Glenohumeral JointJessica Vila

&

Carrie A. Hoch

Ligaments

Anterior view

http://www.mlcmarlins.com.au/content/training/coaching_clinic/shoulders/shoulders.htm

Bursae

subscapular bursa

subacromial bursa subdeltoid bursa

subcoracoid bursa

http://www.aidmybursa.com/shoulder-bursitis.php

Cartilage and Articular Capsule

glenoid labruim

glenoid labruim articular cartilage

synovial membrane fibrous layer

Anterior/sliced view

synovial membrane

http://home.comcast.net/~pegglestoncbsd/skeletal.htm

Humerus

head

surgical neckgreater tubercle

lesser tubercle

anatomical neckanatomical neck

intertubercular sulcus

surgical neck

deltoid tuberosity

http://www.medicalook.com/human_anatomy/organs/Brachium.html

Scapula✗

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subscapularfossa

superior angle✗

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inferior angle✗Anterior view Posterior view

http://thesebonesofmine.wordpress.com/category/scapula/

Clavicle

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http://legacy.owensboro.kctcs.edu/gcaplan/anat/Notes/API%20Notes%20H%20Skeletal%20Arm.htm

Rotator Cuff Muscles

subscapularis infraspinatus

teres minor

supraspinatus

Rotator cuff

http://www.rci.rutgers.edu/~uzwiak/AnatPhys/Blood_Vessels.html

Clinical Issues

Common rotator cuff injuries:• Tendinitis = tendons are inflamed due to

overuse or overload

• Bursitis = bursa become irritated or inflamed

• Strain or tear = can result from tendinitis or stress

http://www.mayoclinic.com/health/rotator-cuff-injury/DS00192

Rotator Cuff Cont.

Common causes:• Normal wear & tear - leads to breakdown of

collagen in tendons and muscles• Poor posture - muscle or tendons can become

pinched under clavicle• Falling - breaking fall w/ arm or falling onto

arm can bruise or tear tendon or muscles

Common Causes Cont.

• Lifting or pulling – can strain or tear tendons or muscles

• Repetitive stress – repetitive overhead movement can result in inflammation and tearing in tendons or muscles

Risk Factors

• Age - most common in people > 40

• Athletes - pitchers, tennis players

• Construction trades – painters, carpenters

• Weak shoulder muscles

Surface AnatomyEssential Clinical Anatomy p. 428

acromial part of deltoid

spinal part of deltoid

triangle ofauscultation

middle part of trapezius

ascending partof trapezius

clavicular head ofpectoralis major

clavipectoraltriangle clavicle

descending partof trapezius

clavicular part of deltoid

posterior axillary

fold

manubrium

sternocostal headpectoralis major

anterioraxillary

fold

Accessory Nerve XI, Cervical & Brachial Plexus

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Cerv

ical

ple

xus C

1-C4

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http://www.netteranatomy.com/ImageLibrary/

Nerves✪✪

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✪ Brachial PlexusC5-T1

http://www.nerveblocks.net/tutorium/?lang=en_EN&main=1&sub=1&section=content

Brachial Plexus

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http://www.netteranatomy.com/ImageLibrary/

Arteries✓

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Deep Scapular artery????

circumflex scapular a.✓

http://www6.ufrgs.br/favet/imunovet/molecular_immunology/circulation.html

Veins

http://www.rci.rutgers.edu/~uzwiak/AnatPhys/Blood_Vessels.html

Anterior DeltoidOrigin: Lateral third of clavicle

Insertion: Deltoid tuberosity

Action: Shoulder flexion, Medial Rotation, Horizontal ADDuction

Innervation: Axillary Nerve

Vascular supply: Posterior Circumflex artery

Middle DeltoidOrigin: Acromion process

Insertion: Deltoid Tuberosity

Action: Shoulder ABDuction

Innervation: Axillary nerve

Vascular supply: Posterior circumflex artery

Posterior Deltoid

Origin: Spine of Scapula

Insertion: Deltoid Tuberosity

Action: Shoulder extension, hyperextension, lateral rotation and horizontal ABDuction

Innervation: Axillary Nerve

Vascular Supply: Posterior Circumflex artery

Pectoralis Major(clavicular and sternal portions)

Origin: Medial third of clavicle, sternum, costal cartilages of the first six ribs

Insertion: Lateral lip of bicipital groove of humerus

Action: Shoulder ADDuction, medial rotation and horizontal ADDuction

Innervation: Lateral and medial pectoral nerve

Vascular Supply: Lateral thoracic artery

1.)Teres Minor Origin: Axillary border of scapula Insertion: Greater tubercle of Humerus

Action: Shoulder Lateral rotation horizontal and horizontal ABDuction

Innervation: Axillary nerve

Vascular supply: Circumflex scapular artery

2.) Teres Major Origin: Axillary border of scapula (near the inferior angle) Insertion: Crest below lesser tubercle next to the latissimus dorsi muscle attachment Action: Shoulder extension, ADDuction and medial rotation

Innervation: Subscapular nerve

Vascular supply: Circumflex scapular artery

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Latissimus Dorsi

Origin: Lower three ribs, Spinous processes of T7 through L5( via dorsolumbar fascia), posterior surface of sacrum and iliac crest.

Insertion: Medial lip of bicipital groove of humerus

Action: Shoulder extension, ADDuction, medial rotation and hyperextension

Innervation: Thorocodorsal nerve

Vascular supply: DEEP scapular nerve

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1.) SubscapularisOrigin: Subscapular fossa of the scapula

Insertion: Lesser tubercle of the humerus

Action: Shoulder medial rotation

Innervation: Subscapular nerve

Vascular supply: Subscapular artery

http://thewinger.com/2009/subscapularis

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2.)Supraspinatus Origin: Supraspinous fossa of the scapula

Action: Shoulder ABDuction

3.)Infraspinatus Origin: Infraspinous fossa of scapula

Action: Shoulder Lateral rotation horizontal and ABDduction

The Supraspinatus and Infraspinaus have the same:Insertion : Greater tubercle of the Humerus

Innervation : Suprascapular nerve

Vascular Subscapular artery

TrapeziusUpper Trapezius

Origin: Occipital bone, nuchal ligament

Insertion: Outer third of clavicle, acromion process

Action: Scapular elevation and upward rotation

Middle Trapezius

Origin: Spinous process of C7 through T3

Insertion: Scapular Spine

Action: Scapular depression

Lower Trapezius

Origin: Spinous processes of middle and lower thoracic vertebrae

Insertion: Base of scapular spine

Action: Scapular depression and upward rotation

Innervation of all Three: Spinal accessory (cranial nerve XI)

Vascular supply of all Three: Transverse cervical artery

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Levator ScapulaeOrigin: Transverse process of first four cervical vertbrae

Insertion: Vertebral border of scapula between the superior angle and spine

Action: Scapular elevation and downward rotation

Innervation: Third and fourth cervical nerve

Vascular supply: Dorsal scapular artery

Pectoralis minorOrigin: Anterior Surface, third through fifth ribs

Insertion: Coracoid process of the scapula

Action: With ribs fixed: draws the scapula forward(ABDucts) and rotates scapula downward against the thoracic wallWith scapula fixed: elevated the rib cage

Innervation: Medial pectoral nerve

Vascular supply: Axillary artery

Serratus AnteriorOrigin: Lateral surface of the upper eight ribs

Insertion: The anterior surface of vertebral border of the scapula

Action: Scapular protraction and upward rotation

Innervation: Long thoracic nerve

Vascular supply: Lateral thoracic artery

The RHOMBOIDES!!!

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1.) Rhomboideus minor

Origin: Spinous processes of C7 through T1

Insertion: Vertebral border of scapula at the spine process2.) Rhomboideus MAJOR:

Origin: Spinous processes of T2 through T5

Insertion: Vertebral border of scapula between the spine and inferior angle

The Rhomboideus major and the Rhomboideus major have the same:

Action: Scapular retraction and downward rotation

Innervation: Dorsal scapular nerve

Vascular supply: Dorsal scapular artery

Coracobrachialis

Origin: Coracoid process

Insertion: Medial aspect of humerus

Action: Weakly ADDucts shoulder joint

Innervation: Musculocutaneous nerves, C6 and C7

Vascular Supply: Brachial Artery

Study Reference

http://www.rocmd.com/conditions-treated/shoulder

Study Referencehttp://www.netteranatomy.com/ImageLibrary/

! Who is this handsome man?