The ShoulderThe shoulder is unlike any other joint in the body. Its structure allows much more movement than anyother joint. In order to move freely, the ball is much larger than the socket, often compared to a golf ball ona tee. This means that the shoulder is much more dependent on the soft tissues that surround it, to keepthe joint in place, and to control its movement.

If you think of the shoulder in layers, the deepest layer is bone, then the joint capsule and ligaments, followedby the tendons and muscles on the surface. Nerves and blood vessels supply the muscles and bones of theshoulder. Nerves carry signals from the brain to the muscles to move the shoulder and carry signals from themuscles back to the brain about pain, pressure, and temperature. Here is a breakdown of the various parts ofthe shoulder:

Bone and JointsThe shoulder is made up of three bones and three joints. What we think of as the shoulder joint is alsocalled the glenohumeral joint, and it is the main ball and socket joint of the shoulder. The ball, or humeralhead, is much bigger than the socket, or glenoid. This joint allows the shoulder to move more than anyother joint in the body. The socket, or glenoid, is part of the shoulder blade, or scapula. The shoulder bladeforms a joint with the rib cage that is also called the scapulothoracic joint. Overall shoulder movement ismade up of the movement from both the glenohumeral joint and scapulothoracic joint. The final joint isthe connection between the collarbone, or clavicle, and the acromion (part of the shoulder blade) knownas the acromioclavicular joint. This joint has a small amount of movement, but is important as the joint actsas a pivot point. A shoulder “separation” involves an injury of this joint.

CapsuleThe capsule is the deepest layer of soft tissue and acts as a cover for the shoulder joint. The capsule’sfunction is to keep the lubrication fluid in the joint and to help support the joint. There are ligaments inthe capsule that are thicker parts of the capsule. The ball and socket joint, or glenohumeral joint, and theacromioclavicular joint both have a joint capsule. The joint between the shoulder blade and rib cage, orscapulothoracic joint, does not have a joint capsule.

LigamentsLigaments, together with the capsule, act to hold the bones of the shoulder together. There are ligamentsbetween the ball and socket, known as the glenohumeral ligaments, between the collarbone andacromion (part of the shoulder blade), known as the acromioclavicular ligaments, and between the collarbone and the coracoid (part of the shoulder blade), known as the coracoclavicular ligaments. All of these ligaments function to keep the bones in place as the shoulder moves during activity.

Tendons and MusclesTendons are made up of elastic and soft connective tissue and they attach muscles to bones. Musclesmove the bones by pulling on the tendons. When a muscle is activated or contracts, the tendon pulls onthe bone, causing the bone to move. Together, the tendon and muscle form a unit called a muscle-tendonunit. In the shoulder, there is a deep layer of tendons and muscles known as the rotator cuff, and a more superficial layer, made up of the deltoid, pectoralis major, and a number of other muscles of the shoulder,chest, upper back, and neck, that all assist with shoulder motion.

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The Shoulder

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Rotator CuffThe rotator cuff consists of four muscle-tendon units that originate on the shoulder blade, or scapula, andattach to the tuberosities (bumps of bone) on the ball of the humerus. The role of the rotator cuff is tokeep the ball of the humerus centred in the shoulder socket as the shoulder moves through its range ofmotion and helps to start the movement of the shoulder. The rotator cuff is the primary stabilizer duringmovement of the ball and socket, or glenohumeral joint. Overuse and traumatic injuries to the rotator cuffare among the most common problems in the shoulder.

Subacromial BursaThe bursa is a lubricating sac that is between the rotator cuff and the deltoid. It helps the rotator cuff toglide smoothly when the shoulder moves. When the shoulder or rotator cuff is injured or damaged, thebursa can become inflamed, which may lead to pain and a loss of function. This is often referred to as impingement.

Deltoid MuscleThe deltoid is the big muscle that forms a large part of the superficial, or outer layer of the shoulder. It hasthree parts – the front (anterior), middle, and back (posterior). The deltoid helps to lift the shoulder outsideways (abduction). The front part helps to lift the arm up forwards (flexion) and the back part helps tolift the arm up backwards (extension).

Pectoralis MajorThe pectoralis major is a large muscle covering a large portion of the chest, crossing over the shoulderjoint, and attaching to the collarbone and humerus. It is part of the superficial, or outer layer of the musclesaround the shoulder. The pectoralis major helps with shoulder rotation and flexion, and also helps withposture.

Scapular StabilizersThe scapular, or shoulder blade, stabilizers consist of muscles around the shoulder blade. The two majormuscles are the trapezius and the serratus anterior. Smaller muscles include the rhomboids, the levatorscapulae and the latissimus dorsi. The function of these muscles is to stabilize and support the shoulderblade against the rib cage and control its movement. Abnormalities in the movement and rhythm of theshoulder blade are referred to as scapular dyskinesis. These abnormalities may contribute to shoulder painand are most commonly helped by an active exercise or rehabilitation program that strengthens thesemuscles.

The Shoulder

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