Atlas of Functional Shoulder Anatomy

241 Pages·2008·13.604 MB·English

by  Giovanni Di Giacomo

A F S A
TLAS OF UNCTIONAL HOULDER NATOMY
Giovanni Di Giacomo • Nicole Pouliart • Alberto Costantini • Andrea De Vita
Editors
Atlas of
Functional
Shoulder Anatomy
1 3
Giovanni Di Giacomo Nicole Pouliart
Concordia Hospital for Special Surgery Vrije Universiteit Brussels
Rome,Italy Universitair Ziekenhuis Brussel
Brussel,Belgium
Alberto Costantini Andrea De Vita
Concordia Hospital for Special Surgery Concordia Hospital for Special Surgery
Rome,Italy Rome,Italy
Library ofCongress Control Number:2008522466
ISBN 978-88-470-0758-1 Springer Milan Berlin Heidelberg New York e-ISBN 978-88-470-0759-8
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To my father Dr.Sergio Di Giacomo,and in memory
ofmy friends Dr.Richard B.Caspari,and Dr.Douglas T.Harryman,II
Giovanni Di Giacomo
To teachers and mentors who have inspired me
to keep delving deeper for knowledge
Nicole Pouliart
To my family,to my love Andrea and Stefano
Alberto Costantini
To my family and to my teachers Giovanni and Alberto
Andrea De Vita
We wish to express our grateful thanks to Mauro Fermariello for providing the scientific images,
and to Valeria Di Spirito,Barbara Pucci and Sonia Errera for their editorial assistance.
Credit must be given to Prof.Dr.F.Anderhuber ofthe Anatomical Institute ofKarl-Franzens-University,Graz,
and Prof.Dr.W.Firbas ofthe Institute ofAnatomy ofthe University ofVienna (Austria) for their support
to the realization ofthe book images.
Foreword
Functional Anatomy of the Shouldergives the shoulder surgeon a fresh look and feel for shoulder anato-
my.The endless energy and the inquisitive nature that characterise Dr.Di Giacomo and his team are evi-
dent in every dissection and image in this book.His meticulous dissections and crisp photography give
the reader a clear insight into the functional anatomical relationships of this elegant piece of machinery
called the shoulder.He shows us how the stabilization and movement muscles provide power and motion
and how it is that the ligament changes,which send signals to the brain,masterfully regulate the freedom
of movement we enjoy throughout our lives with a minimal amount of pain and problems.The discern-
ing clear photography of clean dissections gives new life to anatomical structures.
I have had the opportunity of viewing all the excellent images and listening to the Authors’descrip-
tions ofthe biceps pulley and shoulder proprioception over the past several years.It pleases me that they
have taken it upon their shoulders to share their expertise and enthusiasm.This is an exciting,essential
book for everyone who is interested in the shoulder.
James C.Esch,MD
President,San Diego Shoulder Institute
Assistant Clinical Professor,Department of Orthopaedics
University of California
San Diego,School of Medicine
Tri-City Orthopaedics
Oceanside,CA,USA
Preface
Dr.Di Giacomo and his team have undertaken a very important task – the production ofa book on shoul-
der anatomy that relates the static description of the anatomy to the dynamic function of the shoulder.
This book has done an excellent job of showing the anatomy of the individual structures around the
shoulder in a beautiful series of pictures and then relating this anatomy to the developing knowledge of
how the shoulder functions as a dynamic,integrated whole.In addition,this book emphasizes the rela-
tion of shoulder anatomy and function to the larger kinetic chain that supports, guides, and provides
force for shoulder function.
This book will serve two purposes.It is the newest and freshest addition to shoulder anatomy books,
and it will serve to show the clinician the importance of a deep knowledge of functional anatomy as a
basis for understanding how the shoulder works in function.With this knowledge,the clinician can bet-
ter understand dysfunction – the combination of structural deficits that brings the patient to treatment.
In addition,this knowledge of function will allow a framework of treatment that will restore the perti-
nent anatomy.
I am glad Dr.Di Giacomo’s team has produced this work.It should become a standard reference for
clinicians who will treat shoulder injuries.It will give doctors much more information with which they
can effectively treat patients.
W.Ben Kibler,MD FACSM
Medical Director
Lexington Clinic Sports Medicine Center
Lexington,KY,USA
Contents
List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XV
P 1 - S J
ART CAPULOTHORACIC OINT
Andrea De Vita,W.Ben Kibler,Nicole Pouliart,Aaron Sciascia
1.1 Muscles for Scapulothoracic Control:Role ofthe Scapula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.1.1 Serratus Anterior Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.1.2 Trapezius Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.1.3 Pectoralis Minor Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.1.4 Biomechanics and Functional Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.1.5 Clinical Relevance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
1.2 Latissimus DorsiMuscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
1.3 Pectoralis MajorMuscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
1.3.1 Biomechanics and Functional Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
1.3.2 Clinical Relevance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
P 2 - A J S L
ART CROMIOCLAVICULAR OINT AND CAPULAR IGAMENTS
Alberto Costantini
2.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
2.1.1 Acromioclavicular and Coracoclavicular Ligaments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2.1.2 Biomechanics and Functional Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
2.1.3 Clinical Relevance (Acromioclavicular Joint Separations) . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
2.2. Scapular Ligaments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
2.2.1 The Coracoacromial Ligament (Ligamentum Coracoacromial) . . . . . . . . . . . . . . . . . . . . . . 48
2.2.2 The Superior Transverse Ligament (Ligamentum Transversum Scapulae Superius;
Transverse or Suprascapular Ligament) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
XII Contents
2.2.3 The Inferior Transverse Ligament (Ligamentum Transversum Scapulae Inferius;
Spinoglenoid Ligament) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
P 3 - G J ( - )
ART LENOHUMERAL OINT MUSCLE TENDON
3.1 Deltoid Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Andrea De Vita
3.1.1 Biomechanics and Functional Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
3.1.2 Clinical Relevance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
3.2 Rotator Cuff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Alberto Costantini,Hiroshi Minagawa
3.2.1 The Subscapularis (Muscle-Tendon) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
3.2.2 The Supraspinatus (Muscle-Tendon) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
3.2.3 The Infraspinatus (Muscle-Tendon) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
3.2.4 The Teres Minor (Muscle-Tendon) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
3.2.5 Anatomy of the Rotator Cuff Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
3.2.6 Biomechanics and Functional Anatomy of the Rotator Cuff . . . . . . . . . . . . . . . . . . . . . . . . . 90
3.2.7 Clinical Relevance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
3.3 The Long Head ofthe Biceps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Alberto Costantini
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
P 4 - G C
ART LENOHUMERAL APSULE
4.1 Fibrotendinous Cuffofthe Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Giovanni Di Giacomo
4.2 Superior (Glenohumeral Ligament) Complex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Giovanni Di Giacomo,Nicole Pouliart
4.2.1 Coracohumeral Ligament . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
4.2.2 Superior Glenohumeral Ligament . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
4.2.3 Coracoglenoid Ligament . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
4.2.4 Posterosuperior Glenohumeral Ligament . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Contents XIII
4.2.5 Rotator Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
4.2.6 Rotator Cuff Interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
4.2.7 Biceps Pulley . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
4.2.8 Arthroscopic Description of the Anterosuperior Structures . . . . . . . . . . . . . . . . . . . . . . . . . 146
4.2.9 Biomechanics and Functional Anatomy of Superior Glenohumeral Ligament Complex . 150
4.2.10 Clinical Relevance of the Superior Glenohumeral Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . 158
4.3 Anterior and Inferior Glenohumeral Capsuloligamentous Complex . . . . . . . . . . . . . . . . . . . . . . . . 162
Nicole Pouliart
4.3.1 Middle Glenohumeral Ligament . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
4.3.2 Fasciculus Obliquus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
4.3.3 Inferior Glenohumeral Ligament Complex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
4.3.4 Synovial Recesses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
4.3.5 Biomechanics and Functional Anatomy ofthe Anteroinferior Glenohumeral Complex . . . . 176
4.3.6 Clinical Relevance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
4.3.7 Glenoid and Humeral Insertion of the Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
4.3.8 Glenoid Labrum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
4.3.9 Biomechanics of the Glenoid Labrum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
4.3.10 Clinical Relevance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
4.3.11 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
P 5 - N C P S
ART EUROMUSCULAR ONTROL AND ROPRIOCEPTION OFTHE HOULDER
Introduction
Scott M.Lephart
5.1 Mechanoreceptors ofthe Shoulder Joint:Structure and Function . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Zdenek Halata,Klaus L.Baumann
5.1.1 Innervation of the Shoulder Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
5.1.2 Sensory Nerve Endings in Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
5.1.3 Sensory Nerve Endings in the Joint Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
5.2 The Role of“Proprioception”in Shoulder Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
Giovanni Di Giacomo,Todd S.Ellenbecker
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228