The Shoulder

Question 1

Define the shoulder joint and what its made up of -

Answer 1

Gleno-humeral joint
Area of articulation of the upper limb with the shoulder girdle
Bones - humerus and scapula

Question 2

Components of the humerus -

Answer 2

Long bone
Largest in the upper limb
Proximally rounded, greater tubercle of humerus found next to proximal head
Articulates with glenoid fossa of scapula

Radial groove and deltoid tuberosity found on medial aspect

Distally flatter and wider, slightly tilted anteriorly
3 fossae at distal end
Articulates with radius and ulnar

Question 3

Components of proximal humerus -

Answer 3

Head - articulates with glenoid fossa
Anatomical neck
Greater tubercle (more lateral), intertubercular sulcus (bicepital groove) and less tubercle (more anterior)
Surgical neck - common area for proximal humeral fractures

Question 4

Components of mid shaft of humerus -

Answer 4

Deltoid tuberosity
Radial groove - spirals around humerus, radial nerve sits within

Question 5

Components of distal humerus -

Answer 5

Medial supracondylar ridge
Lateral supracondylar ridge
Medial and lateral epicondyles
Trochlea
Coronoid fossa
Radial fossa
Olecranon fossa

Question 6

Joints of the shoulder
Glenohumeral joint
Classify, Articular surface -

Answer 6

Synovial ball and socket joint
Articular surfaces - covered in hyaline cartilage
Humeral head is larger than convex and comma shaped glenoid labrum
Glenoid labrum much smaller than humeral head therefore high ROM but joint is slightly unstable

Question 7

Joints of the shoulder
Gelnohumeral joint
Joint capsule and movements available -

Answer 7

Joint capsule - loosely surrounds joint and has an inferior fold which allows capsule o stretch so full flexion and abduction can be reached
Strengthened by ligaments and rotator cuff tendons

Flexion/extension
Abd/add
Med/lateral rotation
And combined movements

Question 8

Joints of the shoulder
Glenohumeral joint
Synovial membrane and labrum -

Answer 8

Synovial - lines capsule and inferior fold allows for abduction of shoulder joint

Labrum - fibrocartilaginous structure
Depends glenoid cavity and increase stability of the joint

Question 9

Ligaments present at the gelnohumeral joint -

Answer 9

Superior glenohumeral
Middle glenohumeral
Inferior glenohumeral
All the above are found on the anterior aspect of the shoulder and strengthen the joint capsule

Transverse humeral ligament - between greater tuberosity and lesser tuberosity

Coracohumeral - coracoid process to humerus
Coracoacromial - between coracoid process and acromium process

Question 10

Name the bursae present at the glenohumeral joint -

Answer 10

Subtendinous bursa of subscapularis - sits deep to subscapularis tendon

Subacromial/supra-acromial bursa - sits deep to acromium and supra sits superficial

Subcoracoid - sits inferior to coracoid process

Question 11

What helps increase stability at the glenohumeral joint as it is inherently quite an unstable joint?

Answer 11

Glenoid labrum - deepens glenoid fossa
Ligaments
Surrounding muscles - particularly rotator cuff and long head of biceps tendon

Question 12

What makes up the joint line for the glenohumeral joint?

Answer 12

Between coracoid process and lesser tubercle of humerus just below the acromium process

Question 13

Scapulohumeral rhythm
Describe what happens during elevation of the upper limb to the glenohumeral joint and the shoulder girdle:

Answer 13

As the shoulder flexes/abducts the scapula will laterally rotate, this laters the angle of the glenoid fossa therefore allowing for a larger range of movement at the shoulder

Question 14

Scapuohumeral rhythm
Describe movements at 0-30 degrees of shoulder elevation -

Answer 14

Movement in this range is largely the glenohumeral joint
Scapula doesn’t move - provides stable base for glenohumeral movement

Question 15

Scapulhumeral rhythm
Describe the movements when the shoulder is nearing full range of elevation, approx 30-150 degrees -

Answer 15

Most scapula rotation occurs in this range
Lateral end of clavicle elevates and posteriorly rotates

Question 16

Scapulohumeral rhythm
Describe the movements at the last 20-30 degrees of range of movement of shoulder elevation -

Answer 16

Movement in this range is largely glenohumeral
Scapula role here is control and stability

Question 17

What movements are available at the shoulder joint?

Answer 17

Flexion
Extension
Abduction
Medial rotation
Lateral rotation
Elevation (through flexion or abduction)
Circumduction (combination of movements)

Question 18

ROM available and muscles that produce:
Flexion -
Extension -

Answer 18

Sag plane and frontal axis
Flexion - 150-180 degrees
Deltoid (anterior fibres)
Pectoralis major (clavicular head)

Extension - 50-70 degrees
Deltoid (posterior fibres)
Teres minor
Latissimus dorsi
Pectoralis major (sterno-costal head)

Question 19

ROM available and muscles that produce:
Abduction -
Adduction -

Answer 19

Occur in frontal plane and sag axis

Abduction - 150-170 degrees
Deltoid (middle fibres)

Adduction - 30-40 degrees
Latissimus dorsi
Pectoralis major
Teres major
Coracobrachialis

Question 20

ROM and muscles that produce:

Lateral rotation -
Medial rotation -

Answer 20

Lateral - 70-90 degrees
Infraspinatus
Teres minor
Deltoid (posterior)

Medial - 70-90 degrees
Subscapularis
Pectoralis major
Latissimus dorsi
Deltoid (anterior)

Question 21

What is circumduction a combination of?

Answer 21

Flexion/extension
Abduction/adduction

Question 22

Define elevation of the shoulder -

Answer 22

Refers to lifting the hand above the head, can be done through flexion, abduction or in the scapular plane

Question 23

Define the scapula plane?

Answer 23

Very functional plane of movement
Approximately 30-45 degrees forward of the frontal plane

Question 24

Muscle of the shoulder
Pectoralis major -

Answer 24

Forms anterior fold of axilla
Proximal - clavicular head - anterior surface, medial 1/2 of clavicle
Sternocostal head - anterior sternum, 1-7 costal cartilages and aponeurosis of external oblique

Distal - lateral lip of intertubercular groove
Nerve - medial and lateral pectoral nerves, C5-8 and T1

Actions - clavicular head - flexion
Sternocostal head - extension (back to neutral)
Both heads - adduction and medial rotation

Question 25

Muscles of the shoulder
Latissimus dorsi -

Answer 25

Forms posterior fold of axilla
Proximal - thoracolumbar fascia
Spinous processes T7-12
Related interspinous ligaments
Iliac crest
Lower 3-4 ribs

Distal - floor of intertubercular groove
Nerve - throacodorsal nerve C6-8
Actions - shoulder extension
Shoulder medial rotation
Shoulder adduction