The part of the body where the humerus attaches to the
The shoulder must be mobile enough for the wide range
actions of the arms and hands, but also stable enough to
allow actions such as lifting, pushing and pulling.
It is made up of three bones.
of the shoulder:
joint (main one, ball and socket joint, articulation between the
glenoid fossa of the scapula (shoulder blade) and the head of the humerus
2. Acromioclavicular joint (articulation between the acromion process of the
scapula and the lateral end of the clavicle )
3. Sternoclavicular joint
(articulation between sternal end of the clavicle, and the
There are two kinds of cartilage in the joint:
1. Articular cartilage : covers humerus head and glenoid surface.
It’s a white cartilage which allows the bones to glide and move on
each other. When this type of cartilage starts to wear out (a process
called arthritis), the joint becomes painful and stiff.
2. Labrum : its a ring of rigid fibrous cartilage surrounding the
glenoid cavity, it stabilizes the ball and socket joint!
4. :SHOULDER MOVEMENTS
It is the most mobile joint in the human body.
The muscles and joints of the shoulder allow it to move
through a remarkable range of motion,
Medial rotation of the arm (55°)
Lateral rotation of the arm(40_45°)
Arm circumduction (this is a combination of
the above movement)
5. ROTATOR CUFF MUSCLES
The group of four muscles and their tendons that act to
stabilize the shoulder .
*the strength of the joint depend on the tone of these group
of muscle which across in front,above ,behind the jont
1- Supraspinatous – abducts the arm
2- Infraspinatous – external rotation
3- Teres Minor – external rotation
4- Subscapularis – internal rotation
7. These muscles arise from the scapula and connect to the
head of the humerus, forming
a cuff at the shoulder joint.
They hold the head of the humerus in the small and
shallow glenoid fossa of the scapula.
Nerve supply:axillary and suprascapular nerve
10. Calcific Tendinitis
A disorder characterized by deposits of crytalline calcium
phosphate in any tendon of the rotator cuff muscles
causing inflammation and pain.
It is of unknown etiology.
Most people over the age of 40
Pain is aggravated by elevation of the arm above
shoulder level or by lying on the shoulder.
sever Pain may awaken the patient from sleep.
its one of the most painful conditions in the shoulder
11. When this condition is symptomatic, it may present in the
following 2 ways:
• Chronic, relatively mild pain with intermittent flares, similar
to shoulder impingement syndrome, is believed to indicate
that the condition is in the formative phase.
• Mechanical symptoms may arise from a large calcific
build up of pressure in the tendon
→limitation of movement
Diagnoses by :
 Ultrasound (more accurate)
calcific deposits are visible as lumps or cloudy
areas. Mostly found on the greater tuberosity
 Injections, needling, and lavage Breaking up the calcific
deposits by repeatedly puncturing them with a needle,
aspirating the calcific material, with the help of saline.
 Surgery(rarely required)
 Physiotherapy to regain muscle strength
14. IMPINGEMENT SYNDROME
Also called: swimmer's shoulder or thrower's
It is a clinical syndrome which occurs when the
tendons of the rotator cuff muscles become irritated
and inflamed as they pass through the subacromial
space, the passage beneath the acromion.
Individuals at highest risk are laborers and those
working in jobs that require repetitive overhead
activity like swimmers and athletes.
Symptoms: pain increase at night, weakness and loss
of movement at the shoulder
increase in shoulder pain with overhead activities
The rotator cuff muscle tendons pass through a
narrow space between the acromion process of the
scapula and the head of the humerus. Anything
which causes further narrowing of this space can
result in impingement syndrome. This can be
caused by bony structures such as subacromial
spurs (bony projections from the acromion(,
osteoarthritic spurs on the acromioclavicular
joint, and variations in the shape of the acromion.
Thickening or calcification of the
coracoacromial ligament can also cause
impingement. Loss of function of the rotator cuff
muscles, due to injury or loss of strength, may
cause the humerus to move superiorly, resulting in
impingement. Inflammation and subsequent
thickening of the subacromial bursa.
Conservative mostly :
 injectable corticosteroid
 Ice packs
 Cessation of painful activity and rest
If the patient remains significantly disabled and
has no improvement after 3 months of conservative
 consider other etiologies or refer for surgical
17. ROTATOR CUFF TEARS
Rotator cuff tears are tears of one or more of the four
tendons of the rotator cuff muscles .
Rotator cuff tears are among the most common
conditions affecting the shoulder
The most frequent cause of rotator cuff damage is age
related degeneration and less frequently by sports
injuries or trauma
the supraspinatus muscle is most frequently torn as it
passes below the acromion;
the tear usually occurs at its point of insertion onto the
humeral head at the greater tuberosity
18. Clincal Features
.Age:45-75 year old
Acute tears: raising arm against resistance, (like in weight
lifting,) or falling forcefully, causes Immediate pain that
radiates through the arm, and limited range of motion,
specifically during abduction motions of the shoulder .
Drop Arm sign. (The result is positive if the patient is
unable to lower the affected arm slowly and smoothly from a
position of 90 degrees of abduction. The arm drops
(.immediately to the side
Partial tear: recover gradually
With supraspinatus tendonitis
Sudden shoulder strainor a complication of
 pain soon subside
 gross weakness of abductor muscles
- young active individuals with complete
- contraindicated in elderly