20

R e g i o n a l O r t h o p a e d i c

Lesions of
Tissue
Soft Shoulder, Elbow
Neck,

Wrist and Hand

Forearm,
at the elbow
Soft Hissue inJurles
acqured Tennis elbow (lateral epicondylitis)
ofneck Golfer's elbow or medial epicondylitis
t o r t c e sonotomy
Ancionol
h o e r Functional anatomy

and
shoulder Olecranon bursitts (Minor's elbow
of neck
espedesons
capsulis,
Sof odhestve Wrist spraln
shoukder (syn:
voren Ganglion
perlarthritis D e Quervaln's disease
Aminda c syndrome

fhe rolator
cuf Trigger finger
lesions of
Intbospinats fendlinis

(a) Glenohumeral joint

SHOULDER JOINT
ANATONY OF THE (b) Acromioclavicular joint
FUNCTIONAL
free all round mobil- (c) Sternoclavicular joint
proximal positioning, (d) Scapulothoracic joint
The factors like unstable joint
surrounded

and comparatvely
ity. o e r u s e susceptible to Multidirectional wide arcs of movements are the
issues make the joint
crowded soft
by sot tissue lesions. results of the immacuiate structural design of the shoul
varnety of
fractures and a great
der complex. The dynamic force and stability to this
complex are provided by precisely controlled muscular
FUNCTIONAL ANATOMY actions. The structure and disposition of these muscles
provide a base for a wide range of controlled activities
Movements from strong and powerful actions in sports and heavy
of the shoulder complex, work to fine coordinated prehensile finger movements
Perfecty synchronized action
is necessary for
consishing of four diferent articulations, of a musician.
of
the opimal function of this joint. The components The normal process of raising the arm to vertical
shoulder complexare as follws (Fig. 20.1): position ábove the head is carried out with smooth
uninterrupted mouon at all the above-mentioned four
ACL joints of the stoulder complex. The intricate interplay
SCL of ali the four joints was termed as scapulohumeral
GLH rhythm by Codman (1934) which was later modiñed by
McMillan (1966) to scapulo humeroclavicular niychm,
SCTH as clavicle also participates along with scapula
ana

humerus. However, the appropriate terminology

describe the movement of the whole complex wo
be scapulohumeroclaviculothoracic rhythm since scapu
fron
apart
thoracic articulation is also actively involved
the other three joints. x n t r i b u -

n of 180 degrees
the total arc of elevation,co
120 degrees
Fig.20.1 Shoutder joint complex. SCL: tion from the glenohumeral joint is
davicular joint, GLA: Glenahumeral Sternocfavicular joint, ACL: Acromio- the rest 60 degrees is contributed througn r For ere
of 2:1.
joint, SCTH: Scapulothoracic rotation of scapula, i.e. in the
ratio
jont.