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Shoulder region and extrinsic

back muscles

Dr. Oladiran Olateju

oladiran.olateju@wits.ac.za
x72763
Room 2B40
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Lecture Outline
• Shoulder Region • Back
• Shoulder Joint • Joint (vertebral joints)
• Acromioclavicular Joint • Extrinsic back muscles
• Muscles • Superficial
• Innervations and actions • intermediate
• Deep
• Scapular anastomosis
• Spaces
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Format for describing synovial joints

• Joint classification and type of

joint
• Articulating bones & their
articular surfaces
• Articular capsule
• Ligaments
➢ Intra-& Extra- capsular
• Synovial membrane
• Bursae
• Vascular supply & innervation
• Movements & Muscles
producing movements
• Stability
• Applied Anatomy (dislocation or
disease)

Glenohumeral (Shoulder) Joint
. Classification:
• Synovial joint
• Diarthrosis joint
• Type: Ball & Socket.
Articulating Surfaces
• Head of humerus (H)
• Glenoid fossa of scapula (S)
• Glenoid labrum increases the
concavity of the fossa
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Classification by type of tissue:
Fibrous – bones connected by fibrous tissue.
Cartilaginous – bones connected by cartilage.
Synovial – articulating surfaces enclosed within a fluid-filled joint capsule.
Classification by degree of movement:
Synarthrosis – immovable (e.g. fibrous joint)
Amphiarthrosis – slightly moveable (e.g. symphysis joint)
Diarthrosis – freely moveable (synovial joint).
***Each class of joint has different types
H S
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Articular capsule (AC)

• Thin fibrous membrane

AC
attached to margin of glenoid
fossa & around anatomical
neck of humerus
• Deficient inferiorly

• Synovial membrane lines the

inner wall of the fibrous
capsule
• Supported by SITS tendons
Ligaments

• Glenohumeral
• 3 bands (superior, middle & inferior glenohumeral ligaments), visible from within joint
• Transverse humeral
• Coracoacromial
• strong accessory ligament.
• medial border of acromion to lateral border of coracoid
• Coracohumeral
• Strong ligament that blends with the fibrous capsule
• From inferior surface of coracoid process to margin of greater tubercle of humerus
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Bursae
• Several (8)
• Located where a tendon rubs
against a bone, ligament or
tendon

• Subacromial (or subdeltoid)

• Highly pain sensitive
• Large & under coracoacromial
ligament, acromiom & deltoid
muscle

• Does not communicate with

the synovial cavity
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Interior of shoulder joint

Note:
1. Glenoid labrum
2. Tendon of long head
of biceps
(intracapsular)
3. SITS muscles
4. Bursa
 Acromioclavicular Joints
• Synovial
• Plane type
• Articulations: btw the acromial
end of clavicle and the clavicular
facet of the acromion of scapula
• Fibrocartilaginous cartilage with
incomplete articular disc
• Ligament:
– Intrinsic: Superior& inferior
acromioclavicular ligaments T
C
– Extrinsic: Coracoclavicular ligament
(with conoid (C) and trapezoid (T)
parts)
• Movements:
– Gliding & sliding producing
• protraction-retraction,
• elevation-depression, and
• axial rotation
• Muscles:
– No specific muscle act on this joint
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Vascular Supply

• Anterior & posterior

circumflex humeral
• Suprascapular
• Subscapular (circumflex
scapular branch)
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• Articular branches from:

- Axillary nerve
- Suprascapular nerve
- Lateral pectoral nerve
Nerve Supply
• Hilton’s Law - The motor nerve to a muscle tends
to give a branch/twig to the joint which the muscle
moves and another to the skin over the joint.
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Movements at the Shoulder Joint

http://bestperformancegroup.com/
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Movements & Muscles producing movements

Movement Muscles Involved (Prime movers and synergists)

Abduction Deltoid, Supraspinatus- initiates movement (first 15° degrees)

Adduction Pectoralis major, Latissimus dorsi, (Teres major, long
head of triceps, Subscapularis, Infraspinatus)
Flexion Pectoralis major, Deltoid, (Coracobrachialis, biceps
brachii)
Extension Deltoid, (Teres major, Latissimus dorsi, long head of of
triceps, Pectoralis major)
Medial Rotation Subscapularis, (Pectoralis major, Deltoid, Latissimus
dorsi)
Lateral Rotation Infraspinatus, (Deltoid, Teres minor)

Circumduction Combination of all movements above

*Endeavour to recall the prime movers

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Factors for Stability

➢Glenoid labrum
➢ increase concavity
➢Coracoacromial arch
• coracoid process, coracoacromial
ligament & acromion prevent upward
dislocation
➢Tendons of
➢ Long head of biceps provides
additional superior support
➢ Rotator cuff muscles provide
congruency and strong lateral stability
➢ Long head of triceps provides inferior
support especially during abduction
➢Ligaments
➢ Glenohumeral, coracoacromial,
coracohumeral
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Applied Anatomy Shoulder Joint

✓Most frequently dislocated joint

✓Dislocation (especially in
violent abduction) occurs
towards inferior aspect which is
devoid of muscles
H
✓Axillary nerve S
• prone to tear in injury at surgical
neck of humerus
• close relation to inferior aspect of
articular capsule
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Muscles of posterior scapular region

Supraspinatus and infraspinatus

- Originate from the two large on the

posterior surface of the scapula.
- They insert on the greater tubercle
of the humerus.

Teres minor and teres major

Long head of triceps brachii

Deltoid
- large and triangular in shape, with
its base attached to the scapula &
clavicle and its apex attached to the
humerus
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The back (extrinsic)

• Bones – Vertebral Column,
Scapula and ribs
• Joints
• Intervertebral Joints at body of
vertebra
• Vertebral arch
• Superior and Inferior facets
• Muscles
• Superficial &
• Intermediate groups
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The back muscles

Superficial (extrinsic) – movers of the shoulder
e.g. trapezius, latissimus dorsi, rhomboid
major, rhomboid minor, and levator scapulae.
Intermediate (extrinsic) – movers of the thoracic
cage
e.g. serratus posterior superior and inferior
Deep (intrinsic) – movers of the vertebral column.

conceptart.org Superficial and intermediate layers Sabotta

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Superficial Muscles of Back

• Trapezius
• Latissimus dorsi

• Triangle of auscultation
• Latissimus dorsi, trapezius &
medial border of scapula
• Post segments of lungs
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Superficial Muscles of Back – cont’d

• Levator scapulae
• Rhomboid minor
• Rhomboid major
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Superficial and intermediate muscles of Back – cont’d

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Anastomosis around scapula

• What is an Anastomosis?
1. Transverse cervical artery (from
thyrocervical trunk) of subclavian
artery.
• Gives off dorsal scapular artery
2. Suprascapular artery (from
thyrocervical artery)
3. Subscapular artery (from Axillary
artery) divides into
• circumflex scapular and
thoracodorsal
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Quadrangular Space
• Boundaries
❖Superior: Teres minor
❖Inferior: Teres major
❖Lateral: Surgical neck of
humerus
❖Medial: Long head triceps
• Contents
❖Axillary nerve
❖Posterior circumflex
humeral artery
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Triangular Space - Upper

• Boundaries
❖Lateral: Long head
of triceps
❖Superior: Teres minor
❖Inferior: Teres major
• Contents
❖Circumflex scapular
artery
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Triangular Space - Lower

Boundaries
• Above - subscapularis
anteriorly and teres major
posteriorly
• Medially - long head of
triceps
• Laterally - humerus
Contents
• Radial nerve
• Profunda brachii vessels
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Questions!!!
• With the aid of a table, list the movements at the
shoulder joint and the muscles producing each
movement.
• Describe the shoulder joint.
• List the factors that stabilize the shoulder joint.
• List the arteries involved in the scapular
anastomosis.
• What are the boundaries and contents of the
quadrangular and triangular spaces.
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Thank you!!!!