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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
⏎
⏎
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
⏎
Cerv
ical
ple
xus
C1-C
4
⏎
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§ion=content
Brachial Plexus
✪
✪
http://www.netteranatomy.com/ImageLibrary/
Arteries✓
✓
✓
✓
✓
✓
✓
✓
✓
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
1
2
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
13
2
1.) Subscapularis
Origin: 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
1
2
3
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
1
2
3
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 minor
Origin: 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 Anterior
Origin: 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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2
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?