Bursae:

• Several bursa are present, most important

are subacromial and subdeltoid bursa
• Help to separate the supraspinatus and the
head of humerus from the acromion,
coracoid process and the deltoid muscle
• Bursa may be separate but commonly are
continuous with each other and referred to
as Subacromial Bursa
• This permits smooth gliding
movement of humerus
and supraspinatus tendon
• Interruption of this mechanism is a
common cause of pain
• Subacromial bursitis is most
commonly secondary to inflammation
or degeneration of the supraspinatus
tendon
Coracoacromial Arch/supra humeral arch:
• Formed by the coracoid process, acromion
and the coracoacromial ligament
• An osteoligamentous vault that covers
humeral head and forms a space within
which the subacromial bursa, supraspinatus
tendon and a portion of the long head of the
biceps lie
• It protects these structures
from direct trauma,
such trauma could
simply be carrying
a heavy bag on the shoulder
• The arch also prevents the upward
dislocation of the head of the humerus. If
this were to occur it would cause
impingement of all the structures lying in
the supra humeral space
• Narrowing of the space could also result
from
iii. Change in the shape of the acromion
inferiorly
iv. Change in the slope of the acromion
v. AC joint osteophytes or large
coracoacromial ligament
Glenohumeral Motions:
• Motions occurring at glenohumeral
junction can be understood in two phases
• Osteokinematics and Arthrokinematics
Osteokinematics :
• 3° of freedom : flexion/extension,
medial/lateral rotation, abduction /
adduction
• ROM – flexion - 1200, extension - 500
• ROM of medial / lateral rotation varies and
depends on arm position
• With arm by the side, range could be limited to
500 as compared to 1200 when the arm is in 900
abduction
• The restricted arc of medial and lateral rotation
when the arm is by the side is due to the impact of
the lesser tubercle on the anterior glenoid fossa in
medial rotation, and the impact of greater tubercle
on the acromion in lateral rotation
• When the arm is abducted these bony restrictions
play little role so the checks of motion become
capsular and muscular
• Range of abduction depends whether the arm
is neutral, medially or laterally rotated
• In neutral range of abduction is 900
• In medial rotation the humerus will not abduct
on the glenoid fossa beyond 600, restriction to
abduction is due to impingement of greater
tubercle on the coracoacromial arch
• When the humerus is laterally rotated by
30-450, the greater tubercle passes under or
behind the arch thus prevents the
impingement of the greater tubercle on the
coracoacromial arch and so abduction can
continue unimpeded up to 1800
Plane of scapula:
• Plane lies through the resting scapula
which is 30º – 40º anterior to the frontal
plane
• Abduction in plane of scapula –
scpation
• When humerus elevates in this plane
there is presumably less restriction to
motion because the capsule is less
twisted
Arthrokinematics:
• Glenoid fossa and humeral head are
incongruent,the convex humeral head is a
substantially large surface and may have a
different radius of curvature than the shallow
concave fossa
• Given this incongruence, rotations of the joint
do not occur as pure spins, but have changing
centers of rotation and shifting contact
surfaces
• Elevation of the humerus requires the humeral
head to glide inferiorly in a direction opposite
to movement of the shaft of the humerus
• For eg. Abduction of humerus
would cause a superior
rolling of humeral head
on the fossa
• The humeral head would soon run out of
glenoid fossa and the head would impact the
coracoacromial arch
• If head glides inferiorly while it rolls up on
fossa full ROM can be achieved
• Additionally humeral head
may glide anteriorly,
posteriorly, medially
or laterally on the fossa