2. shoulder joint & its applied anatomy 07[1]

1. Shoulder Joint & Its Applied Anatomy By - Nazeem Naheed - Suhada Zawawi Fatimah Az Zaharah Suhaimi Nur Izzaty Abdul Rahim

2. Introduction

3. - Articulation Between rounded head of humerus and shallow, pear-shaped glenoid cavity of scapula. Articular surface covered by hyaline articular cartilage. Glenoid cavity is deepened by glenoid labrum ( fibrocartilaginous rim).

4. - Type Synovial ball-and-socket joint. Capsule Surrounds joint and attached : Medially to the scapula beyond the supraglenoid tubercle and the margins of the labrum . Laterally to the anatomical neck of humerus . Thin and lax, allow wide range of movement. Strengthened by slips of tendons of subscapularis m., supraspinatus m., infraspinatus m. & teres minor (rotator cuff muscles).

5. - Ligaments Glenohumeral Ligament 3 weak bands (superior, middle & inferior) of fibrous tissue that strengthen the anterior (front) of capsule. Transverse humeral Ligament Bridge the upper part of bicipital grooves of humerus (between greater and lesser tubercles). Tendon of long head biceps brachii passes deep to it. Coracohumeral Ligament Strecthes from root of the coracoid process of scapula to greater tuberosity of humerus . Strength the capsule above. Coracoacromial Ligament Accessory ligament . Extends between coracoid process of scapula and acromion . Protects the superior aspect of joint.

6. - Bursae Related To The Joint Subacromial ( Subdeltoid ) bursa Subscapularis bursa Infraspinatus bursa

7.   - Synovial Membrane Lines capsule and is attached to the margins of the cartilage covering the articular surface. Extends through the anterior wall of the capsule to form the subscapularis bursa beneath the subscapularis muscle. Forms tubular sheath around the tendon of the long head biceps brachii .

8.  - Blood Supply Anterior circumflex humeral vessels Posterior circumflex humeral vessels Suprascapular vessels Subscapular vessels

9.  - Blood Supply

10.  - Nerve Supply Axillary nerve Suprascapular nerve Musculocutaneous nerve

11. - Relations Superiorly Supraspinatus m. Subacromial bursa Coracoacromial ligament Deltoid m. Inferiorly Long head triceps brachii m. Axillary nerve Post. circumflex humeral vessels Anteriorly Subscapularis m. Coracobrachialis Short head of biceps brachii Deltoid Posteriorly Infraspinatus Teres minor Deltoid Within the joint - Tendons of long head biceps brachii

12. Movements

13. Flexion – Arm moves forwards & medially . Extension – Arm moves backwards & laterally. - Flexion & Extension MAIN ACCESSORY MOVEMENT

14. Abduction – Arm moves away from trunk. Adduction – Arm moves towards the trunk. - Abduction & Adduction MAIN ACCESSORY MOVEMENT

15. Medial rotation – Hand moves medially . Lateral rotation – Hand moves laterally . - Medial & Lateral Rotation MAIN ACCESSORY MOVEMENT

16. Combination of dif. movements, results in hand moving along a circle . - Circumduction

17. Applied Anatomy Dislocation is an injury to your joint in which the ends of your bones are forced from their normal positions. This injury temporarily deforms and immobilizes your joint and may result in sudden and severe pain. The shoulder is more prone to dislocate than any other joint. This due to : laxity of the capsule Disproportionate area of articular surfaces Occurs when the arm is abducted 3 types of shoulder joints: Glenohumeral joint Acromioclavicular joint Sternoclavicular joint

18. Applied Anatomy Dislocation of glenohumeral joint Glenohumeral joint Extremely mobile Providing wide movement at the expense of stability Relatively small bony glenoid cavity Supplemented by : Robust fibrocartilagious glenoid labrum Ligamentous support Make it susceptible to dislocation Divided into : Anterior dislocation Posterior dislocation

19. Applied Anatomy Anterior dislocation Occurs most frequently. Usually associated with an isolated traumatic incident. Clinically, all anterior dislocation are anteroinferior . Once joint capsule and cartilage disrupted Joint is susceptible to further (recurrent) dislocation When dislocation occurs, During abduction, the head of humerus presses against the lower unsupported part of capsular ligament Thus, almost always the dislocations primarily subglenoid,later it may become subcoracoid,subclavicular or subspinous . Dislocations ends with : Axillary nerve injured (by direct compression of humeral head on the nerve inferiorly as it passes through quadrangular space) Lengthening effect of humerus may stretch the radial nerve which cause radial nerve paralysis

20. Applied Anatomy Occasionally, anteroinferior dislocation associated with fracture and require surgical reduction. Posterior dislocation Rare Most common cause : Extremely vigorous muscle contraction associated with An epileptic seizure caused by electrocution

21. Applied Anatomy Fractures of the clavicle and dislocations of the acromioclavicular and sternoclavicular joints Its relative size and the potential forces that it trasmits from the upper limb to the trunk, it is not surprising that it is often fractured. The typical site of fracture is the middle third. The medial and lateral thirds are rarely fractured. The acromial end of the clavicle tends to dislocate at the acromioclavicular joints with trauma The outer third of the clavicle is joined to the scapula by the conoid and trapezoid ligaments of the coracoclavicular ligament. Minor injury, tends to Tear the fibrous joint capsule and ligaments of the acromioclavicular joint resulting Acromioclavicular separation on a plain radiograph

22. Applied Anatomy More severe trauma disrupt the conoid and trapezoid ligaments of coracoclavicular ligament results in elevation and upward subluxation of the clavicle The typical injury at the medial end of the clavicle is an anterior or posterior dislocation of the sternoclavicular joint. Importantly, a posterior dislocation of the clavicle may impinge on the great vessels of the superior mediastinum and compress or disrupt them.

23. SHOULDER TIP PAIN Irritation of the diaphragm from any surrounding pathology causes referred pain in the shoulder This is so because the phrenic nerve and supraclavicular nerves both arise from spinal segment C3,C4 FROZEN SHOULDER / ADHESIVE CAPSULITIS Is a disorder in which capsule and CT surrounding the glenohumeral joint becomes inflamed and stiff, and grows together with abnormal bands of tissue, called adhesions, greatly restricting motion and causing chronic pain The patient may recover spontaneously in about 2 years

24. INFLAMMATION OF THE SUBACROMIAL (SUBDELTOID) BURSA Subacromial Bursa  between supraspinatus and deltoid muscles laterally and acromion medially Supraspinatus tendinopathy -this bursa may become inflamed, making movements of the glenohumeral joint painful Treated by injection of corticosteroid

25. CLINICAL CASE A 35-year-old baseball pitcher came to the clinic with a history of a recurrent dislocation of the shoulder. An MRI scan was performed to assess the shoulder joint prior to any treatment. The MRI demonstrates the anatomical structures in multiple planes,allowing the physician to obtain an overview of the shoulder and to assess any structures that may have been damaged and require surgical repair The MRI findings are typical for an anterior inferior dislocation These injuries include the abutment of the posterior superior aspect of the humeral head on the anterior inferior aspect of the glenoid cavity

26. Continued… This type of injury (when recurrent) may avulse a small fragment of the glenoid labrum and some cases this may attach to a small fragment of bone (the Bankart lesion). When the shoulder is relocated, the intergrity of the capsular atttachment antero -inferiorly has been disrupted and make it more prone to dislocate An arthroscopic repair was performed ( is surgery that uses a tiny camera called an arthroscope to examine or repair the tissues inside or around shoulder joint. The arthroscope is inserted through a small incision (cut) in your skin)

27. Thank You!