COLLEGE OF ALLIED COLLEGE OF ALLIED HEALTH AND SCIENCEHEALTH AND SCIENCE

HERMIZAN HALIHANAFIAHHERMIZAN HALIHANAFIAHBsc Biomedicine (Hons) UKMBsc Biomedicine (Hons) UKM

Pectoral/shoulder Girdle

Upper LimbPelvic Girdle

Lower LImb

Pectoral GirdlesPectoral Girdles Attach the bones of upper limb to the axial Attach the bones of upper limb to the axial

skeleton.skeleton.

Consist Consist clavicleclavicle and and scapulascapula bones. bones.

The pectoral girdles does not articulate The pectoral girdles does not articulate with the vertebral column. Held in position with the vertebral column. Held in position by complex of muscle attachment.by complex of muscle attachment.

Pectoral GirdlesPectoral Girdles

S shapeS shape

Also known as a collarboneAlso known as a collarbone

Classified as a long bone.Classified as a long bone.

Medial 2/3 convex anteriorly and lateral 1/3 Medial 2/3 convex anteriorly and lateral 1/3

concave anteriorly.concave anteriorly.

Situated lies horizontally in the superior and Situated lies horizontally in the superior and

anterior part of the thorax, superior to the 1anterior part of the thorax, superior to the 1stst rib. rib.

CLAVICLE

It acts as a strut to keep the scapula in position so the It acts as a strut to keep the scapula in position so the

arm can hang freely.arm can hang freely.

Palpable region because most of the region cover by Palpable region because most of the region cover by

skin (subcutaneous).skin (subcutaneous).

Have several function:Have several function:

- rigid support for the scapula and upper limb - rigid support for the scapula and upper limb

suspended. This arrangement keep upper limb (arm) suspended. This arrangement keep upper limb (arm)

away from thorax – maximum ROMaway from thorax – maximum ROM

CLAVICLECLAVICLE

Covers the cervicoaxillary canal (passageway between Covers the cervicoaxillary canal (passageway between

the neck and arm), through which several important the neck and arm), through which several important

structures pass (brachial plexus, artery etc)structures pass (brachial plexus, artery etc)

Transmits physical impacts from the upper limb to the Transmits physical impacts from the upper limb to the

axial skeleton. axial skeleton.

Provide some muscles attachment. (Deltoid, subclavius, Provide some muscles attachment. (Deltoid, subclavius,

trapezius, pec major etc)trapezius, pec major etc)

CLAVICLECLAVICLE

ClavicleClavicle

CLAVICLECLAVICLE

CLAVICLECLAVICLE

The medial end of the clavicle called sternal end is The medial end of the clavicle called sternal end is

rounded shape articulate with clavicular notch of rounded shape articulate with clavicular notch of

manubrium of sternum to form sternoclavicular manubrium of sternum to form sternoclavicular

joints.joints.

The lateral end of the clavicle called acromial The lateral end of the clavicle called acromial

extremity is broad and flat and articulate with extremity is broad and flat and articulate with

acromion process of scapula to form acromion process of scapula to form

acromioclavicular joint.acromioclavicular joint.

CLAVICLECLAVICLE

Sternoclavicular JointSternoclavicular Joint

Acromioclavicular Joint

The conoid tubercle on the inferior surface of the The conoid tubercle on the inferior surface of the

lateral end of the clavicle is a point attachment for lateral end of the clavicle is a point attachment for

the conoid ligament (coracoclavicular lig)the conoid ligament (coracoclavicular lig)..

The costal tuberosity on the inferior surface of the The costal tuberosity on the inferior surface of the

medial end is point attachment for the medial end is point attachment for the

costoclavicular ligament.costoclavicular ligament.

CLAVICLECLAVICLE

SCAPULASCAPULA Shoulder bladeShoulder blade

Large boneLarge bone

TriangularTriangular

Flat Flat

IrregularIrregular

SCAPULASCAPULA

Situated in the superior part of the Situated in the superior part of the

posterolateral aspect of the thorax posterolateral aspect of the thorax

between the levels of the 2between the levels of the 2ndnd and 7 and 7thth ribs. ribs.

The medial border of scapula lie about The medial border of scapula lie about

5cm from the vertebral column.5cm from the vertebral column.

Anterior View Posterior View

Consist 3 border; superior, lateral (axillary) and Consist 3 border; superior, lateral (axillary) and

medial (vertebra) border.medial (vertebra) border.

Consist 3 angle; superior angle, inferior angle Consist 3 angle; superior angle, inferior angle

and lateral angle.and lateral angle.

Consist 3 fossa; supraspinous and infraspinous Consist 3 fossa; supraspinous and infraspinous

fossa (posterior) and subscapular fossa fossa (posterior) and subscapular fossa

(anterior).(anterior).

ScapulaScapula

SpineSpine, runs diagonally across the posterior of , runs diagonally across the posterior of

the scapula separate supraspinous and the scapula separate supraspinous and

infraspinous fossa.infraspinous fossa.

The lateral end of spine projects as a flattened, The lateral end of spine projects as a flattened,

expanded process called the expanded process called the acromion acromion

processprocess..

ScapulaScapula

Acromion process articulate with the acromial Acromion process articulate with the acromial

extremity of clavicle to form extremity of clavicle to form acromioclavicular acromioclavicular

jointjoint..

Inferior to the acromion process is a shallow Inferior to the acromion process is a shallow

depression called depression called glenoid cavityglenoid cavity..

This cavity accepts the head of humerus to form This cavity accepts the head of humerus to form

glenohumeral jointglenohumeral joint..

ScapulaScapula

Medial (vertebral) border – the Medial (vertebral) border – the thin edgethin edge of the of the

bone near to the vertebral column.bone near to the vertebral column.

Lateral (axillary border) – the Lateral (axillary border) – the thick edgethick edge closer closer

to the arm.to the arm.

Medial border join the lateral border at the Medial border join the lateral border at the

inferior angleinferior angle..

ScapulaScapula

The superior edge of scapula , called superior The superior edge of scapula , called superior

border joins the vertebral border at the superior border joins the vertebral border at the superior

angle.angle.

The scapular notch is a prominent indentation The scapular notch is a prominent indentation

along the superior border through which the along the superior border through which the

subscapular nerve passes.subscapular nerve passes.

ScapulaScapula

At the lateral end of the superior border is At the lateral end of the superior border is

projection of the anterior surface called projection of the anterior surface called coracoid coracoid

processprocess, which the tendons and muscle attach., which the tendons and muscle attach.

Superior and inferior to the spine are two fossae; Superior and inferior to the spine are two fossae;

supraspinoussupraspinous and i and infraspinousnfraspinous fossafossa, surfaces , surfaces

of attachment of muscles and tendons.of attachment of muscles and tendons.

On the anterior surface is a slightly hollowed out On the anterior surface is a slightly hollowed out

area called area called subscapular subscapular fossafossa..

ScapulaScapula

Movements of the Movements of the ScapulaScapula

Movements of the ScapulaMovements of the Scapula

Elevation of ScapulaElevation of Scapula

Superior movement

of the shoulder

girdle; moving the

scapula up.

Depression of ScapulaDepression of Scapula

Inferior movement of

the shoulder girdle;

moving the scapula

down.

Movements of the ScapulaMovements of the Scapula

Upward Rotation of ScapulaUpward Rotation of Scapula

Rotary movement of

the scapula; moving

inferior angle of scapula

laterally and upward

Downward Rotation of Downward Rotation of ScapulaScapula

Rotary movement of

the scapula; moving

inferior angle of

scapula medially and

downward.

Movements of the ScapulaMovements of the Scapula

Abduction/Protraction of Abduction/Protraction of ScapulaScapula

Forward movement

away the midline of

the body; moving the

scapula away from

the spine during

protraction of the

shoulder girdle.

Adduction/Retraction of Adduction/Retraction of ScapulaScapula

Backward movement

toward the midline of the

body; moving the

scapula back toward the

spine during retraction

of the shoulder girdle.

Movement of the Scapula Movement of the Scapula as a Wholeas a Whole

Movement of the pec girdle serve to Movement of the pec girdle serve to increase the range of movement increase the range of movement (ROM) of the shoulder jt.(ROM) of the shoulder jt.

Remember!!! – movements of the Remember!!! – movements of the pectoral girdle accompany virtually pectoral girdle accompany virtually to all movements of the shoulder to all movements of the shoulder joint.joint.

Pairing of Pec Girdle and Pairing of Pec Girdle and Shoulder Jt MovementsShoulder Jt Movements

Shoulder Jt Shoulder Girdle

Abduction Upward rotation

Adduction Downward rotation

Flexion Elevation / upward rotation

Extension Depression / downward rotation

Internal rotation Internal rotation Abduction (protraction)Abduction (protraction)

External rotationExternal rotation Adduction (retraction)Adduction (retraction)

Horizontal abductionHorizontal abduction Adduction (retraction)Adduction (retraction)

Horizontal adductionHorizontal adduction Abduction (protraction)Abduction (protraction)

Orientation Muscles of the Orientation Muscles of the Pectoral GirdlePectoral Girdle

Muscles of the thorax that move the pectoral Muscles of the thorax that move the pectoral

girdlegirdle

Anterior thoracic musclesAnterior thoracic muscles

Posterior thoracic musclesPosterior thoracic muscles

Muscles of the thorax that move the humerus.Muscles of the thorax that move the humerus.

Axial muscles that move the humerusAxial muscles that move the humerus

Scapular muscles that move the humerus.Scapular muscles that move the humerus.

Muscles of the Thorax Move the Muscles of the Thorax Move the Pectoral GirdlePectoral Girdle

Anterior thoracic Anterior thoracic

musclesmuscles

SubclaviusSubclavius

Pectoralis minorPectoralis minor

Serratus anteriorSerratus anterior

Posterior thoracic Posterior thoracic

musclesmuscles

Fiber of trapeziusFiber of trapezius

Levator scapulaeLevator scapulae

Rhomboid minorRhomboid minor

Rhomboid majorRhomboid major

Muscles of the Thorax that Move Muscles of the Thorax that Move the Humerusthe Humerus

Axial musclesAxial muscles

Pectoralis majorPectoralis major

Latissumus dorsiLatissumus dorsi

Scapular musclesScapular muscles

Fiber of deltoidFiber of deltoid

Rotator cuffRotator cuff

Teres majorTeres major

CoracobrachalisCoracobrachalis

Long & short head of Long & short head of

bicepsbiceps

Long head of tricepsLong head of triceps

ORIGIN, INSERTION, ACTIONS ORIGIN, INSERTION, ACTIONS AND NERVE SUPPLYAND NERVE SUPPLY

Subclavius MuscleSubclavius Muscle Origin – 1Origin – 1stst rib rib

Insertion – lower surface of clavicleInsertion – lower surface of clavicle

Action Action

Depression and move clavicle Depression and move clavicle

anteriorly anteriorly

Helps stabilize pectoral girdleHelps stabilize pectoral girdle

Nerve supplyNerve supply

Subclavian nerveSubclavian nerve

Subclavius

Pectoralis MinorPectoralis Minor Origin Origin

22nd nd - 5- 5thth ribs, 3 ribs, 3rdrd – 5 – 5thth ribs or 2 ribs or 2ndnd – 4 – 4thth ribs. ribs.

InsertionInsertion Coracoid process of scapulaCoracoid process of scapula

ActionAction Abduction scapula and rotates it downwardAbduction scapula and rotates it downward Elevate the ribs during forced inhalation.Elevate the ribs during forced inhalation.

Nerve supplyNerve supply Medial pectoral nerveMedial pectoral nerve

Pectoralis MinorPectoralis Minor

Serratus AnteriorSerratus Anterior Origin – Superior 8 or 9 ribsOrigin – Superior 8 or 9 ribs Insertion – vertebral border and Insertion – vertebral border and

inferior angle of scapulainferior angle of scapula Action Action

Abduction and rotates the Abduction and rotates the scapula upwardscapula upward

Elevate ribs when scapula Elevate ribs when scapula stabilized.stabilized.

Also known as “boxer’s Also known as “boxer’s muscles”muscles”

Nerve supplyNerve supply Long thoracic nerveLong thoracic nerve

Fiber of TrapeziusFiber of Trapezius Consists 3 fibersConsists 3 fibers

Superior or upper fiber, Superior or upper fiber,

middle fiber and inferior or middle fiber and inferior or

lower fiber.lower fiber.

Important for move the Important for move the

scapula.scapula.

Nerve supply - accessory Nerve supply - accessory

nerve and cervical spinal nerve and cervical spinal

nervenerve..

Upper / Superior Upper / Superior Fiber of TrapeziusFiber of Trapezius

Origin – medial one third of Origin – medial one third of

the superior nuchal line, the superior nuchal line,

external occipital protuberance external occipital protuberance

and ligamentum nuchae.and ligamentum nuchae.

Insertion – posterior border of Insertion – posterior border of

the lateral one third of the the lateral one third of the

clavicle.clavicle.

Action – scapular elevationAction – scapular elevation

Middle Fiber of TrapeziusMiddle Fiber of Trapezius

Origin – spinous process Origin – spinous process

of T1 – T5of T1 – T5

Insertion – medial border Insertion – medial border

of the acromion process of the acromion process

of scapula, and superior of scapula, and superior

border of the spine of the border of the spine of the

scapula.scapula.

Action – scapular Action – scapular

adductionadduction..

Lower / Inferior Fiber of Lower / Inferior Fiber of TrapeziusTrapezius

Origin – spinous Origin – spinous

process of T6-T12process of T6-T12

Insertion – spine of the Insertion – spine of the

scapulascapula

Action scapular Action scapular

depression and depression and

adductionadduction

Levator ScapulaeLevator Scapulae Origin – transverse process of Origin – transverse process of

Superior four or five cervical Superior four or five cervical

vertebrae.vertebrae.

Insertion – superior vertebral Insertion – superior vertebral

border of scapulaborder of scapula

Action – Elevates scapula and Action – Elevates scapula and

rotates it downward.rotates it downward.

Nerve supply – dorsal scapular Nerve supply – dorsal scapular

nerve and cervical spinal nervenerve and cervical spinal nerve

Rhomboid MajorRhomboid Major

Origin – Spine of 2Origin – Spine of 2ndnd to 5 to 5thth thoracic vertebraethoracic vertebrae

Insertion – vertebral border of Insertion – vertebral border of scapula inferior to spine of scapula inferior to spine of scapulascapula

Action – elevates and adducts Action – elevates and adducts scapula and rotate it scapula and rotate it downward; stabilize scapuladownward; stabilize scapula

Nerve – dorsal scapular nerveNerve – dorsal scapular nerve

Rhomboid MinorRhomboid Minor Origin – Spine of 7Origin – Spine of 7thth cervical cervical

and 1and 1stst thoracic vertebrae. thoracic vertebrae. Insertion – Vertebrae border Insertion – Vertebrae border

of scapula superior to spineof scapula superior to spine Action – elevates and Action – elevates and

adducts scapula and rotate it adducts scapula and rotate it downward; stabilize scapuladownward; stabilize scapula

Nerve – dorsal scapular Nerve – dorsal scapular nervenerve

Clavicle origin of Clavicle origin of Pectoralis MajorPectoralis Major

Origin – medial half of anterior Origin – medial half of anterior clavicleclavicle

Insertion – greater tubercle and Insertion – greater tubercle and intertubercular sulcus of humerusintertubercular sulcus of humerus

Action – Flexion, adduction and Action – Flexion, adduction and medial rotation arm at shoulder medial rotation arm at shoulder joint.joint.

Nerve supplyNerve supply Medial and lateral pectoral Medial and lateral pectoral

nervenerve

Sternal origin of Pectoralis Sternal origin of Pectoralis MajorMajor

Origin – anterior surface of Origin – anterior surface of sternum, costal cartilage of 2sternum, costal cartilage of 2ndnd - -66thth ribs. ribs.

Insertion – greater tubercle and Insertion – greater tubercle and intertubercular sulcus of humerusintertubercular sulcus of humerus

Action – extend arm at shoulder Action – extend arm at shoulder joint.joint.

Nerve supplyNerve supply Medial and lateral pectoral Medial and lateral pectoral

nervenerve

Latissimus DorsiLatissimus Dorsi Origin – Spines of inferior 6 thoracic vertebrae Origin – Spines of inferior 6 thoracic vertebrae

(T6-T12), lumbar vertebrae (L1-L5), crest of (T6-T12), lumbar vertebrae (L1-L5), crest of

sacrum and illiac crest of hip bone and inferior sacrum and illiac crest of hip bone and inferior

four ribs.four ribs.

Insertion – Intertubecular sulcus of humerusInsertion – Intertubecular sulcus of humerus

ActionAction

Extends, adduction and medial rotation arm at Extends, adduction and medial rotation arm at

shoulder joint.shoulder joint.

Nerve supply - Thoracodorsal nerveNerve supply - Thoracodorsal nerve

Latissimus Dorsi

Fiber of DeltoidFiber of Deltoid

Consists 3 fibersConsists 3 fibers

Anterior, middle and Anterior, middle and

posterior fibers.posterior fibers.

Responsible for Responsible for

movements of the humerus movements of the humerus

at GH jointat GH joint

Nerve supply – axillary Nerve supply – axillary

nerve.nerve.

Anterior Fiber of DeltoidAnterior Fiber of Deltoid

Origin – anterior border of Origin – anterior border of

the lateral one third of the the lateral one third of the

clavicleclavicle

Insertion – deltoid Insertion – deltoid

tuberosity tuberosity

Action – flexion and Action – flexion and

middle rotation arm at GH middle rotation arm at GH

joint.joint.

Middle fiber of DeltoidMiddle fiber of Deltoid

Origin – lateral border and Origin – lateral border and

superior surface of the superior surface of the

acromion process of the acromion process of the

scapulascapula

Insertion – deltoid Insertion – deltoid

tuberositytuberosity

Action – abduction arm at Action – abduction arm at

GH jointGH joint

Posterior Fiber of DeltoidPosterior Fiber of Deltoid

Origin – inferior lip of the Origin – inferior lip of the

crest of the spine of the crest of the spine of the

scapulascapula

Insertion – deltoid Insertion – deltoid

tuberositytuberosity

Action – extension and Action – extension and

lateral rotation arm at GH lateral rotation arm at GH

joint.joint.

Rotator Cuff MusclesRotator Cuff Muscles

Consists 4 musclesConsists 4 muscles

S – SupraspinatusS – Supraspinatus

I – InfraspinatusI – Infraspinatus

T – teres minorT – teres minor

S – SubscapularisS – Subscapularis

Group of muscles that stabilize GH jointGroup of muscles that stabilize GH joint..

Supraspinatus MuscleSupraspinatus Muscle Origin – supraspinous fossa Origin – supraspinous fossa

of scapulaof scapula Insertion – Greater tubercle Insertion – Greater tubercle

of humerus (anterior aspect)of humerus (anterior aspect) Action – initially abduction Action – initially abduction

(15 degrees) at shoulder (15 degrees) at shoulder joint, stabilizing shoulder jointjoint, stabilizing shoulder joint

Nerve supply - Nerve supply - Suprascapular nerveSuprascapular nerve

Infraspinatus MuscleInfraspinatus Muscle

Origin – Infraspinous fossa Origin – Infraspinous fossa of scapulaof scapula

Insertion – Greater tubercle Insertion – Greater tubercle of humerus (posterior of humerus (posterior aspect)aspect)

Action – Laterally rotation Action – Laterally rotation and adduction arm at and adduction arm at shoulder jointshoulder joint

Nerve supply - Nerve supply - Suprascapular nerveSuprascapular nerve

Teres MinorTeres Minor Origin – Inferior lateral Origin – Inferior lateral

border of scapulaborder of scapula

Insertion – Greater tubercle Insertion – Greater tubercle

of humerus (inferior aspect)of humerus (inferior aspect)

Action – Laterally rotation, Action – Laterally rotation,

extends and adduction arm extends and adduction arm

at shoulder jointat shoulder joint

Nerve supply – axillary Nerve supply – axillary

nervenerve

Subscapularis MuscleSubscapularis Muscle

Origin – subscapular Origin – subscapular

fossa of scapulafossa of scapula

Insertion – lesser tubercle Insertion – lesser tubercle

of humerusof humerus

Action – Medial rotation Action – Medial rotation

arm at shoulder jointarm at shoulder joint

Nerve supply – upper and Nerve supply – upper and

lower subscapular nervelower subscapular nerve

Teres MajorTeres Major Origin – Inferior angle of Origin – Inferior angle of

scapulascapula Insertion – Intertubecular Insertion – Intertubecular

sulcus of humerussulcus of humerus ActionAction

Extends arm at shoulder Extends arm at shoulder jointjoint

Assist in adduction and Assist in adduction and medial rotation of arm medial rotation of arm at shoulder joint.at shoulder joint.

Nerve supplyNerve supply Lower subscapular Lower subscapular

nervenerve

CoracobrachialisCoracobrachialis

Origin - Coracoid process of Origin - Coracoid process of

scapulascapula

Insertion - Middle of medial Insertion - Middle of medial

surface of shaft of humerus.surface of shaft of humerus.

Action - Flexion and adduction Action - Flexion and adduction

arm at shoulder joint.arm at shoulder joint.

Nerve supply - Nerve supply -

Musculocutaneous nerveMusculocutaneous nerve

Biceps BrachiiBiceps Brachii

Consists 2 headConsists 2 head Long head and Long head and

short head of short head of

bicepsbiceps

Short head of BicepsShort head of Biceps Origin – Coracoid process of Origin – Coracoid process of

scapulascapula Insertion – radial tuberosity of Insertion – radial tuberosity of

radius radius Action – Flexion forearm at Action – Flexion forearm at

elbow joint, flexion arm at GH elbow joint, flexion arm at GH joint and supination at joint and supination at radioulnar joint.radioulnar joint.

Nerve supply - Nerve supply - Musculocutaneous nerveMusculocutaneous nerve

Long head of BicepsLong head of Biceps

Origin – Tubercle above the Origin – Tubercle above the glenoid cavity of scapula glenoid cavity of scapula (supraglenoid tubercle)(supraglenoid tubercle)

Insertion – Radial tuberosity Insertion – Radial tuberosity of radiusof radius

Action – flexion forearm at Action – flexion forearm at elbow joint, flexion arm at elbow joint, flexion arm at GH joint and supination GH joint and supination forearm at radioulnar joint.forearm at radioulnar joint.

Nerve supply - Nerve supply - Musculocutaneous nerveMusculocutaneous nerve

Long head of TricepsLong head of Triceps

Origin – tubercle below to Origin – tubercle below to

glenoid cavity of scapula glenoid cavity of scapula

(infraglenoid tubercle)(infraglenoid tubercle)

Insertion – Olecranon of ulnaInsertion – Olecranon of ulna

Action - Extends forearm at Action - Extends forearm at

elbow joint , Extends arm at elbow joint , Extends arm at

shoulder jointshoulder joint

Nerve supply - Radial nerveNerve supply - Radial nervePosterior View

Sternomastoid / Sternomastoid / CleidomastoidCleidomastoid

Join together to form sternocleidomastoid Join together to form sternocleidomastoid

musclemuscle

Origin Origin

(i) Sternomastoid - upper part of the anterior (i) Sternomastoid - upper part of the anterior

surface of the manubrium of sternum.surface of the manubrium of sternum.

(ii) Cleidomastoid - superior border and anterior (ii) Cleidomastoid - superior border and anterior

surface of the medial third of the clavicle.surface of the medial third of the clavicle.

Insertion – Mastoid process of Insertion – Mastoid process of

the mastoid portion of temporal the mastoid portion of temporal

bone.bone.

Action - Acting together, flexes Action - Acting together, flexes

the neck, raises the sternum and the neck, raises the sternum and

assists in forced inspiration.assists in forced inspiration.

Nerve supply – accessory nerve Nerve supply – accessory nerve

(cranial nerve XI)(cranial nerve XI)

Sternomastoid / CleidomastoidSternomastoid / Cleidomastoid

Joints on Pectoral GirdleJoints on Pectoral Girdle

There is two type of joint:There is two type of joint:

1.1. Sternoclavicular jointSternoclavicular joint

2.2. Acromioclavicular jointAcromioclavicular joint

Sternoclavicular JointSternoclavicular Joint

1.1. Articular componentsArticular components

• Between sternal end of clavicle and clavicular Between sternal end of clavicle and clavicular

notch of manubrium of sternum.notch of manubrium of sternum.

2.2. ClassificationClassification

• Synovial joint (planar)Synovial joint (planar)

3.3. MovementsMovements

• Gliding, with limited movements in nearly every Gliding, with limited movements in nearly every

direction.(backward, upward, forward, direction.(backward, upward, forward,

downward, circumduction)downward, circumduction)

Cont…Cont…

Sternoclavicular joint strengthen by series of Sternoclavicular joint strengthen by series of

ligaments:ligaments:

The Articular Capsule The Articular Capsule

The Anterior Sternoclavicular The Anterior Sternoclavicular

The Posterior Sternoclavicular The Posterior Sternoclavicular

The Interclavicular The Interclavicular

The Costoclavicular The Costoclavicular

Sternoclavicular Ligaments

Articular CapsuleArticular Capsule

The articular capsule surrounds the articulation and The articular capsule surrounds the articulation and

varies in thickness and strength. varies in thickness and strength.

In front and behind it is of considerable thickness, In front and behind it is of considerable thickness,

and forms the anterior and posterior and forms the anterior and posterior

sternoclavicular ligaments; but above, and sternoclavicular ligaments; but above, and

especially below, it is thin and partakes more of the especially below, it is thin and partakes more of the

character of areolar than of true fibrous tissue.character of areolar than of true fibrous tissue.

Anterior Sternoclavicular Anterior Sternoclavicular LigamentLigament

The anterior sternoclavicular ligament is a broad The anterior sternoclavicular ligament is a broad

band of fibersband of fibers

Covering the anterior surface of the articulation Covering the anterior surface of the articulation

attached attached aboveabove to the upper and front part of the to the upper and front part of the

sternal end of the clavicle, and, passing obliquely sternal end of the clavicle, and, passing obliquely

downward and medialward, is attached below to downward and medialward, is attached below to

the front of the upper part of the manubrium the front of the upper part of the manubrium

sternum.sternum.

Posterior Sternoclavicular Posterior Sternoclavicular LigamentLigament

The posterior sternoclavicular ligament is a similar The posterior sternoclavicular ligament is a similar

band of fibers, covering the posterior surface of the band of fibers, covering the posterior surface of the

articulationarticulation

attached above to the upper and back part of the attached above to the upper and back part of the

sternal end of the clavicle, and, passing obliquely sternal end of the clavicle, and, passing obliquely

downward and medialward, is fixed below to the back downward and medialward, is fixed below to the back

of the upper part of the manubrium of sternum.of the upper part of the manubrium of sternum.

Interclavicular LigamentInterclavicular Ligament

This ligament is a flattened band, which varies This ligament is a flattened band, which varies

considerably in form and size in different individuals, considerably in form and size in different individuals,

it passes in a curved direction from the upper part of it passes in a curved direction from the upper part of

the sternal end of one clavicle to that of the other, and the sternal end of one clavicle to that of the other, and

is also attached to the upper margin of the sternum. is also attached to the upper margin of the sternum.

Costoclavicular LigamentsCostoclavicular Ligaments

This ligament is short, flat, strong, and rhomboid in This ligament is short, flat, strong, and rhomboid in

form. form.

Attached below to the upper and medial part of the Attached below to the upper and medial part of the

cartilage of the first rib, it ascends obliquely cartilage of the first rib, it ascends obliquely

backward and lateralward, and is fixed above to the backward and lateralward, and is fixed above to the

costal tuberosity on the under surface of the clavicle. costal tuberosity on the under surface of the clavicle.

Acromioclavicular JointAcromioclavicular Joint1.1. Articular componentsArticular components

• Between acromion process of scapula and acromial Between acromion process of scapula and acromial

end of clavicle.end of clavicle.

2.2. ClassificationClassification

• Synovial joint (planar)Synovial joint (planar)

3.3. MovementsMovements

• Gliding and rotation of scapula on clavicle.Gliding and rotation of scapula on clavicle.

• Rotation of scapula forward and backward upon Rotation of scapula forward and backward upon

clavicle.clavicle.

Acromioclavicular joint strengthened by series of Acromioclavicular joint strengthened by series of

ligaments:ligaments:

Acromioclavicular ligamentsAcromioclavicular ligaments

Coracoclavicular ligamentsCoracoclavicular ligaments

Coracoacromial ligaments.Coracoacromial ligaments.

Acromioclavicular JointAcromioclavicular Joint

Acromioclavicular JointAcromioclavicular Joint Coracoaromial ligamentCoracoaromial ligament

Controls anterior and posterior translation of the Controls anterior and posterior translation of the lateral claviclelateral clavicle

Coracoclavicular ligamentCoracoclavicular ligament Control vertical stability; restrains superior and Control vertical stability; restrains superior and

anterior displacements.anterior displacements.

Acromioclavicular ligamentAcromioclavicular ligament Provides stability across the joint; restrains posterior Provides stability across the joint; restrains posterior

translation and displacement of the clavicletranslation and displacement of the clavicle..

Acromioclavicular LigamentsAcromioclavicular Ligaments

The AC ligaments surround and support The AC ligaments surround and support

the AC joint. the AC joint.

Together, they form the joint capsule. Together, they form the joint capsule.

The joint capsule is a watertight sac that The joint capsule is a watertight sac that

encloses the joint and the fluids that bathe encloses the joint and the fluids that bathe

the joint.the joint.

Coracoclavicular LigamentsCoracoclavicular Ligaments

The coracoclavicular ligaments, hold the The coracoclavicular ligaments, hold the

clavicle down by attaching it to a bony clavicle down by attaching it to a bony

knob on the scapula called the coracoid knob on the scapula called the coracoid

process.process.

Clinical ConditionClinical Condition

Clavicle fractureClavicle fracture

Frozen shoulderFrozen shoulder

AC joint injuryAC joint injury

Shoulder dislocationShoulder dislocation

Clavicle FractureClavicle Fracture This bone is usually fracture as This bone is usually fracture as

a result of falling badly onto an a result of falling badly onto an

outstretched arm or onto the outstretched arm or onto the

shoulder.shoulder.

The bone usually fractures in The bone usually fractures in

it's middle third and is very it's middle third and is very

painful.painful.

Athletes (physical impact), Athletes (physical impact),

newborn, babynewborn, baby

Frozen Shoulder Frozen Shoulder (Adhesive Capsulitis)(Adhesive Capsulitis)

This is a condition which This is a condition which affects the ability to move the affects the ability to move the shoulder, and usually only shoulder, and usually only occurs on one side. occurs on one side.

Sticky and inflammation of the Sticky and inflammation of the shoulder joint.shoulder joint.

Inflammation of the joint Inflammation of the joint capsule – restricting capsule – restricting movement of the head of movement of the head of

humerushumerus..

AC Joint InjuryAC Joint Injury Separation of the two Separation of the two

bones forming this joint bones forming this joint

is caused by damage to is caused by damage to

the ligaments the ligaments

connecting them. connecting them. The most common way The most common way

of injuring the AC joint of injuring the AC joint

is by landing on the is by landing on the

shoulder, elbow, or onto shoulder, elbow, or onto

an outstretched hand. an outstretched hand.

Shoulder DislocationShoulder Dislocation In most cases, the head of the In most cases, the head of the

humerus is forced forwards humerus is forced forwards

when the arm is turned when the arm is turned

outwards (externally rotated) outwards (externally rotated)

and held out to the side and held out to the side

(abducted).(abducted).

This causes an anterior This causes an anterior

dislocation, which make up dislocation, which make up

approximately 95% of all approximately 95% of all

shoulder dislocations. shoulder dislocations.

Shoulder DislocationShoulder Dislocation