major, Subscapularis, and Pectoralis Major Antagonist:

-Abduction: Deltoids and Supraspinatus

-Lateral Rotation: Infranspinatus, Teres Minor, and Posterior Deltoid

SUBSCAPULARIS Origin: Subscapular fossa of the

scapula Insertion: Lesser tubercle of the

humerus Action: Shoulder Medial Rotation and

adduction, also helps hold Humeral Head in Glenoid Cavity

Innervation: Subscapular nerve and Subscapular Artery

Roots: C5-C7 Synergists:

-Adduction: Pectoralis Major, Teres Major, Latissumus dorsi

-Medial Rotation: Latissimus dorsi, Teres Major, Pectoralis Major, Anterior Deltoid Antagonists:

-Abduction: Deltoid, Supraspinatus

-Lateral Rotation: Teres Minor, Posterior Deltoid

CORACOBRACHIALIS Origin: Coracoid process of the

scapula Insertion: Medial 1/3 of the humerus

Action: Helps adduct the shoulder joint

Innervation: Musculocutaneus nerve Roots: C6-C7

Synergists: -Arm Flexion: Biceps Brachii, Anterior Deltoid-Adduction: Subscapularis, Teres major, Pecotalis Major Antagonists: -Forearm extension: Triceps Brachii, Posterior Deltoid-Abduction: Deltoids, Supraspinatus

INFRASPINATUS Origin: Infraspinous fossa of

the scapula Insertion: Greater tubercle

of the humerus Action: External (lateral)

Rotation  Innervation: Suprascapular

nerve Root: c5 and c6 Synergist:-Lateral Rotation: Teres Minor and Posterior Deltoid Antagonist:-Medial Rotation: Latissimus Dorsi, Teres Major, Subscapularis, Pectoralis Major and Anterior Deltoid

TERES MINOR Origin: Superior lateral border of the scapula Insertion: Greater tubercle of the humerus Action: External Rotation, weak rotation Innervation: Axillary nerve Root: c5 and c6 Synergist

-Lateral Rotation: Infraspinatus and

the Posterior Deltoid Antagonist:

-Medial Rotation: Latissimus Dorsi,

Teres Major, Subscapularis,

Pectoralis Major,

and Anterior Deltoid

OVERVIEW OF THE MUSCLES OF THE SHOULDER/GLENOHUMERAL REGION

References

http://teachmeanatomy.info/upper-limb/misc/surface-anatomy/surface-anatomy-of-the-axilla-anterior-and-posterior-axillary-folds/

http://uni-doctors.blogspot.com/search?q=clavipectoral+triangle

https://web.duke.edu/anatomy/Lab10/Lab11_preLab.html

http://www.science-art.com/image/?id=2961#.VF7jXtEtDVI

https://web.duke.edu/anatomy/Lab10/images/Grant's%20Atlas%206.30%20(1).jpg

http://www.musclesused.com/wp-content/uploads/2012/08/Trapezius-Muscle-3.jpg

http://med.uc.edu/labmanuals/ga/HEMATOLOGY%20AND%20CARDIOVASCULAR/

Clemente, Carmine D. Atlas, A regional Atlas of the Human Body. 6th edition. 2011

https://www.google.com/search?q=levator+scapulae&biw=1301&bih=641&source=lnms&tbm=isch&sa=X&ei=kD9hVJy7JsTuoASNp4CoBg&sqi=2&ved=0CAYQ_AUoAQ#tbm=isch&q=pectoralis+major+images&imgdii=_

BLEVINS, GARY THE OFFICIAL MUSCLE SHEET. 2014