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076 Biome Anat Shoulder
076 Biome Anat Shoulder
Glenohumeral joint
Bony anatomy
Average radius 26.9mm in men
Bony contact 35% of humeral head
Total contact (labrum included) 75% of humeral head
Socket depth: horizontal=5mm(+60% by labrum); vertical=9mm(+50% by
labrum)
Humerus retroverted 20 to 35o; upward 45o
Scapular axis anteverted 30o, but glenoid to scapular axis angle varies fron 7o
retroversion to 10o anteversion
Labrum
Average socket depth doubled by labrum
Dense fibrous tissue, no chondrocytes
Labrum attached directly to biceps
Vertical passive stability = 2x horizontal (effect of socket depth)
Labrum contributes 20% of passive resistance to translation
Capsule
On scapula 1cm beyond labrum
On humerus to anatomic neck; inferiorly doun to surgical neck
Intraarticular vacuum important to stability
Glenohumeral ligaments – thickenings of capsule; constant in presence, variable in size
Superior glenohumeral ligament
From labrum anterior to biceps at base of coracoid
To superior and medial part of lesser tuberosity
Middle glenohumeral ligament
Most variable in size
From inferior to sup glenohum lig
To anatomic neck on medial part of lesser tuberosity
Inferior glenohumeral ligament
The thickest
Broad: anterior, inferior and posterior parts
Anterior margin thick, called Superior band; to anatomic neck
Rest thin, called axillary pouch; posteriorly to surgical neck
Ligamentous resistance to external rotation
In neutral all ligaments slack, but there is some tension in SGHL&MGHL
In neutral abduction + ER the MGHL and superior band of IGHL tighten
In 45o abduction superior band of IGHL tight
In 90o abduction major strain in superior band of IGHL
Coracohumeral ligament
The most consistent capsular ligament
From lateral base of coracoid process
Over the rotator interval
To lesser and greater tuberosities (forms part of the roof of the bicipital sheath
Coracoacromial ligament
Passive restraint to humeral superior translation in rotator cuff deficient shoulders
Scapulothoracic articulation
Loose areolar tissue
Sternoclaicular joint
Clavicle – if excised, stability preserved by posterior sheath and muscular attachments
Large clavicular facet + small sternal facet + small 1st rib facet
Articular disc attached to clavicle superiorly and 1st rib inferiorly
Costo-clavicular ligaments + strong anterior/weak posterior sterno-clavicular ligaments
Acromioclavicular joint
Unique ligamentous arrangement: other than superior acromio-clavicular capsular
ligament, the other ligamentous stabilizers are 2cm away (coraco-clavicular
ligaments)
Conoid ligament: stability against anterior and superior displacement of clavicle
Trapezoid ligament: less important
Scaption: elevation in the plane of the scapula (30 to 40o anterior to coronal plane)
Elevation: 168o men/175o women (1/3 scapulo-thoracic & 2/3 gleno-humeral)
Glenohumeral rhythm: during first and last 30o of elevation humerus moves bur scapula
does not
Scapulothoracic mobility
Largest arc: upward rotation = 60o
Elevation-depression; retraction-protraction