Examination Of Shoulder Joint (Range Of Movements)

There are three types of joints in the shoulder complex. Sterno clavicular articulation Acromioclavicular Articulation Humeral Articulation

Sterno-clavicular articulation Articulatio Sternoclavicularis

Double arthrodial joint The parts entering into its formation are sternal end of clavicle upper and lateral part of the manubrium sterni cartilage of first rib

Ligaments The Interclavicular The Anterior Sternoclavicular The Articular Capsule The Costoclavicular The Posterior Sternoclavicular The Articular Disk

Articular Capsule (capsula articularis) Surrounds the Thick in front and behind Forms the anterior and posterior sternoclavicular ligaments Thin above and below, (more of the character of areolar than of true fibrous tissue)

Anterior Sternoclavicular Ligament (ligamentum sternoclaviculare anterior) Attached to antero-superior part of the sternal end of clavicle antero-superior part of manubrium sterni

Posterior Sternoclavicular Ligament (ligamentum sternoclaviculare posterius) Attached to postero-superior part of the sternal end of clavicle postero-superior part of the manubrium sterni

The Interclavicular Ligament (ligamentum interclaviculare) Passes in a curved direction from the superior part of the sternal end of one clavicle to that of the other Also attached to the upper margin of the sternum

Costoclavicular Ligament (ligamentum costoclaviculare) Rhomboid in form Attached to superio-medial part of cartilage of first rib costal tuberosity on under surface of the clavicle

Articular Disk (discus articularis) Flat and nearly circular Attached to postero-superior border of articular surface of clavicle cartilage of the first rib, near junction with the sternum interclavicular and anterior & posterior sternoclavicular ligaments It divides the joint into two cavities, each of which is furnished with a synovial membrane

Synovial Membranes Lateral is reflected from the sternal end of the clavicle, over the adjacent surface of the articular disk, and around the margin of the facet on the cartilage of the first rib Medial is attached to the margin of the articular surface of the sternum and clothes the adjacent surface of the articular disk

Movements Limited amount of motion in nearly every direction—upward, downward, backward, forward, as well as circumduction When these movements take place in the joint, the clavicle in its motion carries the scapula with it, this bone gliding on the outer surface of the chest Forms the center from which all movements of the supporting arch of the shoulder originate Only point of articulation of the shoulder girdle with the trunk

Acromioclavicular Articulation (Articulatio Acromioclavicularis)

Arthrodial joint Between the acromial end of the clavicle and the medial margin of the acromion of the scapula.

Ligaments The Articular Capsule The Articular Disk The Superior Acromioclavicular The Coracoclavicular {Trapezoid and Conoid) The Inferior Acromioclavicular  

Articular Capsule (capsula articularis) Completely surrounds the articular margins Strengthened above and below by the superior and inferior acromioclavicular ligaments

Superior Acromioclavicular Ligament (ligamentum acromioclaviculare) Extending between the upper part of the acromial end of the clavicle and the adjoining part of the upper surface of the acromion

Inferior Acromioclavicular Ligament Attached to the adjoining surfaces of the two bones

Articular Disk (discus articularis) Frequently absent in this articulation When present, it generally only partially separates the articular surfaces Occupies the upper part of the articulation

The Synovial Membrane Usually only one synovial membrane in this articulation, but when a complete articular disk is present, there are two

Coracoclavicular Ligament (ligamentum coracoclaviculare) Connects the clavicle with the coracoid process of the scapula

Trapezoid Ligament (ligamentum trapezoideum) The anterior and lateral fasciculus Between upper surface of coracoid process and oblique ridge on the under surface of clavicle Anterior border is free Posterior border is joined with the conoid ligament

Conoid Ligament (ligamentum conoideum) Posterior and medial fasciculus Attached by its apex to the base of the coracoid process, medial to the trapezoid ligament and by its expanded base, to the coracoid tuberosity on the under surface of the clavicle

Movements (1) a gliding motion of the articular end of the clavicle on the acromion (2) rotation of the scapula forward and backward upon the clavicle

Ligaments of the Scapula Coracoacromial Superior and Inferior Transverse

Coracoacromial Ligament (ligamentum coracoaromiale) Attached, by its apex, to the summit of the acromion just in front of the articular surface for the clavicle and by its broad base to the whole length of the lateral border of the coracoid process forms a vault for the protection of the head of the humerus.

Superior Transverse Ligament (ligamentum transversum scapulæ superius) Converts the scapular notch into a foramen Attached by one end to the base of the coracoid process, and by the other to the medial end of the scapular notch Suprascapular nerve runs through the foramen; the transverse scapular vessels cross over the ligament

Inferior Transverse Ligament (ligamentum transversum scapulæ inferius) Stretching from the lateral border of the spine to the margin of the glenoid cavity Forms an arch under which the transverse scapular vessels and suprascapular nerve enter the infraspinatous fossa

GLENOHumeral Articulation (Articulatio Humeri)

Enarthrodial or ball-and-socket joint The joint is protected above by an arch, formed by the coracoid process, the acromion, and the coracoacromial ligament

Ligaments The Articular Capsule The Glenohumeral The Coracohumeral The Transverse Humeral The Glenoidal Labrum

Articular Capsule (capsula articularis) Completely encircles the joint Attached to the circumference of the glenoid cavity beyond the glenoidal labrum & to the anatomical neck of the humerus Strengthened above, by the Supraspinatus below, by the long head of the Triceps brachii behind, by the tendons of the Infraspinatus and Teres minor In front, by the tendon of the Subscapularis. Three openings in the capsule Anteriorly, below the coracoid process Posteriorly, between the joint and bursal sac Between the tubercles of the humerus

Coracohumeral Ligament (ligamentum coracohumerale) Arises from the lateral border of the coracoid process, and passes to the front of the greater tubercle of the humerus, blending with the tendon of the Supraspinatus Intimately united to the capsule by its posterior and lower border Anterior and upper border presents a free edge, which overlaps the capsule

Glenohumeral Ligaments From medial edge of the glenoid cavity to the lower part of the lesser tubercle From under edge of the glenoid cavity to the under part of the anatomical neck From apex of the glenoid cavity to just above the lesser tubercle of the humerus

Transverse Humeral Ligament From the lesser to the greater tubercle of the humerus Converts the intertubercular groove into a canal

Glenoidal Labrum (labrium glenoidale) Fibrocartilaginous rim attached around the margin of the glenoid cavity Triangular on section Base fixed to the circumference of the cavity Free edge is thin and sharp Continuous above with the tendon of the long head of the Biceps brachii

Synovial Membrane Reflected from the margin of the glenoid cavity over the labrum Reflected over the inner surface of the capsule, and covers the lower part and sides of the anatomical neck of the humerus as far as the articular cartilage on the head of the bone

Bursæ Between the tendon of the Subscapularis muscle and the capsule Between the tendon of the Infraspinatus and the capsule Between the under surface of the Deltoideus and the capsule On the summit of the acromion Between the coracoid process and the capsule Beneath the Coracobrachialis Between the Teres major and the long head of the Triceps brachii In front of, and another behind, the tendon of the Latissimus dorsi

Arterial supply Nerve supply Articular branches of the anterior and posterior humeral circumflex Transverse scapular Derived from the axillary and suprascapular

Movements The shoulder-joint is capable of every variety of movement, flexion, extension, abduction, adduction, circumduction, and rotation

THANK YOU  THAKSITHAN . S of VL