The Shoulder PDF

The Shoulder The Shoulder Girdle/Complex Bones (4) Joints (4) Ligaments Muscles Movements Injuries  AC jt GHJ jt Shoulder Girdle ST jt SC jt Shoulder Girdle 4  Sternum (breastbone) 3 Main Parts - Manubrium...

The Shoulder The Shoulder Girdle/Complex Bones (4) Joints (4) Ligaments Muscles Movements Injuries  AC jt GHJ jt Shoulder Girdle ST jt SC jt Shoulder Girdle 4  Sternum (breastbone) 3 Main Parts - Manubrium - Body - Xiphoid Process 5 Sternum Marks the level of the 2nd rib A small amount of movement occurs here when we breathe 6 Clavicle “Collarbone” ‘S’ shaped long bone Extends from sternum to scapula Most common bone fractured 7 Clavicle Superior Surface 3 Sections Sternal (Medial) End Shaft Inferior Surface Trapezoid line Acromial (Lateral) End 8 1. Sterno-clavicular Joint Medial end of the clavicle Clavicle articulates with the sternum 11  Sterno-clavicular Joint Synovial saddle joint (one surface is concave and the other is convex) Articular surfaces: Medial (sternal) end of clavicle Clavicular notch of sternum Connects trunk to upper limb Allows upper limb to perform full ROM 12  Sternoclavicular Joint Movement Small range of movement is possible Movement of SC joint is essential to allow arm to elevate passed shoulder level No muscles act directly on the SC joint, it moves as a result of muscles causing the rest of the shoulder girdle to move Movements: (lateral end of clavicle is reference point) Elevation & Depression Protraction & Retraction Axial Rotation 13 Movements at the SC jt Elevation Depression Protraction Retraction Axial Rotation  SC Joint Ligaments Anterior & Posterior SC ligaments Interclavicular ligament Costoclavicular ligament 15 SC Joint Injury 16  2. AC Joint Where the lateral end of clavicle meets the acromion of the scapula Synovial plane joint No muscles directly act on the joint, so all movement is passive, or indirectly from other joints 17  Acromio-clavicular joint Lateral end of the clavicle Articulates (joins) with the medial aspect of the acromion of scapula 18  AC Joint Ligaments Acromioclavicular ligament – clavicle to acromion Conoid ligament – coracoid process to the conoid tubercle of clavicle Trapezoid ligament – coracoid process to the trapezoid line of clavicle *Collectively the conoid and trapezoid ligaments are known as the Coracoclavicular ligament 19 AC jt Injury AC jt Injury AC jt surgical repair  Scapula Commonly known as the “shoulder blade” Important site for muscle attachments – about 17 Serves as a connection between humerus and clavicle 23 Scapula- Borders and Angles Superior Superior Angle Border Lateralx Border Medial Border Inferior Angle 24 Scapula – Posterior View Spine of Scapula Lateral Border Medial Border Inferior Angle 25 Scapula – Lateral View Coracoid Process Acromion Lateral Border 26 Scapula – Anterior View Suprascapular Notch __________ Border __________ Border 27 Scapula - Muscle Attachment Sites Right Right Anterior Posterior 28  Scapular Articulations Scapulothoracic joint Glenohumeral joint Acromioclavicular joint 29 3. Scapulothoracic Joint Is not a “true joint” : it doesn’t have specific articular surfaces, ligaments or a joint capsule Better described as a connection between the anterior surface of scapula and the superolateral surface of the thoracic wall. 30 Scapulothoracic Joint Movements Elevation Depression Protraction (Abduction) Retraction (Adduction) Downward Rotation Described relative to the movement of the acromion Upward Rotation Described relative to the movement of the acromion 31 Scapulothoracic Joint Movements Downward Rotation Described relative to the movement of the acromion Upward Rotation Described relative to the movement of the acromion Rhomboid Major Origin Spinous processes of T2-T5 Insertion Medial border of scapula Lies underneath Upper Trapezius Action Retraction, elevation and downward rotation of scapula 33 Rhomboid Minor Origin Spinous processes of C7-T1 Insertion Medial border of scapula Lies underneath Upper Trapezius Action Retraction, elevation and downward rotation of scapula 34 Rhomboids – retraction, protraction Rhomboid = shape = parallelogram in which adjacent sides are of unequal lengths and angles are non- right angled. Levator Scapula Origin Transverse processes of C1-C4 Insertion Medial border of scapula Lies underneath Upper Trapezius Action Elevation and downward rotation of scapula 36 Levator Scapula - Elevation and downward rotation of scapula Trapezius Origin Base of the Occiput Ligamentum nuchae of the cervical spine Spinous processes of vertebrae C7-T12 Insertion Lateral 1/3rd of the clavicle Medial aspect of acromion Spine of scapula 38 Trapezius A muscle in 3 parts Upper Middle Lower Trapezoid/Trapezium = shape = is a flat closed shape having 4 straight sides, with one pair of parallel sides. Upper Trapezius - Elevation & Upward rotation Middle Trapezius - Retraction Lower Trapezius - depression & upward rotation Trapezius Pectoralis Minor Origin Anterior surface of ribs 2-5 Insertion Coracoid process of scapula Lies under Pectoralis Major Action Protraction of scapula Pectoral = relating to the chest 44 Pectoralis Minor Pectoralis Minor - Posture Serratus Anterior Origin Laterally on the upper 9 ribs Insertion Anterior surface of the medial border of scapula Action Protraction Assists upward rotation 47 Serratus Anterior – protraction ‘The Boxers muscle’  Humerus Long bone of the upper arm Shoulder - Articulates proximally with the glenoid fossa of scapula to form the glenohumeral joint Elbow - Articulates distally with the radius and ulna to form the elbow joints 49 Humerus – Proximal End Head Smooth articular surface to articulate with glenoid fossa of scapula Anatomical Neck Inferior to head – attachment site for joint capsule Surgical Neck Inferior to tuberosities. Frequent site of fracture. 50 Humerus – Proximal End Greater Tubercle A rounded bump of bone for muscle attachment Deltoid Tuberosity Roughened insertion point on lateral shaft Lesser Tubercle A rounded bump of bone for muscle attachment Intertubercular Groove Groove between the greater and lesser tubercles 51 Humerus - Shaft Shaft of the bone = main section of the bone. Humerus Site for many muscle attachments Shaft Roughened area on lateral aspect – Deltoid Tuberosity Common site for fracture 52  4. Glenohumeral Joint Synovial ball & socket joint Articular Surfaces: Glenoid fossa of scapula Glenoid Fossa Head of humerus 53 GH Joint Movement 54  GH Joint Ligaments Superior GHL Middle GHL Inferior GHL Connect bone to bone Help to stabilise the joint (hold the joint in place) 55 GH Joint Ligaments Coracohumeral ligament Coracoacromial ligament Transverse Humeral ligament holds the long head of biceps brachii tendon in place Transverse Humeral Ligament 56 GH Joint Labrum A ‘collar’ around the edge of the joint Made of ‘stiff’ cartilage (fibrocartilage) Is attached to the edge of the glenoid fossa Helps to make a deeper joint socket Helps to create a vacuum in the joint GH Joint - Labral tear Caused by Overuse Repetitive Motion Trauma Forced rotation of shoulder Fracture Dislocation  Diagnosed definitively on MRI May need to be surgically repaired GH Joint Capsule Completely surrounds and encloses the joint Helps to hold the joint in place (stability)  GH Jt. Stability Due to a large degree of mobility available at the GH Jt. there is a large amount of stability needed Head of humerus surface is about 4 times larger than the glenoid fossa Passive Stability Dynamic/Active Stability Glenoid Labrum Rotator Cuff Muscles Joint Capsule Scapula Stabilizing Muscles Glenohumeral Ligaments 61 GH Joint – Passive Stability Labrum Ligaments Capsule GHJ Dislocation GHJ Dislocation Rotator Cuff The Rotator Cuff is a group of four muscles that come together as tendons to form a "cuff” over the head of the humerus. All originate from the scapula All attach around the humeral head at various points to surround the glenohumeral joint Keep the head of the humerus firmly within the shallow socket of the glenoid fossa. The 4 muscles that make up the Rotator Cuff are: 65 Rotator Cuff The rotator cuff muscles have 2 roles: 1. They provide a significant role in the stability of the gleno-humeral join 2. They provide rotation movement at the glenohumeral joint. 66 Supraspinatus Origin Medial 2/3 of supraspinous fossa Insertion Greater tuberosity of humerus Action GH jt. abduction Rotator cuff stability 67 Infraspinatus Origin Medial 2/3 of infraspinous fossa Insertion Greater tuberosity of humerus (posterior) Action GH Jt. external rotation Rotator cuff stability 68 Teres Minor Origin Lateral border of scapula Insertion Greater tuberosity of humerus (posteriorly) Action GH Jt. external rotation Rotator cuff stability 69 Subscapularis Origin Subscapular fossa of scapula Insertion Lesser tuberosity of humerus (anterior) Action GH Jt. internal rotation Rotator cuff stability 70 Rotator Cuff Tear Caused by: Can be partial tear or complete Wear and tear rupture Repetitive overhead activity May need surgical repair Trauma Strength training essential for Dislocation recovery Fracture Gradual Excessive force Progressive Fall Functional Sport Specific Biceps Brachii Origin Long head – supraglenoid tubercle of scapula Short head – coracoid process of scapula Insertion Radial tuberosity of radius Action GH Jt. flexion Elbow flexion Forearm supination 72 Biceps Tear Rupture of proximal tendon Rupture of distal tendon Biceps Tear Triceps Brachii Origin Long head – infraglenoid tubercle of scapula Lateral head – posterior humerus Medial head – posterior humerus Insertion Olecranon process of ulna Action Elbow extension Long head: GH Jt. extension and adduction 75 Coracobrachialis Origin Coracoid process of scapula Insertion Anteromedial shaft of humerus Action GH Jt. flexion and adduction 76 Deltoid Origin Lateral 1/3 of clavicle Acromion of scapula Spine of scapula Insertion Deltoid tuberosity of humerus Action All Fibres: GH Jt. abduction Anterior Fibres: flexion & internal Rotation Posterior Fibres: extension & external rotation 77 Pectoralis Major Origin Clavicular head – anterior surface of medial clavicle Sternocostal head - anterior surface of sternum, costal cartilages ribs 1-6, aponeurosis of external oblique muscle Insertion Lateral lip of the intertubercular groove Action GH Jt. adduction, internal rotation, flexion, and extension 78 Pec Major Tear Latissimus Dorsi Origin Posterior iliac crest Spinous processes of T7-T12 Thoracolumbar fascia Ribs 9-12 Insertion Floor of intertubercular groove of humerus Action GH Jt. extension, internal rotation, and adduction 80 Lats –the swimmers muscle Teres Major Origin Lateral border and inferior angle of scapula Insertion Lesser tubercle Action GH Jt. internal rotation, extension, and adduction 82 GH Joint Muscle Actions 83 The Shoulder Bones (4) Joints (4) Ligaments Muscles (18 covered in this module) Movements (15) Injuries