SHOULDER COMPLEX

Sternoclavicular Joint & Acromioclavicular Joint

STERNOCLAVICULAR JOINT

 Only structural attachment of

 Clavicle,
 Scapula,
 And Upper Extremity

 to the Axial Skeleton

 This joint has a synovial capsule, a joint disk, and three major
ligaments.
STERNOCLAVICULAR JOINT: articular surfaces

 Sternoclavicular joint (SC joint)

 Proximal Component: Sternum
 Saddle-shaped Sternal Manubrium
 Distal Component: Clavicle
 Saddle-shaped Medial End Of The Clavicle.

 disc between 2 articular surfaces

STERNOCLAVICULAR JOINT: articular surfaces

 Sternoclavicular Joint Classification

 Sellar (saddle) Joint

 Frontal Plane:
 Clavicle is convex &
 Sternum is concave

 Transverse Plane:
 Clavicle is concave
 Sternum is convex
STERNOCLAVICULAR ARTICULATING SURFACES

 Two saddle-shaped surfaces

1. Sternal or medial end of the clavicle
2. Notch formed by the manubrium of the sternum and first
costal cartilage

 Clavicle and the manubrium are incongruent

 Little contact is between their articular surfaces.
 The superior portion of clavicle
 does not contact the manubrium at all
 Serves as the attachment for the
 SC joint disk
 Interclavicular ligament.
STERNOCLAVICULAR ARTICULATING SURFACES

 Movementsof the clavicle in relation to the

manubrium result in changes to the areas of contact
between

 clavicle
 SC joint disk
 manubriocostal cartilage
STERNOCLAVICULAR DISK :FUNCTIONS
 Provides stability by:

 Increases congruence between joint surfaces.

 Absorbing forces that may be transmitted along the
clavicle from its lateral end.

 Diagonally transects the SC joint space, divides the

joint into two separate cavities

 Acts like a hinge or pivot point during clavicle motion

 Upper attachement .

 Check medial movement of the clavicle that might

cause the large medial articular surface of the
clavicle to override the shallow manubrial facet.

 Permitting the disk to dissipate the medially directed

forces that would cause high pressure at the small
manubrial facet.
STERNOCLAVICULAR JOINT CAPSULE AND LIGAMENTS
 The SC joint is surrounded by a fairly strong fibrous capsule but must depend on three
ligaments for the majority of its support.

 Sternoclavicular Ligaments (anterior and posterior)

 costoclavicular ligament
 Interclavicular ligament
STERNOCLAVICULAR JOINT LIGAMENTS

 Anterior And Posterior SC Ligaments

 reinforce the capsule
 check anterior and posterior translatory movement of the
medial end of the clavicle
STERNOCLAVICULAR JOINT LIGAMENTS

 The interclavicular ligament

 resists excessive depression of the distal clavicle
 resists superior glide of the medial end of the clavicle.
 Because limitation to clavicular depression is critical to protecting
structures such as the brachial plexus and subclavian artery that pass
under the clavicle and over the first rib.

 support the weight of the upper extremity

 when the clavicle is depressed and the interclavicular ligament
and superior capsule are taut
STERNOCLAVICULAR JOINT LIGAMENTS
 Costoclavicular Ligament
 Found between the clavicle and the first rib.
 Has two segments or laminae.
 Anterior lamina has fibers directed laterally from the first rib to
the clavicle
 Fibers of posterior lamina are directed medially from the rib to
the clavicle
STERNOCLAVICULAR JOINT LIGAMENTS
 Costoclavicular Ligament

 Check elevation of the lateral end of the clavicle

 May contribute to the inferior gliding of the medial clavicle
that occurs with clavicular elevation
 Counter the superiorly directed forces applied to the
Clavicle by the sternocleidomastoid and sternohyoid
muscles.
 The medially directed fibers of the posterior lamina will
resist medial movement of the clavicleabsorbing the force
that would otherwise be imposed on the sc disk.
STERNOCLAVICULAR JOINT: DOF
 Three degrees of freedom

 –Elevation/depression (A/P axis)

 –Protraction/retraction (vertical axis)
 –Anterior/posterior rotation (longitudinal axis)

 Closed Pack Position

 Arm in full elevation
 At rest, the SC joint space is wedge-shaped and open superiorly
STERNOCLAVICULAR MOTIONS
 Elevation and Depression of the Clavicle
 occur around(A-P) axis
 between a convex clavicular surface and a concave surface
 formed by the manubrium and the first costal cartilage.

 With elevation,
 the lateral clavicle rotates upward,
 with depression
 the lateral clavicle rotates downward.
 ELEVATION/DEPRESSION:
Clavicular elevation/depression at the SC joint occurs as movement of the lateral clavicle
about an A-P axis. The medial clavicle also has small magnitudes of medial/lateral translation
and superior/inferior translation at the SC joint.

Elevation/depression: 30o
STERNOCLAVICULAR MOTIONS
 Protraction And Retraction Of The
Clavicle
 occur at the SC joint around an approximately vertical
(superoinferior) axis
 lies at the costoclavicular ligament .

 With protraction, the lateral clavicle moves

anteriorly
 With retraction, the lateral clavicle moves posteriorly.
STERNOCLAVICULAR MOTIONS
 Protraction And Retraction Of The Clavicle

 The configuration of joint surfaces in this plane is the

opposite of that for elevation/depression;
 medial end of the clavicle is concave
 manubrial side of the joint is convex.

 During protraction, the medial clavicle slide anteriorly

on the
 Manubrium
 first costal cartilage
STERNOCLAVICULAR MOTIONS
 Anterior/Posterior, Or Long Axis, Rotation Of The Clavicle
 occurs as a spin between the saddle shaped surfaces of the
medial clavicle and manubriocostal facet
 the clavicle rotates primarily in only one direction from its resting
position.
 Rotates posteriorly from neutral
 bringing the inferior surface of the clavicle to face anteriorly.

 Axis Of Rotation
 runs longitudinally through the clavicle
 intersecting the SC and AC joints.

Anterior/Posterior Rotation: less than 50o

ARTHROKINEMATICS
 Elevation – OF SC JOINT
 (48°) Convex rolls superiorly and slides inferiorly
 Depression –
 (less than 15°) Convex rolls inferiorly and slides superiorly
 Protraction –
 (15-20°) Concave rolls and slides anteriorly
 Retraction –
 (20-30°) Concave rolls and slides posteriorly
 Rotation –
 Post Rot: (as much as 50o) , Ant Rot: back to neutral
 Ant Rot : past neutral 10o
 Spin with flex or abd
 (cannot occur with arm at side)
ARTHROKINEMATICS OF STERNOCLAVICULAR JOINT

 In elevation and depression

 The medial end of the clavicle rolls and slides on the relatively
stationary disk, with the upper attachment of the disk serving as a
pivot point.
 In protraction/retraction
 the SC disk and medial clavicle roll and slide together on the
manubrial facet, with the lower attachment of the disk serving as
a pivot point.

 The articular disk, therefore, is considered

 part of the manubrium in elevation/depression
 part of the clavicle in protraction/retraction.
 IMPORTANCE OF SC JOINT MOTIONS
 Dislocations Of The SC Joint
 Only 1% Of Joint Dislocations In The Body

 Perform Dual Functions Of Mobility And Stability

 Serves Its Purposes Of Joining The Upper Limb To The Axial Skeleton,
 Contributing To Upper Limb Mobility
 Withstanding Imposed Stresses
ACROMIOCLAVICULAR JOINT

 Attaches the scapula to the clavicle.

 Plane synovial joint with 3 degrees of freedom

.
 Three rotational
 Three translational
ACROMIOCLAVICULAR JOINT
 Has joint capsule and two major ligaments
 Allow the scapula additional range of rotation on the thorax
 Allow for adjustments of the scapula (tipping and internal/external
rotation)in order to follow the changing shape of the thorax as arm
movement occurs.
 Joint allows transmission of forces from the upper extremity to the
clavicle
ACROMIOCLAVICULAR ARTICULATING SURFACES

 Articulation is between
 The lateral end of the clavicle
 A small facet on the acromion of the scapula
ACROMIOCLAVICULAR ARTICULATING SURFACES

 The Articular Facets are

 Incongruent , Flat , Small And Afford Limited Motion
 Vary in configuration (Either surface may be slightly convex with other being reciprocally
concave)
 Inclination of the articulating surfaces varies from individual to individual.
ACROMIOCLAVICULAR CAPSULE AND LIGAMENTS
 Capsule of the AC joint is
 Weak
 Cannot maintain integrity of the joint
without reinforcement of ligaments

 Superior and Inferior Acromioclavicular

 Coracoclavicular Ligaments
 Conoid Ligament
 Trapezoid Ligament

 The AC capsule and ligament can resist

small rotary and translatory forces at the
AC joint, restraint of larger displacements
is by coracoclavicular ligament.
 ACROMIOCLAVICULAR LIGAMENTS
 The Coracoclavicular Ligament
 Firmly unites the clavicle and scapula
 Provides much of the joint’s stability
 Divided into
 Lateral portion, the trapezoid ligament,
 Medial portion, the conoid ligament.

 Trapezoid ligament
 Quadrilateral in shape
 Is nearly horizontal in orientation.

 Conoid ligament,
 Medial and slightly posterior to the trapezoid,
 Is more triangular
 Vertically oriented

 Separated by adipose tissue and a large bursa

 Ligaments Attach to the undersurface of the clavicle
CORACOCLAVICULAR LIGAMENTS
 Conoid portion
 Provides the primary restraint for the AC joint
 In superior and inferior directions

 Trapezoid portion
 Provides the majority of resistance to posterior
translatory forces
 Applied to the distal clavicle

 Both Portions Of Coracoclavicular Ligament

 Limit upward rotation of the scapula at the AC joint.
ACROMIOCLAVICULAR LIGAMENTS

 The superior acromioclavicular ligament

 Assists the capsule in apposing articular surfaces
 Providing A-P joint stability.
 Superior fibers are reinforced by aponeurotic fibers of
the trapezius and deltoid muscles
 Makes the superior joint support stronger than the inferior
WEIGHT BEARING AND TRANSFER

 When A Person Bears Weight On The Arm,

 A Medially Directed Force Up The Humerus

(1) Transferred To The Scapula

(2) Through The Glenoid Fossa And
Then To The Clavicle
(3) Through The Coracoclavicular Ligament.
ACROMIOCLAVICULAR MOTIONS

The primary rotatory motions that take place at the AC

joint are
 internal/external rotation
 anterior/posterior tipping or tilting
 upward/downward rotation
occur around axes that are oriented to the plane of the
scapula rather than to the cardinal planes.
 ACROMIOCLAVICULAR MOTIONS
 Upward/ Downward Rotation of the AC Joint
 Frontal Plane ( plan of scapula)
 Oblique AP Axis

 Internal/external rotation at the AC Joint

 Transverse Plane
 Vertical Axis

 Anterior/posterior tilting or tipping at AC Joint

 Sagittal Plane
 Frontal Axis or oblique “coronal” Axis

 Closed Packed Position

 90o abduction
ACROMIOCLAVICULAR MOTIONS

 Internal and External Rotation(30o)

 At scapula in relation to the clavicle
 occurs around an approximately vertical axis through the
AC joint
 visualized as bringing the glenoid fossa of the scapula
anteromedially and posterolaterally,
 maintain contact of the scapula with the horizontal
curvature of the thorax as the clavicle protracts and
retracts,
 Also, scapula sliding around the thorax in scapular
protraction and retraction, and to “aim” the glenoid fossa
toward the plane of humeral elevation
 ACROMIOCLAVICULAR MOTIONS

 Anterior and Posterior Tipping (30o to 40o)

 tilting of the scapula in relation to the clavicle around an
oblique “coronal” axis through the joint.

 Anterior tipping will result in

 the acromion tipping forward (inferior translation)
 the inferior angle tipping backward

 Posterior tipping will result in

 Rotation of the acromion backward (superior translation)
 The inferior angle forward.
ACROMIOCLAVICULAR MOTIONS
 Upward/Downward Rotation
 rotation of the scapula in relation to the clavicle about an
oblique “A-P” axis
 approximately perpendicular to the plane of the scapula
 passing midway between the joint surfaces of the AC joint.

 Upward rotation (30o )tilts the glenoid fossa upward

 Downward rotation (17o )tilts the glenoid fossa downward
 limited by the attachment of the Coracoclavicular ligament.
ACROMIOCLAVICULAR STRESS TOLERANCE

 Extremely susceptible to both trauma and degenerative change.

 Due to its small and incongruent surfaces.

 Degenerative change
 common from the second decade
 Joint space commonly narrowed by the sixth decade
 IMPORTANCE OF SC AND AC JOINTS

 Facilitates motion of the scapula on thorax

 contributes about 1/3rd of total motion of shoulder
complex
 necessary for elevation of the arm through the linked SC
and AC joint motions
 Relative contribution of the SC and AC joints to the 60o arc of
upward rotation of the scapula as the scapula moves through
its full ROM.