Shoulder
Region
DR. ASAAD AL-SHOUK
M.D. PH .D.
Bones of shoulder girdle
CLAVICLE SCAPULA
clavicle
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Scapula
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Sternoclavicular joint
Acromioclavicular joint
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•Muscles of pectoral girdle:
• Direct and indirect attachment.
• The direct muscles are the muscles that attach the clavicle or scapula to axial skeleton.
e.g. Pectoralis Minor, subclavius, trapezius, rhomboids, levator scapulae, serratus anterior.
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❖Pectoral fascia
❖Clavipectoral fascia
❖Costocoracoid lig.
❖Suspensory lig of axilla
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Shoulder joint
The shoulder joint (or glenohumeral joint). It is a
ball and socket synovial joint .The bone
conformation and range of movement affects joint
stability. Movement of the shoulder occurs at both
the glenohumeral and scapulothoracic joints.
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Glenohumeral joint
The joint is lined by synovium and enclosed by a fibrous
capsule. The glenoid cavity is deepened by a rim of
fibrocartilage – the glenoid labrum –Stability is
provided by a capsule, various ligaments and the rotator
cuff muscles.
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Capsule
The capsule is attached to the glenoid labrum, the
scapula and the anatomical head of the humerus. It
bridges the intertubercular groove of the humerus and
extends medially to the surgical neck of the humerus.
It is thickened in some areas due to the attachment of
three glenohumeral ligaments anteriorly and a
coracohumeral ligament above.
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Apertures of articular capsule
➢2 in number
➢Opening between tubercles of
humerus (for passage of the
tendon of long head of biceps
brachii m)
➢Situated anteriorly, inf to
coracoid process, allows
communication between
subscapular bursa & synovial
cavity of joint
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Ligaments
Intracapsular ligaments
There are three intracapsular ligaments
which are fibrous bands between the glenoid
labrum and the humerus.
These ligaments are continuous with the
fibrous capsule and reinforce the capsule
anteriorly. They are:
➢Superior glenohumeral ligament
➢Middle glenohumeral ligament
➢Inferior glenohumeral ligament
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Extracapsular ligaments
There are also three extracapsular
ligaments:
➢Coracoacromial ligament → links the
acromion and the coracoid process
➢Coracohumeral ligaments → passes fro
the base of the coracoid process to the
anterior part of the greater tubercle of the
humerus
➢Transverse humeral ligament → holds the
tendon of the long head of the biceps in
place during shoulder movement
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Coraco Acromial Arch
The coracoarcomial arch is a strong, osseoligamentous structure which provides a smooth under-surface
of the acromion, the coracoacromial ligament and the coracoid process.
It overlies the humeral head and prevents the upper displacement of the humerus
The tendon of the supraspinatus muscle is separated from the coracoacromial arch by the subacromial
bursa.
There is a small space between the acromion and the head of the humerus, within this space are:
◦ The subacromial bursa
◦ Rotator cuff tendons
◦ Tendon of the long head of the biceps
During abduction there is risk of soft tissue impingement between the head of the humerus and the
acromion.
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Bursae around the glenohumeral joint
❖There is the subscapular bursa which facilitates the
movement of the tendon of subscapularis over the
scapula. A bursa is a sack of synovial fluid between 2
articulating surfaces to reduce friction on movement.
The subscapular bursa separates the tendon of
subscapularis from the joint. The synovium and the
joint cavity are continuous with the subscapular
bursa through a gap in the capsule.
❖Subacromial bursa facilitates the movement of the
supraspinatus tendon under the coraco acromial arch
and the deltoid muscle over the shoulder joint and the
greater tubercle of the humerus
❖Inflammations of the bursa can occur:
Subacromial bursitis causes pain on abduction of the arm
between 50-130 degrees, this is painful arch syndrome
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Neurovascular Supply to the Glenohumeral Joint
The blood supply is via the anterior and
posterior circumflex humeral arteries and the
suprascapular artery.
The joint is innervated by the suprascapular,
axillary and lateral pectoral nerves. These are
all from the brachial plexus roots C5 and C6
therefore upper brachial plexus injuries affect
shoulder movement.
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THANK YOU
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