Shoulder joint pdf lecture notes by Dr.N.Mugunthan

50 %
50 %
Information about Shoulder joint pdf lecture notes by Dr.N.Mugunthan

Published on November 25, 2016

Author: MUGUNTHANDrMugunthan

Source: slideshare.net

1. Shoulder Joint Lecture by Dr.N.Mugunthan.MBBS,MS,DNB,MNAMS,PhD Associate Professor, MGMC&RI. © Dr.N.Mugunthan 1

2. Learning objectives Shoulder joint: • Type & variety • Articular surfaces • Ligaments • Relations • Blood & nerve supply • Movements • Applied anatomy LAQ: Describe the shoulder joint under following headings: a. articular surfaces b. ligaments c. movements d. applied anatomy (2+3+3+2)© Dr.N.Mugunthan 2

3. How to describe a joint 9. Movements 10. Muscles producing movements 11. Unique features of particular joint 12. Applied anatomy 1. Definition 2. Type of joint 3. Variety of joint 4. Articular surfaces 5. Ligaments 6. Relations 7. Blood supply 8. Nerve supply © Dr.N.Mugunthan 3

4. Shoulder joint Definition :  Shoulder joint is formed by articulation of the scapula (glenoid cavity) and head of the humerus  Glenohumeral joint © Dr.N.Mugunthan 4

5. Type of joint Synovial joint Polyaxial © Dr.N.Mugunthan 5

6. Variety of joint Ball and socket variety © Dr.N.Mugunthan 6

7. Articular surfaces Proximal articular surface : Glenoid fossa of scapula  Pyriform in shape  Surface area, concavity of glenoid fossa increased by glenoidal labrum  Glenoidal labrum – fibro cartilaginous ribbon like structure  Covered with hyaline cartilage © Dr.N.Mugunthan 7

8. Articular surfaces cont… Distal articular surface: The head of humerus Hemispherical in shape Covered with hyaline cartilage © Dr.N.Mugunthan 8

9. Shoulder joint – weak joint o Glenoid fossa is too small & shallow o to hold the head of the humerus in place o The head is four times the size of glenoid cavity o Structurally, it is a weak joint Stability of the joint is ? © Dr.N.Mugunthan 9

10. Ligaments 1. Capsule 2. Glenohumeral ligaments 3. Transverse humeral ligament 4. Coracohumeral ligament 5. Secondary socket / ligament (Coracoacromial arch) 6. Glenoidal labrum © Dr.N.Mugunthan 10

11. Capsule Loose fibrous covering Inner surface lined with synovial membrane Attachments: Proximal attachments: Margins of glenoid fossa (proximal to glenoid labrum) Distal attachments: Anatomical neck of humerus (except inferiorly, extends to shaft for 1.25cm) © Dr.N.Mugunthan 11

12. Weakness of the capsule  Lax and weak Capsule is deficient at 3places Superiorly - for passage the tendon of the long head of the biceps brachii. Anteromedial side – joint communicates with subscapular bursa Posterolateral side – communicates with bursa under infraspinatus tendon © Dr.N.Mugunthan 12

13. Capsule © Dr.N.Mugunthan 13

14. Glenohumeral ligaments : Three : 1. Superior band 2. Middle band 3. Inferior band Seen on inner side of ant. part of capsule Ligaments cont… © Dr.N.Mugunthan 14

15. Attachments : Proximally: (Glenoid)  All 3 bands attached to upper end of glenoid fossa Distal : (Humerus)  Upper band – top of lesser tuberosity  Middle band – lower part  Lower band – shaft just below lesser tuberosity Glenohumeral ligaments cont… © Dr.N.Mugunthan 15

16. Transverse humeral ligament Stretches between tops of greater & lesser tuberosities Long head of biceps tendon passes out deep to this ligament © Dr.N.Mugunthan 16

17. Coracohumeral ligament Attachment : Lateral margin of root of coracoid process to Greater tuberosity of humerus All the accessory ligaments attach either lesser/greater tuberosity of humerus © Dr.N.Mugunthan 17

18. Coracoacromial ligament (secondary socket) Triangular band Base –attached to lateral margin of coracoid process Apex – attached to tip of acromion Coracoid process,ligament & acromion together form – coracoacromial arch Which forms secondary socket for the joint © Dr.N.Mugunthan 18

19. Rotator cuff (Codman’s musculo-tendinous cuff) Laxity & weakness of joint is compensated by this cuff Derived from tendons of – SITS 1. Supraspinatus 2. Infraspinatus 3. Teres minor 4. Subscapularis © Dr.N.Mugunthan 19

20. Expansions from these tendons fuse with capsule Strengthens the capsule all round (except inferiorly) Injury to rotator cuff – recurrent dislocation Rotator cuff cont… (Codman’s musculo-tendinous cuff) © Dr.N.Mugunthan 20

21. Rotator cuff © Dr.N.Mugunthan 21

22. Glenoidal labrum Fibro cartilaginous ribbon like structure Attached to margins of the glenoid cavity Increase the depth of glenoid cavity Increase the articular surface of glenoid Lined with hyaline cartilage © Dr.N.Mugunthan 22

23. Relations of shoulder joint a) Muscles b) Bursae c) Vessels & nerves © Dr.N.Mugunthan 24

24. a) Muscles: Anteriorly: • Subscapularis, coracobrachialis, short head of biceps and deltoid. Posteriorly: • Infraspinatus, teres minor and deltoid. Relations of shoulder joint © Dr.N.Mugunthan 25

25. a) Muscles: cont… Superiorly: • Long tendon of biceps inside the capsule • Supraspinatus outside the capsule Inferiorly: • Long head of the triceps  Deltoid – covers superiorly, anteriorly, posteriorly & laterally Relations of shoulder joint cont… © Dr.N.Mugunthan 26

26. Subacromial (Subdeltoid) bursa:  Lies between deltoid muscle & capsule  Does not communicate with joint  Extends between supraspinatus and acromion & coracoacromial arch Longest bursa in the body b) Bursae related to shoulder joint cont… © Dr.N.Mugunthan 28

27. C) Vessels & nerves related to shoulder joint Posterior circumflex humeral vessels Axillary/ circumflex nerve  Related to inferior part of capsule © Dr.N.Mugunthan 30

28. Blood supply Arterial supply:  Anterior circumflex humeral artery  Posterior circumflex humeral artery  Suprascapular artery  Circumflex scapular branch of Subscapular artery. Venous drainage :  Corresponding veins © Dr.N.Mugunthan 31

29. Nerve supply A twig from lateral pectoral nerve Suprascapular nerve Axillary nerve (posterior division) © Dr.N.Mugunthan 32

30. Movements @ shoulder joint Flexion & extension Adduction & abduction Medial & lateral rotation Circumduction © Dr.N.Mugunthan 33

31. Movements @ shoulder joint © Dr.N.Mugunthan 34

32. Flexion & extension Transverse axis : Flexion: • Pectoralis major (clavicular part), • Deltoid (anterior fibres) coracobrachialis • Assisted by biceps. Extension: • Deltoid (posterior fibres) • Teres major, • Latissimus dorsi and pectoralis major (sternocostal part) © Dr.N.Mugunthan 35

33. Abduction & adduction Antero-posterior axis Abduction: • Supraspinatus : 0-30° • Deltoid (middle fibers) 30-90° • Serratus anterior & trapezius: 90-180° Adduction: • Pectoralis major • Latissimus dorsi • Teres major • Corachobrachialis • Biceps (short head) © Dr.N.Mugunthan 36

34. Medial & lateral rotation Longitudinal axis Medial rotation: • Pectoralis major • Deltoid (anterior fibres) • Latissimus dorsi • Teres major and subscapularis. Lateral rotation: • Infraspinatus • Deltoid (posterior fibres) and teres minor. © Dr.N.Mugunthan 37

35. Circumduction • Combination of 3 axis • Combination of all the muscles around shoulder © Dr.N.Mugunthan 38

36. Muscles producing movements © Dr.N.Mugunthan 39

37. Applied anatomy • Referred pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &C5) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Supraspinatus Tendinitis • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty © Dr.N.Mugunthan 40

38. Applied anatomy • Referred pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Supraspinatus Tendinitis • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty © Dr.N.Mugunthan 41

39. Applied anatomy • Referred pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Supraspinatus Tendinitis • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty © Dr.N.Mugunthan 42

40. Applied anatomy • Referred pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Supraspinatus tendinitis & • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty © Dr.N.Mugunthan 43

41. Applied anatomy • Referred pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Supraspinatus Tendinitis • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty © Dr.N.Mugunthan 44

42. Applied anatomy • Referred pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Tendinitis • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty © Dr.N.Mugunthan 45

43. Applied anatomy • Referred pain from diaphragm, pleura & peritoneum (supplied by phrenic nerve -C3,C4 &) to tip of shoulder via supraclavicular nerve (C3&C4) • Dislocation • Bursitis • Supraspinatus Tendinitis • Rupture of supraspinatus • Rotator cuff injury • Frozen shoulder • Arthroscopy & arthroplasty © Dr.N.Mugunthan 46

44. Arthroscopy shoulder joint -normal © Dr.N.Mugunthan 47

45. Arthroscopy –rotator cuff repair © Dr.N.Mugunthan 48

46. Take home message Shoulder joint: • Type & variety • Articular surfaces • Ligaments • Relations • Blood & nerve supply • Movements • Applied anatomy © Dr.N.Mugunthan 49

47. © Dr.N.Mugunthan 50

Add a comment