Shoulder Complex

SHOULDER
COMPLEX :
Introduction
Arthrology
• Four joints within the shoulder complex are
1. Sternoclavicular joint
2. Acromioclavicular joint
3. Scapulothoracic joint
4. Glenohumeral joint
1 ) Sternoclavicular Joint
Plane synovial joint.
Articular surfaces
 Medial end of
clavicle
 Clavicular facet on
sternum
 Sup. Border of the
cartilage of first
rib.
SC joint is subjected to unique functional
demands that are met by a complex saddle shaped
articular surface.
 Medial end of clavicle –convex along longitudinal

diameter and concave along transverse diameter.
 Clavicular facet on sternum –slightly concave

longitudinal diameter and a slightly convex
transverse diameter
Tremendous individual difference exist across

people and the saddle shape of these surfaces exist
across people and the saddle shape of these
surfaces is very subtle, the SC joint is often
classified as plan synovial joint.
Links axial skeletal with appendicular skeleton.

Tissues that stabilizes the SC joint :
1. Anterior and Posterior
Sternoclavicular
ligament
2. Interclavicular
ligament
3. Costoclavicular
ligament
4. Articular Disc
5. SCM , Sternohyoid,
sternothyroid and
subclavius muscles.
Sternoclavicular Disk
The articular disc at the
SC joint separates the
joint into distinct
medial and lateral joint
cavities
The disc is flattened
piece of fibrocartliage
that attaches inferiorly
near the lateral edge of
clavicular facet and
superiorly at the head of
clavicle and
interclavicular ligament
The remaining outer edge of the disc attaches to the
internal surface of the capsule
The disc functions as shock absorber within the joint
by increasing the surface area of joint
SC joint Ligaments
Sternoclavicular
ligament
The anterior and
posterior
sternoclavicular
ligaments reinforce the
capsule
They function primarily
to check anterior and
posterior translatory
movement of the
medial end of clavicle
Costoclavicular
Ligament
The ligament is a strong
structure extending from the
cartilage of the first rib to the
costal tuberosity on the
inferior surface of clavicle
The ligament has two

distinct fiber bundle running
perpendicular to each other.
The anterior bundle runs

obliquely in a superior and
lateral direction, the
posterior bundle runs
obliquely in superior and
medial direction
 This ligament firmly stabilizes the SC joint and limits the
extreme of all Clavicular motion
 Checks elevation of lateral end of clavicle and when
limits of ligament are reached ,it contributes to inferior
gliding of medial clavicle.
Counters the superiorly directed forces applied to clavicle
by SCM and sternohyoid muscles
Medially directed fibers of posterior lamina –resist medial
movement of clavicle absorbing some force – sc disk
Interclavicular ligament
The Interclavicular
ligament spans the
jugular notch and
connects the medial end
of the right and left
clavicles
Kinematics of SC joint
• The Osteokinematics clavicle involve a rotation
in all three degrees of freedom.
• Each degree of freedom is associated with one of
the three cardinal planes: Sagital, Frontal and
Horizontal
• Osteokinematics of SC joint includes:
1) Elevation(45 deg) and Depression (10 deg):

Plane - frontal
Axis – AP axis
2) Protraction and Retraction (15-30 deg each)
plane-horizontal
axis –superior -inferior axis
3) Axial rotation of the clavicle (post. Rotation 20-35
deg during sh. Abduction /flexion)
axis – clavicle’s longitudnal axis
Arthrokinematics of SC joint
 Along sc jt’s longitudnal

diameter
A. Elevation B. Depression
Arthrokinematics
during retraction of
Scapula around the right
SC joint
(along transverse
diameter)
2) Acromioclavicular Joint
A. Anterior view B. Posterior View

Acromioclavicular Joint :
Palne synovial joint

Articular surfaces
 Lateral end of clavicle
(acromial facet)
 Small clavicular facet on
acromion of scapula
AC joint Ligaments
Superior and Inferior AC
joint capsular ligaments
They together reinforce the

capsule
The superior AC ligament
assists the capsule in
opposing articular surfaces
and in controlling A-P joint
stability
The superior capsular
ligament is reinforced
through attachments from
the deltoid and trapezius
Kinematics of AC joint
• AC joint permits subtle and often slight movement of
the scapula
• The motion of the scapula at the AC joint are
described in three degrees of freedom
• The AC joint influences and is also influenced by
rotation of the clavicle around its long axis
• Osteokinematics of the AC joint includes
1. Upward and Downward rotation
2. Internal and External rotation
3. Anterior and Posterior tipping
Osteokinematics of AC joint :
2) Anterior and Posterior tipping
- “Coronal” axis through the AC joint.
- Anterior tipping
*Acromion tips forward
*Inferior angle tips backward.
Eg-Shoulder shrug
Elevation of scapula
Anterior tipping
-Posterior tipping-
*Acromion tips backward
*Inferior angle tips forward
Eg- Flexion/Abduction
Depression of the scapula
Posterior tipping
3) Upward/Downward Rotation
- Oblique “A-P” axis passing

midway between the joint surfaces
of the AC joint.
-Upward rotation - Glenoid fossa
tilts upward
Downward rotation - Glenoid
fossa tilts downward.
-It is limited by the attachment
of coracoclavicular ligament.
-The acromion also has a small
magnitude of medial and lateral
translatory motion that can occur.
-Upward/Downward rotation - 30
degrees.
3) Scapulothoracic Joint
The ST joint is a typical joint which lacks all the
traditional characteristics of a joint except one that is
motion
The primary role of this joint is to amplify the motion
of GH joint
 ANATOMIC POSITION OF SCAPULA :
 Between 2nd and 7th ribs,
 Medial border located about 6cm lateral to spine ,
 10deg ant. Tilt ,5-10 deg. Upward rotation, 35deg
internal rotation—plane of scapula
Movements at the scapulothoracic joint
• Elevation and depression
• Protraction and retraction
• Upward and downward rotation
ST joint: A composite of the AC and SC joint
Internal rotation
GLENOHUMERAL JOINT
Glenohumeral Joint
Articular Surfaces
 Large convex head of the
humerus
 Shallow concavity of the
glenoid fossa
Glenoid fossa is tilted upwardly
about 5degree relative to
scapular medial border and
facing about 35 degrees anterior
to the frontal plane.
The “Loose-Fit” of GH joint
Glenoid fossa covers only
one-third of articular
surface of humeral head.
In typical adult, the
longitudinal diameter of
humeral head is about 1.9
times larger and
transverse diameter is 2.3
times larger than the
same diameter of the
glenoid fossa.
Tissues that Stabilizes the GH joint
GH joint capsule
Ligaments
Rotator cuff muscles
Glenoid labrum
Static stability at GH joint
Kinematics of GH joint
• The GH joint has three degrees of freedom
• Osteokinematics of the GH joint includes
1. Abduction and Adduction
2. Flexion and Extension
3. Internal and External rotation
Arthrokinematics
During abduction
(120 degree)
Adduction
Importance of Roll and Slide
Arthrokinematics at the GH joint
Frontal plane v/s Scapular
plane
3 factors-
GT under high
point of CA arch
Humeral head fit
into glenoid fossa
Supraspinatous
placed along a
straight line
Arthrokinematics
During flexion
(120 degree)
Extension
Arthrokinematics
During external
rotation
(60-70 degree)
Internal rotation
(75-85 degree)
Arthrokinematics
Scapulohumeral Rhythm
• A natural kinematic rhythm or timing exists between
GH abduction and Scapulothoracic upward rotation
• Inman reported this rhythm as constant throughout
abduction, occurring at a ratio of 2:1
• For every 3 degrees of shoulder abduction, 2 degrees by
GH joint abduction and 1 degree by ST joint upward
rotation
Major kinematic event during shoulder
abduction
Posterior rotation of clavicle
DYNAMIC STABILIZATION BY ROTATOR CUFF
MUSCLES
Muscles that adduct and extend the
shoulder

Shoulder Complex

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SHOULDER

 Medial end of clavicle –convex along longitudinal

 Clavicular facet on sternum –slightly concave

Tremendous individual difference exist across

Links axial skeletal with appendicular skeleton.

The ligament has two

The anterior bundle runs

• Osteokinematics of SC joint includes:

1) Elevation(45 deg) and Depression (10 deg):

 Along sc jt’s longitudnal

A. Anterior view B. Posterior View

Palne synovial joint

They together reinforce the

Depression of the scapula

- Oblique “A-P” axis passing

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