 Anterior and Posterior Axillary Fold
 Pectoralis Major
 Clavicular head
 Sternocostal head
 Deltoid
 Clavicular part
 O: Lat. 1/3 of Clavicle
 I: Deltoid Tuberosity
 Acromial part
 O: Acromion
 I: Deltoid Tuberosity
 Spinal part
 O: Spine of Scapula
 I: Deltoid Tuberosity
 Above the Latissimus Dorsi, lateral to
the Lower Trapezius and Medial to
the Teres major and minor.
 Parts of Trapezius
 Ascending
 Middle
 Descending
 Clavicle
 Manubrium
 * Acromion process
 * Coracoid process
 * Borders: Superior, Vertebral and
Axillary
 * Fossae: Subscapular, Supraspinatus,
Infraspinatus, Glenoid
 * Spine
LIGAMENTS OF THE SHOULDER
Coracohumeral ligament-passes
from the base of the coracoid process
to the anterior aspect of the greater
tubercle. Strengthens capsule
superiorly.
Acromioclavicular ligament-sits at
the top of the shoulder; part of the
acromioclavicular joint, located
between the acromion and the
clavicle. Divided into two parts,
superior and inferior. Gives the
acromioclavicular joint its horizontal
stability.
Superior transverse scapular
ligament-bridges the scapular notch
to convert it into suprascapular
foramen for the suprascapular nerves
and vessels.
Transverse humeral ligament-runs from the
greater to lesser tubercle, bridging over the
intertubercular sulcus converting the groove
into a canal for the biceps brachii tendon and
its synovial sheath.
Coracoclavicular ligament-has two parts:
the Conoid and Trapezoid ligaments.
Connects the clavicle with the coracoid
process. Doesn't properly belong to
acromioclavicular joint articulation, but
described with it because it retains the
clavicle in contact with the acromion.
Another view of:
Coracohumeral ligament
Superior transverse scapular ligament
Acromioclavicular ligament
Glenohumeral ligamentsare evident only in the
internal aspect of the
capsule. Consists of three
parts: superior, middle, and
inferior. These ligaments
strengthen the anterior
aspect of the capsule.
1. Subdeltoid bursa
2. Subscapular bursa
3. Subcoracoid bursa
4. Coracoclavicular
bursa
5. Supra-acromial bursa
6. Subacromial bursa
The subdeltoid bursa
• Inferior to the deltoid muscle and superior to the head of the humerus.
• Thin, flat sac made of fibrous connective tissue lined with synovial membrane.
The subscapular bursa
• Between the joint capsule and the tendon of the subscapularis muscle.
• Continuous with the synovial cavity of the joint cavity.
The subcoracoid bursa ( or subcoracoid bursa of Collas)
• Anterior to the subscapularis muscle and inferior to the coracoid process.
• Reduces friction between the coracobrachialis, subscapularis and short head of
the biceps tendons.
• Facilitates internal and external rotation of the shoulder.
The subacromial bursa
• Sac of fluid that separates the acromion from the rotator cuff.
• Bursa is underneath the coracoacromial ligament, acromion bone, and the
deltoid muscle.
Glenoid Labrum
The shoulder joint is considered a 'ball and socket' joint, however, the
'socket' (the glenoid fossa of the scapula) is quite shallow and small,
covering at most only a third of the 'ball' (the head of the humerus).
The socket is deepened by the glenoid labrum. The glenoid labrum is
similar to the meniscus of the knee. It is a fibro-cartilaginous rubbery
structure which encircles the glenoid cavity deepening the socket
providing static stability to the glenohumeral joint. It acts and looks
almost like a washer, sealing the two sides of the joint together.
Articular Cartilage
The most important piece of cartilage is the labrum, otherwise
descibed as the articular cartilage. The labrum is a piece of cartilage
that lies directly between the the humerus head and the glenoid. This
piece of cartilage provides a smooth surface that allows for the
humerus head to rotate with minimal friction, thus cushioning both the
humerus and the scapula. Also, the labrum is shaped like a ring, with
the outer part of the labrum being much thicker than the center of the
ring. This specific shape allows for the labrum to fit against the
humerus head and the glenoid, physically matching up the larger
humerus head with the small surface of the glenoid. Thus the labrum is
also very important for the stabilization of the joint.
ARTICULAR CAPSULE
Synovial Membrane
The synovial membrane (also known as synovium or stratum synoviale)is the
soft tissue found between the joint capsule and the joint cavity of synovial
joints. It secretes the synovial fluid, which fills the joint cavity and lubricates
the joint.
Fibrous Layer
The most common type of joint in your body, called a synovial joint, has what's
known as a joint capsule, which is a sac composed of the fibrous and synovial
membranes that surround a joint in order to enclose a space, called a joint
cavity.
The joint cavity within the joint is filled with a protective fluid called synovial
fluid. If there was no joint capsule, the joint space would have nothing with
which to hold in the protective synovial fluid.
4 Muscles (SITS)
1) Supraspinatus
2) Infraspinatus
3) Teres Minor
4) Subscapularis
 Each muscle of the rotator cuff
originates at the scapula
 SIT (Supraspinatus, Infraspinatus, Teres
Minor) attaches at the greater tubercle
of the humerus
 S (Subscapularis) attaches at the lesser
tubercle
 Together, the tendons and other tissues
form a cuff around the humerus.
 Stabilizes the glenohumeral joint
 Abduction
 External rotation
 Internal rotation of the humerus
 Commonly injured during repetitive use of
the upper limb above the horizontal
 E.g. during throwing, and racquet sports, swimming,
and weight lifting
 Common cause of shoulder pain
 Results in tears of the rotator cuff
 2 Main Causes
 Injury (Acute)
 Degenerative (Chronic and
Cumalitive)
 Rotator cuff tear: An injury tears a rotator cuff tendon
that’s been weakened by age or wear and tear.
Weakness in the arm (and usually pain) are the
symptoms.
 Rotator cuff tendinitis (tendonitis): Repetitive
overhead use of the arms (such as painting or
throwing) causes a painful strain injury. Rest, ice, and
pain relievers are usually effective treatments.
 Rotator cuff impingement: The tendons of the rotator
cuff are squeezed between the humerus and the
acromion. Symptoms and treatment of impingement
are similar to tendinitis.
 Frozen shoulder (adhesive capsulitis): The humerus
adheres to the shoulder blade, causing shoulder pain
and stiffness. Symptoms usually resolve with time and
exercise, or steroid injections.
 Subacromial bursitis: Inflammation of the small sac of
fluid (bursa) that cushions the rotator cuff tendons
from a nearby bone (the acromion).
 Pain medicines: Nonsteroidal anti-inflammatory
drugs (NSAIDs), acetaminophen, or other medicines
 Corticosteroid injections: Reduces inflammation
 Physical therapy: Various exercises can improve
flexibility and strength of the other muscles in the
rotator cuff. This increased strength can help
compensate for a rotator cuff problem.
 Occupational therapy: Focuses on daily tasks that
require shoulder movements.
 Arthroscopic surgery: A surgeon operates through
small incisions, using an arthroscope (a tube with a
camera and tools on its end), in order to reattach the
rotator cuff tendon to the bone or fix other bone
problems.
 Traditional (open) surgery: Through a larger incision,
a surgeon cuts through the muscles and other tissues
to reach a torn rotator cuff tendon. The tendon can
then be reattached to the bone.
 Nerve: Spinal
Accessory
 Origin: Occipital bone,
ligamentum nuchae,
and spines of cervical
vertebrae.
 Insertion: Lateral 1/3
of Clavicle and
acromion process.
 Nerve: Spinal
accessory Nerve
 Origin: Spinous
processes of T1 and T5
 Insertion: Scapular
Spine
 Nerve: Spinal
Accessory Nerve
 Origin: Spinous
Processes of Middle
and Lower Thoracic
Vertebra (T6-T12)
 Insertion: Base of the
scapular spine
 Nerve: Dorsal and
Scapular Nerve
 O: Nuchal ligament and
spinous processes of C7
and T1
 I: Vertebral border of
scapula
 Nerve: Dorsal Scapular
Nerve
 O: Spinous Processes
of T2-T5 Vertebrae
 I: Vertebral Border of
Scapula from Spine to
Inferior Angle
 Nerve: Axillary Nerve
 O: Lateral 1/3 of Clavicle
 I: Deltoid Tuberosity
 Action: Shoulder
Abduction, Flexion, Medial
Rotation, and Horizontal
Adduction
 Nerve: Axillary Nerve
 Roots: C5-C6
 O: Acromion Process
 I: Deltoid Tuberosity
 Action: Shoulder
Abduction
 Nerve: Axillary Nerve
 Origin: Spine of Scapula
 Insertion: deltoid Tuberosity
 Action: Shoulder abduction,
extension, hyperextension, lateral
rotation, horizontal abduction.
 Nerves: Lateral and medial pectoral
nerves
 Origin: clavicular head (medial ½ of
Clavice) Sternocostal (Sternum, ribs
1-6, aponeurosis of External Oblique)
 Insertion: humerus
 Nerve: Medial pectoral nerves
 Origin: Anterior Superior surface of
ribs 3-5
 Insertion: Coracoid process of
scapula
 Nerve: Thoracodorsal Nerve
 Origin: Spinous processes of
T7-L5, posterior surface of
sacrum, iliac crest, lower 3 ribs
 Insertion: Medial lip of the
intertubercular sulcus of
humerus.
 Nerve: Dorsal scapular and cervical
nerves
 Origin: Transverse processes of C1-
C4
 Insertion: Superior vertebral border
of scapula
 Nerve: Long thoracic nerve
 Origin: Lateral surface of Superior 8
or 9 ribs.
 Insertion: Vertebral border and
inferior angle of scapula
 Nerve: Lower Subscapular nerve
 Origin: Dorsal surface of inferior
angle of scapula
 Insertion: Humerus
 Innervation: musculocataneous nerve
 Origin: coracoid process of scapula
 Insertion: medial humerus
Most Cutaneous nerves of the
shoulder come from the Cervical
Plexus
Nerves and Muscles pg. 415, 417,
418
C5-T1 Most of the cutaneous
nerves of the upper arm come
from the Brachial Plexus
Lateral Cord-musculocutaneous,
suprascapular, lateral pectoral
Posterior Cordsubscapular(upper/lower),
thoracodorsal, axillary
Medial Cord-medial pectoral
C5-dorsal scapular, long thoracic
 Subclavian Artery-left and right arm, head, thorax
 Transverse Cervical Artery-trapezius muscle and
surrounding tissues
 Dorsal Scapular Artery-levator scapulae,
rhomboideus major, rhomboideus minor
 Suprascapular artery-supraspinatous,
sternocleidomastoid, subclavius
 Axillary-lateral aspect of the thorax, axila, upper limb
 Axillary (3 parts, Originates at the 1st rib and
becomes the brachial after passing the lower margin
of the teres major)- lateral aspect of the thorax, axila,
upper limb
 1st part
 superior thoracic
 2nd part
 thoracoacromial
 lateral thoracic-lateral structures of the thorax and
breast
 3rd part
 anterior humeral circumflex
 posterior humeral circumflex-deltoid muscle and
shoulder joint
 subscapular-muscles of shoulder and
scapular region
 circumflex scapular-clavicle, teres major, teres
minor, infraspinatus
 Brachial
 The shoulder joint is under an incredible amount of stress due to the many forces
that act upon it throughout the typical day.
 It is made up of:
•
•
•
•
•
Ligaments
Bursae
Capsule cartilage and membranes
Muscles and bones
Nerves, arteries, and veins
 It is important to remember:
The shoulder joint is one of the two ball-and-socket joints in the body, the other being
the hip.
• The muscles of the rotator cuff (SITS) and the clinical concerns associated.
• The nerves arise from the brachial plexus.
• The arteries arise from the subclavian and axillary
•