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Shoulderjoint 2

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6 views32 pages

Shoulderjoint 2

Uploaded by

mirudhulhamirudhu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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SHOULDER JOINT

OR
GLENOHUMERAL JOINT
• TYPE
• ARTICULATION
• CAPSULE
• LIGAMENTS
• SYNOVIAL MEMBRANE
• BURSAE
• RELATIONS
• MOVEMENTS AND MUSCLES
PRODUCING
• BLOOD SUPPLY AND NERVE SUPPLY
• APPLIED ANATOMY
TYPE: Polyaxial, Ball & Socket type
of Synovial joint
ARTICULAR ENDS
PROXIMAL:

• The Glenoid fossa of the scapula. It is lined by

hyaline articular cartilage. Socket depth is

increased by glenoidal labrum.


DISTAL:
– The Head of Humerus.
– Lined by hyaline articular cartilage.
– The head of the humerus is 3 times bigger
than the glenoid fossa.As a result there is
more mobility at the cost of stability.
LIGAMENTS
• Stability of a joint is maintained by the
ligaments holding the articulating
parts together.

1. Fibrous capsule
2. Glenohumeral ligaments
3. Transverse humeral ligament
4. Coracohumeral ligament
5. Coracoacromial arch - Secondary
socket (or) ligament
FIBROUS CAPSULE
• Outer most covering of the joint.
• It is very loose all around the joint to
allow free movements.
• Attachments
• PROXIMAL: Attached to the margins
of glenoid fossa proximal to Glenoidal
labrum.
• Encloses origin of long head of Biceps.
• DISTAL: Anatomical neck of humerus,
except inferiorly where the capsular
attachment extends 1.25cms below
upto the surgical neck
GLENOHUMERAL LIGAMENTS
• ATTACHMENTS
• Proximal : Upper end of anterior border of glenoid fossa.
• Distal: splits into 3 parts
– Superior: Top of lesser tuberosity.
– Middle: Lower part of lesser tuberosity.
– Inferior: Shaft below lesser tuberosity.

TRANSVERSE HUMERAL LIGAMENT

• Stretches between the two tuberosities.


• Tendon of long head of biceps passes deep to it.
• Helps to hold the tendon in position during various movements of the
shoulder.
CORACOHUMERAL LIGAMENT
• Attachments
Lateral margin of coracoid process to greater tuberosity
of the humerus.
CORACO ACROMIAL lig.

 Coraco acromial
ligament: A triangular
band stretching
between tip of the
acromium to lateral
margin of coracoid
process.
Synovial membrane

• Synovial membrane lines the capsule and it is attached


to the margins of the cartilage covering the articular
surfaces.
• It surrounds the tendon of the biceps and extends
beyond transverse humeral ligament for a short distance
as tubular sheath around tendon of long head of biceps.
• Protrudes anteriorly - subscapularis bursa.
BURSAE AROUND THE
SHOULDERJOINT
1.Subscapular bursa
2.Infraspinatus bursa
3.Subcoracoid bursa
4.Subacromial bursa
(Longest bursa in body)
5.Bursa above coracoid process
6.Bursa on upper surface of
acromion process
ROTATOR CUFF
( MUSCULOTENDINOUS CUFF)
The laxity & weakness of the capsule is
compensated by the expansions of the following
tendons as they cross the joint to reach their sites of
insertion.
MUSCLES TAKING PART
• Anteriorly : Subscapularis
• Superiorly : Supraspinatus
• Posteriorly :Infraspinatus &
Teresminor
Most important for stability of the joint.
These tendons blend with the capsule
while crossing it & strengthen it all
around except inferiorly.
Hence the weakest part of the capsule
is inferior part.
Superiorly:
1. Middle fibres of Deltoid, RELATIONS
2. Supraspinatus,
3. Subacromial bursa &
4. Coraco acromial arch
• Inferiorly:
1. Long head of triceps,
2. Axillary nerve
3. Posterior circumflex
4. humeral vessels.
.
• Anteriorly:
1. Anterior fibres of Deltoid,
2. Subscapularis,
3. Coracobrachialis & Short
4. head of bisceps.
• Posteriorly:
1. Posterior fibres of
2. Deltoid,Infraspinatus &
3. Teres minor.
MOVEMENTS
• Flexion and Extension - Transverse axis
• Abduction and Adduction - Anterior posterior Axis
• Medial rotation and Lateral Rotation - Vertical
Axis
• Circumduction
FLEXION & EXTENSION
Flexion:
• Pectoralis Major,
• Anterior fibres of Deltoid,
• Coracobrachialis &
• Biceps Brachii.

Extension:
• Posterior fibres of Deltoid
• Lattissmus dorsi &
• Teres major.
• Long head of triceps
MEDIAL & LATERAL ROTATION
Medial rotation:
• Subscapularis.
• Anterior fibres of Deltoid,
• Pectoralis major,
• Teres major,
• Latissimus dorsi &
Lateral rotation:
• Posterior fibres of Deltoid
Infraspinatus,
• Teres Minor &
ADDUCTION ABDUCTION

• Pectoralis major, • Deltoid lateral


• Subscapularis, fibres.
• Teres major, • Supraspinatus.
• Coracobrachialis • Serratus Anterior
• Long head of • Upper and lower
triceps. fibres of Trapezius
ABDUCTION
 Abduction is initiated by Supraspinatus muscle. It abducts the shoulder
to 150.
 Further abduction is brought by middle fibres of deltoid.
 The supraspinatus holds the head of humerus in contact with glenoid
fossa. Subscapularis, teres major & infraspinatus exerts a downward
pull.
 Balance between these muscles abducts the shoulder upto 90 0.
 At 900 abduction the articular surface of humerus is completely used.
 The humerus is laterally rotated by teres minor & infraspinatus muscles.
 The articular surface of humerus faces superiorly & in now available for
further abduction.
 The scapula is also rotated laterally by serratus anterior , upper & middle
fibres of trapezius. This tilts the glenoid fossa upwards.
 Further abduction is now completed upto 1800.
• Upto 300 abduction the movement involves
predominantly shoulder joint.
• 300 – 1800 abduction involves both
shoulder joint & scapular rotation.
• For every 20 movement in shoulder joint
there is 10 movement in scapula.
• This is called as scapulo humeral rhythm.
BLOOD SUPPLY & NERVE SUPPLY
• Arteries
– Supra scapular artery.
– Anterior & Posterior circumflex humeral
– arteries.
– Circumflex scapular branch of subscapular
– artery.

• Nerves
– Lateral pectoral nerve.
– Posterior division of Axillary nerve.
– Suprascapular nerve.
STABILITY OF SHOULDER JOINT –
FACTORS RESPONSIBLE

• Rotator cuff.
• Supraspinatus tendon, Glenohumeral,
Coracohumeral ligament & Coraco acromial arch
–Supra humeral support.
• Long head of Triceps & Biceps – act like splints
below & above the joint.
• Glenoidal labrum – Deepens the glenoid cavity.
APPLIED ANATOMY
SUPRASPINATUS TENDINITIS

• Impingement of
Supraspinatus tendon on
the acromiun during
abduction leads to
tendinitis.
• Diminished vascularity
aggravates.
• Calcium deposition
causes irritation.
• Subacromial bursitis
occurs.
Inferior part of the capsule is weak.
Therefore anterior dislocation of shoulder is
more
common.
The humeral head slips downwards & forwards
&
may press upon the vessels & brachial plexus
AXILLARY NERVE DAMAGE

• Occurs in antero
inferior
dislocations.
• Paralysis of Deltoid
& Loss of
sensation over skin
covering Deltoid
muscle.
ROTATOR CUFF INJURIES
• Repetitive use of rotator cuff (sportsmen)
leads to…
1. Humeral head & rotator cuff impinge on

coraco acromial arch.


2. Irritation of arch & inflammation of cuff.
• Recurrent inflammation of Rotator cuff
causes shoulder pain & tearing of rotator
cuff.
• Injury to rotator cuff– can affect the
stability of the shoulder joint.
ADHESIVE CAPSULITIS(OR)FROZEN SHOULDER

• Caused by adhesive
fibrosis & scarring of
capsule, rotator cuff,
subacromial bursa &
deltoid due to peri
arthritis.
• Pain in shoulder, joint
stiffness & restricted
mobility (40 – 60 yrs).
• Disuse atrophy of
surrounding muscles.
RADIOLOGICAL VIEW OF
SHOULDER

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