PTA 106 Fall 2008
Shoulder Joint
Candace
Rio
Alicia
Shoulder Joint
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AC (acromialclavicular) ligament: extends from the
acromium to the clavicle
Coracoclavicular ligament: divided into the conoid
and trapezoid ligaments
- conoid: apex attaches to the root of the conoid
process, base attaches to the inferior surface of the
conoid tubercle of the clavicle
- trapezoid: nearly horizontal, attaches to superior
surface of coracoid process, lateral and posterior to
trapezoid line on the inferior surface of the clavicle
Glenohumeral ligaments: part of the fibrous layer
of the capsule
- coracohumeral: base of the coracoid process to
anterior of greater tubercle
- transverse humeral: broad fibrous band from
greater to lesser tubercle, converts the
intertuberclar groove into a canal for the tendon of
the long head of the biceps brachii and its synovial
sheath
Glenohumeral joint: ball and socket joint, more
freedom than any other joint, movement around
three axis, allows flexion-extension, abductionadduction, medial and lateral rotation of the
humerous, and circumduction
Cartilage
• Articular cartilage: caps the
surfaces of articulating
bones to provide a smooth,
low-friction gliding action
allowing for free movement
• Cartilage: avascular and is
nourished by diffusion
Labrum
• Glenoid labrum: ring like,
fibrocartilaginous material
that adds some depth to
the glenoid cavity
• Injuries: Baseball players
are prone to glenoid labrum
tears due to the biceps
tendon pulling sharply on
the top part of the labrum,
golfers who allow their
clubs to hit the ground
during a swing are also at
risk.
Bursae
• Subacromial (subdeltoid)bursa:
facilitates movement of the
supraspinatus tendon
• Subscapular bursa:
communicates with the cavity of
the glenohumeral joint through
an opening in the fibrous layer of
the joint capsule
Bursae Continued
Subcoracoid Bursa
Articular Capsules
• Articular capsule: fiborous capsule lined with a synovial membrane,
two articulating bones are joined by the capsule, the outer layer of
the capsule is the fibrous layer and the inner layer is the synovial
membrane, the joint cavity created, holds the synovial fluid, these
synovial joints are functionally the most important and common
joints throughout the body
• Fibrous layer: surrounds the glenohumeral joint, attaches medially
to the margin of glenohmeral cavity and laterally to the anatomical
neck of the humerous, superiorly- encloses the proximal
attachment of the long head of the biceps brachii to the
supraglenoid tubercle of the scapula
• Synovial membrane: lining of the interior surface of the fibrous
capsule, it reflects onto glenoid labrum and the articular margin of
the head of the humerous, forms a tubular sheath for the biceps
brachii (longhead), anteriorly- allows for communication between
the subscapular bursa and the synovial cavity
Bones of the Shoulder
Shoulder Joint
Bones
• Humerus
• Scapula
• Clavicle
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Primary Functions
Support
Protection
Assist in Movement
Blood Cell Production
Storage of Minerals
Storage of Chemical Energy
Humerus
Scapula
Features
• Acromion Process
• Borders
– Superior
– Vertebral (medial)
– Axillary (lateral)
• Angles
– Superior
– Inferior
• Fossae
– Sub scapular
– Supraspinatous
– Infraspinatous
• Spine
• Gleniod Fossa (cavity)
Clavicle
• Conoid Tubercle
• Acromial End
– Articulates with the
Acromian Process of the
Scapula
Surface Anatomy
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Anterior Axillary Fold
Clavicle
Acromial Part of Deltoid
Claviclular part of Deltoid
Clavipectoral Triangle
Clavicular Head of Pec
Major
• Manubrium
• Sternocostal Head of Pec
Major
Surface Anatomy
• Posterior Axillary Fold
• Spinal Part of Deltoid
• Triangle of Auscultation
– Borders
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Trapezius
Rhomboid Major
Latissimus Dorsi
Medial Margin of Scapula
Surface Anatomy
• Ascending Part of
Trapezius
• Middle part of Trapezius
• Descending Part of
Trapezius
Muscles
(origins, insertions, innervations and vascular
supplies)
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Upper Trapezius
– :O Occipital bone, nuchial ligament
– I: Outer third of clavical, acromion
process
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Middle Trapezius
– O: Spinous Process of C7-T3
– I: Scapular Spine
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Lower Trapezius
– O: Spinous processes of Middle and
Lower Thoracic
– I: Base of Scapular Spine
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Innervation: Spinal Accessory
Vascular: Transverse Cervical Artery
• Levator Scapulae
– O:Transverse of C1-C4
– I: Vertebral border of scapula
• Innervation: CN 3&4
• Vascular: Dorsal Scapular Artery
• Pectoralis Minor
– O: Ant. Surface of 3-5 Ribs
– I: Corocoid process of scapula
• Innervation: medial pectoral nerve
• Vascular: axillary nerve
• Serratus Anterior
– O: Lateral surface of ribs 1-8
– I: Vertebral border of scapula
• Innervation: long thoracic nerve
• Vascular: lateral thoracic artery
• Rhomboid Major
– O: spinous process of T2T5
– I: Vertebral border of
scapula
• Rhomboid Minor
– O: spinous process of C7T1
– I: Vertebral border of
scapula
• Innervation: dorsal scapular
nerve
• Vascular: Dorsal Scapular Artery
• Anterior Deltoid
– O:Lateral third of clavicle
• Middle Deltoid
– O: Acromion Process
• Posterior Deltoid
– O: Spine of Scapula
– I: Deltoid Tuberosity
• Innervation:. Axillary Nerve
• Vascular: Posterior
circumflex artery
• Pectoralis Major
– O: Medial third of clavicle,
sternum, cartilage of 1-6 ribs
– I: Lateral lip of bicipital
groove.
• Innervation: lateral and medial
pectoral nerve
• Vascular: lateral thoracic
artery
• Teres Major
– O: Axillary border of scapula
– I: Crest below lesser tubercle
of humerus
• Innervation: subscapular nerve
• Vascular: circumflex scapular
artery
• Latissimus Dorsi
– O: Spinous process of T7-L5,
Posterior surface of sacrum,
Iliac Crest, lower three ribs.
– I: Medial lip of bicipital
groove
• Innervation: thoracodorsal
nerve
• Vascular: Deep scapular artery
• Coracobrachialis
– O: corocoid process
– I: Medial aspect of humerus
• Innervation: C6&C7 nerves
• Vascular: Brachial Artery
• Teres Minor
Rotator Cuff
– O: Axillary border of scapula
– I: Greater tubercle of humerus
• Innervation: axillary nerve
• Vascula: circumflex scapular artery
• Supraspinatus
– O: Supraspinatus fossa of scapula
– I: Greater Tubercle of humerus
• Infraspinatus
– O: Infraspinatus fossa of scapula
– I: Greater Tubercle of humerus
• Innervation: Suprascapular nerve
• Vascular: Suprascapular artery
• Subscapularis
– O: Subscapular fossa of scapula
– I: Lesser Tubercle of humerus
• Innervation: Subscapular nerve
• Vascular: Subscapular artery
Rotator Cuff Injury
• What is it?
Rotator cuff injury can be as simple as an inflammation of the muscle,
(tendonitis) to a complete or partial tear of the muscle that may lead to
surgery to correct.
• Causes
Chronic Tear: sports, jobs that require excessive overhead activity i.e.
pitchers, painters (occurs more often in dominant arm)
Acute Tear: sudden powerful raising of arm against resistance (often in
attempt to cushion a fall) significant amount of force needed.
Tendinitis: degeneration of muscle with age. Repetitive trauma to muscle
by everyday movement of shoulder. (May lead to chronic tear.)
Testing for Rotator Cuff Injury
Inpingement Injection Test: Doctor raises arm of pt forward to see if it
causes pain. If it does lodocaine (a numbing agent) is injected into muscle
and test is preformed again. If there is no pain pt is said to have tendinitis
or a small tear in the rotator cuff.
Drop Arm Test: Doctor raises arm at a 90 degree angle and has pt hold it in
that position. Dr. applies slight pressure to forarm and wrist that may cause
pt to drop wrist suddenly. This is a sign of a significant tear.
Treatment
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rest shoulder
Ice first 2 days then heat
Ibprofen-naproxen
Possible steriod injection
Sling
Possible surgery
PROM excercises
Follow up:
• work with PT.
• Orthopedic surgeon can evaluate further
need for surgery.
Prevention:
• avoid landing on shoulder in
sports or falls… Easier said than
done.
• Seek early medical attention if
shoulder pain develops because of
over use.
AND IF YOU DON’T KNOW
NOW YOU KNOW