Shoulder joint, mbbs 3 9-2015, dr vvs
-
Upload
sachin-patne -
Category
Education
-
view
676 -
download
1
Transcript of Shoulder joint, mbbs 3 9-2015, dr vvs
![Page 1: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/1.jpg)
SHOULDER JOINT
![Page 2: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/2.jpg)
2
Objectives Shoulder joint - Type Articular surfaces Ligaments Movements & muscles bringing
about the movements Blood supply Nerve supply Structures undercover of deltoid Applied anatomy
![Page 3: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/3.jpg)
3
Shoulder joint – Type
Also known as gleno-humeral joint
Type – multi-axial ball & socket type of synovial joint
![Page 4: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/4.jpg)
4
Shoulder joint – Articular surfaces Ball – spheroidal
head of humerus, 1/3rd of a sphere, directed medially,
upwards & backwards
Covered by hyaline articular cartilage – thickest in centre & thinner at periphery
![Page 5: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/5.jpg)
5
Shoulder joint – Articular surfaces Socket – pear-shaped, small &
shallow glenoid cavity of scapula
Directed upwards, forwards & laterally
hyaline articular cartilage – thin – centre; thick - periphery
Fossa deepened - glenoidal labrum - fibro-cartilaginous, attached to its peripheral margin
![Page 6: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/6.jpg)
![Page 7: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/7.jpg)
7
Shoulder joint – Ligaments Fibrous capsule Synovial membrane Glenoid labrum Glenohumeral
ligaments Coraco-humeral
ligament Transverse humeral
ligament
![Page 8: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/8.jpg)
8
Ligaments - Fibrous capsule Loose envelope
permitting free movements
Medially – peripheral margin of glenoid cavity outside the labrum, includes origin of long head biceps brachii
Laterally – anatomical neck of humerus
![Page 9: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/9.jpg)
9
Ligaments - Fibrous capsule Deficient at two areas At upper end of
intertubercular sulcus - passage - tendon of long head of biceps
Infero-medially – it extends about 1 cm below to enroach on surgical neck of humerus
Supported by expansions - rotator cuff muscles
![Page 10: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/10.jpg)
10
Ligaments - Synovial membrane Lines the capsule Reflected along the
intra-capsular part of neck upto the articular cartilage of humeral head.
Synovial sheath extends along the long head of biceps brachii
![Page 11: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/11.jpg)
Ligaments - Glenoid labrum Fibro-cartilaginous rim Attached to peripheral
margin of glenoid cavity except above – long head of biceps brachii
Deepens the glenoid fossa & also forms a pliable cushion for the ball to roll
![Page 12: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/12.jpg)
12
Ligaments - Glenohumeral ligaments Three fibrous bands
derived - thickening of the anterior part of fibrous capsule
Can be seen from within the joint
Converge upward & medially to supero-medial margin of glenoid cavity & blends with labrum
![Page 13: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/13.jpg)
13
Ligaments - Glenohumeral ligaments Superior band – lies
parallel to anterior edge of biceps tendon & attached to upper end of lesser tubercle of humerus
Middle band – attached ot lower part of lesser tubercle
Inferior band – lower part of anatomical neck of humerus
![Page 14: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/14.jpg)
![Page 15: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/15.jpg)
15
Ligaments - Coraco-humeral ligament Thick band in the
upper part of capsule & extends from lateral border of coracoid process to anatomical neck of humerus b/w greater & lesser tubercle
Resists lateral rotation & adduction
![Page 16: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/16.jpg)
16
Ligaments - Transverse humeral ligament Connects two
lips of upper part of intertubercular sulcus & acts as retinaculum
![Page 17: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/17.jpg)
![Page 18: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/18.jpg)
18
Rotator cuff Musculo-tendinous
cuff Formed -
supraspinatus, infraspinatus, subscapularis & teres minor – tonic contractions keep ball in contact with socket
![Page 19: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/19.jpg)
![Page 20: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/20.jpg)
![Page 21: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/21.jpg)
21
Stability Coraco-acromial
arch – secondary socket for head of humerus
Musculo-tendinous cuff
Glenoidal labrum
![Page 22: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/22.jpg)
Relations of joint Above –
supraspinatus, subacromial bursa, coraco-acromial arch
Below – quadrangular space
In front – subscapularis, coracobrachialis & short head of biceps
Behind – infraspinatus, teres minor
![Page 23: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/23.jpg)
23
Bursae in relation to joint Subacromial bursa
– b/w supraspinatus & coraco-acromial arch, extends laterally b/w deltoid & greater tubercle; acts as secondary socket
![Page 24: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/24.jpg)
24
Bursae in relation to joint Subscapular bursa –
b/w subscapularis tendon & fibrous capsule; communicates with joint cavity - oval gap b/w superior & middle glenohumeral ligaments
Infraspinatus bursa
![Page 25: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/25.jpg)
25
Movements Movement Axis Muscles
Flexion Plane parallel to surface of glenoid cavity
Pectoralis major – clavicular head, deltoid – anterior fibres
Extension Deltoid – posterior fibres, latissimus dorsi
![Page 26: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/26.jpg)
26
Movements Movement Axis Muscles
Adduction Perpend- icular to plane of flexion & extension
Pectoralis major, teres major, Deltoid – anterior & posterior fibres, latissimus dorsi, coracobrachialis, long head of triceps
Abduction Supraspinatus – 0-150
Deltoid – middle fibres-15-900
Serratus anterior, trapezius – 90 – 1800
![Page 27: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/27.jpg)
27
Movements Movement Axis Muscles Medial rotation
Vertical Pectoralis major, teres major, Deltoid – anterior fibres, latissimus dorsi.
Lateral rotation
Deltoid – posterior fibres, infraspinatus, teres minor
![Page 28: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/28.jpg)
Movements Circumduction –
succession of flexion, extension, adduction & abduction movements
28
![Page 29: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/29.jpg)
![Page 30: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/30.jpg)
30
Blood supply Anterior & posterior
circumflex humeral vessels
Supra & subscapular vessels
![Page 31: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/31.jpg)
31
Nerve supply
Axillary nerve Musculocutaneous nerve Suprascapular nerve
![Page 32: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/32.jpg)
Structures under cover of deltoid Bones Muscles Vessels & nerves Joints & ligaments Bursa
32
![Page 33: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/33.jpg)
Structures under cover of deltoid Bones – coracoid
process; lesser & greater tubercle, intertubercular sulcus, upper part of shaft & surgical neck of humerus
33
![Page 34: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/34.jpg)
Structures under cover of deltoid Muscles –
pectoralis major & minor, coracobrachialis, both headsof biceps brachii, latissimus dorsi, long head of triceps, rotator cuff muscles
34
![Page 35: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/35.jpg)
![Page 36: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/36.jpg)
Structures under cover of deltoid Vessels & nerves
– anterior & posterior circumflex humeral vessels, axillary nerve
36
![Page 37: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/37.jpg)
Structures under cover of deltoid Joints &
ligaments – Shoulder joint & its ligaments; Coraco-acromial ligament
37
![Page 38: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/38.jpg)
Structures under cover of deltoid Bursa –
subacromial bursa
38
![Page 39: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/39.jpg)
Radiology of shoulder joint
![Page 40: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/40.jpg)
Shoulder joint dislocation
Common due to laxity of ligaments & disproportionate articular surfaces. Inferior dislocation common & nerve damaged is axillary nerve
![Page 41: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/41.jpg)
Shoulder joint inflammation
An inflammation of the shoulder joint can cause pain and restricted joint movement.
![Page 42: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/42.jpg)
Painful arc syndrome
Chronic thickening of tendon of supraspinatus – pain b/w 60 & 120 abduction – impingement of tendon against coraco-acromial arch.
![Page 43: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/43.jpg)
Frozen shoulder/ Adhesive capsulitis Causes
restriction of motion in the shoulder joint.
Causes the capsule surrounding the shoulder joint to contract and form scar tissue.
![Page 44: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/44.jpg)
Bursitis
![Page 45: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/45.jpg)
Arthodesis of shoulder ( surgical fixation) Optimum
position – 450
abduction & 200 flexion
![Page 46: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/46.jpg)
Osteoarthritis
![Page 47: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/47.jpg)
Arthroplasty Osteoarthritis -
joint replacement by metallic prosthesis
Hemiarthroplasty – joint surface of humerus only is replaced
Total arthroplasty – joint surface of humerus & glenoid surface is replaced
![Page 48: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/48.jpg)
![Page 49: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/49.jpg)
Can you? Describe the shoulder joint under the following
headings – Type Articular surfaces Ligaments Movements & muscles bringing about the
movements Applied anatomy Rotator cuff
![Page 50: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/50.jpg)
50
To summarize Shoulder joint - Type Articular surfaces Ligaments Movements & muscles bringing about the
movements Blood supply Nerve supply Structures undercover of deltoid Applied anatomy
![Page 51: Shoulder joint, mbbs 3 9-2015, dr vvs](https://reader033.fdocuments.in/reader033/viewer/2022042907/58ea227a1a28abf9018b52cb/html5/thumbnails/51.jpg)
Life is a drawing without an eraser