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Anatomy of Shoulder Part 2

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1 Anatomy of Shoulder Part 2

2 Ligaments Sternoclavicular Joint Ligaments
Extremely weak because of boney arrangement Anterior sternoclavicular Prevents upward displacement of clavicle Posterior sternoclavicular Interclavicular Prevents lateral displacement of clavicle Costoclavicular Prevents lateral and upward displacement of clavicle

3 Ligaments Consists of Anterior, posterior, superior, and inferior portions Coracoclavicular ligaments joins the coracoid process and clavicle helps maintain the position of the clavicle relative to the acromion Coracoclavicular Divided into Coniod and trapezoid ligaments Coracoacromial ligament Connects the coracoid to the acromion

4 Ligaments Glenohumeral Joint Ligaments
Superior Ligament Middle Ligament Inferior Ligament Produce major restraint in shoulder flexion, extension and rotation

5 Ligaments Glenohumeral Joint Ligaments Anterior Posterior Middle
Tense in extension, abduction or external rotation Posterior Tension is in extension with external rotation Middle Tension in flexion and external rotation Inferior Tense in abduction, extended or externally rotated

6 Ligaments Glenohumeral Ligaments Inferior GH Ligament
Primarily a check against both anterior and posterior dislocation of humeral head Transverse ligament Retains the long biceps tendon within the bicipital groove

7 Muscles Dynamic motion
Establish stability to compensate for a great deal of mobility Flexion, extension, abduction, adduction, horizontal adduction/abduction, internal/external rotation and circumduction

8 Muscles 1st group 2nd group Rotator cuff muscles
Originate on axial skeleton Attach to humerus Latissiumus dorsi Pectoralis major 2nd group Originates on scapula Deltoid Teres major coracobrachialis Rotator cuff muscles Subscapularis, supraspinatus, infraspinatus and teres minor Tendons adhere to the articular capsule and serve as reinforcing structures Biceps and triceps Attach on the glenoid and effect elbow motion

9 Muscles Scapular Muscles 3rd group
Levator scapulae Trapezius Rhomboids Serratus anterior Important in providing dynamic stability to the shoulder complex

10 Bursae Most important Subacromial Bursa Subacromial bursa
Between coracoacromial arch and glenohumeral capsule Reinforced by the supraspinatus tendon Subacromial bursa Easily subjected to trauma in overhead position Compressed under coracoacromial arch

11 Nerve Supply Spinal nerve roots Innervate muscles of upper extremity
5th cervical vertebra through 1st Thoracic vertebra Create the brachial plexus Innervate muscles of upper extremity Axillary (C5-C6) Musculocutaneous (C5-C7) Subscapular (C5-C6) Suprascapular (C5-C6) Dorsal scapular (C5) Pectoral (C5-T1) Radial (C5-T1)

12 Functional Anatomy Rotator Cuff Muscles Supraspinatus
Subscapularis, infraspinaturs, supraspinatus and teres minor (along with long head of biceps) Provide dynamic stability Control position Prevent excessive displacement of the humeral head Supraspinatus Compresses humeral head Infraspinatus, teres minor and subscapularis Depress the humeral head during overhead movements

13 Functional Anatomy Glenohumeral joint capsule
As muscle contracts they dynamically tighten the joint capsule Which helps center the humeral head to the glenoid Dynamic movement and stabilization of shoulder Also needs scapulothoracic, acromioclavicular and sternocalvicular joint to move as well

14 Functional Anatomy Muscles that produce movement of the scapula on the thorax help maintain the position of the glenoid relative to the moving humerus Levator scapula and upper trapezius (elevate scapula) Middle trapezius and rhomboids (adduct scapula) Lower trapezius (adducts and depresses scapula) Serratus anterior (abducts and upwardly rotates the scapula)

15 Scapulohumeral Rhythm
Describes the movement of the scapula relative to the movement of the humerus throughout a full range of abduction Humerus elevates to 30 degrees: no movement of scapula Setting phase 30 to 90 degrees: scapula abducts and upwardly rotates 90 degrees to full abduction: scapula abducts and upwardly rotates 1 degree for each 1 degree of humeral elevation Clavicular movement must occur at both the SC and AC joints Clavicle must elevate 40 degrees and rotate in a poster superior direction at least 10 degrees


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