E154: Shoulder Anatomy - Ligaments of the Shoulder

E154: Shoulder Anatomy - Ligaments of the Shoulder
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Anatomy of the Shoulder
To really understand the different types of rotator cuff tears we have to start with and understanding of the shoulder, shoulder blade, and trunk. The shoulder, or glenohumeral joint, is considered a ball and socket joint.
The ball of the joint is the humeral head, or the top portion of the arm bone, and the socket is made by the shoulder blade, or the scapula.

Important anatomical structures surrounding the joint include bones, ligaments, cartilage, muscles, and tendons.

Bones of the Shoulder
The bones creating the shoulder joint proper are:
the humerus, the scapula

The shoulder joint is held to the body by one bony attachment from the front side of the body. The following bones make up that bony attachment: the clavicle, the sternum.

It is extremely important to remember that the shoulder has only one bony attachment site that keeps it on the rest of the body. Especially when considering methods of rehabilitation, and the overall health of the shoulder, the rotator cuff, the labrum, and the shoulder blade. Why is this important to remember?
Because, a single bony attachment is not intended to take on the load of an entire limb! If the arm and shoulder are being used properly, then the weight and the worKload should be spread out throughout the area.

Think of it this way…
When someone fall off of their bike of if they fall out of a tree, where do they usually injure themselves? More often than not, they will suffer a broken collarbone of a sprain in the AC (acromioclavicular) joint.
The shoulder and rotator cuff will only function well if the load is spread to the shoulder blade. Muscles of the shoulder blade play a critical role in saving the rotator cuff. To put it simply, in order to save the rotator cuff, the shoulder blade AND torso need to be strong and functional.
Cartilages of the Shoulder. As for cartilages, there are two important types in the shoulder joint. Articular Cartilage, Fibrocartilage.

The articular cartilage is located on the “ball” of the humeral head and the face of the “socket,” otherwise known as the glenoid fossa. The purpose of the articular cartilage is to decrease friction in the joint and to create a smooth surface for two bones to slide against each other. Fibrocartilage is made of a very different substance than articular cartilage and is therefore used for a very different purpose. In the shoulder, fibrocartilage is located on the face of the glenoid fossa, or socket. The labrum of the shoulder is located there and is made of fibrocartilage. The labrum is much like an O-ring. It creates a tight seal meant to provide extra stabilization of this very mobile joint. 70% of shoulder-joint stability relies on this cartilage being intact. It is no wonder why labral tears have such a profound effect on shoulder stability.

Ligaments of the shoulder come from many places and they surround the shoulder. Here are some of the noteworthy ligaments of the shoulder: Glenohumeral Ligaments (GHL), Coraco-acromial Ligament (CAL), Coraco-clavicular Ligaments (CCL), Transverse Humeral Ligament (THL)

The Glenohumeral Ligaments:
These ligaments create the most stabilization for the glenohumeral joint and prevent the shoulder from dislocating. The glenohumeral ligaments are: the superior glenohumeral ligament, the middle glenohumeral ligament, and the inferior glenohumeral ligament.
The Coraco-acromial Ligament: The Coraco-acromial Ligament, which is commonly thickened in causes of shoulder impingement syndrome. Impingement syndrome is commonly found in cases of rotator cuff tears in pitchers.
The Coraco-clavicular Ligament: The Coraco-clavicular Ligament is composed of two ligaments: the trapezoid ligament and conoid ligament.

These two ligaments connect the coracoid process of the scapula to the clavicle.
The Coraco-clavicular Ligament is extremely strong and keeps the shoulder attached to the rest of the body in that single bony attachment that was mentioned earlier. This is the ligament that gets damaged with AC joint injuries. When this ligament is damaged, the shoulder will present with a “step deformity” and it is typical to have long-term pain associated with this injury, as well as the development of osteoarthritis in the years to follow.