Shoulder Region

Clinical Anatomy of Upper Limb

1. UL: Shoulder Region Lecture 1 Maryna Kornieieva, PhD, MD Asst . of Clinical Anatomy

2. Learning objectives: 1. Overview: UL regions 2. Pectoral girdle 3. Osteology: clavicle, scapula, humerus 4. Shoulder joint: N and P 5. Muscles of “Rotator Cuff” Basic MRI anatomy of GH joint 7 . Anterior axio - appendicular mm. 6. Posterior axio - appendicular mm. 8. Shoulder as a functional unit

3. Segments, Bones and Regions of the UL

4. Pectoral Girdle: Bones and Joints Sternoclavicular joint (SC) Acromioclavicular joint (AC) Glenohumeral ( Shoulder joint) Sternum Clavicle Scapulae Humerus Type: Synovial plane Type: Synovial ball-and-socket Type: Synovial saddle

5. Clavicle : C linical C onsideration https:// youtu.be /nxiWfbU5Mjs S ternal end A cromial end 1 2 3 4 5 Ligaments: 1. - interclavicular , 2. – sternoclavicular, 3. - costoclavicular , 4. – coracoclavicular ( conoid and trapezoid parts), 5. – acromioclavicular. Subclavian vein and artery Brachial plexus Pleura N F

6. Clavicle: Fracture

7. Sternoclavicular Joint (SC) SC Anterior dislocation SC Posterior dislocation: MRI Clavicle S ternum 1 st rib Ligaments: Interclavicular lig . (1); Sternoclavicular lig . (2 ); Costoclavicular lig . (3). Articular disc 1 2 3 Retraction , protraction Posterior rotation Elevation, depression

8. Acromioclavicular joint: Shoulder Separation Grades of shoulder separation C oracoclavicular lig . N Acromioclavicular lig .

9. Anatomy of Scapula https:// youtu.be /l1LYGizECN0 S pine C oracoid process S ubscapular fossa S upraspinous fossa I nfraspinous fossa G lenoid cavity A cromion G lenoid cavity

10. 1. Suprascapular notch, 2. Coracoid process, 3. S uperior transverse scapular ligament, 4. Suprascapular a., 5. Suprascapular nerve, 6. Supraspinous fossa, 7. Spine of scapula, 8. Spinoglenoid notch, 9. Inferior scapular ligament, 10. Acromion. Anatomy of Scapula Suprasapular notch Spinoglenoid notch C oraco -acromial arch: s ub-acromial arch; s ub- coracoacromial arch . a b

11. Humerus and Glenohumeral joint Humeral shaft Proximal Humerus - Anterior view Humeral head Anatomic neck Lesser tuberosity Greater tuberosity Intertrubercular sulcus/ bicipital groove Surgical neck M: abduction, adduction, flexion, extension, med/lat. rotation, circumduction. Labral tear: https:// youtu.be /4-p0qcZ8MeY

12. Ligaments of GH joint Gleno -humeral ligaments Coraco -acromial Transverse h umeral Anterior dislocation: Posterior dislocation Coraco -humeral

13. Reduction of Anterior Shoulder Dislocation Classical Kocher technique

14. Muscles Connecting Scapula to the Humerus 1. Supraspinatus 2 . Infraspinatus 3 . Teres minor 1 2 3 1 2 3 Origin: Insertion: “Rotator cuff” muscles

15. 4. Subscapularis Muscles Connecting Scapula to the Humerus Origin: Insertion: “Rotator cuff” muscles Rotator cuff tear Rotator cuff tendinitis

16. Basic MRI Anatomy of GH joint MRI of the shoulder showing normal appearance of joint and tendons of the “rotator cuff” muscles a round the head of the humerus, as well as the biceps tendon within the joint capsule. A) coronal plane; B) a xial plane. Rotator-cuff tear. MRI, T2 weighted sequence (fluid sensitive) A B C Understanding the MRI signals: - dark - - intermediate - - bright - A B T1 T2

17. Other ScapuloHumeral Muscles Origin: Insertion: Origin: Insertion: 6 . Coracobrachialis 5 . Teres major

18. Deltoid Origin: Insertion: To initiate movement during the first 15° of abduction, the deltoid is assisted by the supraspinatus.

19. Posterior Axio -Appendicular Muscles Superficial: 3. Trapezius 4. Latissimus dorsi Intermediate : Levator scapulae R homboids (minor and major) 1 2 3 4 Upward rotation/ Downward rotation Protraction / Retraction Elevation / Depression

20. A nterior Axio -Appendicular M uscles 1. Pectoralis major 2. Pectoralis minor 4 . Subclavius 3 . Serratus anterior

21. Shoulder as a Unit: Scapulo -humeral mechanism

22. Thank you for your attention!!!

23. Trapezius Origin: Origin: Insertion: Upper part Lower part Elevates scapula Depresses scapula Retract scapula Innervation: Spinal Accessory nerve (CN XI)

24. Latissimus D orsi Origin: Insertion:

25. Levator Scapulae and Rhomboids Levator scapulae Origin: Origin: Insertion: Insertion: C7-T1 T2-T5