Shoulder joint

Scaption

Similar to flex and abd

Occurs in scapular plane

Glenoid fossa

Small size makes shoulder an unstable joint

Angled upward, anterior and lateral in a way that increases stability

Closed packed position: 90dg abd, full lateral rotation

Loose packed: 55dg abd, 30dg horizontal add

Glenoid labrum

Fibrocartilage ring attached to the rim of the glenoid fossa

Deepens articular cavity

Joint capsule

Attaches to rim of glenoid fossa and anatomical neck of humerus

Reinforced by anterior glenohumeral ligaments and superior coracohumeral ligaments

Coracohumeral ligament

Lateral side of coracoid process to medial side of greater tubercle

Strengthens anterior/superior portion of joint capsule

Bursae

Small pad like sacs that prevent excess friction

Subdeltoid, subacromial

Rotator cuff

Tendinous band formed by the tendons of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles

Thoracolumbar fascia (lumbar aponeurosis)

Superficial fibrous sheet that forms a broad attachment place for the lats

Anterior deltoid OIAN

O: lateral third of the clavicle

I: deltoid tuberosity

A: shoulder abd, flex, IR, horizontal add

N: axillary nerve (C5-C6)

Middle deltoid OIAN

O: acromion process

I: deltoid tuberosity

A: shoulder abd

N: axillary nerve (C5-C6)

Posterior deltoid OIAN

O: spine of the scapula

I: deltoid tuberosity

A: shoulder abd, extn, hyperextn, ER, horizontal abd

N: axillary nerve (C5-C6)

Pectoralis major OIAN

O: medial third of clavicle, sternum, costal cartilage of first 6 ribs

I: lateral lip of bicipital groove of humerus

A: shoulder add, IR, horizontal add (both; shoulder flex to first 60dg (clavicular); shoulder extn to first 60dg (sternum)

N: lateral and medial pectoral nerve

Latissimus dorsi OIAN

O: spinous processes of T7-L5, posterior surface of sacrum, iliac crest, lower 3 ribs

I: medial floor of bicipital groove of humerus

A: shoulder extn, add, IR, hyperextn

N: thoracodorsal nerve (C6-C8)

Teres major OIAN

O: inferior axillary border of scapula near inferior angle

I: medial lip of bicipital groove on anterior surface of humerus

A: shoulder extn, add, IR

N: lower subscap nerve (C5-C7)

Supraspinatus OIAN

O: supraspinous fossa of scapula

I: greater tubercle of humerus

A: shoulder abd

N: subscapular nerve (C5-C6)

Infraspinatus OIAN

O: infraspinous fossa of scapula

I: greater tubercle of humerus

A: shoulder ER, horizontal abd

N: suprascapular nerve (C5-C6)

Teres minor OIAN

O: axillary border or scapula

I: greater tubercle of humerus

A: shoulder ER, horizontal abd

N: axillary nerve (C5-C6)

Subscapularis OIAN

O: subscapular fossa of the scapula

I: lesser tubercle of the humerus

A: shoulder IR

N: upper and lower subscap nerve (C5-C6)

Coracobrachialis OIAN

O: coracoid process of the scapula

I: medial surface of the humerus near the midpoint

A: stabilizes the shoulder joint

N: musculocutaneous nerve (C6-C7)

Abduction of shoulder

Humeral head rolls superiorly and glides inferiorly

Humeral head laterally rotates

Sagittal plane convex/concave

Flexion: convex humeral head spins posteriorly

Extension: convex humeral head spins anteriorly

Horizontal plane convex/concave

IR: convex humeral head glides posteriorly and rolls anteriorly

ER: convex humeral head glides anteriorly and rolls posteriorly

Anterior deltoid, clavicular portion of pec major

Flexion

Posterior deltoid, lat, teres major, sternal portion of pec major

Extension

Lat, posterior deltoid

Hyper extension

Deltoid, supraspinatus

Abd

Pec major, teres major, lat

Add

Posterior deltoid, infraspinatus, teres minor

Horizontal abd

Pec major, anterior deltoid

Horizontal add

Infraspinatus, teres minor, posterior deltoid

ER

Lat, teres major, subscap, pec major, anterior deltoid

IR

Clavicular fx

Usually from a fall on the lateral aspect of shoulder

FOOSH injury

80% occur midshaft of clavicle

Humeral neck fx

FOOSH injury

Impacted fracture in the elderly pop

Pathological fx

Caused by benign or metastatic tumors, disease, aging

Glenohumeral subluxation

Caused by muscle weakness or paralysis of rotator cuff muscles, compromised integrity of joint capsule, large traction force through the joint

Common side effect of CVA due to paralysis of supraspinatus and deltoids

Usually occurs anteriorly or inferiorly

Glenohumeral dislocation

Total loss of joint congruency

Most commonly anteriorly

Adhesive capsulitis

“Frozen shoulder”

Scarring and adhesions around the shoulder lead to pain, inflammation, dec motion

Impingement syndrome

Compression of soft tissue between acromial arch and head of humerus

Primary due to narrowing subacromial space

Secondary due to functional disturbance

Calcific tendonitis

Accumulation of mineral deposits within the tendon

Bicipital tendonitis

Tendonitis of the long head of the biceps tendon

Inflammation occurs when the tendon crosses the humeral head and changes directions

Can eventually result in tendon rupture

Rotator cuff tear

Tear of one or more rotator cuff muscles

Osteokinematics & Arthrokinematics of the shoulder joint