Anatomy of the shoulder joint
Summary
The shoulder joint and its associated joints form one of the most complex joint systems
of the human locomotor apparatus. Its large range of motion is made possible by the
interplay of 5 joints: sternoclavicular-joint, acromioclavicular-joint, glenohumeral
joint, thoracoscapular joint and subacromial joint. The rotator cuff works mostly
as an active stabilizer of the shoulder joint. The supraspinatus muscle causes a compression
of the humerus in the glenoid mainly, furthermore it effects synergistic the abduction
with the delta muscle. On the basis of its lever-arm the supraspinatus works between
0 and 60° abduction the most optimally. With failure of the supraspinatus, the deltoideus
can almost completely take its function. The inferior glenohumeral ligament-complex
is the main passive stabilizer. The blood supply of the humerus head is ensured mainly
by the a. circumflexa anterior and its rami ascendentes, by several small branches
from the a. circumflexa posterior and over intraosseous anastomoses. The most important
vessel of the cap is the intraosseous a. arcuata out of the ramus ascendens lateralis
of the a. circumflexa anterior.
Zusammenfassung
Eines der komplexesten Gelenke des Bewegungsapparates des Menschen ist das Schultergelenk.
Der große Bewegungsraum des Arms wird durch das Zusammenspiel von 5 Gelenken (Sternoklavikulargelenk,
Akromioklavikulargelenk, Glenohumeralgelenk, Thorakoskapulargelenk und subakromialer
Raum) ermöglicht. Die Rotatorenmanschette wirkt hauptsächlich als aktiver Stabilisator
des Schultergelenkes. Der M. supraspinatus bewirkt eine Kompression des Humerus im
Glenoid, außerdem wirkt er synergistisch mit dem Delta bei der Abduktion. Aufgrund
seines Hebelarmes arbeitet der Supraspinatus zwischen 0 und 60° Abduktion am optimalsten.
Bei einem Ausfall des Supraspinatus kann der M.deltoideus seine Funktion fast vollständig
übernehmen. Der inferiore glenohumerale Ligament-Komplex ist ein wichtiger Stabilisator.
Die Blutversorgung des Humeruskopfes erfolgt hauptsächlich über die A. circumflexa
anterior mit ihren Rami ascendentes, mehreren kleinen Ästen aus der A. circumflexa
posterior und über intraossäre Anastomosen. Das wichtigste Versorgungsgefäß der Kalotte
ist die intraossär verlaufende A.arcuata aus dem Ramus ascendens lateralis aus der
A.circumflexa anterior.
Key words
Sternoclavicular joint - acromioclavicular joint - glenohumeral joint - labrum - rotator
interval - glenohumeral ligaments - inferior glenohumeral ligament-complex - rotator
cuff - subacromial joint - a. arcuata
Schlüsselwörter
Sternoklavikulargelenk - Akromioklavikulargelenk - Glenohumeralgelenk - Labrum - Rotatoren-Intervall
- Ligg. glenohumeralia - Inferiorer glenohumeraler Ligament-Komplex - Rotatorenmanschette
- Subakromiales Gelenk - A. arcuata
Literatur
- 1
Andrews J R, Carson W, McLeod W D.
Glenoid labrum tears related to the long head of the biceps.
Am J Sports Med.
1985;
13
337-341
- 2
Andrews J R, Kupferman S P, Dillman C J.
Labral tears in throwing and racquet sports.
Clin Sports Med.
1991;
10
901-911
- 3
Basmajian J V, Bazant F J.
Factors preventing downward dislocation of the adducted shoulder joint in an electromyographic
and morphological study.
J Bone Joint Surg [Am].
1959;
26
1182-1186
- 4
Bigliani L U, Kelkar R, Flatow E L, Pollock R G, Mow V C.
Glenohumeral stability. Biomechanical properties of passive and active stabilizers.
Clin Orthop.
1996;
13-30
- 5
Bowen M K, Deng X H, Warner J P.
The effect of joint compression on stability of the glenohumeral joint.
Trans Orthop Res Soc.
1992;
17
289
- 6
Brooks C H, Revell W, Heatley F W.
Vascularity of the humeral head after proximal humeral fractures.
J Bone Joint Surg [Br].
1993;
75
132-136
- 7
Brooks C H, Revell W J, Heatley F W.
A quantitative histological study of the vascularity of the rotator cuff tendon.
J Bone Joint Surg [Br].
1992;
74
151-153
- 8
Clark J M, Harryman D T.
Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy.
J Bone Joint Surg [Am].
1992;
74
713-725
- 9
Cooper D E, Arnoczky S P, O'Brien S J, Warren R F, DiCarlo E, Allen A A.
Anatomy, histology, and vascularity of the glenoid labrum. An anatomical study.
J Bone Joint Surg [Am].
1992;
74
46-52
- 10 Echtermeyer V, Sangmeister M. Funktionelle Anatomie. In: Echtermeyer V, Sangmeister
M (Hrsg). Praxisbuch Schulter. Thieme, Stuttgart 1996; 1-20
- 11
Gerber C, Schneeberger A G, Vinh T S.
The arterial vascularization of the humeral head: an anatomical study.
J Bone Joint Surg [Am].
1990;
72
1486-1994
- 12
Harryman D T, Sidles J A, Harris S L, Matsen F A.
The role of the rotator interval capsule in passive motion and stability of the shoulder.
J Bone Joint Surg [Am].
1992;
74
53-66
- 13
Howell S M, Galinat B J.
The glenoid-labral socket: A constrained articular surface.
Clin Orthop.
1989;
243
122-125
- 14
Inman V T, Saunders J B.
Observations on the function of the shoulder joint.
J Bone Joint Surg [Am].
1944;
26
1-30
- 15
Itoi E, Motzkin N E, An K N.
Scapular inclination and inferior stability of the shoulder.
Trans Orthop Res Soc.
1992;
17
288
- 16
Katzer A, Wening J V, Becker-Mannich H U, Lorke D E, Jungbluth K H.
Rotator cuff rupture. Vascular supply and collagen fiber processes as pathogenetic
factors (see comments).
Unfallchirurgie.
1997;
23
52-59
- 17
Kuechle D K, Newman S R, Itoi E, Morrey B F, An K N.
Shoulder muscle moment arms during horizontal flexion and elevation.
J Shoulder Elbow Surg.
1997;
6
429-439
- 18
Laing P G.
The arterial supply of the adult humerus.
J Bone Joint Surg [Br].
1956;
38
1105-1115
- 19
Lephart S M, Pincivero D M, Giraldo J L, Fu F H.
The role of proprioception in the management and rehabilitation of athletic injuries.
Am J Sports Med.
1997;
25
1, 130-137
- 20
Ling S C, Chen C F, Wan R X.
A study on the vascular supply of the supraspinatus tendon.
Surg Radiol Anat.
1990;
12
161-165
- 21
Lohr J F, Uhthoff H K.
The microvascular pattern of the supraspinatus tendon.
Clin Orthop.
1990;
35-38
- 22
Malicky D, Soslowsky L J, Blasier R B, Shyr Y.
Anterior glenohumeral stabilization factors: progressive effects in a biomechanical
model.
J Orthop Res.
1996;
14
282-288
- 23
Minagawa H, Itoi E, Konno N, Kido T, Sano A, Urayama M, Sato K.
Humeral attachment of the supraspinatus and infraspinatus tendons: An anatomic study.
Arthroscopy.
1998;
14
302-306
- 24
Moseley H F, Goldie I.
The arterial pattern of the rotator cuff of the shoulder.
J Bone Joint Surg [Br].
1963;
45
780-789
- 25 Murakami M, Kojima Y, Maeda T. Sensory nerve endings in the shoulder joint capsule
of the monkey as sensors of dynamic stabilizing system. Trans of Comb Mfg of ORS of
USA, Japan and Canada, 1991; 315
- 26
Müller-Gerbl M, Putz R, Hodler J.
Computed tomography-osteoabsorptiometry for assessing the density distribution of
the subchondral bone as a measure of long-term mechanical adaptation in individual
joints.
Skeletal Radiol.
1989;
18
507-512
- 27
Müller-Gerbl M, Schulte E, Putz R.
The thickness of the calcified layer of the articular cartilage: a function of the
load supported?.
J Anat.
1987;
154
103-111
- 28
O'Brein S J, Neves M C, Arnoczky S F.
The anatomy and histology of the inferiorglenohumeral ligament complex of the shoulder.
Am J Sports Med.
1990;
18
449-456
- 29
O'Brien S J, Schwartz R S, Warren R F, Torzilli P A.
Capsular restraints to anterior-posterior motion of the abducted shoulder: a biomechanical
study.
J Shoulder Elbow Surg.
1995;
4
298-308
- 30
Payne L Z, Deng X H, Craig E V, Torzilli P A, Warren R F.
The combined dynamic and static contributions to subacromial impingement. A biomechanical
analysis.
Am J Sports Med.
1997;
25
801-808
- 31
Randelli M, Gambrioli P L.
Glenohumeral osteometry by computed tomography in normal and unstable shoulders.
Clin Orthop.
1986;
208
151-156
- 32
Rathbun J B, Macnab I.
The microvascular pattern of the rotator cuff.
J Bone Joint Surg [Br].
1970;
52
540-553
- 33
Reeves B.
Experiments on the tensile strength of the anterior capsular structures of the shoulder
in man.
J Bone Joint Surg [Br].
1968;
50
858-865
- 34
Rodosky M W, Harner C D, Fu F H.
The role of the long head of the biceps muscle and superior glenoid labrum in anterior
stability of the shoulder.
Am J Sports Med.
1994;
22
121-130
- 35
Rothman R H, Parke W W.
The vascular anatomy of the rotator cuff.
Clin Orthop.
1965;
41
176-186
- 36
Saha A K.
Dynamic stability of the glenohumeral joint.
Acta Orthop Scand.
1971;
42
491-505
- 37
Soslowsky L J, Ateshian G A, Bigliani L U.
Sphericity of glenohumeral joint articulating surfaces.
Trans Orthop Res Soc.
1989;
14
228
- 38
Soslowsky L J, Bigliani L U, Flatow E L.
Articular geometry of the glenohumeral joint.
Clin Orthop.
1992;
285
181-190
- 39
Soslowsky L J, Malicky D M, Blasier R B.
Active and passive factors in inferior glenohumeral stabilization: a biomechanical
model.
J Shoulder Elbow Surg.
1997;
6
371-379
- 40
Soslowsky L J, Malicky D M, Blasier R B.
Active and passive factors in inferior glenohumeral stabilization: a biomechanical
model.
J Shoulder Elbow Surg.
1997;
6
371-379
- 41
Soslowsky L J, Pawluk R J, Ark J W.
In-situ articular contact at the glenohumeral and subacromial joints.
Trans Orthop Res Soc.
1991;
37
569
- 42
Vangsness C T, Ennis M, Taylor J G, Atkinson R.
Neural anatomy of the glenohumeral ligaments, labrum, and subacromial bursa.
Arthroscopy.
1995;
11
180-184
- 43
Vangsness C T, Jorgenson S S, Watson T, Johnson D L.
The origin of the long head of the biceps from the scapula and glenoid labrum. An
anatomical study of 100 shoulders.
J Bone Joint Surg [Br].
1994;
76
951-954
- 44
Warner J J, Deng X H, Warren R F.
Static and capsuloligamentous restraints to superior-inferior translation of the glenohumeral
joint.
J Sports Med.
1992;
20
675-685
- 45
Wilk K E, Arrigo C A, Andrews J R.
Current concepts: the stabilizing structures of the glenohumeral joint.
J Orthop Sports Phys Ther.
1997;
25
364-379
- 46
Williams M M, Snyder S J, Buford D.
The Buford complex - the “cord-like” middle glenohumeral ligament and absent anterosuperior
labrum complex: a normal anatomic capsulolabral variant.
Arthroscopy.
1994;
10
241-247
- 47
Wuelker N, Plitz W, Roetman B.
Biomechanical data concerning the shoulder impingement syndrome.
Clin Orthop 1994;.
242-249
- 48
Wuelker N, Plitz W, Roetman B, Rossig S.
Biomechanic results in impingement syndrome of the shoulder.
Z Orthop Ihre Grenzgeb.
1995;
133
61-66
- 49
Wuelker N, Schmotzer H, Thren K, Korell M.
Translation of the glenohumeral joint with simulated active elevation.
Clin Orthop.
1994;
193-200
Dr. T. Jansen
Klinik für Unfall- und Wiederherstellungschirurgie
Allgemeines Krankenhaus Celle
Siemensplatz 40
D-29223 Celle
