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 anatomical
® Bones Involve neck of the humerus
o Large globular head of ® Thicker above and below
humerus ® Loose and lax
o Glenoid cavity of scapula o Allow bone to be separated
® Protected against displacement by from each other more than an
tendons and by atmospheric inch
pressure. Muscles Supporting Capsular Ligament
® Ligaments around gleno-humeral ® Superiorly: Supraspinatus
joint; Limit the amount of joint ® Inferiorly: Long Head of Triceps
movement ® Posteriorly: Tendons of Infraspinatus
o Capsular and Teres Minor
o Coracohumeral ® Anteriorly: Tendon of Subscapularis
o Transverse Humeral Openings of Capsular Ligament
o Glenoid Ligament 3 Openings
® Above protected by arched vault ® Anteriorly
formed by: o Below coracoid Process,
o Under surface of coracoid connection between synovial
process membrane of the joint and a
o Under surface of acromion bursa beneath the tendon of
process subscapularis muscle
o Coraco-acromial ligament o Between the 2 tuberosities,
Glenoid Cavity passage of the biceps long
® Pear Shape head.
® Shallow ® Posteriorly
® Directed Laterally and Upward o Not constant, where a
® Only1/3rd of the humeral head comes communication exists
in contact with the glenoid cavity at between joint and a bursal
any position. sac belonging to Infraspinatus
® Glenoid Fossa is deepened by a muscle.
fibro- cartilaginous rim of Glenoid Supplemental Bands of Capsular
labrum. Ligament
ARTICULATING SURFACE ® Strengthen capsular ligament in the
interior of the joint.
® Flood’s Ligaments
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.
 Situated on inner side of joint
o ® Broad band of fibrous tissues
Passes from inner edge of
o ® Connects the two lips of the upper
glenoid cavity part of intertubercular sulcus and acts
o Attached to lower part of as a retinaculum to keep the long
lesser tuberosity of humerus tendon of biceps in position.
® Schlemm’s Ligaments GLENOID LABRUM
o Situated at lower part of the ® Fibro-cartilage rim attached around
joint margin of glenoid cavity.
o Passes from under edge of ® Triangular on section
glenoid cavity ® Thickest portion at circumference of
o Attached to under part of neck cavity, free edge is sharp and thin
of humerus ® Continuous above with long head of
® Glenohumeral Ligaments biceps
o Situated at upper part of the ® Deepens cavity for articulation and
joints, projects into its interior protects edges of bone
(can only be seen when ® Lined by synovial membrane
capsule is open). SYNOVIAL MEMBRANE
o Attached above apex of ® Reflected from margin of glenoid
glenoid cavity close to root of cavity over fibro- cartilaginous rim
coracoid process, attached surrounding it.
below lesser tuberosity of
® Over internal surface of capsular
humerus (Forms inner
ligaments.
boundary of upper part of
® Covers lower part and sides of
bicipital groove)
anatomical neck of humerus.
Glenohumeral Ligaments
BURSAE IN RELATION TO THE
® 3 fibrous bands derived from
SHOULDER JOINT
thickening of the anterior part of
1. SUBSCAPULAR BURSA
fibrous capsule.
2. INFRASPINATUS BURSA
® All 3 Converge upward and medially 3. SUBACROMIAL BURSA
blend with glenoid labrum: (SUBDELTOID)
o SUPERIOR BAND : attached 4. SUBCORACOID BURSA
to the upper end of lesser BURSA
tubercle
® SUBSCAPULAR BURSA
o MIDDLE BAND : attached to
o Intervenes between the
lower part of lesser tubercle
tendon of subscapularis and
o INFERIOR BAND : lower part
fibrous capsule.
of anatomical neck of
Communicates with the joint
humerus.
cavity through oval gap
CORACO-HUMERAL LIGAMENT
between superior and middle
® Broad Thick Band glenohumeral ligaments.
® Strengthens Upper part of Capsular ® Infraspinatus bursa
Ligament o Communicates with the joint
® Attachments from behind
o Arises from outer border of ® Subacromial bursa
coracoid process o Largest bursa of the body
o Blended with tendon of intervenes between
supraspinatus muscles supraspinatus and coraco-
o United to capsule in greater acromial arch
part of its extend
TRANSVERSE HUMERAL 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.
 oIt does not communicate with (acromio and sterno-
the joint clavicular joints).
o It is of great value in the ® Spinal Cord regulating Shoulder
abduction of arm at the movements (C5, C6, C7 & C8)
shoulder joint where is o Flexion, Abduction, & lateral
protects the supraspinatus rotation (C5, C6,).
tendon against friction with o Extension, Adduction, &
the acromion Medial rotation is (C6, C7, C8)
Muscles in Relation to the Joint Osteo- & Arthrokinematics of Shoulder
® Above: Supraspinatus Joint
® Below: Long head of Triceps Osteokinematics
® Front: Subscapularis o Flexion
® Behind: Infraspinatus and Teres o Extension
Minor o Hyperextension
® Deltoid is placed most externally and o Abduction
covers the articulation from its outer o Adduction
side, as well as in front and behind. o Medial rotation (internal rotation)
Blood and Nerve Supply o Lateral rotation (external rotation)
Blood Supply o Horizontal abduction
1. Anterior circumflex humeral vessels o Horizontal adduction
2. Posterior circumflex humeral vessels o Circumduction
3. Suprascapular vessels Concave-convex rule
NERVE SUPPLY ® Convex humeral head moves within
1. Axillary nerve the concave glenoid fossa
2. Musculocutaneous nerve ® The Convex joint surface (Humeral
3. Suprascapular Nerve Head) moves in a direction opposite
4. Lateral pectoral nerve to the movement of the body segment
MOVEMENTS AT THE SHOULDER (Humeral Shaft)
JOINTS Flexion
® Movement in every direction (Flexion, ® Plane of Motion: Sagittal Plane
extension, abduction, adduction, ® Axis of Motion: Transverse Axis
rotation, circumduction) through the center of the humeral
® Highly mobile due to: head
o Large size of head of ® Muscles Involved:
humerus in comparison with o Pectoris major
the depth of glenoid cavity o Anterior Fibres of Deltoid
(Even when supplemented by o Coraco-brachialis
glenoid ligament) o Biceps (When the foreare is
o Looseness of the capsule of flexed)
the joint (Laxity of fibrous ® Humeral head glides posterior
capsule) laterally in the glenoid cavity
o When movements of arm are ® Range of Motion o 0 – 90 degrees
arrested by contact of the ® Factors Limiting Shoulder Flexion
bony surface à Tension of o Inferior Glenohumeral
corresponding fibers and ligament
muscles acting on accessory o Tightness of posterior joint
ligaments farther movements capsule
of scapula and accessory Extension
structures to the shoulder joint ® Plane of Motion: Sagittal Plane

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.
 ® Axis of Motion: Transverse Axis ® Factors Limiting:
through the center of the humeral o Trunk
head Internal Rotation
® Muscles Involve: ® Plane of Motion: Transverse Plane
o Latissimus dorsi ® Axis of Motion: Vertical axis through
o Teres major the center of humeral head
o Posterior fibers of Deltoid ® Muscles Involve:
o Triceps (When forearm is o Subscapularis
extended) o Pectoralis Major
® Humeral head glide anterior medially o Latissimus dorsi
in glenoid cavity o Teres major
® Range of Motion o 0 – 45 degrees or ® Humeral head glide posteriorlaterally
60 degrees in glenoid cavity
® Factors Limiting Shoulder Extension ® Range of Motion
o Superior and medial o 0-70º as the arm at 90º of
glenohumeral ligament shoulder abduction and 90º
Abduction elbow flexion
® Plane of Motion: Frontal Plane o If the elbow is extended,
® Axis of Motion: Sagittal axis through shoulder rotation occurs
the center of the humeral head simultaneously with forearm
® Muscles Involve: rotation.
o Deltoid ® Factors Limiting Internal Rotation
o Supraspinatus o Posterior Capsule
® Humeral head glide inferiorly in External Rotation
glenoid cavity ® Plane of Motion: Transverse Plane
® Range of Motion ® Axis of Motion: Vertical axis through
o Total : 0 – 165 degrees or 175 the center of humeral head
degrees ® Muscles Involve:
o Full internal rotation of o Infraspinatus
humerus: 0 – 60 degrees o Teres Minor
o Full external rotation of ® Humeral head glide anteriomedially
Humerus: 0 – 90 degrees in glenoid cavity
® Factors Limiting Shoulder Abduction ® Range of Motion
o Inferior glenohumeral o 0-90º as the arm at 90º of
ligament shoulder abduction and 90º
o Tightness of the inferior joint elbow flexion
capsule of the glenoumeral o If the elbow is extended,
joint shoulder rotation occurs
Adduction simultaneously with forearm
® Plane of Motion: Frontal Plane rotation.
® Axis of Motion: Sagittal axis through ® Factors Limiting External Rotation
the center of the humeral head o Coracohumeral ligament
® Muscles Involve: o 3 glenohumeral ligaments
o Subscapularis Circumduction
o Pectoralis Major ® A combination of flexion, abduction,
o Latissimus dorsi extension, and adduction or in the
o Teres major reversed sequence
® Humeral head glide superiorly in ® glenohumeral flexion à abduction
glenoid cavity à extension à 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.
 ® glenohumeral extension
abduction à flexion à adduction
Close and Loose Packed Position
® Close Packed position
o Position where the articular
surfaces of joint are in
maximal congruency status,
resulting in greatest
mechanical stability.
o Most ligament and capsule
surrounding joint are taut.
o 90° of glenohumeral
abduction and full external
rotation
® Loose Packed position
o Position where the articular
surface of joint are in minimal
congruency status.
o Supporting structures are
most lax.
o 55° of semi-abduction and
30° of horizontal adduction
Dislocation
® Humeral head is hold in place by the
Rotator cuff (S,I,T,S) Muscles.
® Humeral Head separated from
scapula at glenohumeral joint.
® Commonly downward dislocation
because Rotator Cuff protects joints
in all direction except inferiorly.
® Hemiparesis/Hemiplegia patients
prone to dislocate their shoulder à
their Rotator cuff muscles are weak to
hold the shoulder joint in place.
Adhesive Capsulitis
® Frozen Shoulder
® Pain and Stiffness in the Shoulder
® Shoulder capsule thickens and
becomes tight. Stiff bands of tissue —
called adhesions — develop. In many
cases, there is less synovial fluid in
the joint.
® Unable to move your shoulder - either
on your own or with the help of
someone else.
Stages of Adhesive Capsulitis
It develops in three stages:
à 1.Freezing (Pain worsens, shoulder
loses range of motion. Typically lasts
from 6 weeks to 9 months.)
2. Frozen (Painful symptoms may
actually improve during this stage,
but the stiffness remains. During the
4 to 6 months of the "frozen" stage,
daily activities may be very difficult.)
3. Thawing (Shoulder motion slowly
improves. Complete return to normal
or close to normal strength and
motion. Typically takes from 6
months to 2 years.)
SLAP LESION
® Injury to the labrum of the shoulder.
® SLAP = Superior Labrum Anterior
and Posterior.
® In a SLAP injury, the superior part of
the labrum is injured. This top area is
also where the biceps tendon
attaches to the labrum.
® SLAP tear occurs both in front
(anterior) and back (posterior) of this
attachment point.
® The biceps tendon can be involved in
the injury as well.
Bankart Lesion
® Tear of the labrum and attached joint
capsule along the anterior inferior
quadrant of the Glenoid
ligament/Inferior glenohumeral
ligament.
® Associated with shoulder dislocation.
® Bony Bankart is when some of the
glenoid bone is broken off with the
anterior inferior labrum (Shoulder
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

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.
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.