Applied Anatomy of The Shoulder Common Shoulder Conditions

▪ Fractured clavicle
▪ SC Joint Dislocation
▪ AC Joint Dislocation
▪ Glenohumeral Instability
▪ Rotator cuff tear
▪ Rotator cuff tendonitis
▪ Impingement Syndrome
▪ Frozen shoulder
Dr. Alistair Hunter ▪ Glenohumeral arthritis

Shoulder Pain Prevalence (%) Top 3 in middle age

Mario Pribicevic (2012). The Epidemiology of Shoulder Pain: A Narrative Review of the Literature
Top three > 45 years Common Shoulder Conditions

▪ Fractured clavicle
▪ SC Joint Dislocation
▪ AC Joint Dislocation
▪ Glenohumeral Instability
▪ Rotator cuff tear
▪ Rotator cuff tendonitis
▪ Impingement Syndrome
▪ Frozen shoulder
▪ Glenohumeral arthritis

Clavicular Fracture Clavicular Fracture

 Common Shoulder Conditions Sternoclavicular Joint

▪ Fractured clavicle
▪ SC Joint Dislocation
▪ AC Joint Dislocation
▪ Glenohumeral Instability
▪ Rotator cuff tear
▪ Rotator cuff tendonitis
▪ Impingement Syndrome
▪ Frozen shoulder
▪ Glenohumeral arthritis

Sternoclavicular Joint Sternoclavicular Joint

▪ synovial (articular disc)
▪ sup-inf movement (60o)
▪ ant-post movement (20o)
▪ ant.& post. sternoclavicular ligs.
▪ inter-clavicular ligament
▪ costoclavicular ligament
▪ blood supply - clavicular branch
of thoracoacromial artery,
internal thoracic artery
▪ nerve supply - nerve to
subclavius & medial
supraclavicular nerve
 Sternoclavicular Joint: Dislocations Common Shoulder Conditions
▪ Although rare, posterior
sternoclavicular ▪ Fractured clavicle
dislocations may be life- ▪ SC Joint Dislocation
threatening emergencies. ▪ AC Joint Dislocation
The clavicle may
compress or lacerate a ▪ Glenohumeral Instability
lung, a great vessel, the ▪ Rotator cuff tear
trachea, or the ▪ Rotator cuff tendonitis
oesophagus. ABC’s.
▪ Impingement Syndrome
▪ usually caused by an
MVA, sports, or a fall, with ▪ Frozen shoulder
a force to the shoulder ▪ Glenohumeral arthritis

Acromioclavicular Joint Acromioclavicular Joint

▪ small area of contact
▪ synovial (may have disk)
▪ lax capsule
▪ acromioclavicular lig.
▪ blood supply - suprascapular art. & post.
circumflex hum. & acromial br. of thoracoacromial
art.
▪ nerve supply - axillary, suprascapular, lateral
pectoral
▪ coracoclavicular lig. (conoid & trapezoid)
 AC Injuries: Trauma
Mechanism -- downward blow to
the lateral shoulder or fall on an
outstretched arm
Glenohumeral Joint Dislocation
Common Shoulder Conditions
▪ Fractured clavicle
▪ SC Joint Dislocation
▪ AC Joint Dislocation
▪ Glenohumeral Instability
▪ Rotator cuff tear
▪ Rotator cuff tendonitis
▪ Impingement Syndrome
▪ Frozen shoulder
▪ Glenohumeral arthritis
The Y-View
Scapulothoracic Movement Scapular Rotations

Bony Factors for Stability Shoulder Instability

 Pathologies: Avascular Necrosis Pathologies: Avascular Necrosis

Hass’ disease “The snowcap sign”

Common Shoulder Conditions Glenoid Labrum Tear

▪ Fractured clavicle
▪ SC Joint Dislocation
▪ AC Joint Dislocation
▪ Glenohumeral Instability
▪ Rotator cuff tear
▪ Rotator cuff tendonitis
▪ Impingement Syndrome
▪ Frozen shoulder
▪ Glenohumeral arthritis
 Rotator Cuff Tears Common Shoulder Conditions

▪ Progressive ▪ Fractured clavicle

thinning and ▪ SC Joint Dislocation
weakening with ▪ AC Joint Dislocation
▪ Glenohumeral Instability
age
▪ Rotator cuff tear
▪ Potential damage ▪ Rotator cuff tendonitis
to cuff during ▪ Impingement Syndrome
elevation of the ▪ Frozen shoulder
▪ Glenohumeral arthritis
humerus

Subacromial Roughness Calcific Tendonitis

 GHJ “Impingement” Syndrome Acromial Spur
Occurs when a bursae/ tendon is squeezed between moving
▪
structures ▪ Greater
» supraspinatus is commonly impinged
▪ Sports that emphasize overhead arm movements show a
tuberosity
relative high incidence of these injuries.
reactive
changes

▪ Acromial
spur

Shoulder Pain Common Shoulder Conditions

▪ Fractured clavicle
▪ SC Joint Dislocation
▪ AC Joint Dislocation
▪ Glenohumeral Instability
▪ Rotator cuff tear
▪ Rotator cuff tendonitis
▪ Impingement Syndrome
▪ Frozen shoulder
▪ Glenohumeral arthritis
 “Frozen Shoulder” Inflammation and Adhesions
▪ “Adhesive Capsulitis”
▪ Definition - Symptomatic
limitation of passive
motion in a shoulder
▪ Cause – Thickening and
stiffening of joint capsule
after inflammation
▪ X-rays of frozen
shoulders should show
no evidence of arthritis,
calcium deposits or other
abnormalities.

Frozen Shoulder Peak age = 55 years

Four Types (etiologies) of Stiffness

» Idiopathic Frozen Shoulder

» Diabetic Stiff Shoulder
» Post-Traumatic Stiff Shoulder
» Post-Surgical Stiff Shoulder
 Common Shoulder Conditions Arthritis of the Shoulder

▪ Fractured clavicle
▪ SC Joint Dislocation
▪ AC Joint Dislocation
▪ Glenohumeral Instability
▪ Rotator cuff tear
▪ Rotator cuff tendonitis
▪ Impingement Syndrome
▪ Frozen shoulder
▪ Glenohumeral arthritis

Pathologies: Rheumatoid Arthritis Pathologies: Osteoarthritis