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Shoulder Girdle
cage/Thorax
process
bottom triangle
Clavicle
distallyarticulateswiththe
acromionprocesstoformthe
ACjoint
Proximallyarticulateswith
thesternumtoformSCjoint
Scapula
5-7
Scapula
theshoulderblade
Glenoidfossahasringof
cartilagecalledlabrumto
deepenthearticularsurface
theglenoidfossaofthe
scapulaarticulateswiththe
humerustoformthe
glenohumeraljoint(shoulder)
theacromionprocess
articulateswiththeclavicleto
fromtheacromioclavicular
joint(tipoftheshoulder)
Humerus
Humerus
proximalendarticulates
withscapulatoform
shoulder
distalendarticulateswith
bonesoftheforearmto form
elbow
Sternoclavicular Articulation
site of most movement of shoulder girdle
articulation between the
sternum and clavicle
elevation/depression (up and down, 30-40o)
a modified ball-and-socket joint
o
mobile in frontal and transverse
plane
limited sagittal movement
rotation (40-50 )
protraction/retraction (A/P, rowing, 30o)
Interclavicular
Ligament
Clavicle
Sternoclavicular
Ligament
Costoclavicular
Ligament
Sternum
Clavicle
Articular
disk
Costal
cartilage
14
Acromioclavicular
Articulation
articulation between
acromion process and
distal end of clavicle
coracoclavicular ligament
serves as axis of rotation for
associated scapular mvmts
15
AC Mvmts
3 df
protraction/retraction: acromion process
moves on meniscus, scapula rotates
about medial coracoclavicular ligament
(conoid) 30-50
upward/downward rotation: clavicle
moves on meniscus, scapula rotates
about lateral coracoclavicular
ligament (trapezoid) 60
elevation/depression: relative motion of
acromion & clavicle with no rotation
30
Note: mvmts @ AC joint will be
opposite those at SC joint
(e.g., AC elevation -- SC depression)
16
Scapulothoracic Articulation
physiological articulation (no bone-to-bone connection) between
the anterior surface of the scapula (scapular fossa) and the
thoracic wall
scapula rests on 2 muscles (serratus anterior and subscapularis)
60 ROM
17
Shoulder Joint
(aka glenohumeral)
- articulation of humerus and
glenoid fossa
- designed for mobility
(greatest ROM of any jt
in body)
- lacks bony and ligamentous
support
- shallow glenoid fossa
(1/4 size of humeral head)
-half-spherical humeral head
18
- Articulation
Between rounded head
of humerus and shallow,
pear-shaped glenoid
cavity of scapula.
Articular surface covered
by hyaline articular
cartilage.
Glenoid cavity is
deepened by glenoid
labrum
(fibrocartilaginous rim).
- Type
Synovial ball-and-socket joint.
Capsule
Subacromial Arch
coracoacromial
ligament
provides a buffer
for the rotator cuff
muscle tendons
21
GlenoidLabrum
Ringofcartilagesimilartothemeniscioftheknee.
Deepensthearticularsurfaceofthegenoidfossaandaddstothestabilityoftheshoulder
Glenohumeral Joint
Glenohumeral
ligaments
provide stability
especially
anteriorly &
inferiorly
inferior
glenohumeral
ligament
5-25
Shoulder
Ligamentous Support
no ligament to prevent backward displacement
fossa angle slightly anterior
prevents backward displacement
26
Subacromial
(Subdeltoid) bursa
Subscapularis
bursa
Infraspinatus bursa
- Relations
Superiorly
Supraspinatus m.
Subacromial bursa
Coracoacromial ligament
Deltoid m.
Inferiorly
Long head triceps brachii m.
Axillary nerve
Post. circumflex humeral vessels
Anteriorly
Subscapularis m.
Coracobrachialis
Short head of biceps brachii
Deltoid
Posteriorly
Infraspinatus
Teres minor
Deltoid
trapezius
Middle trapezius
Lower trapezius
Muscles
Anterior
Pectoralis major
Coracobrachialis
Subscapularis
Superior
Deltoid
Supraspinatus
Muscles
Superior
Deltoid
Supraspinatus
Posterior
Latissimus dorsi
Teres major
Infraspinatus
Teres minor
Deltoid
themuslcethatgives
contourtotheshoulder
originatesalongthe
spineofthescapulaand
clavicle,insertsonthe
humerus
allfibersabductthe
arm
anteriorfibers:flex
andmediallyrotatearm
posteriorfibers:extend
andlaterallyrotatearm
PectoralisMajor
thechestmuscle
originatesalongthe
sternumandclavicle,
insertsonthehumerus
itfunctionsto:
~adduct
~flex
~mediallyrotate
thearm.
Biceps
thepopeyemuscle
onanterioraspectof
arm
crossesboththe
shoulderandelbow
flexesthearm
Triceps
ontheposterioraspect
ofthearm
crossesboththe
shoulderandelbow
extendsthearm
LatissimusDorsi
thelats
giveswinglike
appearancetosides
startsalongthe
thoracicvertebraeof
backandinsertsonthe
anterioraspectof
humerus
functionsextend,
adductandmedially
rotatethearm
Coracobrachialis
Teres Major
RotatorCuff
Groupoffourmusclesthatacttoholdthe
headofthehumerusintotheglenoidfossa
Supraspinatus
Infraspinatus
TeresMinor
Subscapularis
Supraspinatus:1st10degreesofabduction
Infraspinatus:externalrotation
Teresminor:externalrotation
Subscapularis:internalrotation
Stabilizing Influence of
Rotator Cuff
muscles have a large
stabilizing component when
active
all have a large horizontal
component
so play a significant role in
stabilizing the humerus
against the glenoid fossa
50
51
MOVEMENTS
MAIN MUSCLE
ACCESSORY MUSCLE
FLEXION
0-135*
PECTORALISMAJOR(clavicular part)
DELTOID ant fibres
Coracobrachialis
Biceps short head
EXTENSION
45-60*
Teres major
Triceps long head
P major[sternocoastal head]
ADDUCTION
PECTORALIS MAJOR
LATISSMUS DORSI
BICEPS long head
TRICEPS short head
Teres major
coracobrachialis
ABDUCTION
SUPRASPINATUS[0-15*]
DELTOID[15*-90*]
SERRATUS ANTERIOR[90*-180*]
TRAPEZOIDupper,lower fibres[90-180]
MEDIAL ROTATION
[INTERNAL]
90*
PECTORALIS MAJOR
DELTOID ant fibres
LATISSMUS DORSI
TERES MAJOR
LATERAL ROTATION
[EXTERNAL]
70*-90*
subscapularis
- Blood Supply
Anterior circumflex
humeral vessels
Posterior circumflex
humeral vessels
Suprascapular
vessels
Subscapular
vessels
Nerves
All shoulder joint muscles are innervated from the brachial
plexus
Lateral pectoral nerve arising from C5, C6, & C7
Pectoralis major (clavicular head)
Nerves
Axillary nerve branching
from C5 & C6
Deltoid
Teres minor
Sensation to lateral patch of
skin over deltoid region of
arm
Nerves
Lower subscapular nerve arising from
C5 & C6
Subscapularis
Teres major
Nerves
Musculotaneous nerve
branching from C5, C6, &
C7
Coracobrachialis
Sensation to radial aspect
of forearm
Applied Anatomy
Dislocation of glenohumeral joint
Glenohumeral joint
Extremely mobile
Providing wide movement at the
expense of stability
Relatively small bony glenoid cavity
Supplemented by :
Robust fibrocartilagious glenoid labrum
Ligamentous support
Make it susceptible to dislocation
Divided into :
Anterior dislocation
Posterior dislocation
Applied Anatomy
Fractures of the clavicle and dislocations of the acromioclavicular
and sternoclavicular joints
Its relative size and the potential forces that it trasmits from the upper
limb to the trunk, it is not surprising that it is often fractured.
The typical site of fracture is the middle third.
The medial and lateral thirds are rarely fractured.
The acromial end of the clavicle tends to dislocate at the
acromioclavicular joints with trauma
The outer third of the clavicle is joined to the scapula by the conoid
and trapezoid ligaments of the coracoclavicular ligament.
Minor injury,
tends to
Applied Anatomy
More severe trauma
disrupt the conoid and trapezoid ligaments of coracoclavicular
ligament
results in elevation and upward subluxation of the clavicle
The typical injury at the medial end of the clavicle is an anterior or
posterior dislocation of the sternoclavicular joint.
Importantly, a posterior dislocation of the clavicle may impinge on
the great vessels of the superior mediastinum and compress or
disrupt them.