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The rotator cuff muscles have a very important role in stabilising the glenohumeral joint. They are often under heavy strain, and therefore injuries of these muscles are relatively common.

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The spectrum of rotator cuff pathology comprises tendinitis, shoulder impingement and sub-acromial bursitis. Tendinitis refers to inflammation of the muscle tendons – usually due to overuse.  Over time, this causes degenerative changes in the subacromial bursa and the supraspinatus tendon, potentially causing bursitis and impingement.

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The head of the humerus is much larger than the glenoid fossa, giving the joint a wide range of movement at the cost of instability. To reduce the disproportion in surfaces, the glenoid fossa is deepened by a fibrocartilage rim –  called the glenoid labrum.

The shoulder joint is formed by an articulation between the head of the humerus and the glenoid cavity (or fossa) of the scapula. This gives rise to the alternate name for the shoulder joint – the glenohumeral joint.

Indeed, so-called ‘reverse Hill-Sachs lesions’ (impaction fracture of anteromedial humeral head) and ‘reverse Bankart lesions’ (detachment of posteroinferior labrum) can be seen in posterior dislocations.

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The shoulder joint is supplied by the anterior and posterior circumflex humeral arteries – which are both branches of the axillary artery.

The shoulder joint is one of the most mobile in the body, at the expense of stability. Here, we shall consider the factors the permit movement, and those that contribute towards joint structure.

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The axillary nerve runs in close proximity to the shoulder joint and around the surgical neck of the humerus, and so it can be damaged in the dislocation or with attempted reduction. Injury to the axillary nerve causes paralysis of the deltoid, and loss of sensation over regimental badge area.

Clinically, dislocations at the shoulder are described by where the humeral head lies in relation to the glenoid fossa. Anterior dislocations are the most prevalent (95%), although posterior (4%) and inferior (1%) dislocations can sometimes occur. Superior displacement of the humeral head is generally prevented by the coraco-acromial arch.

The synovial membrane lines the inner surface of the joint capsule and produces synovial fluid to reduce friction between the articular surfaces.

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In this article, we shall look at the anatomy of the shoulder joint – its structure, blood supply, and clinical correlations.

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The characteristic sign of supraspinatus tendinitis is the ‘painful arc’ – pain in the middle of abduction between 60-120 degrees, where the affected area comes into contact with the acromion. This sign may also suggest a partial tear of supraspinatus.

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It extends from the anatomical neck of the humerus to the border or ‘rim’ of the glenoid fossa. The joint capsule is lax – permitting greater mobility (particularly abduction).

A bursa is a sac-like structure containing a small amount of synovial fluid. It functions to decrease friction between tendons, bone, and skin during movement. There are several bursae present in the shoulder joint:

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An anterior dislocation is usually caused by excessive extension and lateral rotation of the humerus. The humeral head is forced anteriorly and inferiorly – into the weakest part of the joint capsule. Tearing of the joint capsule is associated with an increased risk of future dislocations. Hill-Sachs lesions (impaction fracture of posterolateral humeral head against anteroinferior glenoid) and Bankart lesions (detachment of antero-inferior labrum with or without an avulsion fracture) can also occur following anterior dislocation.