Shoulder Girdle/Joint Shoulder Girdle/Joint LabLab

Josh AdetulaJosh Adetula

Deborah YangDeborah Yang

From Which joint is the From Which joint is the shoulder connected to the shoulder connected to the

spinal column?spinal column?• The shoulder is The shoulder is

connected to connected to the spinal the spinal column via the column via the scapulothoracic scapulothoracic joint.joint.

Which of the following Which of the following joints is NOT a part of the joints is NOT a part of the

shoulder complex?shoulder complex?• The Alatoaxial joint is not a part of the The Alatoaxial joint is not a part of the

shoulder complexshoulder complex

Where is the insertion of Where is the insertion of the Pectoralis minor?the Pectoralis minor?

• It is inserted at the coracoid process of It is inserted at the coracoid process of the scapula.the scapula.

Q: What is the function of Q: What is the function of the Levator Scapulae the Levator Scapulae

Muscle?Muscle?A.A. The Levator The Levator

Scapulae’s Scapulae’s Function is to Function is to elevate the elevate the scapula.scapula.

FlexionFlexion

• Movement of Movement of humerus straight humerus straight anteriorly from anteriorly from any point in the any point in the sagittal plane.sagittal plane.

ExtensionExtension

• Movement of the Movement of the humerus straight humerus straight posteriorly from posteriorly from any point in the any point in the sagittal planesagittal plane

AbductionAbduction

• Upward lateral Upward lateral movement of the movement of the humerus in humerus in frontal plane out frontal plane out to the side, and to the side, and away from the away from the body.body.

• Can be diagonal Can be diagonal or horizontalor horizontal

AdductionAdduction

• Downward Downward movement of the movement of the humerus in the humerus in the frontal plane frontal plane medially toward medially toward the body.the body.

• Can be diagonal Can be diagonal or horizontalor horizontal

RotationRotation

• Lateral movment Lateral movment of the humerus in of the humerus in the tranverse the tranverse plane along its plane along its long axis.long axis.

• There are 2 types: There are 2 types: Internal and Internal and ExternalExternal

Sternoclavicular JointSternoclavicular Joint

• Distal (also is Distal (also is medial) to the medial) to the most lateral edge most lateral edge of the deltoid. of the deltoid.

Q: Which Nerve Q: Which Nerve innervates the rhomboid innervates the rhomboid

muscle?muscle?

A.A. The rhomboid muscle is The rhomboid muscle is innervated by the dorsal scapula innervated by the dorsal scapula nervenerve

From which cord does the From which cord does the musclocutaneous nerve musclocutaneous nerve

originate?originate?• The nerve The nerve

originates from originates from the lateral cord the lateral cord of the brachial of the brachial plexus.plexus.

In which part of the In which part of the scapula does the humeral scapula does the humeral

head fit, to make the head fit, to make the glenohumeral joint?glenohumeral joint?

• The humeral head fits into the The humeral head fits into the glenoid cavity to make the glenoid cavity to make the glenohumeral joint.glenohumeral joint.

ScapulaScapula

1.1. Coracoid Process (A)Coracoid Process (A)2.2. Scapular Notch (J)Scapular Notch (J)3.3. Superior Margin (B)Superior Margin (B)4.4. Supraspinatus Fossa (L)Supraspinatus Fossa (L)5.5. Superior Angle (K)Superior Angle (K)6.6. Scapular Spine (C)Scapular Spine (C)7.7. Vertebral Margin (D)Vertebral Margin (D)8.8. Infraspinatus Fossa (H)Infraspinatus Fossa (H)9.9. Inferior Angle (I)Inferior Angle (I)10.10. Axillary Margin (E)Axillary Margin (E)11.11. Glenoid Cavity Margin (F)Glenoid Cavity Margin (F)12.12. Acromion Process (G)Acromion Process (G)

The Deltoid musle is…The Deltoid musle is…

• ……the main adductor of the the main adductor of the shoulder joint.shoulder joint.

If the long thoracic nerve gets If the long thoracic nerve gets injured, then which movement injured, then which movement of the shoulder girdle will be of the shoulder girdle will be

affected?affected?• Injury to the LTN Injury to the LTN

would greatly would greatly affected affected abduction.abduction.

Subclavius Muscle can be Subclavius Muscle can be strengthened by…strengthened by…

• The subclavius muscle can be The subclavius muscle can be strengthened by active depression.strengthened by active depression.

The origin of rhomboid The origin of rhomboid muscle is the spineous muscle is the spineous

process of…process of…• Its origin is the Its origin is the

spineous process spineous process of C7 to T5.of C7 to T5.

Left Scapula (seen in Left Scapula (seen in lateral view)lateral view)

1.1. Coracoid ProcessCoracoid Process

2.2. Glenoid CavityGlenoid Cavity

3.3. Scapular SpineScapular Spine

4.4. Acromion Acromion ProcessProcess

5.5. Infraspinatus Infraspinatus FossaFossa

6.6. Inferior AngleInferior Angle

Clavicle injury Clavicle injury results….results….

• When dealt a blow When dealt a blow to the medial end to the medial end of the clavicle, this of the clavicle, this will cause an AC will cause an AC separation (aka separation (aka dislocated dislocated shoulder), which shoulder), which tears up the joint tears up the joint capsule.capsule.

MuscleMuscle OriginOrigin InsertionInsertion ActionAction InnervationInnervationss

Pectoralis MinorPectoralis Minor Anterior Surfaces of the Anterior Surfaces of the 33rdrd to 5 to 5thth ribs ribs

Coracoid process of the Coracoid process of the scapulascapula

Abduction, Abduction, Depression, & Depression, & Downward Downward RotationRotation

Medial pectoral Medial pectoral nerve (C8 & T1)nerve (C8 & T1)

Serratus AnteriorSerratus Anterior Surface of the upper 9 Surface of the upper 9 ribs at the side of the ribs at the side of the chestchest

Anterior side of the Anterior side of the medial scapula medial scapula

Abduction & Abduction & Upward Upward RotationRotation

Long Thoracic Long Thoracic Nerve (C5 –C7)Nerve (C5 –C7)

Trapezius – upper Trapezius – upper fibersfibers

Base of skull, occ. Base of skull, occ. Protuberance, and Protuberance, and posterior ligaments of posterior ligaments of the neckthe neck

Posterior aspect of the Posterior aspect of the lateral 3lateral 3rdrd of the of the clavicleclavicle

Elevation & Elevation & Extension or Extension or Rotation at the Rotation at the head of the head of the neckneck

Spinal accessory Spinal accessory nerve and branches nerve and branches of C3 & C4of C3 & C4

Trapezius – middle Trapezius – middle fibersfibers

Spinous process of C7-T3Spinous process of C7-T3 Medial border of the Medial border of the acromion process and acromion process and upper border of upper border of scapular spinescapular spine

Elevation, Elevation, Adduction, & Adduction, & Upward Upward rotationrotation

Trapezius – lower Trapezius – lower fibersfibers

Spinous process of 4Spinous process of 4thth--1212thth thoracic vertebrae thoracic vertebrae

Triangular space at the Triangular space at the base of the scapular base of the scapular spinespine

Adduction, Adduction, Depression, & Depression, & Upward Upward rotationrotation

RhomboidsRhomboids Spinous processes of C7-Spinous processes of C7-T5T5

Medial border of Medial border of scapula, below scapula scapula, below scapula spinespine

Adduction, Adduction, downward downward rotation, & rotation, & ElevationElevation

Dorsal Scapula Dorsal Scapula Nerve (C5)Nerve (C5)

Levator ScapulaeLevator Scapulae Transverse processes of Transverse processes of C1-C4C1-C4

Medial border of Medial border of scapulascapula

ElevationElevation Dorsal Scapula Dorsal Scapula Nerve (C5) and Nerve (C5) and branches of C3 & C4branches of C3 & C4

MuscleMuscle OriginOrigin InsertionInsertion ActionAction InnervationInnervationss

Pectoralis majorPectoralis major Upper Fibers – medial half of Upper Fibers – medial half of front of claviclefront of clavicle

Lower Fibers- Anerior surface of Lower Fibers- Anerior surface of first 6 ribsfirst 6 ribs

Flat tendon 2 or 3 inches Flat tendon 2 or 3 inches wide to lateral lip of IT wide to lateral lip of IT groove of humerusgroove of humerus

Rotation, Rotation, Adduction, Adduction, Flexion, Flexion, Extension, & Extension, & AbductionAbduction

Lateral Pectoral Nerve Lateral Pectoral Nerve (C5, C6, C7)(C5, C6, C7)

SubscapularisSubscapularis Entire Anterior surface of Entire Anterior surface of subscapular fossasubscapular fossa

Lesser Tubercle of HumerusLesser Tubercle of Humerus Rotation Rotation (Internal)(Internal)

Medial Pectoral Nerve Medial Pectoral Nerve (C8, T1)(C8, T1)

CoracobrachialisCoracobrachialis Coracoid process of scapulaCoracoid process of scapula Middle of medial border or Middle of medial border or humeral shafthumeral shaft

Adduction Adduction (Horizontal & (Horizontal & Diagonal)Diagonal)

Upper and lower Upper and lower subscapular nerve subscapular nerve (C5, C6)(C5, C6)

DeltoidDeltoid Anterior - Anterior lateral C3Anterior - Anterior lateral C3

Middle – Acromion (lateral)Middle – Acromion (lateral)

Posterior – Spine of Scapula Posterior – Spine of Scapula (Inferior edge)(Inferior edge)

Deltoid Tuberosity on the Deltoid Tuberosity on the lateral humeruslateral humerus

Abduction Abduction Flexion, Flexion, AdductionAdduction

Axillary NerveAxillary Nerve

(C5, C6)(C5, C6)

SupraspinatusSupraspinatus Medial 2/3 of SSP FossaMedial 2/3 of SSP Fossa Superiorly on Greater Superiorly on Greater Tubercle of humerusTubercle of humerus

AbductionAbduction Suprascapula nerve Suprascapula nerve (C5)(C5)

Latissimus DorsiLatissimus Dorsi At Lumbar Vertebrae to Lower At Lumbar Vertebrae to Lower 6 Thoracic Vertebrae, back of 6 Thoracic Vertebrae, back of Sacrum, and Posterior crest of Sacrum, and Posterior crest of iliumilium

Medial side of IT groove of Medial side of IT groove of humerus, anterior to teres humerus, anterior to teres major insertionmajor insertion

Extension, Extension, Adduction, and Adduction, and Rotation Rotation (internal)(internal)

Thoracodorsal (C6, Thoracodorsal (C6, C7, C8)C7, C8)

Teres MajorTeres Major Inferior 3Inferior 3rdrd of lateral border of of lateral border of scapulascapula

Medial lip of IT groove of Medial lip of IT groove of humerus, posterior to humerus, posterior to latissimus dorsi insertionlatissimus dorsi insertion

Extension, Extension, Adduction, and Adduction, and Internal RotationInternal Rotation

Lower subscapular Lower subscapular nerve (C5, C6)nerve (C5, C6)

InfraspinatusInfraspinatus Medial aspect of infraspinatus Medial aspect of infraspinatus fossa, just below spine of fossa, just below spine of scapulascapula

Posteriorly on greater Posteriorly on greater tubercle of humerustubercle of humerus

External External rotation, rotation, Horizontal/DiagoHorizontal/Diagonal abduction,nal abduction,

Suprascapula nerve Suprascapula nerve (C5, C6)(C5, C6)

Teres MinorTeres Minor Posteriorly on upper and middle Posteriorly on upper and middle aspect of lateral border of aspect of lateral border of scapulascapula

Posteriorly on greater Posteriorly on greater tubercle of humerustubercle of humerus

External External rotation, rotation, Horizontal Horizontal abduction, and abduction, and diagonal diagonal adductionadduction

Axillary Nerve (C5, Axillary Nerve (C5, C6)C6)