1. PTA 106 Fall 2008 Shoulder Joint
Candace Rio Alicia

2. Shoulder Joint
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, abduction-adduction, medial and lateral rotation of the humerous, and circumduction

3. 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

4. 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.

5. 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

6. Bursae Continued
Subcoracoid Bursa

7. 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

8. Bones of the Shoulder

9. Shoulder Joint Bones Primary Functions Humerus Scapula Clavicle
Support
Protection
Assist in Movement
Blood Cell Production
Storage of Minerals
Storage of Chemical Energy

10. Humerus

11. Scapula Features Acromion Process Borders Angles Fossae Spine
Superior
Vertebral (medial)
Axillary (lateral)
Angles
Inferior
Fossae
Sub scapular
Supraspinatous
Infraspinatous
Spine
Gleniod Fossa (cavity)

12. Clavicle Acromial End Conoid Tubercle
Articulates with the Acromian Process of the Scapula

13. Surface Anatomy 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

14. Surface Anatomy Posterior Axillary Fold Spinal Part of Deltoid
Triangle of Auscultation
Borders
Trapezius
Rhomboid Major
Latissimus Dorsi
Medial Margin of Scapula

15. Surface Anatomy Ascending Part of Trapezius Middle part of Trapezius
Descending Part of Trapezius

16. Muscles (origins, insertions, innervations and vascular supplies)
Upper Trapezius
:O Occipital bone, nuchial ligament
I: Outer third of clavical, acromion process
Middle Trapezius
O: Spinous Process of C7-T3
I: Scapular Spine
Lower Trapezius
O: Spinous processes of Middle and Lower Thoracic
I: Base of Scapular Spine
Innervation: Spinal Accessory
Vascular: Transverse Cervical Artery

17. Levator Scapulae Pectoralis Minor Serratus Anterior
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
Innervation: long thoracic nerve
Vascular: lateral thoracic artery

18. Innervation: dorsal scapular nerve Vascular: Dorsal Scapular Artery
Rhomboid Major
O: spinous process of T2-T5
I: Vertebral border of scapula
Rhomboid Minor
O: spinous process of C7-T1
Innervation: dorsal scapular nerve
Vascular: Dorsal Scapular Artery

19. Innervation:. Axillary Nerve Vascular: Posterior circumflex 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

20. Pectoralis Major Teres 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

21. Latissimus Dorsi Coracobrachialis
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

22. Rotator Cuff Teres Minor Supraspinatus Infraspinatus Subscapularis
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
Innervation: Suprascapular nerve
Vascular: Suprascapular artery
Subscapularis
O: Subscapular fossa of scapula
I: Lesser Tubercle of humerus
Innervation: Subscapular nerve
Vascular: Subscapular artery

23. Rotator Cuff Injury What is it? Causes
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.)

24. 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
rest shoulder
Ice first 2 days then heat
Ibprofen-naproxen
Possible steriod injection
Sling
Possible surgery
PROM excercises

25. avoid landing on shoulder in sports or falls… Easier said than done.
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.

26. AND IF YOU DON’T KNOW
NOW YOU KNOW