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Shoulder Anatomy

The shoulder is the most flexible joint in the body enabling a wide range of movements including, forward flexion, abduction, adduction, external rotation, internal rotation, and 360-degree circumduction.

Thus, the shoulder joint is considered the most insecure joint of the body but the support of ligaments, muscles and tendons function to provide the required stability.

Bones of the Shoulder

The shoulder is a ball and socket joint made up of three bones, namely the humerus, scapula and clavicle.

The end of the humerus or upper arm bone forms the ball of the shoulder joint. An irregular shallow cavity in the scapula called the glenoid cavity forms the socket for the head of the humerus to fit in. The two bones together form the glenohumeral joint, which is the main joint of the shoulder.

The scapula is a flat triangular-shaped bone that forms the shoulder blade. It serves as the site of attachment for most of the muscles that provide movement and stability to the joint. The scapula has four bony processes - acromion, spine, coracoid and glenoid cavity. The acromion and coracoid process serve as places for attachment of the ligaments and tendons.

The clavicle bone or collarbone is an S-shaped bone that connects the scapula to the sternum or breastbone. It forms two joints: the acromioclavicular joint, where it articulates with the acromion process of the scapula, and the sternoclavicular joint where it articulates with the sternum or breast bone. The clavicle also forms a protective covering for important nerves and blood vessels that pass under it from the spine to the arms.

Soft Tissues of the Shoulder

The ends of all articulating bones are covered by smooth tissue called articular cartilage which allows the bones to slide over each other without friction enabling smooth movement. Articular cartilage reduces pressure and acts as a shock absorber during movement of the shoulder bones.

Extra stability to the glenohumeral joint is provided by the glenoid labrum, a ring of fibrous cartilage that surrounds the glenoid cavity. The glenoid labrum increases the depth and surface area of the glenoid cavity to provide a more secure fit for the half-spherical head of the humerus.

Ligaments of the Shoulder

Ligaments are the thick strands of fibers that connect one bone to another. The ligaments of the shoulder joint include:

  • Coraco-clavicular ligaments: These ligaments connect the collarbone to the shoulder blade at the coracoid process.
  • Acromio-clavicular ligament: This connects the collarbone to the shoulder blade at the acromion process.
  • Coraco-acromial ligament: It connects the acromion process to the coracoid process.
  • Glenohumeral ligaments: A group of 3 ligaments that form a capsule around the shoulder joint, and connect the head of the arm bone to the glenoid cavity of the shoulder blade. The capsule forms a water-tight sac around the joint. Glenohumeral ligaments play a very important role in providing stability to the otherwise unstable shoulder joint by preventing dislocation.

Muscles of the Shoulder

The rotator cuff is the main group of muscles in the shoulder joint and is comprised of 4 muscles. The rotator cuff forms a sleeve around the humeral head and glenoid cavity, providing additional stability to the shoulder joint while enabling a wide range of mobility.

The deltoid muscle forms the outer layer of the rotator cuff and is the largest and strongest muscle of the shoulder joint.

Tendons of the Shoulder

Tendons are strong tissues that join muscle to bone allowing the muscle to control the movement of the bone or joint. Two important groups of tendons in the shoulder joint are the biceps tendons and rotator cuff tendons.

Bicep tendons are the two tendons that join the bicep muscle of the upper arm to the shoulder. They are referred to as the long head and short head of the bicep.

Rotator cuff tendons are a group of four tendons that join the head of the humerus to the deeper muscles of the rotator cuff. These tendons provide more stability and mobility to the shoulder joint.

Nerves of the Shoulder

Nerves carry messages from the brain to muscles to direct movement (motor nerves) and send information about different sensations such as touch, temperature and pain from the muscles back to the brain (sensory nerves). The nerves of the arm pass through the shoulder joint from the neck.

These nerves form a bundle at the region of the shoulder called the brachial plexus. The main nerves of the brachial plexus are the musculocutaneous, axillary, radial, ulnar and median nerves.

Blood vessels of the Shoulder

Blood vessels travel along with the nerves to supply blood to the arms. Oxygenated blood is supplied to the shoulder region by the subclavian artery that runs below the collarbone. As it enters the region of the armpit, it is called the axillary artery and further down the arm, it is called the brachial artery. The main veins carrying de-oxygenated blood back to the heart for purification include:

  • Axillary vein: this vein drains into the subclavian vein
  • Cephalic vein: this vein is found in the upper arm and branches at the elbow into the forearm region. It drains into the axillary vein.
  • Basilic vein: this vein runs opposite the cephalic vein, near the triceps muscle. It drains into the axillary vein.

If you would like to have additional information on shoulder or would like to learn more about shoulder anatomy, please contact Dr. German serving the communities of Erie, PA

Conditions

Shoulder Arthritis

Shoulder Arthritis

The term arthritis literally means inflammation of a joint but is generally used to describe any condition in which there is damage to the cartilage.

Shoulder Pain

Shoulder Pain

Pain in the shoulder may suggest an injury, which is more common in athletes participating in sports such as swimming, tennis, pitching, and weightlifting.

Rotator Cuff Tear

Rotator Cuff Tear

A rotator cuff is a group of tendons in the shoulder joint that provides support and enables a wide range of motion. A major injury to these tendons may result in rotator cuff tears.

Shoulder Fracture

Shoulder Fracture

The shoulder is the most flexible joint in the body, enabling a wide range of movements. It is a ball-and-socket joint made up of three bones, namely the humerus (upper arm bone), scapula (shoulder blade) and clavicle.

Clavicle Fracture

Clavicle Fracture

The break or fracture of the clavicle (collarbone) is a common sports injury associated with contact sports such as football and martial arts, as well as impact sports such as motor racing.

Frozen Shoulder

Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, is a condition in which you experience pain and stiffness in your shoulder. The symptoms appear slowly, worsen gradually and usually take one to three years to resolve on their own.

Acromioclavicular (AC) Arthritis

Acromioclavicular (AC) Arthritis

The acromioclavicular joint is part of the shoulder joint. It is formed by the union of the acromion, a bony process of the shoulder blade, and the outer end of the collar bone or clavicle.

Subluxation

Subluxation

The shoulder is a highly mobile ball and socket joint. The ball of the upper arm bone (humerus) is held in place at the socket (glenoid) of the shoulder blade (scapula) by a group of ligaments.

Shoulder Trauma

Shoulder Trauma

Early treatment is necessary to prevent serious shoulder injuries. The immediate mode of treatment recommended for shoulder injuries is rest, ice, compression and elevation (RICE). Your doctor may also prescribe anti-inflammatory medications to help reduce the swelling and pain.

Shoulder dislocation

Shoulder dislocation

The most common symptoms of shoulder dislocation include pain and shoulder joint instability. Other symptoms such as swelling, numbness and bruising may also occur.

Massive Retracted Rotator Cuff Tear

Massive Retracted Rotator Cuff Tear

Massive rotator cuff tears involve tears in two complete tendons of the rotator cuff. A tear of more than 5 cm is described as massive.

Bicep Tendon Rupture

Bicep Tendon Rupture

A biceps tendon rupture can either be partial, where it does not completely tear or complete, where it splits in two and is torn away from the bone.

Proximal Biceps Tendon Rupture

Proximal Biceps Tendon Rupture

The biceps muscle is the muscle of the upper arm which is necessary for the movement of the shoulder and elbow. It is made of a ‘short head’ and a ‘long head’ which function together.

Proximal biceps tendinitis

Proximal biceps tendinitis

Proximal biceps tendinitis is the irritation and inflammation of the biceps tendon at the shoulder joint. The biceps muscle is the muscle of the upper arm which is necessary for the movement of the shoulder and elbow.

Sternoclavicular joint

Sternoclavicular Joint (SC joint)

The sternoclavicular joint is the joint between the breastbone (sternum) and the collar bone (clavicle). The SC joint is one of the 4 joints that complete the shoulder and is the only joint that links the arm to the body.

Proximal Humerus Fractures

Proximal Humerus Fractures

Fractures of the proximal humerus are common in elderly individuals suffering from osteoporosis.

Acromioclavicular Joint Injury

Acromioclavicular Joint Injury

The acromioclavicular joint is part of the shoulder joint. It is formed by the union of the acromion, a bony process of the shoulder blade, and the outer end of the collar bone or clavicle.

Shoulder Impingement

Shoulder Impingement

Shoulder impingement is the inflammation of the tendons of the shoulder joint. It is one of the most common causes of pain in the shoulder.

Glenoid fracture

Glenoid Fractures

Fractures of the glenoid are rare but can occur due to major trauma or during high-energy sports activities.

Rotator Cuff Pain

Rotator Cuff Pain

The rotator cuff consists of a group of tendons and muscles that surround and stabilize the shoulder joint. These tendons allow a wide range of movement of the shoulder joint across multiple planes. Irritation or injury to these tendons can result in rotator cuff pain.

Procedures

Total Shoulder Replacement

Total Shoulder Replacement

Total shoulder replacement surgery is performed to relieve symptoms of severe shoulder pain and disability due to arthritis.

Shoulder Arthroscopy

Shoulder Arthroscopy

Arthroscopy is a minimally invasive diagnostic and surgical procedure performed for joint problems. Shoulder arthroscopy is performed using a pencil-sized instrument called an arthroscope.

Rotator Cuff Repair

Rotator Cuff Repair

The rotator cuff is a group of 4 muscles in the shoulder joint including the supraspinatus, infraspinatus, teres minor, and subscapularis.

Shoulder Fracture Care

Shoulder Fracture Care

A break in the bone that makes up the shoulder joint is called a shoulder fracture. The clavicle (collarbone) and end of the humerus (upper arm bone) closest to the shoulder are the bones that usually are fractured.

Bicep Tendon Rupture at Shoulder

Bicep Tendon Rupture at Shoulder

The biceps muscle is present on the front of your upper arm and functions to help you bend and rotate your arm. The biceps tendon is a tough band of connective fibrous tissue that attaches your biceps muscle

Triceps Repair

Triceps Repair

Triceps repair is a surgical procedure that involves the repair of a ruptured (torn) triceps tendon. A tendon is a tough band of fibrous tissue which connects muscle to bone and works together

Reverse Shoulder Replacement

Reverse Shoulder Replacement

Conventional surgical methods such as total shoulder joint replacement are not very effective in the treatment of rotator cuff arthropathy.

Shoulder Resurfacing

Shoulder Resurfacing

The shoulder is an active joint is prone to injuries and may also get affected by conditions such as arthritis, which results in impaired functioning and related discomfort.

Acromioclavicular (AC) Joint Reconstruction

Acromioclavicular (AC) Joint Reconstruction

The acromioclavicular (AC) joint is one of the joints present within your shoulder. It is formed between a bony projection at the top of the shoulder blade

Subacromial Decompression

Subacromial Decompression

Subacromial decompression is a surgical procedure performed for the treatment of a condition called shoulder impingement.

ORIF of the Clavicle Fractures

ORIF of the Clavicle Fractures

A clavicle fracture refers to a broken collarbone and is a common injury associated with contact sports such as football and martial arts, as well as impact sports such as motor racing.

Intraarticular Shoulder Injection

Intraarticular Shoulder Injection

The shoulder is prone to different kinds of injuries and inflammatory conditions. An intraarticular shoulder injection is a minimally invasive procedure to treat pain

Distal Clavicle Excision

Distal Clavicle Excision

Distal clavicle excision is a procedure which involves removal of the outer end of the clavicle (collarbone) to treat shoulder pain and disability due to arthritis or impingement.

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