Bones of the Shoulder

as noted earlier, seventeen muscles on each side attach your shoulder blades to
your arms and to your body. Its much easier to find these muscles for treatment if
you know what the bones of the shoulder look like and can find their bony
landmarks (Figure 1.1 and 1.2). The following is the key to both drawings:
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.

Superior angle of the shoulder blade (highest point)

Medial border of the shoulder blade (inner edge)
Lateral border of the shoulder blade (outer edge)
Inferior angle of the shoulder blade (lowest point)
Acromion (outer tip of the shoulder)
Coracoid process (sticking out through the front of the shoulder)
Head of the humerus and the glenoid cavity (the ball and socket)
Scapular spine (the ridgelike spine of the shoulder blade)
Humerus (upper arm bone)
Collarbone
With the heel of your hand resting on your collarbone, feel for the bony
superior angle (A) of the shoulder blade just above the scapular spine (Figure
1.3). Swing your arm forward and back to make the superior angle move back
and forth under your fingers. This is an important landmark for locating the
supraspinatus, one of the four rotator cuff muscles.
The most touchable part of the shoulder blade is the scapular spine (H). On
Very slender people, you can see it standing out very clearly beneath the skin
(Figure 1.4). See if you can trace it with your fingers. On some people its
nearly horizontal. On others, it angles upward as it goes from the inner edge
of the shoulder blade to the outer tip of the shoulder. Even if youre heavy,
you should still see an angular bulge behind the shoulder that suggests the
presence of this bony ridge beneath the skin.
Now find the acromion (E), the flat shelf of the bone at the outer tip of
the shoulder (Figure 1.5). Feel for a more or less sharp point just behind the
shoulder but still on top. In the drawing, the index finger is touching the
acromion and the third and fourth fingers are on the head of the humerus.
Under your arm at the edge of your back, you should be able to feel the
lateral border (C) of the shoulder blade (Figure 1.6). This is an important
landmark for finding the subscapularis muscle, which lines the inner surface
of the shoulder blade.
Trace the lateral border down to the lowest point of the shoulder blade,
the inferior angle (D). To feel it, move your shoulder forward and back to
make the inferior angle move back and forth under your fingers (Figure 1.7).
If your range of motion isnt hampered by shoulder pain, try reaching all the
way across to touch the media border (B), or inner edge, of the shoulder
blade (Figure 1.8). Also try reaching over your shoulder to touch the upper
part of the medial border. If youre unsure of the lateral and medial borders,

youll have trouble finding the infraspinatus muscle, which covers the lower
two-thirds of the outer surface of the shoulder blade. Infraspinatus trigger
points may be the most common cause of shoulder pain.
Lastly, search for the coracoid process (F). Its part of the shoulder
blade but runs all the way through the shoulder and sticks out under the skin
in front (Figure 1.9). The coracoid process feels like a marble nestled right
under the outer end of the collarbone beside the head of the humerus.
Joints of the Shoulder
Pain and stiffness in the shoulder is too often mistakenly attributed to a
problem with the ball-and-socket joint. Among the first words youll hear are
inflammation, tendinitis, bursitis, or arthritis. Or you may be told that
the joint cartilage has deteriorated or that the joint is hampered by tears or
adhesions. These conditions do exist, but much less often than youd think
from how often you hear the terms. Usually, the ball-and-socket joint is just
fine and its muscles that are in trouble. Lets look more closely at the
structure of the shoulder joints.
Glenohumeral Joint
The technical name for the ball-and-socket joint is the glenohumeral joint
(Figure 1.10). Its also known as a spheroid joint. The two parts of the joint are
the head of the humerus (ball) and the glenoid fossa (socket). The word
glenoid is derived from the Greek word for cavity.
The glenoid fossa is actually quite shallow, although its made somewhat
deeper by the glenoid labrum, a lip or fold of heavy connective tissue around
the edge of the cavity. This shallowness, coupled with the flexibility of the
labrum, allows maximum freedom of movement of the humeral head. The
ball is capable of several kinds of movement in the socket, including inward
and outward rotation. It can also rotate upward and downward, slide up and
down, and glide forward and back.
Acromioclavicular Joint
The acromioclavicular joint links the acromion of the shoulder blade
and the outer end of the collarbone (Figure 1.10). Strong ligaments hold this
joints together while still allowing it to flex to some extent. This joint permits
the two bones to move in the same direction, but also to rotate
independently. Your ability to raise your arm all the way overhead depends on
freedom in the small movements of the acromioclavicular joint (Smith Weiss,
and Lehmkuhl 1996, 230).
Sternoclavicular Joint
The sternoclavicular joint unites the collarbone (clavicle) to the
breastbone (sternum). Its the only joint that actually connects the shoulder
to the body (not shown). Because of this firm connection, the sternoclavicular

joint restricts movement of the shoulder in all directions, particularly in

protraction, or movement forward. The posture of the shoulder and entire
upper body can be permanently distorted when a broken collarbone heals
with overlapping ends or a crooked alignment (Smith, Weiss, and Lehmukhl
1983, 222).
Scapulothoracic Joint
Not a true joint, the association between the shoulder blade and the chest
acts like a joint, although an extraordinary free one. No other articulation of
bones in the body is quite like it. While strong muscles couple the shoulder
blade to the bony structures of the spine, cranium, and rib cage, there are
very few ligaments to keep it from rotating and sliding in a relatively wide
range on the rib cage. Without this freedom of movement, the range of
motion of the arm would be severely limited.
Connective Tissue of the Shoulder Joints
Connective tissue includes everything that attaches muscle to bone. Muscle is
generally too pliant to keep a joint. Connective tissue, on the other hand, is far more
rigid and has much less ability to stretch and lengthen. As a consequence,
ligaments, tendons, and other connective tissue are more susceptible to being torn
or otherwise damaged than muscle tissue is.

Ligaments
Ligaments are bands or sheets of exceptionally strong, fibrous tissue that serve to
hold two or more bones together. Ligaments put limits on the movement between
the bones of a joint, which can have both advantages and disadvantages.
Hypermobility occurs when ligaments are overstretched and become too loose to
provide normal support. This can result in a loose joint, which can leave the joint
associated tissues, including the muscle, vulnerable to excessive strain. The injury
suffered when a joint is pulled with sufficient force to tear or stretch a ligaments is
called a sprain.
The major shoulder ligaments are shown in Figure 1.11. The acromioclavicular
ligaments join the acromial process (the tip of the acromion) to the lateral or outer
end of the collarbone. In a dislocation of the acromioclavicular joint, or a shoulder
separation, these ligaments are usually torn.
The capsular ligaments surround the glenohumeral joint, effectively encapsulating
or sealing it. Synovial fluid, which lubricates the joint, fills the small space inside the
capsule. This sealed capsule helps keep the glenohumeral joint together by creating
an internal vacuum when force tends to pull the joint apart (Edgelow 2004, 222).
The capsular ligaments are ordinarily quite loose and flexible, however, permitting
maximum freedom of movement in the joint.

The sternoclavicular ligaments join the medial, or inner, end of the collarbone to the
top of the sternum, or breastbone (not shown). Theyre very important in keeping
the shoulder complex attached to the body while allowing some amount of
movement between the collarbone and breastbone. Without free movement at this
place, youd have difficulty moving your shoulder or reaching overhead.
The coracoacromial ligaments join the coracoid process and the acromion, both
somewhat vulnerable projections of the shoulder blade. Their ligamentous
attachment allows them to give added support to one another and, together with
the acromion, create a kind of roof over the glenohumeral joint.
The coracoclavicular ligaments connect the outer end of the collarbone to the
coracoid process. They give the shoulder blade a stronger link to the collarbone and
ultimately to the body itself through the sternum.
The coraclavicular ligaments attaches the coracoid process to the greater tubercle
of the humerus (not shown). The grater tubercle is the larger of the two bulges on
either side of the bicipital groove on the upper surface of the head of the humerus.
The coracohumeral ligament, like the capsular ligaments, is rather loose and allows
maximum movement of the head of the humerus while still giving it strong support
at the limits of its movement.