1. Shoulder

2. Surface Anatomy Anterior and Posterior Axillary Fold Pectoralis Major
Clavicular head
Sternocostal head
Deltoid
Clavicular part
O: Lat. 1/3 of Clavicle
I: Deltoid Tuberosity
Acromial part
O: Acromion
Spinal part
O: Spine of Scapula

3. Triangle of Ausculation
Above the Latissimus Dorsi, lateral to the Lower Trapezius and Medial to the Teres major and minor.

4. Surface Anatomy Parts of Trapezius Clavicle Manubrium Ascending Middle
Descending
Clavicle
Manubrium

5. Clavipectoral Triangle

6. Scapula * Acromion process * Coracoid process
* Borders: Superior, Vertebral and Axillary
* Fossae: Subscapular, Supraspinatus, Infraspinatus, Glenoid
* Spine

9. LIGAMENTS OF THE SHOULDER
Coracohumeral ligament-passes from the base of the coracoid process to the anterior aspect of the greater tubercle. Strengthens capsule superiorly.
Acromioclavicular ligament-sits at the top of the shoulder; part of the acromioclavicular joint, located between the acromion and the clavicle. Divided into two parts, superior and inferior. Gives the acromioclavicular joint its horizontal stability.
Superior transverse scapular ligament-bridges the scapular notch to convert it into suprascapular foramen for the suprascapular nerves and vessels.

10. Transverse humeral ligament-runs from the greater to lesser tubercle, bridging over the intertubercular sulcus converting the groove into a canal for the biceps brachii tendon and its synovial sheath.
Coracoclavicular ligament-has two parts: the Conoid and Trapezoid ligaments. Connects the clavicle with the coracoid process. Doesn't properly belong to acromioclavicular joint articulation, but described with it because it retains the clavicle in contact with the acromion.
Another view of:
Coracohumeral ligament
Superior transverse scapular ligament
Acromioclavicular ligament

11. Glenohumeral ligaments-are evident only in the internal aspect of the capsule. Consists of three parts: superior, middle, and inferior. These ligaments strengthen the anterior aspect of the capsule.

13. bursae – Synovial fluid filled sacs near joints where tendons rub against bone, ligaments, or other tendons and where skin moves over bony prominence.
Subdeltoid bursa
Subscapular bursa
Subcoracoid bursa
Coracoclavicular bursa
Supra-acromial bursa
Subacromial bursa

14. The subdeltoid bursa
Inferior to the deltoid muscle and superior to the head of the humerus.
Thin, flat sac made of fibrous connective tissue lined with synovial membrane.
The subscapular bursa
Between the joint capsule and the tendon of the subscapularis muscle.
Continuous with the synovial cavity of the joint cavity.
The subcoracoid bursa ( or subcoracoid bursa of Collas)
Anterior to the subscapularis muscle and inferior to the coracoid process.
Reduces friction between the coracobrachialis, subscapularis and short head of the biceps tendons.
Facilitates internal and external rotation of the shoulder.
The subacromial bursa
Sac of fluid that separates the acromion from the rotator cuff.
Bursa is underneath the coracoacromial ligament, acromion bone, and the deltoid muscle.

16. Glenoid Labrum
The shoulder joint is considered a 'ball and socket' joint, however, the 'socket' (the glenoid fossa of the scapula) is quite shallow and small, covering at most only a third of the 'ball' (the head of the humerus). The socket is deepened by the glenoid labrum. The glenoid labrum is similar to the meniscus of the knee. It is a fibro-cartilaginous rubbery structure which encircles the glenoid cavity deepening the socket providing static stability to the glenohumeral joint. It acts and looks almost like a washer, sealing the two sides of the joint together.
Articular Cartilage
The most important piece of cartilage is the labrum, otherwise descibed as the articular cartilage. The labrum is a piece of cartilage that lies directly between the the humerus head and the glenoid. This piece of cartilage provides a smooth surface that allows for the humerus head to rotate with minimal friction, thus cushioning both the humerus and the scapula. Also, the labrum is shaped like a ring, with the outer part of the labrum being much thicker than the center of the ring. This specific shape allows for the labrum to fit against the humerus head and the glenoid, physically matching up the larger humerus head with the small surface of the glenoid. Thus the labrum is also very important for the stabilization of the joint.

17. ARTICULAR CAPSULE
Synovial Membrane
The synovial membrane (also known as synovium or stratum synoviale)is the soft tissue found between the joint capsule and the joint cavity of synovial joints. It secretes the synovial fluid, which fills the joint cavity and lubricates the joint.
Fibrous Layer
The most common type of joint in your body, called a synovial joint, has what's known as a joint capsule, which is a sac composed of the fibrous and synovial membranes that surround a joint in order to enclose a space, called a joint cavity.
The joint cavity within the joint is filled with a protective fluid called synovial fluid. If there was no joint capsule, the joint space would have nothing with which to hold in the protective synovial fluid.

18. Rotator Cuff 4 Muscles (SITS) 1) Supraspinatus 2) Infraspinatus
3) Teres Minor
4) Subscapularis

19. Rotator Cuff Each muscle of the rotator cuff originates at the scapula
SIT (Supraspinatus, Infraspinatus, Teres Minor) attaches at the greater tubercle of the humerus
S (Subscapularis) attaches at the lesser tubercle
Together, the tendons and other tissues form a cuff around the humerus.
Stabilizes the glenohumeral joint
Abduction
External rotation
Internal rotation of the humerus

20. Rotator Cuff Injuries 2 Main Causes Injury (Acute)
Commonly injured during repetitive use of the upper limb above the horizontal
E.g. during throwing, and racquet sports, swimming, and weight lifting
Common cause of shoulder pain
Results in tears of the rotator cuff
2 Main Causes
Injury (Acute)
Degenerative (Chronic and Cumalitive)

21. Rotator Cuff Injuries
Rotator cuff tear: An injury tears a rotator cuff tendon that’s been weakened by age or wear and tear. Weakness in the arm (and usually pain) are the symptoms.
Rotator cuff tendinitis (tendonitis): Repetitive overhead use of the arms (such as painting or throwing) causes a painful strain injury. Rest, ice, and pain relievers are usually effective treatments.
Rotator cuff impingement: The tendons of the rotator cuff are squeezed between the humerus and the acromion. Symptoms and treatment of impingement are similar to tendinitis.
Frozen shoulder (adhesive capsulitis): The humerus adheres to the shoulder blade, causing shoulder pain and stiffness. Symptoms usually resolve with time and exercise, or steroid injections.
Subacromial bursitis: Inflammation of the small sac of fluid (bursa) that cushions the rotator cuff tendons from a nearby bone (the acromion).

22. Rotator Cuff Treatments
Pain medicines: Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or other medicines
Corticosteroid injections: Reduces inflammation
Physical therapy: Various exercises can improve flexibility and strength of the other muscles in the rotator cuff. This increased strength can help compensate for a rotator cuff problem.
Occupational therapy: Focuses on daily tasks that require shoulder movements.
Arthroscopic surgery: A surgeon operates through small incisions, using an arthroscope (a tube with a camera and tools on its end), in order to reattach the rotator cuff tendon to the bone or fix other bone problems.
Traditional (open) surgery: Through a larger incision, a surgeon cuts through the muscles and other tissues to reach a torn rotator cuff tendon. The tendon can then be reattached to the bone.

24. Upper Trapezius Nerve: Spinal Accessory
Origin: Occipital bone, ligamentum nuchae, and spines of cervical vertebrae.
Insertion: Lateral 1/3 of Clavicle and acromion process.

25. Middle Trapezius Nerve: Spinal accessory Nerve
Origin: Spinous processes of T1 and T5
Insertion: Scapular Spine

26. Lower Trapezius Nerve: Spinal Accessory Nerve
Origin: Spinous Processes of Middle and Lower Thoracic Vertebra (T6-T12)
Insertion: Base of the scapular spine

27. Rhomboideus minor Nerve: Dorsal and Scapular Nerve
O: Nuchal ligament and spinous processes of C7 and T1
I: Vertebral border of scapula

28. Rhomboideus major Nerve: Dorsal Scapular Nerve
O: Spinous Processes of T2-T5 Vertebrae
I: Vertebral Border of Scapula from Spine to Inferior Angle

29. Anterior Deltoid Nerve: Axillary Nerve O: Lateral 1/3 of Clavicle
I: Deltoid Tuberosity
Action: Shoulder Abduction, Flexion, Medial Rotation, and Horizontal Adduction

30. Middle deltoid Nerve: Axillary Nerve Roots: C5-C6 O: Acromion Process
I: Deltoid Tuberosity
Action: Shoulder Abduction

31. Posterior Deltoid Nerve: Axillary Nerve Origin: Spine of Scapula
Insertion: deltoid Tuberosity
Action: Shoulder abduction, extension, hyperextension, lateral rotation, horizontal abduction.

32. Pectoralis Major Nerves: Lateral and medial pectoral nerves
Origin: clavicular head (medial ½ of Clavice) Sternocostal (Sternum, ribs 1-6, aponeurosis of External Oblique)
Insertion: humerus

33. Pectoralis minor Nerve: Medial pectoral nerves
Origin: Anterior Superior surface of ribs 3-5
Insertion: Coracoid process of scapula

34. Nerve: Thoracodorsal Nerve
Origin: Spinous processes of T7-L5, posterior surface of sacrum, iliac crest, lower 3 ribs
Insertion: Medial lip of the intertubercular sulcus of humerus.

35. Nerve: Dorsal scapular and cervical nerves
Origin: Transverse processes of C1- C4
Insertion: Superior vertebral border of scapula

36. Serratus anterior Nerve: Long thoracic nerve
Origin: Lateral surface of Superior 8 or 9 ribs.
Insertion: Vertebral border and inferior angle of scapula

37. Teres major Nerve: Lower Subscapular nerve
Origin: Dorsal surface of inferior angle of scapula
Insertion: Humerus

38. coracobrachialis Innervation: musculocataneous nerve
Origin: coracoid process of scapula
Insertion: medial humerus

39. Cervical Plexus
Most Cutaneous nerves of the shoulder come from the Cervical Plexus
Nerves and Muscles pg. 415, 417, 418

40. The Bracial Plexus
C5-T1 Most of the cutaneous nerves of the upper arm come from the Brachial Plexus
Lateral Cord-musculocutaneous, suprascapular, lateral pectoral
Posterior Cord- subscapular(upper/lower), thoracodorsal, axillary
Medial Cord-medial pectoral
C5-dorsal scapular, long thoracic

41. Brachial Plexus-Roots, Cords, Nerves

42. Veins-Cephalic, Basilic, Axillary

43. Arteries and Muscles they Supply
Subclavian Artery-left and right arm, head, thorax
Transverse Cervical Artery-trapezius muscle and surrounding tissues
Dorsal Scapular Artery-levator scapulae, rhomboideus major, rhomboideus minor 
Suprascapular artery-supraspinatous, sternocleidomastoid, subclavius
Axillary-lateral aspect of the thorax, axila, upper limb
Axillary (3 parts, Originates at the 1st rib and becomes the brachial after passing the lower margin of the teres major)- lateral aspect of the thorax, axila, upper limb
1st part
superior thoracic 
2nd part
thoracoacromial 
lateral thoracic-lateral structures of the thorax and breast
3rd part 
anterior humeral circumflex
posterior humeral circumflex-deltoid muscle and shoulder joint
subscapular-muscles of shoulder and scapular  region
circumflex scapular-clavicle, teres major, teres minor, infraspinatus 
Brachial

46. In Conclusion
The shoulder joint is under an incredible amount of stress due to the many forces that act upon it throughout the typical day.
It is made up of:
Ligaments
Bursae
Capsule cartilage and membranes
Muscles and bones
Nerves, arteries, and veins
It is important to remember:
The shoulder joint is one of the two ball-and-socket joints in the body, the other being the hip.
The muscles of the rotator cuff (SITS) and the clinical concerns associated.
The nerves arise from the brachial plexus.
The arteries arise from the subclavian and axillary