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SHOULDER JOINT
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Objectives Shoulder joint - Type Articular surfaces Ligaments Movements & muscles bringing
about the movements Blood supply Nerve supply Structures undercover of deltoid Applied anatomy
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Shoulder joint – Type
Also known as gleno-humeral joint
Type – multi-axial ball & socket type of synovial joint
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Shoulder joint – Articular surfaces Ball – spheroidal
head of humerus, 1/3rd of a sphere, directed medially,
upwards & backwards
Covered by hyaline articular cartilage – thickest in centre & thinner at periphery
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Shoulder joint – Articular surfaces Socket – pear-shaped, small &
shallow glenoid cavity of scapula
Directed upwards, forwards & laterally
hyaline articular cartilage – thin – centre; thick - periphery
Fossa deepened - glenoidal labrum - fibro-cartilaginous, attached to its peripheral margin
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Shoulder joint – Ligaments Fibrous capsule Synovial membrane Glenoid labrum Glenohumeral
ligaments Coraco-humeral
ligament Transverse humeral
ligament
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Ligaments - Fibrous capsule Loose envelope
permitting free movements
Medially – peripheral margin of glenoid cavity outside the labrum, includes origin of long head biceps brachii
Laterally – anatomical neck of humerus
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Ligaments - Fibrous capsule Deficient at two areas At upper end of
intertubercular sulcus - passage - tendon of long head of biceps
Infero-medially – it extends about 1 cm below to enroach on surgical neck of humerus
Supported by expansions - rotator cuff muscles
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Ligaments - Synovial membrane Lines the capsule Reflected along the
intra-capsular part of neck upto the articular cartilage of humeral head.
Synovial sheath extends along the long head of biceps brachii
Ligaments - Glenoid labrum Fibro-cartilaginous rim Attached to peripheral
margin of glenoid cavity except above – long head of biceps brachii
Deepens the glenoid fossa & also forms a pliable cushion for the ball to roll
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Ligaments - Glenohumeral ligaments Three fibrous bands
derived - thickening of the anterior part of fibrous capsule
Can be seen from within the joint
Converge upward & medially to supero-medial margin of glenoid cavity & blends with labrum
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Ligaments - Glenohumeral ligaments Superior band – lies
parallel to anterior edge of biceps tendon & attached to upper end of lesser tubercle of humerus
Middle band – attached ot lower part of lesser tubercle
Inferior band – lower part of anatomical neck of humerus
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Ligaments - Coraco-humeral ligament Thick band in the
upper part of capsule & extends from lateral border of coracoid process to anatomical neck of humerus b/w greater & lesser tubercle
Resists lateral rotation & adduction
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Ligaments - Transverse humeral ligament Connects two
lips of upper part of intertubercular sulcus & acts as retinaculum
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Rotator cuff Musculo-tendinous
cuff Formed -
supraspinatus, infraspinatus, subscapularis & teres minor – tonic contractions keep ball in contact with socket
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Stability Coraco-acromial
arch – secondary socket for head of humerus
Musculo-tendinous cuff
Glenoidal labrum
Relations of joint Above –
supraspinatus, subacromial bursa, coraco-acromial arch
Below – quadrangular space
In front – subscapularis, coracobrachialis & short head of biceps
Behind – infraspinatus, teres minor
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Bursae in relation to joint Subacromial bursa
– b/w supraspinatus & coraco-acromial arch, extends laterally b/w deltoid & greater tubercle; acts as secondary socket
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Bursae in relation to joint Subscapular bursa –
b/w subscapularis tendon & fibrous capsule; communicates with joint cavity - oval gap b/w superior & middle glenohumeral ligaments
Infraspinatus bursa
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Movements Movement Axis Muscles
Flexion Plane parallel to surface of glenoid cavity
Pectoralis major – clavicular head, deltoid – anterior fibres
Extension Deltoid – posterior fibres, latissimus dorsi
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Movements Movement Axis Muscles
Adduction Perpend- icular to plane of flexion & extension
Pectoralis major, teres major, Deltoid – anterior & posterior fibres, latissimus dorsi, coracobrachialis, long head of triceps
Abduction Supraspinatus – 0-150
Deltoid – middle fibres-15-900
Serratus anterior, trapezius – 90 – 1800
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Movements Movement Axis Muscles Medial rotation
Vertical Pectoralis major, teres major, Deltoid – anterior fibres, latissimus dorsi.
Lateral rotation
Deltoid – posterior fibres, infraspinatus, teres minor
Movements Circumduction –
succession of flexion, extension, adduction & abduction movements
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Blood supply Anterior & posterior
circumflex humeral vessels
Supra & subscapular vessels
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Nerve supply
Axillary nerve Musculocutaneous nerve Suprascapular nerve
Structures under cover of deltoid Bones Muscles Vessels & nerves Joints & ligaments Bursa
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Structures under cover of deltoid Bones – coracoid
process; lesser & greater tubercle, intertubercular sulcus, upper part of shaft & surgical neck of humerus
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Structures under cover of deltoid Muscles –
pectoralis major & minor, coracobrachialis, both headsof biceps brachii, latissimus dorsi, long head of triceps, rotator cuff muscles
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Structures under cover of deltoid Vessels & nerves
– anterior & posterior circumflex humeral vessels, axillary nerve
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Structures under cover of deltoid Joints &
ligaments – Shoulder joint & its ligaments; Coraco-acromial ligament
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Structures under cover of deltoid Bursa –
subacromial bursa
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Radiology of shoulder joint
Shoulder joint dislocation
Common due to laxity of ligaments & disproportionate articular surfaces. Inferior dislocation common & nerve damaged is axillary nerve
Shoulder joint inflammation
An inflammation of the shoulder joint can cause pain and restricted joint movement.
Painful arc syndrome
Chronic thickening of tendon of supraspinatus – pain b/w 60 & 120 abduction – impingement of tendon against coraco-acromial arch.
Frozen shoulder/ Adhesive capsulitis Causes
restriction of motion in the shoulder joint.
Causes the capsule surrounding the shoulder joint to contract and form scar tissue.
Bursitis
Arthodesis of shoulder ( surgical fixation) Optimum
position – 450
abduction & 200 flexion
Osteoarthritis
Arthroplasty Osteoarthritis -
joint replacement by metallic prosthesis
Hemiarthroplasty – joint surface of humerus only is replaced
Total arthroplasty – joint surface of humerus & glenoid surface is replaced
Can you? Describe the shoulder joint under the following
headings – Type Articular surfaces Ligaments Movements & muscles bringing about the
movements Applied anatomy Rotator cuff
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To summarize Shoulder joint - Type Articular surfaces Ligaments Movements & muscles bringing about the
movements Blood supply Nerve supply Structures undercover of deltoid Applied anatomy
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