The Shoulder Joint By : Gan Quan Fu, PT,

MSc. Human Anatomy (Batch 3)

Content
- Introduction
- Glenoid Cavity
- Ligaments Surrounding the joint
- Bursae in Relation to the Shoulder
Joint Capsular Ligament
- Muscles Acting on Shoulder Joint  Encircles entire glenohumeral joint.
- Blood and Nerve Supply  Attached:
- Joint Movement o Medially: Above to the
- Close and Loose Pack Position circumference of glenoid
- Applied Anatomy cavity beyond the glenoid
Introduction ligament
 Enarthrodial or Ball-and-Socket joint o Laterally: Below to
 Bones Involve anatomical neck of the
o Large globular head of humerus
humerus  Thicker above and below
o Glenoid cavity of scapula  Loose and lax
 Protected against displacement by o Allow bone to be separated
tendons and by atmospheric from each other more than
pressure. an inch
 Ligaments around gleno-humeral Muscles Supporting Capsular Ligament
joint; Limit the amount of joint  Superiorly: Supraspinatus
movement  Inferiorly: Long Head of Triceps
o Capsular  Posteriorly: Tendons of Infraspinatus
o Coracohumeral and Teres Minor
o Transverse Humeral  Anteriorly: Tendon of Subscapularis
o Glenoid Ligament Openings of Capsular Ligament
 Above protected by arched vault 3 Openings
formed by:  Anteriorly
o Under surface of coracoid o Below coracoid Process,
process connection between synovial
o Under surface of acromion membrane of the joint and a
process bursa beneath the tendon of
o Coraco-acromial ligament subscapularis muscle
Glenoid Cavity o Between the 2 tuberosities,
 Pear Shape passage of the biceps long
 Shallow head.
 Directed Laterally and Upward  Posteriorly
 Only1/3rd of the humeral head o Not constant, where a
comes in contact with the glenoid communication exists
cavity at any position. between joint and a bursal
 Glenoid Fossa is deepened by a sac belonging to
fibro- cartilaginous rim of Glenoid Infraspinatus muscle.
labrum. Supplemental Bands of Capsular
ARTICULATING SURFACE Ligament

Shoulder Anaphy- Jyrra Neri

References • Gray, H. (2012) Gray’s Anatomy; The classic Anatomical Handbook for Doctors, Students and Artist, 15th edn.
London; Bounty Books. • Saladin, K. S. (2007) Anatomy and Physiology: The Unity of Form and Function. 4th edn. New York;
McGraw-Hill.
  Strengthen capsular ligament in the
interior of the joint.
 Flood’s Ligaments
o Situated on inner side of joint
o Passes from inner edge of
glenoid cavity
o Attached to lower part of
lesser tuberosity of humerus
 Schlemm’s Ligaments
o Situated at lower part of the
joint
o Passes from under edge of
glenoid cavity
o Attached to under part of
neck of humerus
 Glenohumeral Ligaments
o Situated at upper part of the
joints, projects into its interior
(can only be seen when
capsule is open).
o Attached above apex of
glenoid cavity close to root of
coracoid process, attached
below lesser tuberosity of
humerus (Forms inner
boundary of upper part of
bicipital groove)
Glenohumeral Ligaments
 3 fibrous bands derived from
thickening of the anterior part of
fibrous capsule.
 All 3 Converge upward and medially
blend with glenoid labrum:
o SUPERIOR BAND : attached
to the upper end of lesser
tubercle
o MIDDLE BAND : attached to
lower part of lesser tubercle
o INFERIOR BAND : lower part
of anatomical neck
humerus.
CORACO-HUMERAL LIGAMENT
 Broad Thick Band
 Strengthens Upper part of Capsular
Ligament
 Attachments
o Arises from outer border of
coracoid process
Shoulder Anaphy- Jyrra Neri
References • Gray, H. (2012) Gray’s Anatomy; The classic Anatomical Handbook for Doctors, Students and Artist, 15th edn.
London; Bounty Books. • Saladin, K. S. (2007) Anatomy and Physiology: The Unity of Form and Function. 4th edn. New York;
McGraw-Hill.
Blended with tendon of
o
supraspinatus muscles
o United to capsule in greater
part of its extend
TRANSVERSE HUMERAL LIGAMENT
 Broad band of fibrous tissues
 Connects the two lips of the upper
part of intertubercular sulcus and
acts as a retinaculum to keep the
long tendon of biceps in position.
GLENOID LABRUM
 Fibro-cartilage rim attached around
margin of glenoid cavity.
 Triangular on section
 Thickest portion at circumference of
cavity, free edge is sharp and thin
 Continuous above with long head of
biceps
 Deepens cavity for articulation and
protects edges of bone
 Lined by synovial membrane
SYNOVIAL MEMBRANE
 Reflected from margin of glenoid
cavity over fibro- cartilaginous rim
surrounding it.
 Over internal surface of capsular
ligaments.
 Covers lower part and sides of
anatomical neck of humerus.
BURSAE IN RELATION TO THE
SHOULDER JOINT
1. SUBSCAPULAR BURSA
2. INFRASPINATUS BURSA
3. SUBACROMIAL BURSA
(SUBDELTOID)
4. SUBCORACOID BURSA
BURSA
 SUBSCAPULAR BURSA
o Intervenes between the
of tendon of subscapularis and
fibrous capsule.
Communicates with the joint
cavity through oval gap
between superior and middle
glenohumeral ligaments.
 Infraspinatus bursa
o Communicates with the joint
from behind
  Subacromial bursa bony surface  Tension of
o Largest bursa of the body corresponding fibers and
intervenes between muscles acting on accessory
supraspinatus and coraco- ligaments farther movements
acromial arch of scapula and accessory
o It does not communicate with structures to the shoulder
the joint joint (acromio and sterno-
o It is of great value in the clavicular joints).
abduction of arm at the  Spinal Cord regulating Shoulder
shoulder joint where is movements (C5, C6, C7 & C8)
protects the supraspinatus o Flexion, Abduction, & lateral
tendon against friction with rotation (C5, C6,).
the acromion o Extension, Adduction, &
Muscles in Relation to the Joint Medial rotation is (C6, C7,
 Above: Supraspinatus C8)
 Below: Long head of Triceps Osteo- & Arthrokinematics of Shoulder
 Front: Subscapularis Joint
 Behind: Infraspinatus and Teres Osteokinematics
Minor o Flexion
 Deltoid is placed most externally and o Extension
covers the articulation from its outer o Hyperextension
side, as well as in front and behind. o Abduction
Blood and Nerve Supply o Adduction
Blood Supply o Medial rotation (internal rotation)
1. Anterior circumflex humeral vessels o Lateral rotation (external rotation)
2. Posterior circumflex humeral vessels o Horizontal abduction
3. Suprascapular vessels o Horizontal adduction
NERVE SUPPLY o Circumduction
1. Axillary nerve Concave-convex rule
2. Musculocutaneous nerve  Convex humeral head moves within
3. Suprascapular Nerve the concave glenoid fossa
4. Lateral pectoral nerve
 The Convex joint surface (Humeral
MOVEMENTS AT THE SHOULDER
Head) moves in a direction opposite
JOINTS
to the movement of the body
 Movement in every direction segment (Humeral Shaft)
(Flexion, extension, abduction, Flexion
adduction, rotation, circumduction)
 Plane of Motion: Sagittal Plane
 Highly mobile due to:
 Axis of Motion: Transverse Axis
o Large size of head of
through the center of the humeral
humerus in comparison with head
the depth of glenoid cavity
 Muscles Involved:
(Even when supplemented
o Pectoris major
by glenoid ligament)
o Anterior Fibres of Deltoid
o Looseness of the capsule of
o Coraco-brachialis
the joint (Laxity of fibrous
capsule) o Biceps (When the foreare is
o When movements of arm are flexed)
arrested by contact of the  Humeral head glides posterior
laterally in the glenoid cavity
Shoulder Anaphy- Jyrra Neri
References • Gray, H. (2012) Gray’s Anatomy; The classic Anatomical Handbook for Doctors, Students and Artist, 15th edn.
London; Bounty Books. • Saladin, K. S. (2007) Anatomy and Physiology: The Unity of Form and Function. 4th edn. New York;
McGraw-Hill.
  Range of Motion o 0 – 90 degrees  Plane of Motion: Frontal Plane
 Factors Limiting Shoulder Flexion  Axis of Motion: Sagittal axis through
o Inferior Glenohumeral the center of the humeral head
ligament  Muscles Involve:
o Tightness of posterior joint o Subscapularis
capsule o Pectoralis Major
Extension o Latissimus dorsi
 Plane of Motion: Sagittal Plane o Teres major
 Axis of Motion: Transverse Axis  Humeral head glide superiorly in
through the center of the humeral glenoid cavity
head  Factors Limiting:
 Muscles Involve: o Trunk
o Latissimus dorsi Internal Rotation
o Teres major  Plane of Motion: Transverse Plane
o Posterior fibers of Deltoid  Axis of Motion: Vertical axis through
o Triceps (When forearm is the center of humeral head
extended)  Muscles Involve:
 Humeral head glide anterior medially o Subscapularis
in glenoid cavity o Pectoralis Major
 Range of Motion o 0 – 45 degrees or o Latissimus dorsi
60 degrees o Teres major
 Factors Limiting Shoulder Extension  Humeral head glide posteriorlaterally
o Superior and medial in glenoid cavity
glenohumeral ligament  Range of Motion
Abduction o 0-70º as the arm at 90º of
 Plane of Motion: Frontal Plane shoulder abduction and 90º
 Axis of Motion: Sagittal axis through elbow flexion
the center of the humeral head o If the elbow is extended,
 Muscles Involve: shoulder rotation occurs
o Deltoid simultaneously with forearm
o Supraspinatus rotation.
 Humeral head glide inferiorly in  Factors Limiting Internal Rotation
glenoid cavity o Posterior Capsule
 Range of Motion External Rotation
o Total : 0 – 165 degrees or  Plane of Motion: Transverse Plane
175 degrees  Axis of Motion: Vertical axis through
o Full internal rotation of the center of humeral head
humerus: 0 – 60 degrees  Muscles Involve:
o Full external rotation of o Infraspinatus
Humerus: 0 – 90 degrees o Teres Minor
 Factors Limiting Shoulder Abduction  Humeral head glide anteriomedially
o Inferior glenohumeral in glenoid cavity
ligament  Range of Motion
o Tightness of the inferior joint o 0-90º as the arm at 90º of
capsule of the glenoumeral shoulder abduction and 90º
joint elbow flexion
Adduction

Shoulder Anaphy- Jyrra Neri

References • Gray, H. (2012) Gray’s Anatomy; The classic Anatomical Handbook for Doctors, Students and Artist, 15th edn.
London; Bounty Books. • Saladin, K. S. (2007) Anatomy and Physiology: The Unity of Form and Function. 4th edn. New York;
McGraw-Hill.
 o If the elbow is extended,  Frozen Shoulder
shoulder rotation occurs  Pain and Stiffness in the Shoulder
simultaneously with forearm  Shoulder capsule thickens and
rotation. becomes tight. Stiff bands of tissue
 Factors Limiting External Rotation — called adhesions — develop. In
o Coracohumeral ligament many cases, there is less synovial
o 3 glenohumeral ligaments fluid in the joint.
Circumduction  Unable to move your shoulder -
 A combination of flexion, abduction, either on your own or with the help
extension, and adduction or in the of someone else.
reversed sequence Stages of Adhesive Capsulitis
 glenohumeral flexion  abduction It develops in three stages:
 extension  adduction 1. Freezing (Pain worsens, shoulder
 glenohumeral extension  loses range of motion. Typically lasts
abduction  flexion  adduction from 6 weeks to 9 months.)
Close and Loose Packed Position 2. Frozen (Painful symptoms may
actually improve during this stage,
 Close Packed position
but the stiffness remains. During the
o Position where the articular
4 to 6 months of the "frozen" stage,
surfaces of joint are in
daily activities may be very difficult.)
maximal congruency status, 3. Thawing (Shoulder motion slowly
resulting in greatest
improves. Complete return to normal
mechanical stability. or close to normal strength and
o Most ligament and capsule
motion. Typically takes from 6
surrounding joint are taut. months to 2 years.)
o 90° of glenohumeral SLAP LESION
abduction and full external  Injury to the labrum of the shoulder.
rotation  SLAP = Superior Labrum Anterior
 Loose Packed position and Posterior.
o Position where the articular  In a SLAP injury, the superior part of
surface of joint are in minimal the labrum is injured. This top area
congruency status. is also where the biceps tendon
o Supporting structures are attaches to the labrum.
most lax.  SLAP tear occurs both in front
o 55° of semi-abduction and (anterior) and back (posterior) of this
30° of horizontal adduction attachment point.
Dislocation  The biceps tendon can be involved
 Humeral head is hold in place by the in the injury as well.
Rotator cuff (S,I,T,S) Muscles. Bankart Lesion
 Humeral Head separated from  Tear of the labrum and attached joint
scapula at glenohumeral joint. capsule along the anterior inferior
 Commonly downward dislocation quadrant of the Glenoid
because Rotator Cuff protects joints ligament/Inferior glenohumeral
in all direction except inferiorly. ligament.
 Hemiparesis/Hemiplegia patients  Associated with shoulder dislocation.
prone to dislocate their shoulder   Bony Bankart is when some of the
their Rotator cuff muscles are weak glenoid bone is broken off with the
to hold the shoulder joint in place. anterior inferior labrum (Shoulder
Adhesive Capsulitis
Shoulder Anaphy- Jyrra Neri
References • Gray, H. (2012) Gray’s Anatomy; The classic Anatomical Handbook for Doctors, Students and Artist, 15th edn.
London; Bounty Books. • Saladin, K. S. (2007) Anatomy and Physiology: The Unity of Form and Function. 4th edn. New York;
McGraw-Hill.
 joint more unstable than Bankart
Tear)
 Shoulder Bursitis
 Inflammation of shoulder Bursa
 Commonly Subacromion Bursa
 Usually related to shoulder
impingement of Subacromion Bursa
between rotator cuff tendon and
acromion
 Subdeltoid bursa less commonly
inflammed
 Commonly co-exists with rotator cuff
tears or tendonitis
Surgical Intervention
 Front of the shoulder joint is
commonly approached for surgical
intervention
 Aspiration needle maybe introduced
through deltopectoral triangle (closer
to deltoid)

Shoulder Anaphy- Jyrra Neri

References • Gray, H. (2012) Gray’s Anatomy; The classic Anatomical Handbook for Doctors, Students and Artist, 15th edn.
London; Bounty Books. • Saladin, K. S. (2007) Anatomy and Physiology: The Unity of Form and Function. 4th edn. New York;
McGraw-Hill.