Shoulder Anatomy Summary

Shoulder:
Bones:
Clavicle the only bony attachment between upper limb and trunk/axial skeleton. Lateral head is more flat than sternal head. Has a conoid tubercle and trapezoid line on the lateral side for the coracoclavicular ligament. Scapula Large, flat and triangular with an acromion process, coracoid process and spine. Has a glenoid cavity for articulation with humerus and is the site of attachment for many muscles. Humerus proximally consists of a head to articulate with glenoid cavity, and a greater and lesser tubercle which are attachments for the rotator cuff muscles. Has 2 necks: surgical (below the tubercles, around the shaft) and anatomical (between tubercles and head), the surgical neck is important because fractures here may damage the axillary nerve and the posterior circumflex humeral artery. Sternoclavicular synovial, saddle shaped. Reinforced by 4 ligaments: anterior +posterior sternoclavicular ligaments, interclavicular ligament and costoclavicular ligament. Acromioclavicular small synovial joint, surrounded by joint capsule and reinforced by 2 ligaments: acromioclavicular ligament and coracoclavicular ligament (consists of trapezoid ligament and conoid ligament together. Glenohumeral synovial ball and socket joint, providing wide range of motion (mult-axial). Shallow joint (deepened slightly by a fibrocartillagenous collar called the glenoid labrum), and is therefore unstable. Synovial membrane forms many bursa, the most important of which is the subtendinous bursa of subscapularis. Fibrous membrane of the joint capsule is thickened by 5 ligaments: superior, middle and inferior glenohumeral ligaments, coracohumeral ligament, transverse humeral ligament. Joint stability is mainly provided by rotator cuff.

Joints:

Muscles:
Muscle Trapezius Origin Superior nuchal line, Spinous processes C8T12 Insertion Superior edge of the spine scapula, acromion and lateral 1/3rd of clavicle. Innervation Motor = spinal part of accessory nerve Sensory = C3 and C4. Action Elevates scapula (middle fibres retract scapula and lower fibres depress it.

Deltoid

Levator Scapulae

Inferior edge of spine of scapila, acromion and lateral 1/3rd of clavicle Transverse process of C1 and C2 and posterior tubercles of C3 and 4 Lower end of ligamentum nuchae and spinous processes of C7 and T1 vertebrae Spinous processes of T2-5 and related spinous ligaments Oval area on posterior surface of inferior angle of scapula Medial 2/3rds of subscapular fossa Medial 2/3rds of supraspinous fossa Medial

Deltoid tuberosity on humerus.

Axillary nerve

Abducts arm beyond initial 15 degrees done by supraspinatus Elevates scapula

Posterior surface of medial border of scapula from superior angle to root of spine Posterior surface of medial border of scapula at root of spine of scapula. Posterior surface of medial border of scapula from the root of spine of scapula to inferior angle Medial lip of the intertubercular sulcus on the anterior surface of the humerus Lesser tubercle of humerus

Rhomboid Minor

Branches directly from anterior rami of C3 and C4 spinal nerves and by dorsal scapular nerve Dorsal Scapular nerve (C4,C5)

Elevates and retracts scapula

Rhomboid Major

Dorsal scapular nerve (C4,5)

Elevates and retracts scapula.

Teres Major

Inferior subscapular nerve (C5,6,7)

Medial rotation and extension of the arm at glenohumeral joint. Rotator cuff muscle, medially rotates arm at glenohumeral joint. Rotator cuff muscle, initiates abduction of arm to 15 degrees Rotator cuff

Subscapularis

Upper and lower subscapular nerves (C5,C6,C7) Suprascapular nerve

Supraspinatus

Superior facet on greater tubercle of humerus

Infraspinatus

Middle facet on Suprascapular

2/3rds of infraspinous fossa

greater tubercle of humerus

nerve

Teres Minor

Upper 2/3rds or a flat strip of bone on posreior surface of scapula Spinous processes of lower six thoracic vertebrae and related interspinous ligaments Lateral surfaces of upper 8-9 ribs and deep fascia overlying the related intercostal spaces

Inferior facet on greater tubercle of humerus

Axillary nerve

Latissimus Dorsi

Floor of Thoracodorsal intertubercular nerve (C6,7,8) sulcus

muscle, lateral rotation of the arm at the glenohumeral joint Rotator cuff muscle, lateral rotation of arm at glenohumeral joint. Adduction, medial rotation and extension of the arm at the glenohumeral joint Protraction and rotation of the scapula, keeps medial border and inferior angle of scapula opposed to thoracic wall. Flexion, adduction and medial rotation of arm

Serratus Anterior

Costal surface of medial border of scapula

Long thoracic nerve (C5,6,7)

Pectoralis Major Clavicular head: anterior surface of medial half of clavicle Sternocostal head: anterior surface of sternum and first 7 costal cartilages Pectoralis Anterior Minor surfaces and superior borders of ribs 3-5

Lateral lip of intertubercular sulcus of humerus

Medial and Lateral Pectoral nerves.

Coracoid process of scapula

Medial pectoral nerve

Pulls tip of shoulder down

Subclavius

First rib at junction between rib and costal cartilage

Groove on Nerve to inferior subclavius surface of middle 1/3rd of clavicle.

Pulls tip of shoulder down and pulls clavicle medially to stabilise joint

Nerves:
Suprascapular nerve originates from superior trunk of brachial plexus. Innervates supraspinatus, then passes through greater scapular notch to terminate in the infraspinatus muscle. Axillary nerve originates from posterior cord of brachial plexus. Exits the axilla by passing throgh quadrangular space. Innervates the deltoid and teres minor muscles. Also gives off superior lateral cutaneous nerve of the arm. Suprascapular artery branchof the thyrocervical trunk, enters posterior shoulder above the suprascapular foramen, then supplies supraspinatus and infraspinatus, as well as other things. Posterior circumflex humeral artery leaves through the quadrangular space with the axiallary artery the vessel supplies the muscles of the posterior scapular region and the glenohumeral joint. Circumflex scapular artery leaves axilla through the triangular space and forms anastomotic connections with other areas in the region. Quadrangular Space o Borders: Inferior margin of teres minor, medial border of humerus, superior margin of teres major and lateral margin of long head of triceps brachii o Contents: Axillary nerve and posterior circumflex humeral artery Triangular Space o Borders: Medial margin of long head of triceps brachii, superior margin of teres major and inferior margin of teres minor o Contents: Circumflex scapular artery and vein Triangular Interval o Borders: Lateral margin of long head of triceps brachii, shaft of humerus and inferior margin of teres major o Contents: Radial Nerve, Profunda brachii artery and veins

Blood Supply:

Spaces: