NAME: MABHENA THULANI

REG. NUMBER: R205334V

PROGRAMME: BIOMEDICAL SCIENCES

COURSE: ANATOMY
1.THE SHOULDER JOINT
The joint is formed by articulation of the glenoid cavity of scapula and the head of the humerus.
Thus, it is also known as the glenohumeral articulation. Structurally, it is a weak joint because
the glenoid cavity is too small and shallow to hold the head of the humerus in place. The type of
joint, capsule formation bursae, blood supply, nerve supply, movements, relations and the
clinical anatomy related to this important joint are explained below
Type of joint
The shoulder joint is a synovial joint that of a ball and socket variety.
Capsule Formation
The capsule is thin and lax and allows a wide range of movement. This capsule surrounds the
joint and is attached medially to the margin of the glenoid cavity outside the labrum. Laterally, it
is attached to the anatomic neck of the humerus. It is strengthened by fibrous slips from the
tendons of the rotator cuff muscles that is the tendons of the subscapularis, supraspinatus,
infraspinatus, and teres minor muscles.
Bursae
The subacromial bursa and the subdeltoid bursae are commonly continuous with each other but
may be separate. Collectively they are called the subacromial bursa, which separates the
acromion process and the coracoacromial ligaments from the supraspinatus tendon and permits
smooth motion. Any failure of this mechanism can lead to inflammatory conditions of the
supraspinatus tendon. Subacromial bursa is the largest bursa of the body. It is of great value in
the abduction of the arm at the shoulder joint. It protects the supraspinatus tendon against friction
with the acromion. During overhead abduction the greater tubercle of the humerus passes under
the acromion; this is facilitated by the presence of this bursa.
Blood supply
The blood supply of the joint comes from the anterior and posterior circumflex humeral vessels,
suprascapular and subscapular vessels.
Nerve Supply
The nerve supply for the joint comes from the axillary and suprascapular nerves.
Movements
The shoulder joint has a wide range of movement and the mobility of the joint is due to the laxity
of its fibrous capsule and the four times large size of the head of the humerus as compared to the
shallow glenoid cavity of the scapula. The strength of the joint depends on the tone of the short
rotator cuff muscles that cross in front, above, and also behind the joint. These muscles are the
subscapularis, supraspinatus, infraspinatus, and teres minor. When the joint is abducted, the
lower surface of the head of the humerus is supported by the long head of the triceps, which
bows downward because of its length and gives little actual support to the humerus. The inferior
part of the capsule is the weakest area.
During flexion the arm move forward and medially, and during extension the arm moves
backwards and laterally. Thus, flexion and extension take place in a plane parallel to the surface
of the glenoid cavity.
Abduction and adduction take place at right angles to the plane of flexion and extension that is
approximately midway between the sagittal and coronal planes. In abduction, the arm moves
anterolaterally away from the trunk. This movement is in the same plane as that of the body
of the scapula.
Medial and lateral rotations are best demonstrated with a mid-flexed elbow. In this position, the
hand is moved medially across the chest in medial rotation, and laterally in lateral rotation of the
shoulder joint.
Circumduction is a combination of different movements as a result of which the hand moves
along a circle. The range of any movement depends on the availability of an area of free articular
surface on the head of the humerus.
Relation
Superiorly: Coracoacromial arch, subacromial bursa, supraspinatus and deltoid.
Inferiorly: Long head of the triceps brachii, axillary nerves and posterior circumflex humeral
artery.
Anteriorly: Subscapularis, coracobrachialis, short head of biceps brachii and deltoid.
Posteriorly: Infraspinatus, teres minor and deltoid.
Within the joint: Tendon of the long head of the biceps brachii.
Clinical Anatomy
Dislocations of the Shoulder Joint
The shoulder joint is the most commonly dislocated large joint due to the shallow glenoid fossa
which accommodates the large head of the humerus.
Anterior Inferior Dislocation
Sudden violence applied to the humerus with the joint fully abducted tilts the humeral head
downward onto the inferior weak part of the capsule, which tears, and the humeral head comes to
lie inferior to the glenoid fossa. During this movement, the acromion has acted as a fulcrum. The
strong flexors and adductors of the shoulder joint now usually pull the humeral head forward and
upward into the sub coracoid position.
Posterior Dislocations
Posterior dislocations are rare and are usually caused by direct violence to the front of the joint.
On inspection of the patient with shoulder dislocation, the rounded appearance of the shoulder is
seen to be lost because the greater tuberosity of the humerus is no longer bulging laterally
beneath the deltoid muscle. A sub glenoid displacement of the head of the humerus into the
quadrangular space can cause damage to the axillary nerve, as indicated by paralysis of the
deltoid muscle and loss of skin sensation over the lower half of the deltoid. Downward
displacement of the humerus can also stretch and damage the radial nerve.
Shoulder tip pain: Irritation of the peritoneum underlying diaphragm from any surrounding
pathology causes referred pain in the shoulder. This is so because the phrenic nerve carrying
impulses from peritoneum and the supraclavicular nerves (supplying the skin over the shoulder)
both from spinal segments C3, C4. The shoulder joint is most commonly approached (surgically)
from the front. However, for aspiration the needle may be introduced either anteriorly through
the deltopectoral triangle (closer to the deltoid), or laterally just below the acromion.
2.WRIST BONES
The wrist is made up of the carpal bones and the distal ends of the two bones of the forearm that
is the radius and ulna. Carpal bones comprise of the proximal role which consists of the
following bones, from lateral to medial, scaphoid, lunate, triquetral and pisiform. The scaphoid
and lunate articulate with the distal head of the radius. Then we have the distal row which
comprises of the following bones, from lateral to medial, trapezium, trapezoid, capitate and
hamate.
Science behind use of the MRI
FIFA has mandated the use of the MRI to view the wrist bones of the U-17 soccer tournaments
to evaluate the age of the players. The science behind the stipulation is that the fusion of the
distal end of the radius starts at an age of 14-15 years and ends at 20-21 years. Also, regarding
the ulna, fusion the distal end starts at 14-15years which is complete at 19-21years.Thus at the
age of 17 years complete fusion both of the radius and ulnar is very unlikely to occur (less than
1% probability). The radius ossifies by endochondral ossification in which existing hyaline
cartilage is eroded and invaded by osteoblasts, which then begin osteoid production. The bone
ossification occurs by cell proliferation in the epiphyseal plate cartilage. Secondary ossification
centers appear at the epiphyses of the cartilage. Elimination of these epiphyseal plates occurs at
various times with different bones and by about the age of 20 years it will be complete in all
bones thus further bone growth in bone length will no longer possible as the osteoblasts also
would have laid down a layer of new bone on the calcified cartilage matrix. The radius has three
ossification centers, one appears centrally in the shaft in the eighth week of fetal life, and the
others appear in each end. The lower end of the radius which forms the distal end of the radius
we are concerned with, ossifies from a secondary center which appears during the first year and
fuses at about 19 years of age as shown below.
It is the growing end of the bone. (The upper end (head) ossifies from a secondary center which
appears during the 4th year and fuses at 18 years of age.) Thus, if a player has a with a wrist with
complete fusion that means that he is older than his documented age.
To a greater extent this consideration is fair as it eliminates players with a greater relative age or
false lower age that are more likely to be identified as talented because of the likely physical
advantages they have over their younger peers. This would lead to an unfair match and granting
victory to a team which doesn’t deserve. This also leads to an individual with a greater relative
age may be given some opportunities (e.g., scholarships) as they would be identified as talented
of which this would be disadvantages other able peers who were supposed to get those
opportunities. To a lesser extent its not that fair as a player from the 1% probability mentioned
above might have fused bones (but this is unlikely) due to maybe hormonal or genetic factors
and that may disadvantage the person.