Humerus and Shoulder Joint

9,254 views

Published on

Published in: Health & Medicine

Humerus and Shoulder Joint

  1. 1. COLLEGE OF ALLIED HEALTH AND SCIENCES BY Hermizan Halihanafiah Bsc Biomedicine (Hons) UKM SHOULDER JOINT AND HUMERUS
  2. 2. INTRODUCTION <ul><li>Upper limbs consist of 60 bones. </li></ul><ul><ul><li>Arm : Humerus </li></ul></ul><ul><ul><li>Forearm : Ulna and Radius </li></ul></ul><ul><ul><li>Wrist : Carpals </li></ul></ul><ul><ul><li>Palm : Metacarpals </li></ul></ul><ul><ul><li>Hand : Phalanges </li></ul></ul>
  3. 3. HUMERUS BONE <ul><li>Arm bone. </li></ul><ul><li>Longest and largest bone of UL. </li></ul><ul><li>Articulates proximally with the scapula and distally with both radius and ulna. </li></ul>
  4. 4. Humerus <ul><li>Proximal end of the humerus features a rounded head that articulates with glenoid cavity of scapula to form glenohumeral joint. </li></ul><ul><li>Distal to the head is the anatomical neck, the site of epiphyseal line, which is visible as an oblique groove. </li></ul>Head Greater Tubercle Lesser Tubercle Intertubecular Sulcus Anatomical Neck Surgical Neck Shaft
  5. 5. Glenohumeral Joint / Shoulder Joint
  6. 7. Humerus Head Greater Tubercle Lesser Tubercle Intertubecular Sulcus Anatomical Neck Surgical Neck Shaft <ul><li>The greater tubercle is a lateral projection distal to the anatomical neck. </li></ul><ul><li>It is the most laterally palpable bony landmark of the shoulder region. </li></ul><ul><li>The lesser tubercle projects anteriorly. </li></ul>Anterior view of proximal humerus
  7. 8. Humerus Head Greater Tubercle Lesser Tubercle Intertubecular Sulcus Anatomical Neck Surgical Neck Shaft Anterior view of proximal humerus <ul><li>Between both tubercles runs an intertubercular sulcus (bicipital groove). </li></ul><ul><li>The surgical neck is a constriction in the humerus just distal to the tubercles, where the head tapers the shaft, name because fractures often occur here. </li></ul>
  8. 9. Cont… <ul><li>The body (shaft) of the humerus is roughly cylindrical at its proximal end, but gradually becomes triangular until it is flattened and broad at its distal end. </li></ul><ul><li>Laterally, at the middle portion of the shaft, there is roughened, V-shape area called the deltoid tuberosity where attachment for deltoid muscle. </li></ul>Deltoid Tuberosity
  9. 10. Cont… <ul><li>Several prominent features are evident at the distal end of the humerus. </li></ul><ul><li>The capitulum is a rounded knob on the lateral aspect of the bone that articulates with the head of the radius. </li></ul>Capitulum Trochlear
  10. 11. Cont… <ul><li>The radial fossa is an anterior depression that receive the head of radius when the forearm is flexed. </li></ul><ul><li>The trochlea, located medial to the capitulum , is a spool shaped surface that articulates with the ulna. </li></ul>Capitulum Trochlear Radial Fossa
  11. 12. Cont… <ul><li>The coronoid fossa is anterior depression that receive the coronoid process of the ulna when forearm is flexed . </li></ul>Capitulum Trochlear Radial Fossa Coronoid Fossa
  12. 13. <ul><li>The olecranon fossa is a posterior depression that receives the olecranon of the ulna when the forearm is extended. </li></ul>Olecranon Fossa Posterior View
  13. 14. Cont…. <ul><li>The medial epicondyle and lateral epicondyle are rough projections on either side of the distal end to which the tendons of most muscles of the forearm are attached. </li></ul><ul><li>The ulnar nerve lies on the posterior surface of the medial epicondyle and may easily be palpated by rolling a finger over the skin above the medial epicondyle. </li></ul>Medial Epicondyle Lateral Epicondyle
  14. 15. Elbow Joint Lateral View Anterior View
  15. 16. Ulnar Nerve
  16. 18. MOVEMENT OF THE ARM (SHOULDER JOINT) <ul><li>Flexion </li></ul><ul><li>Extension </li></ul><ul><li>Abduction </li></ul><ul><li>Adduction </li></ul>
  17. 19. MOVEMENT OF THE ARM (SHOULDER JOINT) <ul><li>Medial rotation </li></ul><ul><li>Lateral rotation </li></ul><ul><li>Horizontal abduction </li></ul><ul><li>Horizontal adduction </li></ul><ul><li>Circumduction </li></ul>
  18. 20. Muscles of the Thorax that Move the Humerus <ul><li>Axial muscles </li></ul><ul><ul><li>Pectoralis major </li></ul></ul><ul><ul><li>Latissumus dorsi </li></ul></ul><ul><li>Scapular muscles </li></ul><ul><ul><li>Fiber of deltoid </li></ul></ul><ul><ul><li>Rotator cuff </li></ul></ul><ul><ul><li>Teres major </li></ul></ul><ul><ul><li>Coracobrachalis </li></ul></ul><ul><ul><li>Long & short head of biceps </li></ul></ul><ul><ul><li>Long head of triceps </li></ul></ul>
  19. 21. Clavicle origin of Pectoralis Major <ul><li>Origin – medial half of anterior clavicle </li></ul><ul><li>Insertion – lateral lip of intertubercular sulcus of humerus </li></ul><ul><li>Action – Flexion, adduction and medial rotation arm at shoulder joint. </li></ul><ul><li>Nerve supply </li></ul><ul><ul><li>Medial and lateral pectoral nerve </li></ul></ul>
  20. 22. Sternal origin of Pectoralis Major <ul><li>Origin – anterior surface of sternum, costal cartilage of 2 nd -6 th ribs. </li></ul><ul><li>Insertion – lateral lip of intertubercular sulcus of humerus </li></ul><ul><li>Action – extend arm at shoulder joint. </li></ul><ul><li>Nerve supply </li></ul><ul><ul><li>Medial and lateral pectoral nerve </li></ul></ul>
  21. 23. Latissimus Dorsi <ul><li>Origin – Spines of inferior 6 thoracic vertebrae (T6-T12), lumbar vertebrae (L1-L5), crest of sacrum and illiac crest of hip bone and inferior four ribs. </li></ul><ul><li>Insertion – Intertubecular sulcus of humerus </li></ul><ul><li>Action </li></ul><ul><ul><li>Extends, adduction and medial rotation arm at shoulder joint. </li></ul></ul><ul><li>Nerve supply - Thoracodorsal nerve </li></ul>
  22. 24. Latissimus Dorsi
  23. 25. Fiber of Deltoid <ul><li>Consists 3 fibers </li></ul><ul><li>Anterior, middle and posterior fibers. </li></ul><ul><li>Responsible for movements of the humerus at GH joint </li></ul><ul><li>Nerve supply – axillary nerve. </li></ul>
  24. 26. Anterior Fiber of Deltoid <ul><li>Origin – anterior border of the lateral one third of the clavicle </li></ul><ul><li>Insertion – deltoid tuberosity </li></ul><ul><li>Action – flexion and middle rotation arm at GH joint. </li></ul>
  25. 27. Middle fiber of Deltoid <ul><li>Origin – lateral border and superior surface of the acromion process of the scapula </li></ul><ul><li>Insertion – deltoid tuberosity </li></ul><ul><li>Action – abduction arm at GH joint </li></ul>
  26. 28. Posterior Fiber of Deltoid <ul><li>Origin – inferior lip of the crest of the spine of the scapula] </li></ul><ul><li>Insertion – deltoid tuberosity </li></ul><ul><li>Action – extension and lateral rotation arm at GH joint. </li></ul>
  27. 29. Rotator Cuff Muscles <ul><li>Consists 4 muscles </li></ul><ul><li>S – Supraspinatus </li></ul><ul><li>I – Infraspinatus </li></ul><ul><li>T – teres minor </li></ul><ul><li>S – Subscapularis </li></ul><ul><li>Group of muscles that stabilize GH joint. </li></ul>
  28. 31. Supraspinatus Muscle <ul><li>Origin – supraspinous fossa of scapula </li></ul><ul><li>Insertion – Greater tubercle of humerus (superior aspect) </li></ul><ul><li>Action – initially abduction (15 degrees) at shoulder joint, stabilizing shoulder joint </li></ul><ul><li>Nerve supply - Suprascapular nerve </li></ul>
  29. 32. Infraspinatus Muscle <ul><li>Origin – Infraspinous fossa of scapula </li></ul><ul><li>Insertion – Greater tubercle of humerus (middle aspect) </li></ul><ul><li>Action – Laterally rotation and adduction arm at shoulder joint </li></ul><ul><li>Nerve supply - Suprascapular nerve </li></ul>
  30. 33. Teres Minor <ul><li>Origin – Inferior lateral border of scapula </li></ul><ul><li>Insertion – Greater tubercle of humerus (posterior inferior aspect) </li></ul><ul><li>Action – Laterally rotation, extends and adduction arm at shoulder joint </li></ul><ul><li>Nerve supply – axillary nerve </li></ul>
  31. 34. Subscapularis Muscle <ul><li>Origin – subscapular fossa of scapula </li></ul><ul><li>Insertion – lesser tubercle of humerus </li></ul><ul><li>Action – Medial rotation arm at shoulder joint </li></ul><ul><li>Nerve supply – upper and lower subscapular nerve </li></ul>
  32. 35. Teres Major <ul><li>Origin – Inferior angle of scapula </li></ul><ul><li>Insertion – medial lip of Intertubecular sulcus of humerus </li></ul><ul><li>Action </li></ul><ul><ul><li>Extends arm at shoulder joint </li></ul></ul><ul><ul><li>Assist in adduction and medial rotation of arm at shoulder joint. </li></ul></ul><ul><li>Nerve supply </li></ul><ul><ul><li>Lower subscapular nerve </li></ul></ul>
  33. 36. Coracobrachialis <ul><li>Origin - Coracoid process of scapula </li></ul><ul><li>Insertion - Middle of medial surface of shaft of humerus. </li></ul><ul><li>Action - Flexion and adduction arm at shoulder joint. </li></ul><ul><li>Nerve supply - Musculocutaneous nerve </li></ul>
  34. 37. Biceps Brachii <ul><li>Consists 2 head </li></ul><ul><li>Long head and short head of biceps </li></ul>
  35. 38. Short head of Biceps <ul><li>Origin – Coracoid process of scapula </li></ul><ul><li>Insertion – radial tuberosity of radius and bicipital aponeurosis </li></ul><ul><li>Action – Flexion forearm at elbow joint, supination at radioulnar joint and assist flexion arm at GH joint . </li></ul><ul><li>Nerve supply - Musculocutaneous nerve </li></ul>
  36. 39. Long head of Biceps <ul><li>Origin – Tubercle above the glenoid cavity of scapula (supraglenoid tubercle) </li></ul><ul><li>Insertion – Radial tuberosity of radius and bicipital aponeurosis </li></ul><ul><li>Action – flexion forearm at elbow joint, supination forearm at radioulnar joint and assist flexion arm at GH joint. </li></ul><ul><li>Nerve supply - Musculocutaneous nerve </li></ul>
  37. 40. Long head of Triceps <ul><li>Origin – tubercle below to glenoid cavity of scapula (infraglenoid tubercle) </li></ul><ul><li>Insertion – Olecranon of ulna </li></ul><ul><li>Action - Extends forearm at elbow joint , Extends arm at shoulder joint </li></ul><ul><li>Nerve supply - Radial nerve </li></ul>
  38. 41. Shoulder Joint <ul><li>Definition </li></ul><ul><ul><li>Ball and socket joint </li></ul></ul><ul><ul><li>Formed by the head of humerus articulates with glenoid cavity of scapula. </li></ul></ul><ul><ul><li>Also referred as glenohumeral joint or humeroscapular joint. </li></ul></ul>
  39. 42. Glenohumeral Joint / Shoulder Joint
  40. 43. Movements <ul><li>Allows for flexion, extension, abduction, adduction, medial rotation , lateral rotation and circumduction of arm. </li></ul><ul><li>Has more freedom of movement than other joint of body. </li></ul>
  41. 44. Extension / flexion of shoulder Extension Flexion
  42. 45. Abduction / adduction of Shoulder Abduction Adduction
  43. 46. Lateral / medial rotation of Shoulder Lateral / external rotation Medial / internal rotation
  44. 47. Horizontal adduction / abduction of Shoulder Horizontal Adduction Horizontal Abduction
  45. 48. <ul><li>This freedom of movements results from the looseness of the articular capsule and shallowness of the glenoid cavity in relation to the large size of the head of humerus. </li></ul><ul><li>Although the ligaments of the shoulder strengthen it to some extent, most of the strength results from the muscle surround the joint, especially rotator cuff muscles. </li></ul>Shoulder Joint
  46. 49. <ul><li>Rotator cuff muscles work as a group to hold head of humerus in the glenoid cavity. </li></ul>Shoulder Joint
  47. 50. Anatomical Components of Shoulder Joint <ul><li>Articular capsule. </li></ul><ul><ul><li>Thin, loose sac that completely envelops the joint and extends from glenoid cavity to the anatomical neck of humerus. </li></ul></ul><ul><ul><li>Inferior part of the capsule is its weakest area. </li></ul></ul>
  48. 51. <ul><li>Coracohumeral Ligament </li></ul><ul><ul><li>Strong, broad ligament that strengthen the superior part of the articular capsule. </li></ul></ul><ul><ul><li>Provides stability superiorly, preventing superior translation. </li></ul></ul><ul><ul><li>Extends from the coracoid process of the scapula to the greater tubercle of humerus. </li></ul></ul>Anatomical Components of Shoulder Joint
  49. 52. <ul><li>Glenohumeral Ligament </li></ul><ul><ul><li>3 ligaments (middle, inferior and superior) over the anterior surface of the joint. </li></ul></ul><ul><ul><li>This 3 ligaments joint together known as capsular ligament. </li></ul></ul><ul><ul><li>Extend from the glenoid cavity to the lesser tubercle and anatomical neck of the humerus. </li></ul></ul><ul><ul><li>Often indistinct or absent and provide only minimum strength </li></ul></ul>Anatomical Components of Shoulder Joint
  50. 53. <ul><li>Transverse Humeral Ligament </li></ul><ul><ul><li>Narrow sheet ligament. </li></ul></ul><ul><ul><li>Extends from the greater tubercle to the lesser tubercle of the humerus. </li></ul></ul>Anatomical Components of Shoulder Joint
  51. 54. <ul><li>Glenoid labrum </li></ul><ul><ul><li>Narrow rim of fibrocartilage around the edge of the glenoid cartilage. </li></ul></ul><ul><ul><li>Slightly deepens and enlarges the glenoid cavity. </li></ul></ul>Anatomical Components of Shoulder Joint
  52. 55. <ul><li>Bursae </li></ul><ul><ul><li>4 bursae are associated with the shoulder joint. </li></ul></ul><ul><ul><li>They are subscapular bursa, subdeltoid bursa, subacromial bursa and subcoracoid bursa. </li></ul></ul><ul><ul><li>It provides a cushion between bones and tendons and/or muscles around a joint; bursae are filled with synovial fluid and are found around almost every major joint of the body. </li></ul></ul>Anatomical Components of Shoulder Joint
  53. 59. Common Shoulder Injury <ul><li>Rupture of the long head of biceps </li></ul><ul><li>Rotator cuff injury / strain </li></ul><ul><li>Subluxation of shoulder joint </li></ul><ul><li>Humerus fracture </li></ul>
  54. 60. Introduction of Axilla <ul><li>The axilla (or armpit , underarm , or oxter ) is the area on the human body directly under the joint where the arm connects to the shoulder. </li></ul>
  55. 61. Bones Boundaries
  56. 62. Boundaries of Axilla <ul><li>Superior </li></ul><ul><ul><li>Outer border of the 1 st ribs </li></ul></ul><ul><ul><li>Superior border of scapula </li></ul></ul><ul><ul><li>Posterior border of clavicle </li></ul></ul><ul><li>2. Medial </li></ul><ul><ul><li>Serratus anterior </li></ul></ul><ul><ul><li>ribcage </li></ul></ul>
  57. 63. Medial muscles of Axilla
  58. 64. Cont… <ul><li>3. Anterior </li></ul><ul><ul><li>Pectoralis minor </li></ul></ul><ul><ul><li>Pectoralis major </li></ul></ul><ul><ul><li>Subclavius </li></ul></ul><ul><ul><li>The lower border of Pectoralis major forms the rounded anterior axillary fold </li></ul></ul><ul><li>4. Posterior </li></ul><ul><ul><li>Subscapularis above </li></ul></ul><ul><ul><li>Teres major </li></ul></ul><ul><ul><li>Latissimus dorsi </li></ul></ul><ul><ul><li>The posterior axillary fold is a compound structure consisting of the latissimus dorsi and teres major muscles . </li></ul></ul>
  59. 65. Anterior Muscles of Axilla
  60. 66. Posterior Muscles of Axilla
  61. 67. Anterior Axillary Fold
  62. 68. Cont…. <ul><li>5. Lateral </li></ul><ul><ul><li>Intertubercular sulcus of humerus </li></ul></ul><ul><ul><li>tendon of long head of biceps </li></ul></ul><ul><ul><li>coracobrachialis and the short head of the biceps brachii are in the axilla </li></ul></ul><ul><li>6. Floor / base </li></ul><ul><ul><li>by the skin (visible surface of armpit) </li></ul></ul>
  63. 69. Lateral of Axilla
  64. 70. Content of the Axilla <ul><li>The axilla contain the: </li></ul><ul><ul><li>Axillary artery and vein and their branches </li></ul></ul><ul><ul><li>Brachial plexus and their branches </li></ul></ul><ul><ul><li>Axillary lymph nodes </li></ul></ul><ul><ul><li>Muscles </li></ul></ul><ul><ul><li>Fascia </li></ul></ul>
  65. 72. Thank You!!!

×