ANATOMY

OF
SHOULDER JOINT
Dr.Kiruthika shree
 ARTICULATION

Articulation is
between:
• The rounded
head of the
Glenoid humerus and
cavity
• The shallow,
pear-shaped
glenoid cavity
of the scapula.
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 TYPE

• Synovial
• Ball-and-socket joint
• Multiaxial. 3
• Ball: spheroidal head of
humerus. Covered by
hyaline articular
cartilage thick in the
centre & thin at
periphery.

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 Glenoid cavity
• Pear Shape
• Shallow
• Directed Laterally and
Upward
• Only1/3rd of the humeral head
comes in contact with the
glenoid cavity at any position.
The articular surfaces are
covered by hyaline cartilage.
thin in the centre & thick at
periphery.
• The glenoid cavity is deepened
by the presence of a
fibrocartilaginous rim called
the glenoid labrum. 5
 FIBROUS CAPSULE

The fibrous capsule surrounds the joint and is attached:

Medially to the margin of the glenoid cavity outside the labrum;
Laterally to the anatomic neck of the humerus. EXCEPT
at upper end of intertubercular sulcus & infero-medially it
extends 1cm below to surgical neck of humerus 6
 Muscles Supporting
Capsular Ligament
• Superiorly -
Supraspinatus
• Inferiorly -Long
Head of Triceps
• Posteriorly-Tendons
of Infraspinatus and
Teres Minor
• Anteriorly -Tendon
of Subscapularis
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 Openings of Capsular
Ligament
• 3 Openings
Anteriorly
• Below coracoid Process,
connection between
synovial membrane of the
joint and a bursa beneath
the tendon of subscapularis
muscle.
• Between the 2 tuberosities,
passage of the biceps long
head.
• Posteriorly Not constant, where a
communication exists between joint and
a bursal sac belonging to
Infraspinatus muscle. 8
 SYNOVIAL MEMBRANE

• Lines the capsule

• Reflected from margin of
glenoid cavity over
fibrocartilaginous rim upto
humeral head
• Synovial sheaths extends to
the intertubercular sulcus upto
surgical neck.
• Covers lower part and sides
of anatomical neck of
humerus.

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 LIGAMENTS
Accessory ligaments:
The coracoacromial ligament
3. The coracohumeral ligament extends between the coracoid process
strengthens the capsule from and the acromion. Its function is to
above and stretches from the protect the superior aspect of the
lateral borderof the coracoid joint.
process to the anatomiical neck
b/w lesser and greater tubercles.
2. The transverse
humeral ligament
strengthens the
capsule and bridges the
gap between the two
humeral tuberosities.

1. The glenohumeral
ligaments are three
bands of fibrous tissue
that strengthen the front
of the capsule.
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 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 of humerus.

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 BURSAE IN RELATION TO THE
SHOULDER JOINT

1) SUBSCAPULAR BURSA

2) INFRASPINATUS BURSA

3) SUBACROMIAL BURSA
• (SUBDELTOID)

4) SUBCORACOID BURSA

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 Relations
• • Superiorly
- Supraspinatus m.
- Subacromial bursa
- Coracoacromial ligament
- Deltoid m.

• • Inferiorly
- Long head triceps brachii m.
- Axillary nerve
- Post. circumflex humeral
vessels

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 Relations
• Anteriorly
- Subscapularis m.
- Coracobrachialis
- Short head of biceps brachii
- Deltoid

• • Posteriorly
- Infraspinatus
- Teres minor
- Deltoid

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 NERVE SUPPLY

Articular branches of the axillary & the suprascapular nerves16

 The following movements
are possible:

• Flexion • Abduction • Lateral rotation

• Extension • Adduction
Circumduction • Medial rotation
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 Flexion
• Normal flexion is
about 90°
• It is performed by
the:
1. Anterior fibers of
the deltoid
2. Pectoralis major
3. Biceps brachii
4. Coracobrachialis

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 Extension:
• Normal extension is
about 45°
• It is performed by
the:
1. Posterior fibers
of the deltoid,
2. Latissimus dorsi
3. Teres major

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 Abduction:
• Abduction of the upper limb occurs both at the shoulder joint and between
the scapula and the thoracic wall.
• It is initiated by supraspinatus from 0 to 15
• Then from 15 to 120 by the middle fibers of the deltoid.
• Then above 90 by rotation of the scapula by 2 muscles ( Trapezius & S.A..)
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• The supraspinatus muscle:
– initiates the movement of abduction(from 0 to 15) and
– holds the head of the humerus against the glenoid fossa of the scapula;
• This latter function of the supraspinatus allows the deltoid muscle to
contract and abduct the humerus at the shoulder joint. 21
 Adduction:
• Normally the upper limb
can be swung 45°
across the front of the
chest.
• This is performed by:
1. pectoralis major
2. latissimus dorsi
3. teres major
4. teres minor

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 Lateral rotation:
• Normal lateral rotation
is about 40 to 45°.
• This is performed by
the:
1. infraspinatus
2. teres minor
3. the posterior fibers
of the deltoid muscle

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 Medial rotation:
• Normal medial rotation is
about 55°.
• This is performed by the:
1. subscapularis
2. latissimus dorsi
3. teres major
4. anterior fibers of the
deltoid.
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Circumduction:
This is a movement
in which the distal
end of the humerus
moves in circular
motion while the
proximal end
remains stable
• It is formed by
flexion,
abduction,
extension and
adduction.
Successively

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Clinical anatomy

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 STABILITY OF THE SHOULDER JOINT

• This joint is unstable because of the:

– shallowness of the glenoid fossa
– weak ligaments
• Its strength almost entirely depends on the tone of the rotator cuff muscles.
• The tendons of these muscles are fused to the underlying capsule of the shoulder
joint.
• The least supported part of the joint lies in the inferior location, where it is
unprotected by muscles. 27
DISLOCATIONS OF THE SHOULDER JOINT
The shoulder joint is the most
commonly dislocated large joint.

Anterior-Inferior Dislocation
• Sudden violence applied to the humerus
with the joint fully abducted pushes 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.

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DISLOCATIONS OF THE SHOULDER
JOINT

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 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

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ROTATOR CUFF • Lesions of the rotator cuff are a
TENDINITIS common cause of pain in the
shoulder region.
• Excessive overhead activity of
the upper limb may be the cause
of tendinitis, although many
cases appear spontaneously.
• During abduction of the shoulder
joint, the supraspinatus tendon is
exposed to friction against the
acromion.
• Under normal conditions the
amount of friction is reduced to a
minimum by the large
subacromial bursa, which
extends laterally beneath the
deltoid.

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• Degenerative changes in the bursa are followed by degenerative changes
in the underlying supraspinatus tendon, and these may extend into the
other tendons of the rotator cuff.
• Clinically, the condition is known as subacromial bursitis,
supraspinatus tendinitis, or pericapsulitis.
• It is characterized by the presence of a spasm of pain in the middle
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range of abduction when the diseased area impinges on the acromion.
RUPTURE OF THE SUPRASPINATUS TENDON
In advanced cases of rotator cuff
tendinitis, the necrotic supraspinatus
tendon can become calcified or rupture.

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• Rupture of the tendon seriously interferes with the normal abduction
movement of the shoulder joint.

• The patient with a ruptured supraspinatus tendon is unable to initiate

abduction of the arm.
• However, if the arm is passively assisted for the first 15° of
abduction, the deltoid can then take over and complete the
movement to a right angle.
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 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 35
 Bankart Lesion

• Tear of the labrum and

attached joint capsule
along the anterior
inferior quadrant of
the Glenoid labrum

• Associated with
shoulder dislocation.

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 Shoulder Bursitis
• Inflammation of shoulder
Bursa
• Commonly Subacromion
Bursa
• Usually related to
shoulder impingement of
Subacromion Bursa
between rotator cuff
tendon and acromion

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Thank u

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