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Shoulder Joint -pdf lecture notes Dr.N.Mugunthan.M.S
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Shoulder Joint - Gross Anatomy, applied aspects
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Shoulder Joint -pdf lecture notes Dr.N.Mugunthan.M.S
1.
Shoulder Joint Lecture by Dr.N.Mugunthan.MBBS,MS,DNB,MNAMS,PhD Associate
Professor, MGMC&RI. 1© Dr.N.Mugunthan
2.
Learning objectives Shoulder joint: •
Type & variety • Articular surfaces • Ligaments • Relations • Blood & nerve supply • Movements • Applied anatomy LAQ: Describe the shoulder joint under following headings: a. articular surfaces b. ligaments c. movements d. applied anatomy (2+3+3+2)2© Dr.N.Mugunthan
3.
How to describe
a joint 9. Movements 10. Muscles producing movements 11. Unique features of particular joint 12. Applied anatomy 1. Definition 2. Type of joint 3. Variety of joint 4. Articular surfaces 5. Ligaments 6. Relations 7. Blood supply 8. Nerve supply 3© Dr.N.Mugunthan
4.
Shoulder joint Definition :
Shoulder joint is formed by articulation of the scapula (glenoid cavity) and head of the humerus Glenohumeral joint 4© Dr.N.Mugunthan
5.
Type of joint Synovial
joint Polyaxial 5© Dr.N.Mugunthan
6.
Variety of joint Ball
and socket variety 6© Dr.N.Mugunthan
7.
Articular surfaces Proximal articular
surface : Glenoid fossa of scapula Pyriform in shape Surface area, concavity of glenoid fossa increased by glenoidal labrum Glenoidal labrum – fibro cartilaginous ribbon like structure Covered with hyaline cartilage 7© Dr.N.Mugunthan
8.
Articular surfaces cont… Distal
articular surface: The head of humerus Hemispherical in shape Covered with hyaline cartilage 8© Dr.N.Mugunthan
9.
Shoulder joint –
weak joint o Glenoid fossa is too small & shallow o to hold the head of the humerus in place o The head is four times the size of glenoid cavity o Structurally, it is a weak joint Stability of the joint is ? 9© Dr.N.Mugunthan
10.
Ligaments True ligament: 1. Capsule Accessory
ligaments: 2. Glenohumeral ligaments 3. Transverse humeral ligament 4. Coracohumeral ligament 5. Secondary socket / ligament (Coracoacromial arch) 6. Glenoidal labrum 10© Dr.N.Mugunthan
11.
Capsule Loose fibrous covering Inner
surface lined with synovial membrane Attachments: Proximal attachments: Margins of glenoid fossa (proximal to glenoid labrum) Distal attachments: Anatomical neck of humerus (except inferiorly, extends to shaft for 1.25cm) 11© Dr.N.Mugunthan
12.
Glenohumeral ligaments : Three
: 1. Superior band 2. Middle band 3. Inferior band Seen on inner side of ant. part of capsule Accessory ligaments 13© Dr.N.Mugunthan
13.
Attachments : Proximally: (Glenoid)
All 3 bands attached to upper end of glenoid fossa Distal : (Humerus) Upper band – top of lesser tuberosity Middle band – lower part Lower band – shaft just below lesser tuberosity Glenohumeral ligaments cont… 14© Dr.N.Mugunthan
14.
Transverse humeral ligament Stretches
between tops of greater & lesser tuberosities Long head of biceps tendon passes out deep to this ligament 15© Dr.N.Mugunthan
15.
Coracohumeral ligament Attachment : Lateral
margin of root of coracoid process to Greater tuberosity of humerus All the accessory ligaments attach either lesser/greater tuberosity of humerus 16© Dr.N.Mugunthan
16.
Coracoacromial ligament (secondary socket) Triangular
band Base –attached to lateral margin of coracoid process Apex – attached to tip of acromion Coracoid process,ligament & acromion together form – coracoacromial arch Which forms secondary socket for the joint 17© Dr.N.Mugunthan
17.
Rotator cuff (Codman’s musculo-tendinous
cuff) Laxity & weakness of joint is compensated by this cuff Derived from tendons of – SITS 1. Supraspinatus 2. Infraspinatus 3. Teres minor 4. Subscapularis 18© Dr.N.Mugunthan
18.
Expansions from these tendons
fuse with capsule Strengthens the capsule all round (except inferiorly) Injury to rotator cuff – recurrent dislocation Rotator cuff cont… (Codman’s musculo-tendinous cuff) 19© Dr.N.Mugunthan
19.
Glenoidal labrum Fibro cartilaginous
ribbon like structure Attached to margins of the glenoid cavity Increase the depth of glenoid cavity Increase the articular surface of glenoid Lined with hyaline cartilage 21© Dr.N.Mugunthan
20.
Relations of shoulder
joint a) Muscles b) Bursae c) Vessels & nerves 24© Dr.N.Mugunthan
21.
a) Muscles: Anteriorly: • Subscapularis, coracobrachialis,
short head of biceps and deltoid. Posteriorly: • Infraspinatus, teres minor and deltoid. Relations of shoulder joint 25© Dr.N.Mugunthan
22.
a) Muscles: cont… Superiorly: •
Long tendon of biceps inside the capsule • Supraspinatus outside the capsule Inferiorly: • Long head of the triceps Deltoid – covers superiorly, anteriorly, posteriorly & laterally Relations of shoulder joint cont… 26© Dr.N.Mugunthan
23.
Subacromial (Subdeltoid) bursa: Lies
between deltoid muscle & capsule Does not communicate with joint Extends between supraspinatus and acromion & coracoacromial arch Longest bursa in the body b) Bursae related to shoulder joint cont… 30© Dr.N.Mugunthan
24.
Blood supply Arterial supply:
Anterior circumflex humeral artery Posterior circumflex humeral artery Suprascapular artery Circumflex scapular branch of Subscapular artery. Venous drainage : Corresponding veins 33© Dr.N.Mugunthan
25.
Nerve supply A twig
from lateral pectoral nerve Suprascapular nerve Axillary nerve (posterior division) 34© Dr.N.Mugunthan
26.
Movements @ shoulder
joint Flexion & extension Adduction & abduction Medial & lateral rotation Circumduction 35© Dr.N.Mugunthan
27.
Flexion & extension Transverse
axis : Flexion: • Pectoralis major (clavicular part), • Deltoid (anterior fibres) coracobrachialis • Assisted by biceps. Extension: • Deltoid (posterior fibres) • Teres major, • Latissimus dorsi and pectoralis major (sternocostal part) 36© Dr.N.Mugunthan
28.
Abduction & adduction Antero-posterior
axis Abduction: • Supraspinatus : 0-30° • Deltoid (middle fibers) 0-90° • Serratus anterior & trapezius: 90-180° Adduction: • Pectoralis major • Latissimus dorsi • Teres major • Corachobrachialis • Biceps (short head) 37© Dr.N.Mugunthan
29.
Medial & lateral
rotation Longitudinal axis Medial rotation: • Pectoralis major • Deltoid (anterior fibres) • Latissimus dorsi • Teres major and subscapularis. Lateral rotation: • Infraspinatus • Deltoid (posterior fibres) and teres minor. 38© Dr.N.Mugunthan
30.
Circumduction • Combination of
3 axis • Combination of all the muscles around shoulder 39© Dr.N.Mugunthan
31.
Applied anatomy • Referred
pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Supraspinatus Tendinitis • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty 40© Dr.N.Mugunthan
32.
Applied anatomy • Referred
pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Supraspinatus Tendinitis • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty 41© Dr.N.Mugunthan
33.
Applied anatomy • Referred
pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Supraspinatus Tendinitis • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty 42© Dr.N.Mugunthan
34.
Applied anatomy • Referred
pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Supraspinatus tendinitis & • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty 43© Dr.N.Mugunthan
35.
Applied anatomy • Referred
pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Supraspinatus Tendinitis • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty 44© Dr.N.Mugunthan
36.
Applied anatomy • Referred
pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Tendinitis • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty 45© Dr.N.Mugunthan
37.
Applied anatomy • Referred
pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Supraspinatus Tendinitis • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty 46© Dr.N.Mugunthan
38.
Take home message Shoulder
joint: • Type & variety • Articular surfaces • Ligaments • Relations • Blood & nerve supply • Movements • Applied anatomy 49© Dr.N.Mugunthan
39.
50© Dr.N.Mugunthan