Download GLENOHUMERAL JOINT (SHOULDER JOINT)

GLENOHUMERAL JOINT
(SHOULDER JOINT)
Daniel Harris
Amanda House
Rebecca Miller
Ginny Rinaldi
Ligaments
What is a ligament?
• A ligament most commonly refers to a band of tough, fibrous dense
regular connective tissue that connects bones to other bones (not bones
to muscles) to form a joint. Some ligaments limit the mobility of
articulations, or prevent certain movements altogether.
• Ligaments gradually lengthen when under tension, and return to their
original shape when the tension is removed
• The consequence of a broken/overstretched ligament can be instability of
the joint. Over time instability of a joint can lead to wear of the cartilage
which can eventually lead to osteoarthritis.
Acromioclavicular Ligament
 The acromioclavicular ligament is at the top of the shoulder; it is part of
the acromioclavicular joint, which lies between the acromion process and
clavicle. The acromioclavicular ligament is divided into superior and
inferior parts.
 This ligament provides horizontal stability to the Acromioclavicular joint.
CORACOCLAVICULAR LIGAMENT
• The coracoclavicular ligament is the combination of the conoid ligament,
and the trapezoid ligament. Together these ligaments provide stabilization
for the acromioclavicular joint. They are attached between the coracoid
process of the scapula and the underside of the clavicle.
SUPERIOR TRANSVERSE SCAPULAR
LIGAMENT
 The superior transverse scapular ligament creates a small foramen from
the scapular notch. This ligament is attached by one end to the base of
the coracoid process, and by the other to the medial end of the scapular
notch.
 The ligament will sometimes ossify.
CORACOHUMERAL LIGAMENT
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The coracohumeral ligament- a broad ligament which strengthens the upper part
of the capsule of the shoulder joint.
It arises from the lateral border of the coracoid process, and passes diagonally
downward and laterally to the front of the greater tubercle of the humerus.
Flexion, Extension
TRANSVERSE HUMERAL LIGAMENT
 The transverse ligament of the humerus consists of a narrow sheet of
connective tissue fibers that runs between the lesser and the greater
tubercles of the humerus.Together with the intertubercular groove of the
humerus, the ligament creates a canal through which the long head of
the biceps brachi muscle passes.
GLENOHUMERAL LIGAMENTS
 Three ligaments (seen in blue) on the anterior side of the glenohumeral
joint. Together these ligaments reinforce the anterior glenohumeral joint
capsule.
 The superior, middle, and inferior glenohumeral ligaments play different
roles in the stability of the head of the humerus depending on arm
position and degree of rotation.
 Abduction, Adduction,
External/Internal rotation
BURSAE
WHAT DO BURSAE DO?
• Bursae are flattened sacs made of synovial membrane that are filled with
synovial fluid. These sacs function as cushions between your bones and
the muscles (deep bursae) or bones and tendons (superficial bursae)
• Bursae reduce friction and allow your soft tissue to slide over bone easily
during muscle contraction.
• The synovial fluid found in bursae comes form synovial cells and are rich in
protein and collagen. This acts as the lubricant between areas in your
body where friction is greatest.
SUBDELTOID & SUBACROMIAL BURSAE
 Subdeltoid bursa- Located between the deltoid muscle and the shoulder
joint cavity and is usually joined to the subacromial bursa.
 Subacromial bursa- Situated below the acromion process and above the
greater tubercle of the humerus lessening the friction when you move
your arm or raise it overhead.
SUBSCAPULAR & SUBCORACOID
BURSAE
 Subscapular bursa- Located between the joint capsule and the tendon of
the subscapularis muscle. The subscapular bursa usually is continuous
with the synovial cavity of the joint cavity.
 Subcoracoid bursa- sits between the coracoid process of the scapula and
the shoulder joint capsule.
The grey arrow shows subcoracoid bursa
BURSITIS
 When pressure or friction is too great, excess fluid can build up in the
bursa sac causing swelling and inflammation. When a bursa becomes
inflamed, moving the shoulder becomes very painful and movement can
be difficult. Any actions that put pressure on the inflamed bursa can
increase irritation and cause further inflammation and pain.
 If the space becomes too crowded around the subacromial bursa, the
acromion can begin to pinch the bursa or tendon causing an impingement
(more commonly known as tennis shoulder) when your arm is raised in a
forward reaching or overhead position.
CARTILAGE
• Cartilage serves several functions, including providing a framework upon
which bone deposition can begin and also supplying smooth surfaces for
the movement of articulating bones. Cartilage is found in many places in
the body and is classified as either "hyaline," "elastic," or "fibrous"
cartilage.
• Cartilage is distinctive in that it has only one cell type, is avascular (lacks
blood vessels), aneural (no neurons and nerves), and alymphatic (no
lymphatic system).
GLENOID LABRIUM
• A fibrocartilaginous rim attached around the margin of the glenoid cavity
in the shoulder blade. The glenoid fossa (the socket) of the scapula.
Without the glenoid labrium only only one third of the head of the
humerous would be covered (the ball) Therefore the socket is deepened
by the glenoidal labrum.
ARTICULAR CARTILAGE
 The term "articular cartilage" refers to the hyaline cartilage on the
articular surfaces of bones.
 Hyaline cartilage (aka “Gristle") is a type of cartilage found on many joint
surfaces. It is pearly bluish in color with firm consistency and considerable
collagen.
ARTICULAR CAPSULE
• An articular capsule (or joint capsule) is an envelope surrounding a
synovial joint. Each capsule consists of two layers: A fibrous layer and a
synovail membrane.
• On the inside of the capsule, articular cartilage covers the end surfaces of
the bones that articulate within that joint.
• The outer layer is highly innervated by the same nerves which go through
through the adjacent muscles associated with the joint.
FIBROUS LAYER
• An outer layer (fibrous strarum) of the articular capsule composed of
avascular white fibrous tissue.
SYNOVIAL MEMBRANE
• An inner layer (synovial stratum) of the articular capsule which is a
secreting layer, and is usually described separately as the synovial
membrane.
Upper Trapezius
Origin
Occipital Bone,
Nucal Ligament
Insertion
Outer Third of
Clavicle, Acromion
Process
Action
Scapular Elevation
and Upward
Rotation
Middle Trapezius
Origin
Spinous Processes
of C7-T3
Insertion
Scapular Spine
Action
Scapular Retraction
Lower Trapezius
Origin
Insertion
Action
Spinous Processes of
Middle and Lower
Thoracic Vertebrae
Base of the Scapular
Spine
Scapular Depression
and Upward
Rotation
Levator Scapulae
Origin
Transverse Processes
of C1-C4
Insertion
Vertebral Border of
Scapula Between
the Superior Angle
and Spine
Action
Scapular Elevation
and Downward
Rotation
Pectoralis Minor
Origin:
Anterior Surface 3rd-5th
Ribs
Insertion:
Coracoid Process of
Scapula
Action:
With ribs fixed: draws
the scapula forward
(abducts) and rotates
scapula downward
against the thoracic wall.
With scapula fixed:
elevated the rib cage.
Serratus Anterior
Origin
Superior 8 Ribs
Laterally
Insertion
Vertebral Border of
Scapula, Anterior
Surface
Action
Scapular
Protraction and
Upward Rotation
Rhomboideus
Major
Origin
Spinous Processes
of T2 through T5
Insertion
Vertebral Border of
Scapula between
the Spine and
Inferior Angle
Action
Scapular retraction
and Downward
Rotation
Rhomboideus
Minor
Origin
Spinous Processes
of C7 through T1
Insertion
Vertebral Border of
Scapula at the
Spine Process
Action
Scapular Retraction
and Downward
Rotation
Anterior Deltiod
Origin
Lateral Third
of Clavicle
Insertion
Deltoid
Tuberosity
Action
Shoulder
Flexion,
Medial
Rotation,
Horizontal
Adduction
Middle Deltoid
Origin
Acromion
Process
Insertion
Deltoid
Tuberosity
Action
Shoulder
Abduction
Posterior Deltoid
Origin
Scapular Spine
Insertion
Deltoid
Tuberosity
Action
Shoulder
Extension,
Hyperextensio
n, lateral
Rotation,
Horizontal
Abduction
Pectoralis Major
Origin
Insertion
Action
Medial Third
of Clavicle,
Sternum,
Costal
Cartilage of
First Six Ribs
Lateral Lip of
Bicipital
Groove of
Humerus
Shoulder
Adduction,
Medial
Rotation,
Horizontal
Adduction
Latissimus Dorsi
Origin
Spinous Processes
of T7 through L5
(via dorsolumbar
fascia), Posterior
Surface of
Sacrum, Iliac
Crest, and Lower
Three ribs
Insertion
Medial Lip of
Bicipital Groove
of Humerus
Action
Shoulder
Extension,
Adduction,
Medial Rotation,
Hyperextension
Teres Major
Origin
Insertion
Action
Axillary
Border of
Scapula near
the Inferior
Angle
Crest Below
Lesser
Tubercle
Next to the
Latissimus
Dorsi Muscle
Attachment
Shoulder
Extension,
Adduction,
Medial
Rotation
Teres Minor
Origin
Axillary
Border of
Scapula
Insertion
Greater
Tubercle of
Humerus
Action
Shoulder
Lateral
Rotation,
horizontal
abduction
Supraspinatous
Origin
Insertion
Action
Supraspinous
Fossa of the
Scapula
Greater
Tubercle of the
Humerus
Shoulder
Abduction
Infraspinatous
Origin
Infraspinous
Fossa of
Scapula
Insertion
Greater
Tubercle of
Humerus
Action
Shoulder
Lateral
Rotation,
Horizontal
Abduction
Subscapulais
Origin
Insertion
Action
Subscapular
Fossa of the
Scapula
Lesser
Tubercle of
the
Humerus
Shoulder
Medial
Rotation
Coracobrachialis
Origin
Coracoid
Process
Insertion
Medial
Aspect of
Humerus
Action
Weakly
Adducts
Shoulder
Joint
Rotator Cuff Muscles
S.I.T.S
• Supraspinatus
• Infraspinatus
 Teres Minor
• Subscapularis
Clinical Concerns
R.O.M
Normal Range of motion for the shoulder:
Abduction
Adduction
Extension
Flexion
Internal rotation
External rotation
180⁰
45⁰
45⁰
90⁰
55⁰
40-45⁰
Rotator Cuff Injuries:
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Rotator Cuff Conditions
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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 a nearby bone called 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).
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Treatments
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Pain medicines: Nonsteroidal anti-inflammatory drugs (NSAIDs),
acetaminophen, or other medicines can be used to relieve the pain of
rotator cuff injuries.
Corticosteroid injections: Cortisone or another anti-inflammatory
steroid medicine is injected into the shoulder. The reduction in
inflammation helps relieve pain.
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: Similar to physical therapy, occupational
therapy for rotator cuff injuries 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). The
torn rotator cuff tendon is reattached to the bone.
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.
VEINS OF THE SHOULDER JOINT
• CEPHALIC:
The cephalic vein runs up the lateral side of the arm from the hand to the
shoulder. In the shoulder, it pierces the tissues and empties into the
axillary vein. After the cephalic vein joins the axillary vein, it becomes the
subclavian vein and empties into the superior vena cava.
• BASILIC:
The basilic vein passes along the back of the forearm on the ulnar side for a
distance and then curves to the surface below the elbow. It continues to
move up the medial side until it reaches the middle of the upper arm.
There, it enters deep into the tissues and joins the brachial vein. As the
basilic and brachial veins merge, they form the axillary vein.
• AXILLARY:
The axillary vein is formed where the basilic and brachial veins come together,
in the deep tissue of the upper arm.
VEINS
ARTERIES OF THE SHOULDER JOINT
ARTERY
MUSCLE
Subclavian
Transverse Cervical
Trapezius: Upper, Middle, Lower
Lateral Thoracic
Pectoral Major, Serratus Anterior
Deep Scapular
Lattisimus Dorsi.
Rhomboideus: Major and Minor
Suprascapular
Supraspinatus, Infraspinatus
Brachial
Coracobrachialis
Axillary
Pectoralis Minor
Dorsal Scapular
Levator Scapulae
Posterior Circumflex
Deltoid: Anterior, Middle and Posterior
Circumflex Scapular
Teres Major. Teres Minor
Subscapular
Subscapularis
ARTERIES
Muscles Nerve Supply
ARTERY
MUSCLE
Subclavian
Transverse Cervical
Upper, Middle, Lower Trapezius,
Lateral Thoracic
Serratus Anterior, Pectoralis Major
Deep Scapular
Lattisimus Dorsi
Suprascapular
Supraspinatus, Infraspinatus,
Brachial
Coracobrachialis
Axillary
Pectoralis Minor
Dorsal Scapular
Levator Scapulae, Major and Minor
Rhomboideus
Posterior Circumflex
Anterior, Middle, and Posterior Deltoids
Circumflex Scapular
Teres Minor and Major
Subscapular
Subscapularis
NERVES
SHOULDER JOINT NERVES: CERVICAL PLEXUS
NERVE
ORIGIN
STRUCTURE INNERVATED
Cervical Nerves
C3, C4
Levator Scapulae
SHOULDER JOINT NERVES: SPINAL ACCESSORY NERVE
NERVE
ORIGIN
STRUCTURE INNERVATED
Spinal Accessory
Cranial Nerve XI
Upper, Middle, and Lower Trapezius,
Cervical Plexus and
Spinal Accessory Nerve
SHOULDER JOINT NERVES: BRACHIAL PLEXUS
• The Brachial Nerve Plexus is made up of roots,
trunks, divisions and cords, formed by
combining the lower 4 cervical nerves (C5 –
C8) and the first thoracic nerve (T1). The
Brachial Plexus is responsible for the
innervation of the muscles of the upper
extremity (except the Levator Scapula and
trapezius)
BRACHIAL PLEXUS (C5 – T1)
CADAVER of Brachial Plexus
Brachial Plexus: With Muscle and Skin
Brachial Plexus
NERVE
ORIGIN
MUSCLE INNERVATED
Dorsal Scapula
C5, C4
Rhomboids, levator Scapulae
Long Thoracic
C5, C6, C7
Serratus Anterior
Superior Trunk
Suprascapular
C4,C5,C6,
Lateral Cord
Lateral Pectoral
C5, C6, C7
Medial cord
Medial Pectoral
C8, T1
Posterior Cord
Axillary
C5, C6
Lateral Cord
Musculocutaneous C5 - C7
Posterior Cord
Thoracodorsal
C6, C7, C8
Posterior Cord
Subscapular
C5, C6
Supraspinatus and infraspinatus, shoulder joint
Pectoralis major and minor
Pectoralis minor and sternocostal of pectoralis
major
Glenohumeral Joint, teres minor, deltoid muscles,
(sensory) skin of superolateral arm
Coracobrachialias, biceps brachi, brachialias,
(Sensory) skin of lateral forearm
Lattissimus dorsi
Subscapularis, Teres Major
Surface anatomy
Surface anatomy cont.
• TIPS ACCEPTED
• PLEASE APPLAUD
• ANY QUESTIONS?
• THE END