CPT 2: ANATOMY - SHOULDER COMPLEX

REGIONS OF SHOULDER COMPLEX Shoulder Girdle Movement

● Shoulder Shoulder Girdle
● Elbow ➔ Elevation & depression
● Wrist & Hand ➔ Protraction & retraction
GENERAL FUNCTION ➔ Upward & downward rotation
➔ Provide very mobile, yet short base for hand to perform its ➔ Upward tilt
indicate gross & skilled functions Shoulder (Glenohumeral)
➔ Transmits loads from upper extremity to axial skeleton ● Flexion, extension, hyperextension
Bones of Shoulder ● Abduction, adduction, hyperadduction, hyperabduction
● Clavicle (collar bone) ● Medial rotation, lateral rotation, abduction, horizontal
● Scapula (shoulder blade) adduction
● Humerus (upper arm bone) Large range of motion due to:
Bones: 1. Poor bony structure
Scapula & Clavicle 2. Poor ligamentous restraint
➔ Move as a unit STRUCTURE AND FUNCTION OF SPECIFIC JOINT
➔ Clavicle’s articulation w/ sternum is only bony link to axial 1. Sternoclavicular joint – true joint
skeleton 2. Acromioclavicular joint – true joint
Key Bony Landmarks 3. Scapulothoracic joint – true joint
Anterior: 4. Glenohumeral joint – functional joint
● Manubrium 5. Coracoacromial arch – functional joint
● Clavicle Characteristics of True Joint
● Coracoid process a. Have joint space
● Acromion process b. Joint capsule
● Glenoid fossa c. Synovial membrane
● Lateral border d. Synovial fluid
● Inferior border e. Articular cartilage
● Medial border Sternoclavicular Joint:
Posterior: Bony Structure
● Acromion process ● Poor diarthrodial biaxial
● Glenoid fossa Capsule
● Lateral border ● Very strong
● Inferior angle Interclavicular Ligament
● Medial border ● Resists superior & anterior (posterior portion) motion
● Superior angle Sternoclavicular Ligament
● Spine of scapula ● Resists anterior (PSL), posterior (ASL) & superior motion

Inventor, Joanna Marie P. 1

CPT 2: ANATOMY - SHOULDER COMPLEX
Costoclavicular Ligament Accessory Structures
● Resists upward & posterior motion ● Articular disc
Accessory Structures CLAVICLE
● Resists medial & inferior displacement via articular contact ➔ Acts a strut connecting upper extremity to thorax
Motions ➔ Protects brachial plexus & vascular structures
● Axial rotation – 50 degrees ➔ Serves as attachment site for many shoulder muscles
● Elevation/Depression – 35 degrees Glenohumeral Joint:
● Protraction/Retraction – 35 degrees Humerus
● Inclination angle – 45 degree
Glenoid Fossa
● Inclination angle – 5 degree
● Retroversion angle – 7 degree
● Articular cartilage thicker on periphery
● Shallow fossa ⅓ diameter of humeral head
Bony Structure
● Pure rotation
● Bony restraint poor
● Head 4-5x larger than fossa
● Close-packed position – abduction with lateral rotation
Joint Capsule
● Inherently tax
Acromioclavicular Joint: ● Surface area 2x head
Bony Structure ● Provides restraint for abduction, adduction, lateral rotation,
● Poor diarthrodial nonaxial medial rotation
Joint Capsule Superior GH Ligament
● Very weak ● Resists inferior translation in rest/adducted arm
Acromioclavicular Ligament ● Well-developed in 50%
● Resists axial rotation & posterior motion Coracohumeral Ligament
Coracoclavicular Ligament ● Resists inferior translation in shoulders w/ less developed SGH
● Resists superior motion Middle GH Ligament
Motion: ● Great variability in proximal attachment & morphology
● Little relative motion at AC joint ● Absent in 30 %
● UR/DR – 60 degrees ● Resists inferior translation in abduction & ER
● elevation/depression – 30 degrees ● Resists anterior translation (45 degree abduction)
● protraction/retraction – 30-50 degrees

Inventor, Joanna Marie P. 2

CPT 2: ANATOMY - SHOULDER COMPLEX
Inferior GH Ligament Retraction
● 3 components (anterior, posterior, accessory) ● Rhomboids
● Resists inferior, anterior & posterior translation ● Trapezius
Bursae ● Levator scapulae
● Subcoracoid Protraction
● Subacromial ● Serratus anterior
● Subscapular ● Pectoralis minor
Accessory Structures Elevation
● 50% of depth ● Rhomboids
● Increases tangential stability 20 ● Trapezius
Scapulothoracic Joint ● Levator scapulae
● No osseous connection Depression
● SUBSSCAP & SA ● Trapezius
Coracoacromial Arch ● Pectoralis minor
Upward rotation
● Upper & lower Trapezius
● Serratus anterior
Downward rotation
● Rhomboids
● Pectoralis minor
● Levator scapulae
GLENOHUMERAL FLEXION
➔ Prime flexors:
MUSCULAR CONTRACTION ◆ Anterior deltoid
◆ Pectoralis major; clavicular portion
➔ Assistant flexors:
◆ Coracobrachialis
◆ Biceps brachii; short head
GLENOHUMERAL EXTENSION
➔ Gravitational force
➔ Posterior deltoid
➔ Latissimus dorsi
➔ Pectoralis major (sternal)
➔ Teres major (w/ resistance)

Inventor, Joanna Marie P. 3

CPT 2: ANATOMY - SHOULDER COMPLEX
Abduction at Glenohumeral Joint Posterior to joint:
Major abductors of humerus: ● Middle & posterior deltoid, infraspinatus, teres minor
➔ Supraspinatus ● Assisted by teres major, latissimus dorsi
◆ Initiates abduction MUSCLES THAT MOVE THE PECTORAL GIRDLE
◆ Active for 1st 110 degrees of abduction Anterior Thoracic Muscles
➔ Middle deltoid ● Pectoralis minor
◆ Active 90-180 degrees of abduction ● Serratus anterior
◆ Superior dislocating component neutralized by Posterior Thoracic Muscles
infraspinatus, subscapularis, and teres minor ● Trapezius
Adduction of Glenohumeral Joint ● Levator scapulae
Primary adductors: ● Rhomboid major
● Latissimus Dorsi
● Rhomboid minor
● Teres major
SCAPULA
● Sternocostal pectoralis
● a flat triangular bone that lies on the posterior chest wall
Minor assistance:
between the 2nd and 7th ribs
● Biceps brachii: short head
● The spine of the scapula projects backward
● Triceps brachii: long head
● The lateral end of the spine is free and forms the acromion,
● Above 90 degrees– coracobrachialis & subscapularis
which articulates with the clavicle
Glenohumeral Medial Rotation
● The superolateral angle of the scapula forms the pear-shaped
● Subscapularis
glenoid cavity, or fossa, which articulates with the head of the
● Latissmus dorsi
humerus at the shoulder joint
● Pectoralis major
● The coracoid process projects upward and forward above the
● Teres major (w/ resistance)
glenoid cavity and provides attachment for muscles and
Glenohumeral Lateral Rotation
ligaments
Primary:
HUMERUS
● infraspinatus
● Articulates with the scapula at the shoulder joint and with the
Assistant:
radius and ulna at the elbow joint
● Teres minor
● The upper end of the humerus has a head, which forms about
● Posterior deltoid
one third of a sphere and articulates with the glenoid cavity of
Horizontal Adduction and Abduction
the scapula
Anterior to joint:
AXILLA
● Pectoralis major (both heads), anterior deltoid,
● A pyramid-shaped space between the upper part of the arm
coracobrachialis
and the side of the chest
● Assisted by short head of biceps brachii

Inventor, Joanna Marie P. 4

CPT 2: ANATOMY - SHOULDER COMPLEX
● It forms an important passage for nerves, blood, and lymph
vessels as they travel from the root of the neck to the upper
limb
● The upper end of the axilla, or apex, is directed into the root of
the neck and is bounded in front by the clavicle, behind by
the upper border of the scapula, and medially by the outer
border of the first rib
WALLS OF THE AXILLA
Anterior wall (Figs. 9.12, 9.13, and 9.14)
➔ Pectoralis major
➔ Subclavius
➔ Pectoralis minor muscles
Posterior wall (Figs. 9.13, 9.14, 9.15, and 9.16)
➔ Subscapularis
➔ Latissimus dorsi
➔ Teres major muscles from above down
Medial wall (Figs. 9.14, 9.15, and 9.16)
➔ Upper four or five ribs
➔ Intercostal spaces covered by the serratus anterior muscle
Lateral wall (Figs. 9.14, 9.15, and 9.16)
➔ Coracobrachialis
➔ Biceps muscles in the bicipital groove of the humerus
ROTATOR CUFF MUSCLES
1. Subscapularis
2. Infraspinatus
3. Teres minor
4. Supraspinatus

Inventor, Joanna Marie P. 5