1. Shoulder (Glenohumeral) Joint
Heather, Riley, Tonia, and Jo

2. Surface Anatomy
Anterior axillary fold - The inferior border of the pectoralis major muscle forms the anterior axillary fold
Clavicular head of pectoralis major - The clavicular head is the smaller top section of the bare-chested upper-torso
Clavipectoral triangle - The clavipectoral triangle (deltopectoral triangle) is the depressed area just inferior to the lateral part of the clavicle, bounded by the clavicle superiorly, the deltoid laterally, and the clavicular head of the pectoralis major medially.
Sternocostal head of pectoralis major - The sternal-costal head consists of more muscle mass. It originates at the sternum and six sternum costal cartilages

3. Surface Anatomy
Clavicle - can be felt from end to end (subcutaneous) since they produce horizontal ridges visible at the junction of the neck to the thorax
Manubrium – the upper segment of the sternum in which the clavicles and upper two ribs articulate

4. Surface Anatomy Parts of the Deltoid :
•clavicular part ( or anterior): originates on the lateral third of the clavicle
•acromial part (or middle): originates on the acromion process
•spinal part (or posterior): originates on the scapular spine

5. Surface Anatomy
Posterior Axillary Fold – formed by the latissimus dorsi winding around the lateral border of the teres major muscle
Triangle of auscultation - The space bounded by the lower border of the trapezius, the latissimus dorsi, and the medial margin of the scapula, used to listen to (auscultate) the lungs because the stethoscope can be placed close to the thoracic wall at this location
Three areas of the Trapezius Muscle :
Descending Part of Trapezius (the superior region or Upper fibers) - which functions to support the weight of the arm
Ascending Part of Trapezius (the inferior region or Lower Fibers) - which function to rotate and or lower the scapulae.
Middle Part of the Trapezius (the intermediate region or middle fibers) - which function to draw or pull the scapulae  inwards closer to the spine

6. BONES OF THE SHOULDER JOINT
Made up of three bones:
Clavicle
Humerus
Scapula

7. CLAVICLE
Sternal end
2. Acromial end
3. Conoid tubercle

8. HUMERUS Greater Tubercle Lesser Tubercle Head Anatomical Neck
Intertubercular Sulcus
Head
Anatomical Neck
Surgical Neck
Deltoid Tuberosity

9. SCAPULA Angles (Superior and Inferior) Subscapular Fossa
Infraspinatous Fossa
Supraspinatous Fossa
Spine
Glenoid Fossa (Cavity)
Acromion Process
Coracoid Process
Borders (superior, vertebral, and axillary

10. Shoulder Ligaments Coracohumeral ligament Coracoclavicular ligament
Transverse humeral ligament
Acromioclavicular ligament
Glenohumeral ligaments
- superior
- middle
- inferior
Coracoclavicular ligament
- Trapezoid ligament
- Conoid ligament
Superior transverse scapular ligament

11. Shoulder
Bursae
A bursa is a sac between two moving surfaces that contains a small amount of lubricating fluid, and they reduce friction where two body parts are moving against one another and there is no joint.

12. CARTILAGE
Labrum: is a type of cartilage found in the shoulder, found only around the socket where it is attached. This cartilage is more fibrous and rigid
Articulating Cartilage: white cartilage found on the ends of bones, which allows the bones to glide and move on each other. When this type of cartilage starts to wear out you get arthritis.

13. Articular Capsule Synovial Membrane:
Layer of connective tissue that lines the joints, tendon sheaths, and bursae and makes synovial fluid, which has a lubricating function.

14. THE ROTATOR CUFF:
Group of muscles and tendons that surround the shoulder joint
Keep the head of your upper arm bone firmly within the shallow socket of the shoulder. 

15. ROTATOR CUFF MUSCLES Supraspinatus Infraspinatous Teres Minor
Subscapularis
ROTATOR CUFF MUSCLES

16. CLINICAL CONCERNS ROTATOR CUFF INJURY SYMPTOMS:
Dull ache deep in the shoulder
Disturb sleep, particularly if you lie on the affected side
Difficult to comb your hair or reach behind your back
Arm weakness

17. ROTATOR CUFF INJURY TYPES: CAUSE:
Partial tear: damages the soft tissues but does not completely sever it
Full thickness tear or a complete tear: splits the soft tissue into two pieces.
CAUSE:
Injury: Falling on an outstretched hand or lifting something too heavy are two common injuries associated with rotator cuff tears.
Degeneration: Repetitive stress, lack of blood supply, and bone spurs are factors that contribute to degeneration.

18. OTHER COMMON INJURIES TO THE SHOULDER
Labrum Tear
Instability- One shoulder joint moves or is forced out of its normal position. This condition can result in a dislocation of one of the joints in the shoulder.
Impingement-
Caused by excessive rubbing of the shoulder muscles against the top part of the shoulder blade (acromion)
OTHER
COMMON
INJURIES
TO THE
SHOULDER
CLINICAL CONCERNS

19. Cervical Plexus
Accessory (Spinal) Nerve

20. Brachial Plexus Nerves Medial Cord Lateral Cord Posterior Cord
Lateral Pectoral
Medial Pectoral
Long Thoracic
Dorsal Scapular
Musculocutaneous
Thoracodorsal
Axillary
Subscapular
Suprascapular

23. Arteries Subclavian Axillary Transverse Cevical Dorsal Scapular
Lateral Thoracic
Posterior Circumflex
Deep Scapular
Suprascapular
Circumflex Scapular
Subscapular
Brachial

27. Upper Trapezius
Origin: Superior line of the occipital bone, ligamentum nuchae, and cervical vertebrae
Insertion: Lateral 1/3 of clavicle and acromion process
Action: Scapular elevation and upward rotation
Innervation: Spinal Accessory nerve
Roots C3 and C4
Synergists:
-Elevation : Levator Scapulae
-Upward Rotation: Upper and Lower Trapezius
Antagonists:
-Adduction: Rhomboids Major and Minor, Middle Trapezius
-Downward Rotation: Levator Scapula, Rhomboids Major and Minor.

28. Middle Trapezius Origin: Spinous Processes of C7 to T3
Insertion: Scapular Spine
Action: Scapular Adduction (retraction)
Innervation: Spinal Accessory Nerve
Roots C3 and C4
Synergists: Adduction: Rhomboids Major and Minor
Antagonists: Serratus Anterior, Pectoralis Minor

29. Lower Trapezius
Origin: Spinous Processes of Middle and Lower Thoracic Vertebrae
Insertion: Base of the scapular Spine
Action: Scapular depression and upward rotation
Innervation: Spinal Accessory Nerve
Roots C3 and C4
Synergists:
-Depression: Pectoralis Minor
-Upward Rotation: Upper Trapezius, Serratus Anterior
Antagonists:
-Elevation: Levator Scapulae, Upper Trapezius, Rhomboids Major and Minor
-Downward Rotation: Rhomboids Major and Minor, Levator Scapulae

30. Levator Scapulae:
Origin: Transverse process of first four cervical vertebrae
Insertion: Vertebral border of scapula between the superior angle and the spine
Action: Scapular elevation and downward rotation (Inferior rotation of Glenoid Cavity)
Innervation: Dorsal Scapular and Cervical nerves and Dorsal scapular artery
Roots: Dorsal Scapular C5
-Cervical C3 and C4
Synergists:
-Elevation: Upper Trapezius, Rhomboids Major and Minor
-Inferior Rotation: Rhomboid Major and Minor, Pectoralis Major
Antagonists:
-Depression: Lower Trapezius, Pectoralis Minor
-Superior Rotation: Upper and Lower Trapezius, Serratus Anterior

31. Pectoralis Minor Origin: Anterior Surface, third through fifth Ribs
Insertion: Coracoid process of the scapula
Action: Ribs Fixed: Draws scapula forward (abducts) and rotates scapula downward against the thoracic wall
Scapula fixed: Elevates the rib cage.
Innervation: Medial pectoral nerve, Axillary artery
Synergists: Abduction: Serratus Anterior
Respiration: Sternocleidomastoid, Scalenes
Antagonists: Adduction: Rhomboids major and minor, Middle Trapezius
Respiration: Rectus Abdominus

32. Serratus Anterior: Origin: Lateral Surface of the Upper eight ribs
Insertion: Anterior surface of the vertebral border of the scapula
Action: Scapular protraction and Upward Rotation, holds scapula against thoracic wall
Innervation: Long thoracic nerve, Lateral thoracic artery
Roots C5-C7
Synergists:
-Abduction: Pectoralis Minor
-Upward Rotation: Upper and lower Trapezius
Antagonists:
-Adduction: Rhomboids Major and Minor, Middle Trapezius
-Downward Rotation: Levator Scapulae, Rhomboids Major and Minor

33. Rhomboid Major: Origin: Spinous processes of T2 - T5
Insertion: Vertebral border of the scapula between the spine and inferior angle
Action: Adducts (retracts) Scapula, Depresses Glenoid Cavity, Stabilizes scapula
Innervation: Dorsal Scapular Nerve and Dorsal Scapular Artery
Synergists:
-Adduction: Middle Trapezius
-Downward Rotation: Levator Scapulae, Pectoralis Minor
Antagonists:
-Abduction: Serratus anterior, Pectoralis Minor
-Upward Rotation: Upper and lower Trapezius, Serratus Anterior

34. Rhomboid Minor:
Origin: Nuchal Ligament and spinous process of C7 and T1
Insertion: Vertebral border of scapula superior to spine
Action: Adducts (retracts) Scapula, Depresses Glenoid Cavity, Stabilizes scapula
Innervation: Dorsal Scapular Nerve and Dorsal Scapular Artery
Synergists:
-Adduction: Middle Trapezius
-Downward Rotation: Levator Scapulae, Pectoralis Minor
Antagonists:
-Abduction: Serratus anterior, Pectoralis Minor
-Upward Rotation: Upper and lower Trapezius, Serratus Anterior

35. Deltoids Anterior (Clavicular) Origin: Lateral 1/3 of Clavicle
Action: Shoulder Abduction, Flexion, Medial rotation, Horizontal Adduction
Middle (Acromial)
Origin: Acromion process
Action: Shoulder Abduction
Posterior (Spinal)
Origin: Scapular Spine
Action: Shoulder Abduction, Extension, Hyperextension, Lateral Rotation, Horizontal Adduction
All 3 Deltoids Insert on the Deltoid Tuberosity and are Innervated
by the Axillary Nerve with Roots C5-C6
All 3 Deltoids have the Supraspinatus as a Synergist when
performing Abduction

36. Pectoralis Major
Origin: (clavicular head) Medial third of the clavicle, (sternal head) sternum, costal cartilage of first six ribs and the aponeurosis of the External Oblique
Insertion: Lateral lip of bicipital groove of humerus
Action: Shoulder Adduction, Medial Rotation, Draws Scapula anteriorly and inferiorly, Clavicular Head Flexes Humerus, Sternal Head Extends Humerus
Innervation: Lateral and Medial Pectoral Nerve
Roots: Clavicular C5-C6, Sternocostal C7-C8
Synergists:
-Adduction: Latisumus Dorsi, Teres Major
-Medial Rotation: Latissumus Dorsi, Anterior Deltoid, Teres Major
-Extension: Posterior Deltoid, Latissimus Dorsi, Teres Major
Antagonists:
-Abduction: Deltoids, Supraspinatus
-Lateral Rotation: Infraspinatus, Teres Minor, Posterior Deltoid
-Flexion: Anterior Deltoid

37. Latissimus Dorsi
Origin: Spinous Processes of T7 through L5 (via dorsolumbar fascia), posterior surface of sacrum, iliac crest, and lower 3 ribs
Insertion: Medial lip of Intertubercular sulcus of humerus
Action: Shoulder extension, adduction, medial rotation, hyperextension
Innvervation: Thoracodorsal nerve
Roots: C6-C8
Synergists:
-Extension: Posterior Deltoid, Teres Major, Pectoralis Major
-Adduction: Teres Major, Pectoralis Major
-Medial Rotation: Teres Major, Petoralis Major, Subscapularis, Anterior Deltoid
Antagonists:
-Flexion: Anterior Deltoid, Pectoralis Major
-Abduction: Deltoids, Supraspinatus
-Lateral Rotation: Infraspinatus, Teres Minor, Posterior Deltoid

38. Supraspinatus: Origin: Supraspinous fossa of the scapula
Insertion: Greater Tubercle of the humerus
Action: Initiates and Assists the Deltoid Abduct the arm
Innervation: Suprascapular nerve
Root: C5 and C6
Synergist
-Abduction: Deltoids
Antagonist
-Adduction: Pectoralis Major, Teres Major and Latissimus Dorsi

39. Teres Major Origin: Dorsal surface of inferior angle of the scapula
Insertion: Medial lip of intertubercular groove of humerus
Action: Adducts and medially rotates
Innervation: Lower subscapular nerve
Root: C6 and C7
Synergist
-Adduction: Pectoralis Major, Teres Major, Latissimus Dorsi
-Medial Rotation: Latissimus Dorsi, Teres Major, Subscapularis, and Pectoralis Major
Antagonist:
-Abduction: Deltoids and Supraspinatus
-Lateral Rotation: Infranspinatus, Teres Minor, and Posterior Deltoid

40. Subscapularis Origin: Subscapular fossa of the scapula
Insertion: Lesser tubercle of the humerus
Action: Shoulder Medial Rotation and adduction, also helps hold Humeral Head in Glenoid Cavity
Innervation: Subscapular nerve and Subscapular Artery
Roots: C5-C7
Synergists:
-Adduction: Pectoralis Major, Teres Major, Latissumus dorsi
-Medial Rotation: Latissimus dorsi, Teres Major, Pectoralis Major, Anterior Deltoid
Antagonists:
-Abduction: Deltoid, Supraspinatus
-Lateral Rotation: Teres Minor, Posterior Deltoid

41. Coracobrachialis Origin: Coracoid process of the scapula
Insertion: Medial 1/3 of the humerus
Action: Helps adduct the shoulder joint
Innervation: Musculocutaneus nerve
Roots: C6-C7
Synergists:
-Arm Flexion: Biceps Brachii, Anterior Deltoid
-Adduction: Subscapularis, Teres major, Pecotalis Major
Antagonists:
-Forearm extension: Triceps Brachii, Posterior Deltoid
-Abduction: Deltoids, Supraspinatus

42. Infraspinatus Origin: Infraspinous fossa of the scapula
Insertion: Greater tubercle of the humerus
Action: External (lateral) Rotation
 Innervation: Suprascapular nerve
Root: c5 and c6
Synergist:
-Lateral Rotation: Teres Minor and Posterior Deltoid
Antagonist:
-Medial Rotation: Latissimus Dorsi, Teres Major, Subscapularis, Pectoralis Major and Anterior Deltoid

43. Teres Minor Origin: Superior lateral border of the scapula
Insertion: Greater tubercle of the humerus
Action: External Rotation, weak rotation
Innervation: Axillary nerve
Root: c5 and c6
Synergist
-Lateral Rotation: Infraspinatus and
the Posterior Deltoid
Antagonist:
-Medial Rotation: Latissimus Dorsi,
Teres Major, Subscapularis,
Pectoralis Major,
and Anterior Deltoid

44. Overview of the Muscles of the SHOULDER/GLENOHUMERAL region

45. References
anterior-and-posterior-axillary-folds/
Clemente, Carmine D. Atlas, A regional Atlas of the Human Body. 6th edition. 2011
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BLEVINS, GARY THE OFFICIAL MUSCLE SHEET