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Anatomy and Kinematics of the Shoulder Joint

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Orthopaedic Biomechanics in Sports Medicine

Abstract

The shoulder is comprised by the glenohumeral, acromioclavicular, and sternoclavicular joints, the scapulothoracic interface and the subacromial space. It is the most mobile joint in the body; this is due to its unique anatomy and biomechanical behavior. The scapula is the base of the shoulder and has several muscle insertions; the superior shoulder suspensory complex, formed by parts of the scapula and clavicle, connects the upper limb to the trunk through the sternoclavicular joint and the scapulothoracic muscles. The glenohumeral joint is the main joint of the shoulder and is stabilized primarily by soft tissues: the static stabilizers, which include the labrum with its unique shape and attachments, the glenohumeral capsule and ligaments; and the dynamic stabilizers, mainly the rotator cuff and external glenohumeral muscles and tendons. To achieve motion, scapular stability through the range of motion is achieved by dynamic co-contraction of scapular muscles; in turn, this stability provides a platform for optimal glenohumeral motion and thus adequate positioning of the upper limb in space. The apparent incongruity of the humeral head and glenoid surface is what allows a wide, coordinated and stable range of motion; also, coordinated scapular, clavicular, and humeral motion helps achieve these extreme ranges observed in normal shoulders.

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References

  1. Halder AM, Itoi E, An KN. Anatomy and biomechanics of the shoulder. Orthop Clin North Am. 2000;31(2):159–76. https://doi.org/10.1016/s0030-5898(05)70138-3.

    Article  CAS  PubMed  Google Scholar 

  2. Dines D, Williams GR Jr, Laurencin C. Arthritis and arthroplasty: the shoulder. Philadelphia: Elsevier Health Sciences; 2009.

    Google Scholar 

  3. Llusá M, Merí A, Ruano D. Surgical atlas of the musculoskeletal system. Rosemont: American Academy of Orthopaedic Surgeons; 2008. p. ix, 422 p.

    Google Scholar 

  4. Ludewig PM, Cook TM, Nawoczenski DA. Three-dimensional scapular orientation and muscle activity at selected positions of humeral elevation. J Orthop Sports Phys Ther. 1996;24(2):57–65. https://doi.org/10.2519/jospt.1996.24.2.57.

    Article  CAS  PubMed  Google Scholar 

  5. Banas MP, Miller RJ, Totterman S. Relationship between the lateral acromion angle and rotator cuff disease. J Shoulder Elb Surg. 1995;4(6):454–61. https://doi.org/10.1016/s1058-2746(05)80038-2.

    Article  CAS  Google Scholar 

  6. van de Bunt F, Pearl ML, Lee EK, Peng L, Didomenico P. Glenoid version by CT scan: an analysis of clinical measurement error and introduction of a protocol to reduce variability. Skelet Radiol. 2015;44(11):1627–35. https://doi.org/10.1007/s00256-015-2207-4.

    Article  Google Scholar 

  7. Huysmans PE, Haen PS, Kidd M, Dhert WJ, Willems JW. The shape of the inferior part of the glenoid: a cadaveric study. J Shoulder Elb Surg. 2006;15(6):759–63. https://doi.org/10.1016/j.jse.2005.09.001.

    Article  Google Scholar 

  8. Iannotti JP, Gabriel JP, Schneck SL, Evans BG, Misra S. The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg Am. 1992;74(4):491–500.

    Article  CAS  Google Scholar 

  9. Petersen W, Petersen F, Tillmann B. Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg. 2003;123(6):283–8. https://doi.org/10.1007/s00402-003-0527-7.

    Article  PubMed  Google Scholar 

  10. Alashkham A, Alraddadi A. Soames, R er. (2019). Morphometric parameters of the glenoid labrum. Eur J Anat. 2019;23(1):41–7.

    Google Scholar 

  11. Bain GI, Galley IJ, Singh C, Carter C, Eng K. Anatomic study of the superior glenoid labrum. Clin Anat. 2013;26(3):367–76. https://doi.org/10.1002/ca.22145.

    Article  PubMed  Google Scholar 

  12. Williams MM, Snyder SJ, Buford D Jr. The Buford complex--the "cord-like" middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant. Arthroscopy. 1994;10(3):241–7. https://doi.org/10.1016/s0749-8063(05)80105-7.

    Article  CAS  PubMed  Google Scholar 

  13. Rothman RH, Marvel JP Jr, Heppenstall RB. Anatomic considerations in glenohumeral joint. Orthop Clin North Am. 1975;6(2):341–52.

    Article  CAS  Google Scholar 

  14. Yamazaki S. Fibrous structure of the joint capsule in the human shoulder. Okajimas Folia Anat Jpn. 1990;67(2–3):127–39. https://doi.org/10.2535/ofaj1936.67.2-3_127.

    Article  CAS  PubMed  Google Scholar 

  15. Pouliart N, Gagey O. Reconciling arthroscopic and anatomic morphology of the humeral insertion of the inferior glenohumeral ligament. Arthroscopy. 2005;21(8):979–84. https://doi.org/10.1016/j.arthro.2005.04.111.

    Article  PubMed  Google Scholar 

  16. Gelber PE, Reina F, Monllau JC, Yema P, Rodriguez A, Caceres E. Innervation patterns of the inferior glenohumeral ligament: anatomical and biomechanical relevance. Clin Anat. 2006;19(4):304–11. https://doi.org/10.1002/ca.20172.

    Article  PubMed  Google Scholar 

  17. Huri G, Kaymakoglu M, Garbis N. Rotator cable and rotator interval: anatomy, biomechanics and clinical importance. EFORT Open Rev. 2019;4(2):56–62. https://doi.org/10.1302/2058-5241.4.170071.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Boileau P, Walch G. The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. J Bone Joint Surg Br. 1997;79(5):857–65. https://doi.org/10.1302/0301-620x.79b5.7579.

    Article  CAS  PubMed  Google Scholar 

  19. Prescher A. Anatomical basics, variations, and degenerative changes of the shoulder joint and shoulder girdle. Eur J Radiol. 2000;35(2):88–102. https://doi.org/10.1016/s0720-048x(00)00225-4.

    Article  CAS  PubMed  Google Scholar 

  20. Mochizuki T, Sugaya H, Uomizu M, et al. Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. J Bone Joint Surg Am. 2008;90(5):962–9. https://doi.org/10.2106/JBJS.G.00427.

    Article  PubMed  Google Scholar 

  21. Clark JM, Harryman DT 2nd. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg Am. 1992;74(5):713–25.

    Article  CAS  Google Scholar 

  22. Nimura A, Kato A, Yamaguchi K, et al. The superior capsule of the shoulder joint complements the insertion of the rotator cuff. J Shoulder Elb Surg. 2012;21(7):867–72. https://doi.org/10.1016/j.jse.2011.04.034.

    Article  Google Scholar 

  23. Bain GI, Itoi E, Di Giacomo G Sugaya H (Eds.). Normal and pathological anatomy of the shoulder. Springer, Berlin; 2015. doi:10.1007/978-3-662-45719-1

    Google Scholar 

  24. Rajani S, Man S. Review of bicipital groove morphology and its analysis in north Indian population. ISRN Anat. 2013:243780. Published 2013 Sep 11. doi:10.5402/2013/243780.

    Google Scholar 

  25. Khan R, Satyapal KS, Naidoo N, Lazarus L. Dimensional analysis of the bicipital groove and its associated pathology in a South African population. J Orthop. 2019;19:128–131. Published 2019 Nov 18. doi:https://doi.org/10.1016/j.jor.2019.11.019

  26. Hettrich CM, Boraiah S, Dyke JP, Neviaser A, Helfet DL, Lorich DG. Quantitative assessment of the vascularity of the proximal part of the humerus. J Bone Joint Surg Am. 2010;92(4):943–8. https://doi.org/10.2106/JBJS.H.01144.

    Article  PubMed  Google Scholar 

  27. Minagawa H, Itoi E, Sato T, et al. Structure of the rotator cuff muscles [in Japanese]. J Jpn Orthop Assoc. 1995;69:S1642.

    Google Scholar 

  28. Colachis SC Jr, Strohm BR, Brechner VL. Effects of axillary nerve block on muscle force in the upper extremity. Arch Phys Med Rehabil. 1969;50(11):647–54.

    PubMed  Google Scholar 

  29. Klapper RC, Jobe FW, Matsuura P. The subscapularis muscle and its glenohumeral ligament-like bands. A histomorphologic study. Am J Sports Med. 1992;20(3):307–10. https://doi.org/10.1177/036354659202000312.

    Article  CAS  PubMed  Google Scholar 

  30. Burkhart SS, Esch JC, Jolson RS. The rotator crescent and rotator cable: an anatomic description of the shoulder's "suspension bridge" [published correction appears in arthroscopy 1994 Apr;10(2):239]. Arthroscopy. 1993;9(6):611–6. https://doi.org/10.1016/s0749-8063(05)80496-7.

    Article  CAS  PubMed  Google Scholar 

  31. Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma. 1993;7(2):99–106. https://doi.org/10.1097/00005131-199304000-00001.

    Article  CAS  PubMed  Google Scholar 

  32. Bigliani L, Morrison D, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986;10:228.

    Google Scholar 

  33. Green A, Griggs S, Labrador D. Anterior acromial anatomy: relevance to arthroscopic acromioplasty. Arthroscopy. 2004;20(10):1050–4.

    Article  Google Scholar 

  34. Stine IA, Vangsness CT Jr. Analysis of the capsule and ligament insertions about the acromioclavicular joint: a cadaveric study. Arthroscopy. 2009;25(9):968–74.

    Article  Google Scholar 

  35. Fealy S, April EW, Khazzam M, Armengol-Barallat J, Bigliani LU. The coracoacromial ligament: morphology and study of acromial enthesopathy. J Shoulder Elb Surg. 2005;14(5):542–8.

    Article  Google Scholar 

  36. Voss A, Dyrna F, Achtnich A, et al. Acromion morphology and bone mineral density distribution suggest favorable fixation points for anatomic acromioclavicular reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017;25(7):2004–12. https://doi.org/10.1007/s00167-017-4539-1.

    Article  PubMed  Google Scholar 

  37. Petersson CJ, Redlund-Johnell I. The subacromial space in normal shoulder radiographs. Acta Orthop Scand. 1984;55(1):57–8. https://doi.org/10.3109/17453678408992312.

    Article  CAS  PubMed  Google Scholar 

  38. Gumina S, Postacchini F, Orsina L, Cinotti G. The morphometry of the coracoid process - its aetiologic role in subcoracoid impingement syndrome. Int Orthop. 1999;23(4):198–201. https://doi.org/10.1007/s002640050349.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Terra BB, Ejnisman B, de Figueiredo EA, et al. Anatomic study of the coracoid process: safety margin and practical implications. Arthroscopy. 2013;29(1):25–30.

    Article  Google Scholar 

  40. Lo IK, Burkhart SS, Parten PM. Surgery about the coracoid: neurovascular structures at risk. Arthroscopy. 2004;20(6):591–5. https://doi.org/10.1016/j.arthro.2004.04.060.

    Article  PubMed  Google Scholar 

  41. Sewell MD, Al-Hadithy N, Le Leu A, Lambert SM. Instability of the sternoclavicular joint: current concepts in classification, treatment and outcomes. Bone Joint J. 2013;95-B(6):721–31. https://doi.org/10.1302/0301-620X.95B6.31064.

    Article  CAS  PubMed  Google Scholar 

  42. Conduah AH, Baker CL 3rd, Baker CL Jr. Clinical management of scapulothoracic bursitis and the snapping scapula. Sports Health. 2010;2(2):147–55.

    Article  Google Scholar 

  43. Sakoma Y, Sano H, Shinozaki N, et al. Anatomical and functional segments of the deltoid muscle. J Anat. 2011;218(2):185–90. https://doi.org/10.1111/j.1469-7580.2010.01325.x.

    Article  PubMed  Google Scholar 

  44. Ball CM, Steger T, Galatz LM, Yamaguchi K. The posterior branch of the axillary nerve: an anatomic study. J Bone Joint Surg Am. 2003;85(8):1497–501. https://doi.org/10.2106/00004623-200308000-00010.

    Article  PubMed  Google Scholar 

  45. Zhao X, Hung LK, Zhang GM, Lao J. Applied anatomy of the axillary nerve for selective neurotization of the deltoid muscle. Clin Orthop Relat Res. 2001;390:244–51. https://doi.org/10.1097/00003086-200109000-00028.

    Article  Google Scholar 

  46. Liu KY, Chen TH, Shyu JF, Wang ST, Liu JY, Chou PH. Anatomic study of the axillary nerve in a Chinese cadaveric population: correlation of the course of the nerve with proximal humeral fixation with intramedullary nail or external skeletal fixation. Arch Orthop Trauma Surg. 2011;131(5):669–674. doi:https://doi.org/10.1007/s00402-010-1184-2

  47. Uz A, Apaydin N, Bozkurt M, Elhan A. The anatomic branch pattern of the axillary nerve. J Shoulder Elb Surg. 2007;16(2):240–4. https://doi.org/10.1016/j.jse.2006.05.003.

    Article  Google Scholar 

  48. Cetik O, Uslu M, Acar HI, Comert A, Tekdemir I, Cift H. Is there a safe area for the axillary nerve in the deltoid muscle? A cadaveric study. J Bone Joint Surg Am. 2006;88(11):2395–9. https://doi.org/10.2106/JBJS.E.01375.

    Article  PubMed  Google Scholar 

  49. McPherson EJ, Friedman RJ, An YH, Chokesi R, Dooley RL. Anthropometric study of normal glenohumeral relationships. J Shoulder Elb Surg. 1997;6(2):105–12. https://doi.org/10.1016/s1058-2746(97)90030-6.

    Article  CAS  Google Scholar 

  50. Lippitt SB, Vanderhooft JE, Harris SL, Sidles JA, Harryman DT 2nd, Matsen FA 3rd. Glenohumeral stability from concavity-compression: a quantitative analysis. J Shoulder Elb Surg. 1993;2(1):27–35. https://doi.org/10.1016/S1058-2746(09)80134-1.

    Article  CAS  Google Scholar 

  51. Harryman DT, Sidles JA, Clark JM, et al. Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg Am. 1990;72:1334–43.

    Article  Google Scholar 

  52. Bagg SD, Forrest WJ. A biomechanical analysis of scapular rotation during arm abduction in the scapular plane. Am J Phys Med Rehabil. 1988;67:238–45.

    CAS  PubMed  Google Scholar 

  53. Bain GI, Phadnis J, Itoi E, et al. Shoulder crane: a concept of suspension, stability, control and motion. JISAKOS. 2019;4:63–70. https://doi.org/10.1136/jisakos-2017-000187.

    Article  Google Scholar 

  54. Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. Clin Orthop. 1993;291:20–8.

    Google Scholar 

  55. Saha AK. Mechanisms of shoulder movements and a plea for the recognition of “zero position” of the glenohumeral joint. Clin Orthop. 1983;173:3–10.

    Google Scholar 

  56. Bakhsh W, Nicandri G. Anatomy and physical examination of the shoulder. Sports Med Arthrosc Rev. 2018;26(3):e10–22. https://doi.org/10.1097/JSA.0000000000000202.

    Article  PubMed  Google Scholar 

  57. Laumann U. Kinesiology of the shoulder joint. In: Kolbel R, Helbig B, Blauth W, et al., editors. Shoulder Replacement. Berlin: Springer; 1987.

    Google Scholar 

  58. Rockwood CJ, Williams G, Young D. Disorders of the acromioclavicular joint. In: Rockwood CJ, Matsen F, editors. The shoulder, vol. 1. Philadelphia: Saunders; 1998. p. 483–553.

    Google Scholar 

  59. Nieminen H, Niemi J, Takala EP, Viikari-Juntura E. Load-sharing patterns in the shoulder during isometric flexion tasks. J Biomech. 1995;28(5):555–66.

    Article  CAS  Google Scholar 

  60. Poppen NK, Walker PS. Normal and abnormal motion of the shoulder. J Bone Joint Surg Am. 1976;58:195–201.

    Article  CAS  Google Scholar 

  61. O'Connell PW, Nuber GW, Mileski RA, Lautenschlager E. The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint. Am J Sports Med. 1990;18(6):579–84. https://doi.org/10.1177/036354659001800604.

    Article  CAS  PubMed  Google Scholar 

  62. Osias W, Matcuk GR Jr, Skalski MR, et al. Scapulothoracic pathology: review of anatomy, pathophysiology, imaging findings, and an approach to management. Skelet Radiol. 2018;47(2):161–71. https://doi.org/10.1007/s00256-017-2791-6.

    Article  Google Scholar 

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Authors and Affiliations

  1. Upper Limb Unit, Department of Orthopedics and Traumatology, Edgardo Rebagliati Martins National Hospital, Lima, Peru

    Alfonso Ricardo Barnechea Rey

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  1. Alfonso Ricardo Barnechea Rey
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Editors and Affiliations

  1. Department of Orthopaedic Surgery Orthopaedic & Spine Institute, NorthShore University HealthSystem, Skokie, IL, USA

    Jason Koh

  2. IRCCS – Rizzoli Orthopaedic Institute – 2nd Orthopaedic and Trauma Unit, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

  3. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Ryosuke Kuroda

  4. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy

    Umile Giuseppe Longo

  5. Department of Orthopaedic Surgery, Orthopaedic & Spine Institute, NorthShore University Health System, Evanston, IL, USA

    Farid Amirouche

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Barnechea Rey, A.R. (2021). Anatomy and Kinematics of the Shoulder Joint. In: Koh, J., Zaffagnini, S., Kuroda, R., Longo, U.G., Amirouche, F. (eds) Orthopaedic Biomechanics in Sports Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-81549-3_10

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  • DOI: https://doi.org/10.1007/978-3-030-81549-3_10

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