General

Bones and Joints

The bones of the shoulder:

• The humerus is the upper arm bone. This is the "ball" of the shoulder's "ball and socket" joint.
  
• The scapula is the flat, triangular bone commonly called the shoulder blade. Prominent areas of the scapula serve as attachment points for many muscles and ligaments.
       - The glenoid is the shallow "socket" on the side of the scapula that receives the 'ball' of the humerus. Together they form the "ball and socket" arrangement of the shoulder.
       - The scapular spine is a horizontal ridge along the back of the scapula that divides the scapula into upper and lower regions.
       - The acromion is the end of the scapular spine. It projects up to form the top of the shoulder.
       - The coracoid process is a projection towards the front of the scapula and is an attachment site for several muscles and ligaments.
  
• The clavicle is the collarbone. Although it appears to be straight, it actually forms an S-shape when seen from above.
  
• The thorax, or rib cage, is an anchor for several muscles and ligaments. Although the ribs do not physically attach to the scapula, the thorax stabilizes and maintains proper positioning of the scapula so that the arm can function to its fullest capacity.

• The glenohumeral joint is the main joint of the shoulder. Here, the glenoid on the scapula and the head of the humerus come together. The fairly flat socket of the glenoid surrounds only 20% - 30% of the humeral head. Because of its poor fit, this joint relies heavily on the surrounding soft tissue for support. The labrum, a ring of fibrocartilage tissue, attaches to the glenoid and deepens the socket to encircle more of the humerus.
  
• The acromioclavicular joint, or AC joint, is the bony point on the top of the shoulder. It stabilizes the scapula to the chest, by connecting the acromion on the scapula to the clavicle, or "collarbone". A thick disk of fibrocartilage acts as a shock absorber between the two bones. The surrounding capsule and ligaments give this joint great stability.
  
• The sternoclavicular joint, or SC joint, connects the other end of the clavicle to the sternum, or "breastbone". Like the AC joint, this joint contains a fibrocartilage disk that helps the bones achieve a better fit. It also gets excellent support from its joint capsule and surrounding ligaments.
  
• The scapulothoracic articulation is the area where the scapula, embedded in muscle, glides over the thoracic rib cage. The surrounding muscles and ligaments keep the scapula properly positioned so that the arm can move correctly.

• Articular cartilage is the shiny white coating that covers the end of the humeral head and lines the inside surface of the glenoid. It has two purposes:
       - To provide a smooth, slick surface for easy movement
       - To be a shock absorber and protect the underlying bone
  
• Fibrocartilage is the thick tissue that forms the disks of the AC and SC joints and the labrum, the ring that deepens the glenoid. Fibrocartilage has three roles:
       - To act as a cushion in shock absorption
       - To help stabilize the joint by improving the fit of the bones
       - To act as a spacer and improve contact between the articular cartilage surfaces

• The glenohumeral ligaments attach in layers from the glenoid labrum to form the joint capsule around the head of the humerus.
  
• The coracoacromial arch is the group of ligaments that spans the bony projections of the coracoid process and the acromion.
• The coracoclavicular ligaments and the acromioclavicular ligament provide most of the support for the AC joint.

• The rotator cuff muscles are the subscapularis, the supraspinatus, the infraspinatus, and the teres minor. They are the primary stabilizers that hold the "ball" of the humerus to the glenoid "socket". The socket is too shallow to offer much security for the humerus. These four muscles form a "cuff" around the humeral head, securing it firmly in the socket. As its name implies, this group of muscles also rotates the arm. The rotator cuff protects the glenohumeral joint from dislocation, allowing the large muscles that control the shoulder to power the arm with great mobility.
  
• The biceps tendon complex also helps keep the humeral head in the glenoid and helps raise the arm.
  
• The scapulothoracic muscles attach the scapula to the thorax. Their main function is to stabilize the scapula to allow for proper shoulder motion.
  
• The superficial muscles of the shoulder are the large, powerful outer layer of muscles that are important to the overall function of the shoulder. This group includes the deltoid muscle, which covers the rotator cuff muscles.