shoulder shoulder the human shoulder is made up of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as associated muscles, ligaments and tendons. the articulations between the bones of the shoulder make up the shoulder joints. the shoulder joint, also known as the glenohumeral joint, is the major joint of the shoulder, but can more broadly include the acromioclavicular joint. in human anatomy, the shoulder joint comprises the part of the body where the humerus attaches to the scapula, and the head sits in the glenoid cavity. the shoulder is the group of structures in the region of the joint. shouldercapsule of shoulder-joint (distended). anterior aspect.detailsidentifierslatinarticulatio humerimeshd012782ta98a01.1.00.020ta2139fma25202anatomical terminology the shoulder joint is the main joint of the shoulder. it is a ball and socket joint that allows the arm to rotate in a circular fashion or to hinge out and up away from the body. the joint capsule is a soft tissue envelope that encircles the glenohumeral joint and attaches to the scapula, humerus, and head of the biceps. it is lined by a thin, smooth synovial membrane. the rotator cuff is a group of four muscles that surround the shoulder joint and contribute to the shoulder's stability. the muscles of the rotator cuff are supraspinatus, subscapularis, infraspinatus, and teres minor. the cuff adheres to the glenohumeral capsule and attaches to the humeral head. the shoulder must be mobile enough for the wide range actions of the arms and hands, but stable enough to allow for actions such as lifting, pushing, and pulling. structure the shoulder consists of a ball-and-socket joint formed by the humerus and scapula and their surrounding structures - ligaments, muscles, tendons - which support the bones and maintain the relationship of one to another. these supporting structures attach to the clavicle, humerus, and scapula, the latter providing the glenoid cavity, acromion and coracoid processes. the main joint of the shoulder is the shoulder joint (or glenohumeral joint), between the humerus and the glenoid process of the scapular. the acromioclavicular joint and sternoclavicular joint also play a role in shoulder movements. white hyaline cartilage on the ends of the bones (called articular cartilage) allows the bones to glide and move on each other, and the joint space is surrounded by a synovial membrane. around the joint space are muscles - the rotator cuff, which directly surrounds and attaches to the shoulder joint - and other muscles that help provide stability and facilitate movement. two filmy sac-like structures called bursae permit smooth gliding between bone, muscle, and tendon. they cushion and protect the rotator cuff from the bony arch of the acromion. the glenoid labrum is the second kind of cartilage in the shoulder which is distinctly different from the articular cartilage. this cartilage is more fibrous or rigid than the cartilage on the ends of the ball and socket. also, this cartilage is also found only around the socket where it is attached. joint main article: shoulder joint cross-section of shoulder joint the shoulder joint (also known as the glenohumeral joint) is the main joint of the shoulder. it is a ball and socket joint that allows the arm to rotate in a circular fashion or to hinge out and up away from the body. it is formed by the articulation between the head of the humerus and the lateral scapula (specifically-the glenoid cavity of the scapula). the "ball" of the joint is the rounded, medial anterior surface of the humerus and the "socket" is formed by the glenoid cavity, the dish-shaped portion of the lateral scapula. the shallowness of the cavity and relatively loose connections between the shoulder and the rest of the body allows the arm to have tremendous mobility, at the expense of being much easier to dislocate than most other joints in the body. there is an approximately 4-to-1 disproportion in size between the large head of the humerus and the shallow glenoid cavity.the glenoid cavity is made deeper by the addition of the fibrocartilaginous ring of the glenoid labrum. the capsule is a soft tissue envelope that encircles the glenohumeral joint and attaches to the scapula, humerus, and head of the biceps. it is lined by a thin, smooth synovial membrane. this capsule is strengthened by the coracohumeral ligament which attaches the coracoid process of the scapula to the greater tubercle of the humerus. there are also three other ligaments attaching the lesser tubercle of the humerus to lateral scapula and are collectively called the glenohumeral ligaments. the transverse humeral ligament, which passes from the lesser tubercle to the greater tubercle of humerus, covers the intertubercular groove, in which the long head of biceps brachii travels. rotator cuff main article: rotator cuff shoulder anatomy, front view shoulder anatomy, back view the rotator cuff is an anatomical term given to the group of four muscles and their tendons that act to stabilize the shoulder. these muscles are the supraspinatus, infraspinatus, teres minor and subscapularis and that hold the head of the humerus in the glenoid cavity during movement. the cuff adheres to the glenohumeral capsule and attaches to the head of the humerus. together, these keep the humeral head in the glenoid cavity, preventing upward migration of the humeral head caused by the pull of the deltoid muscle at the beginning of arm elevation. the infraspinatus and the teres minor, along with the anterior fibers of the deltoid muscle, are responsible for external rotation of the arm. the four tendons of these muscles converge to form the rotator cuff tendon. this tendon, along with the articular capsule, the coracohumeral ligament, and the glenohumeral ligament complex, blend into a confluent sheet before insertion into the humeral tuberosities. the infraspinatus and teres minor fuse near their musculotendinous junctions, while the supraspinatus and subscapularis tendons join as a sheath that surrounds the biceps tendon at the entrance of the bicipital groove. other muscles muscles from the shoulder region in addition to the four muscles of the rotator cuff, the deltoid muscle and teres major muscles arise and exist in the shoulder region itself. the deltoid muscle covers the shoulder joint on three sides, arising from the front upper third of the clavicle, the acromion, and the spine of the scapula, and travelling to insert on the deltoid tubercle of the humerus. contraction of each part of the deltoid assists in different movements of the shoulder - flexion (clavicular part), abduction (middle part) and extension (scapular part). the teres major attaches to the outer part of the back of the scapula, beneath the teres minor, and attaches to the upper part of the humerus. it helps with medial rotation of the humerus. muscles from the front muscles from the chest wall that contribute to the shoulder are: nameattachmentfunction serratus anteriororiginates on the surface of the upper eight ribs at the side of the chest and inserts along the entire anterior length of the medial border of the scapula.it fixes the scapula into the thoracic wall and aids in rotation and abduction of the shoulders. subclaviuslocated beneath the clavicle, originating from the first rib and inserting on the subclavian groove of the clavicle.it depresses the lateral clavicle and also acts to stabilize the clavicle. pectoralis minorarises from the third, fourth, and fifth ribs, near their cartilage and inserts into the medial border and upper surface of the coracoid process of the scapula.this muscle aids in respiration, medially rotates the scapula, protracts the scapula, and also draws the scapula inferiorly. sternocleidomastoidattaches to the sternum (sterno-), the clavicle (cleido-), and the mastoid process of the temporal bone of the skull.most of its actions flex and rotate the head. in regards to the shoulder, however, it also aids in respiration by elevating the sternoclavicular joint when the head is fixed. levator scapulaearises from the transverse processes of the first four cervical vertebrae and inserts into the medial border of the scapula.it is capable of rotating the scapula downward and elevating the scapula. muscles from the back rhomboid major and rhomboid minor (work together)they arise from the spinous processes of the thoracic vertebrae t1 to t5 as well as from the spinous processes of the seventh cervical. they attach to the inner border of the scapula.they are responsible for downward rotation of the scapula with the levator scapulae, as well as adduction of the scapula. trapeziusarises from the occipital bone, the ligamentum nuchae, the spinous process of the seventh cervical, and the spinous processes of all the thoracic vertebrae. it attaches to the outer clavicle, the acromion process, and into the spine of the scapula.different portions of the fibers perform different actions on the scapula: depression, upward rotation, elevation, and retraction. levator scapulae arises from the transverse processes of cervical vertebrae 1-4, and attaches to the upper part of the inner border of the scapula. elevates the scapula. latissimus dorsi a large muscle that arises from the spinous processes of the lower six thoracic vertebrae, lumbar and all sacral vertebrae, and posterior iliac crest. it attaches to the intertubercular groove of the humerus. adducts, extends and rotates the humerus inwards. armpit the armpit (latin: axilla) is formed by the space between the muscles of the shoulder. the nerves and blood vessels of the arm travel through the armpit, and it possesses several sets of lymph nodes that are able to be examined. the armpit is formed by the pectoralis major and minor muscles at the front, the latissimus dorsi and teres major muscles at the back, the serratus anterior muscle on its inner surface, and the intertubercular groove of the humerus on the outer side. nerve supply and passage the brachial plexus surrounds the axillary artery and is formed from nerve roots from c5-t1. branches of the plexus supply the shoulder region, although several other nerves play a role. nerve roots that supply sensation to the shoulder and arm nerves that supply sensation to the shoulder and arm the skin around the shoulder is supplied by c2-c4 (upper), and c7 and t2 (lower area). the brachial plexus emerges as nerve roots from the cervical vertebrae c5-t1. branches of the plexus, in particular from c5-c6, supply the majority of the muscles of the shoulder. blood vessels the subclavian artery arises from the brachiocephalic trunk on the right and directly from the aorta from the left. this becomes the axillary artery as it passes beyond the first rib. the axillary artery also supplies blood to the arm, and is one of the major sources of blood to the shoulder region. the other major sources are the transverse cervical artery and the suprascapular artery, both branches of the thyrocervical trunk which itself is a branch of the subclavian artery. the blood vessels form a network (anastamosis) behind the shoulder that helps to supply blood to the arm even when the axillary artery is compromised. the axillary artery supplies blood to the arm and is one of the major sources of blood for the shoulder region. function the muscles and joints of the shoulder allow it to move through a remarkable range of motion, making it one of the most mobile joints in the human body. the shoulder can abduct, adduct, rotate, be raised in front of and behind the torso and move through a full 360° in the sagittal plane. this tremendous range of motion also makes the shoulder extremely unstable, far more prone to dislocation and injury than other joints the following describes the terms used for different movements of the shoulder: name description muscles scapular retraction (aka scapular adduction) the scapula is moved posteriorly and medially along the back, moving the arm and shoulder joint posteriorly. retracting both scapulae gives a sensation of "squeezing the shoulder blades together." rhomboideus major, minor, and trapezius scapular protraction (aka scapular abduction) the opposite motion of scapular retraction. the scapula is moved anteriorly and laterally along the back, moving the arm and shoulder joint anteriorly. if both scapulae are protracted, the scapulae are separated and the pectoralis major muscles are squeezed together. serratus anterior (prime mover), pectoralis minor and major scapular elevation the scapula is raised in a shrugging motion. levator scapulae, the upper fibers of the trapezius scapular depression the scapula is lowered from elevation. the scapulae may be depressed so that the angle formed