SHOULDER GIRDLE

https://www.shoulderdoc.co.uk/article/1177

Bones & Joints of the Shoulder

The bones of the shoulder consist of the humerus (the upper arm bone), the scapula (the shoulder
blade), and the clavicle (the collar bone).
The clavicle is the only bony attachment between the trunk and the upper limb. It forms the front portion of
the shoulder girdle and is palpable along its entire length with a gentle S-shaped contour.The clavicle
articulates at one end with the sternum (chest bone) and with the acromion of the scapula at the other.
This articulation between the acromial end of the clavicle and the acromion of the scapula forms the roof
of the shoulder.
The scapula is a large, flat triangular bone with three processes called the acromion, spine and coracoid
process . It forms the back portion of the shoulder girdle. The spine (which is located at the back of the
scapula) and the acromion can be readily palpated on a patient.
The flat blade of the scapula glides along the back of the chest allowing for extended movement of the
arm. The coracoid process is a thick curved structure that projects from the scapula and is the attachment
point of ligaments and muscles.
The scapula is also marked by a shallow, somewhat comma-shaped glenoid cavity , which articulates
with the head of the humerus.
The top end of the humerus consists of the head, the neck, the greater and lesser tubercles, and the
shaft. The head is half-spherical in shape and projects into the glenoid cavity. The neck lies between the
head and the greater and lesser tubercles. The greater and lesser tubercles are prominent landmarks on
the humerus and serve as attachment sites for the rotator cuff muscles.

There are four joints making up the 'shoulder joint':

The shoulder joint itself known as the Glenohumeral joint, (is a ball and socket articulation
between the head of the humerus and the glenoid cavity of the scapula)

The acromioclavicular (AC) joint (where the clavicle meets the acromion of the scapula)

The sternoclavicular (SC) joint (where the clavicle meets the chest bone [sternum])

The scapulothoracic joint (where the scapula meets with the ribs at the back of the chest)

Note how the ball ( head ) of the humerus fits into a shallow socket on the scapula called theglenoid .
One can see that this ball does not fit into the glenoid cup at all; this allows for the wide range of
movement provided by the shoulder, at the cost of skeletal stability. Joint stability is provided instead by
the rotator cuff muscles , related bony processes andglenohumeral ligaments.

Nerver of Shoulder joint

1.

Axillary Nerve - supplies the Deltoid muscle. Most commonly stretched

withshoulder dislocations.

2.

Long Thoracic Nerve - supplies Serratus Anterior muscle and can cause Winging of the
Shoulder

3.

Suprascapular Nerve - supplies supraspinatus and infraspinatus muscles and can be

entrapped or diseased

4.

Musculocutaneous Nerve - supplies the Biceps muscle and can rarely be injured at surgery

Shoulder Anatomy

The shoulder is one of the most sophisticated and complicated joints of the body:

It has the greatest range of motion of any joint in the body with complete global movement
allowing you to position the hand anywhere in space.

The coordinated activity of numerous muscles working together in set patterns is required to
produce this motion

It is made up of FOUR joints and FIVE linked bone groups which are related and work together.

To allow so much movement the joints need to be 'free' to move, therefore the shoulder should be
'unstable' compared to other joints of the body; However a series of complex ligaments and muscle keep
it in joint.
Because the shoulder is such a unique joint it is also prone to particular problems. In fact it would be more
correct to call it the SHOULDER COMPLEX.
This section will hopefully explain some of the terminology you might hear and relate this to disorders of
the shoulder complex. Understanding how the different layers of the shoulder are built and connected can
help you understand how the shoulder works and is affected by injury and overuse.
The deepest layer includes the bones and the joints of the shoulder.
The next layer is made up of the ligaments of the joints.
The tendons and the muscles come next.
The nerves supply all the above stuctures and make them work.

Shoulder Bursae
Sandwiched between the rotator cuff muscles and the outer layer of large bulky muscles is a structure
known as the subacromial bursa. Bursae are everywhere in the body. They are found wherever two
body parts move against one another and there is no joint to reduce the friction. A bursa is simply a sac
between two moving surfaces that contains a small amount of lubricating fluid.Now imagine that you hold
in your hands a small plastic sack that contains a few drops of salad oil. This sack would let your hands
glide freely against each other without a great deal of friction. Inflammation and swelling of the
subacromial bursa is known as bursitis and associated withSubacromial Impingement of the Shoulder

Shoulder Ligaments
Ligaments are soft tissue structures that connect bones to bones. There are several important ligaments
in the shoulder.
Glenohumeral Ligaments (GHL):
A joint capsule is a watertight sac that surrounds a joint. In the shoulder, the joint capsule is formed by a
group of ligaments that connect the humerus to the glenoid. These ligaments are the main source of
stability for the shoulder. They are the superior, middle and inferiorglenohumeral ligaments. They
help hold the shoulder in place and keep it from dislocating .

Coraco-acromial Ligament (CAL):

Another ligament links the coracoid to the acromion - coracoacromial ligament (CAL). This ligament can
thicken and cause Impingement Syndrome
Coraco-clavicular Ligaments (CCL):
These two ligaments (trapezoid and conoid ligaments) attach the clavicle coracoid process of the scapula.
These tiny ligaments (with the acomioclavicular joint) play an important role in keeping the scapula
attached to the clavicle and thus keeping your shoulder 'square'. They carry a massive load and are
extremely strong.
A fall on the point of the shoulder can rupture these ligaments with dislocation of the AC Joint .
Transverse Humeral Ligament (THL) :Holds the tendon of the long head of biceps brachii muscle in the
groove between the greater and lesser tubercle on the humerus (intertubercular sulcus).

Shoulder Tendons
Tendons are extensions of muscles that attach muscles to bone. Muscles move the bones by pulling on
the tendons.

Rotator Cuff
The rotator cuff tendons are a group of four tendons that connect the deepest layer of muscles
to the humerus. They are the tendons of the rotator cuff muscles.
These are (from front to back):
1.

subscapularis

2.

supraspinatus

3.

infraspinatus

4.

teres minor

The supraspinatus is the most commonly affected tendon, both by overuse and trauma. It is the
muscle that lifts your arm out to the side (a very important movement for most daily taks). Injury
to the tendon can result in aRotator Cuff Tear. Overuse can lead
to Subacromial Impingement.

Biceps Tendons
The biceps muscle has two tendons at the shoulder, called the Long Head and Short Head.

The Long Head of Biceps (LHB) is a very important tendon that travels through the shoulder joint
(glenohumeral joint). The biceps tendon begins at the top of the shoulder socket (the glenoid) and then
passes across the front of the shoulder to connect to the biceps muscle. (The biceps is the muscle that
weightlifters are always showing off).