Shoulder joint

Definition of the shoulder joint

The shoulder joint (Articulatio humeri) connects the upper arm (Humerus) with the shoulder blade (Scapula). It is enclosed by a joint capsule, has few ligaments and is mainly due to the strong muscles (Rotator cuff) secured.


The shoulder joint, too Humeroscapular joint, is a ball joint that has three degrees of freedom.
On the one hand, the arm can be moved forwards or backwards in the shoulder. This is known as Anteversion or. Retro version.
In addition, the arm can be spread apart or placed on the body (Abduction / adduction) and turned inwards or outwards (Internal rotation / external rotation).

Read more on the topic: External rotation

The sternoclavicular joint (Articulatio sternoclavicularis), the acromioclavicular joint (Articulatio acromioclavicularis) and two secondary joints (subacromial joint and scapula-thorax joint) involved. The shoulder joint, however, contributes by far the largest share of the range of motion.
The triangle muscle (Deltoid muscle) and the rotator cuff, consisting of Supraspinatus muscle, M. infraspinatus, Subscapularis muscle and M. teres minor, are the most important muscles of the shoulder.

Appointment with a shoulder specialist

I would be happy to advise you!

Who am I?
My name is Carmen Heinz. I am a specialist in orthopedics and trauma surgery in the specialist team of .

The shoulder joint is one of the most complicated joints in the human body.

Therefore, the treatment of the shoulder (rotator cuff, impingement syndrome, calcified shoulder (tendinosis calcarea, biceps tendon, etc.) requires a lot of experience.
I treat a wide variety of shoulder diseases in a conservative way.
The aim of any therapy is treatment with full recovery without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

  • Lumedis - your orthopedic surgeon
    Kaiserstrasse 14
    60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
You can find more information about myself at Carmen Heinz.

Anatomical structure

The shoulder joint is formed by the head of the upper arm (Caput humeri) and the elongated joint part of the shoulder blade (Scapula), which one too Glenoid cavity is called and forms a concave surface. At the lower edge of this area there is a lip made of fibrous cartilage (Glenoid labrum), which is used to enlarge the cavitas. The joint head of this ball joint is in fact many times larger than the joint socket.
This disparity allows a large range of motion, but at the expense of stability. This is ensured by a firm muscle belt (rotator cuff).

Figure shoulder joint

Figure shoulder joint
  1. Humerus head - Caput humeri
  2. Shoulder joint socket -
    Glenoid cavity
  3. Shoulder blade - Scapula
  4. Collarbone - Clavicle
  5. Shoulder corner - Acromion
  6. Shoulder corner-collarbone-
    Joint -
    Articulatio acromioclavicularis
  7. Deltoid - Deltoid muscle
  8. Raven beak process -
    Coracoid process
  9. Raven beak extension shoulder corner
    Tape -
    Coracoacromiale ligament
  10. Joint cavity -
    C.avitas articularis
  11. Fiber cartilage ring -
    Glenoid labrum
  12. Biceps, long head -
    M. biceps brachii
  13. Bursa -
    Subacromial bursa
  14. Upper arm shaft -
    Corpus humeri

You can find an overview of all Dr-Gumpert images at: medical illustrations

Figure Muscles of the right shoulder: A - front view and B - muscles of the back

Shoulder muscles

  1. Scapula hyoid bone muscle -
    Omohyoideus muscle
  2. Anterior stair muscle -
    Scanelus anterior muscle
  3. Head turner -
    Sternocleidomastoid muscle
  4. Collarbone - Clavicle
  5. Deltoid - M. deltoideus
  6. Raven bill process upper arm muscle -
    Coracobrachialis muscle
  7. Subscapular muscle -
    Subscapularis muscle
    (second layer)
  8. Two-headed upper arm muscle
    (Biceps) - M. biceps brachii
  9. Pectoralis major -
    Pectoralis major muscle
  10. Scapula lifter -
    (second layer) -
    Muscle levator scapulae
  11. Upper bone muscle -
    Muscle supraspinatus (second layer)
  12. Scapula bone -
    Spina scapulae
  13. Small round muscle -
    Muscle teres minor
  14. Subbone Muscle -
    Muscle infraspinatus
  15. Large round muscle -
    Muscle teres major
  16. Trapezius -
    Muscle trapezius
  17. Broad back muscle -
    Muscle latissimus dorsi

    Rotator cuff
    = 4 muscles (7th + 11th + 13th + 14th) -
    covered by the deltoid

You can find an overview of all Dr-Gumpert images at: medical illustrations

Joint capsule and ligament protection of the shoulder joint

The joint capsule of the shoulder joint arises on the humerus, encloses the humerus head and the joint space and attaches to the outer surface of the shoulder blade. It is relatively wide and, when the arm is hanging down, it has a bulge in the armpit area, which one can see Axillary recess is called. This bulge serves as a reserve fold, which is particularly used during splaying movements.
Since the joint capsule is very thin, it is supported by three ligament structures (Ligamenti glenohumeralia superius, mediale and inferius) and in the upper area by the Coracohumeral ligament reinforced. These ligaments run from the head of the humerus to the shoulder blade.


Bursa (Bursae) are liquid-filled, capsule-like delimited cavities that lie outside the joint space and cushion strong mechanical loads. Bursae are either congenital or acquired (reactive bursae). Depending on the mechanical load, bursa of different sizes forms in different places in every person. Due to this high individual variability, it is not possible to give precise details on the locations of the bursa.

The Subacromial bursa is a bursa that lies below the acromion, a bony extension of the shoulder blade. Another large bursa (Deltoid bursa) is found between the triangle muscle and the humerus.

The bursae are often below the tendon of the Subscapularis muscle or below the raven beak extension (Coracoid process) in connection with the joint cavity of the shoulder joint.

Introduction - diseases of the shoulder joint

Due to the disproportion between the humerus head and the joint surface of the shoulder blade and the weak ligament retention of the shoulder joint, the shoulder joint tends to become dislocatedDislocations).
Most often, the humerus head dislocates forwards and forwards and downwards, especially when the arm is forced outwardly to rotate, which is why this injury often occurs in sports accidents and falls. After the first dislocation, which still requires massive trauma, further dislocations often occur. With these, slight twisting is usually sufficient to cause the shoulder joint to dislocate. These habitual dislocations often occur even during sleep and are extremely uncomfortable. A dislocated shoulder is very painful and of course can no longer be moved.
Such recurrent dislocations can injure the cartilage and even the underlying bone (so-called impressions), as Hill-Sachs lesion are designated.

Shoulder arthrosis are quite common. They arise as a degenerative disease due to the wear and tear of the cartilage with which the joint surfaces of the shoulder are covered and are accompanied by severe pain and restricted mobility. In severe cases, a shoulder prosthesis can be used here.

The impingement syndrome is caused by pinching connective tissue (capsular or tendon tissue) or signs of wear and tear on the joint structures, which severely impair mobility, in particular the splaying of the arm and rotation.
The frozen shoulder is a temporary stiffening of one or both shoulders.
Severe pain in the shoulder joint is followed by relatively painless movement restrictions. Ideally, the symptoms will subside by themselves.

The traumatic tearing off of the cartilage lip (Glenoid labrum) on the articular surface of the shoulder blade is called Bankart lesion and is one of the causes of habitual dislocations.

Shoulder joint pain

Injuries to the shoulder joint or degenerative changes in the articular surfaces, for example Joint wear, can lead to shoulder pain.
However, only these joint surfaces are rarely affected when the shoulder hurts. Rather, pain is often also the Shoulder joints responsible for the "shoulder joint pain". This includes the so-called Acromioclavicular joint (Joint between a bone process of the shoulder blade - acromion - and the collarbone - clavicle).
Pain can also occur between the acromion and the head of the upper arm. In addition, the soft tissues that stabilize the joint, i.e. ligaments, muscles and joint capsules, can be painful and cause shoulder joint pain. Below is an overview of the common causes of shoulder pain.

Causes of pain

Shoulder pain

1. Shoulder dislocation

A shoulder joint dislocation is a dislocation of the shoulder joint, which can be due to an accident (traumatic) or due to its condition (habitual).
There are various forms of dislocation, of which the anterior dislocation is the most common, accounting for over 90%. With external rotation and abduction, the arm can easily dislocate if it moves inappropriately, such as in an accident.
Constitutional factors, such as anomalies in the ligamentous system or a malnervation of the muscles, can cause the shoulder joint to dislocate. A shoulder dislocation is quite common and is characterized by spontaneous pain and pain when moving. The arm is resiliently fixed in an abnormal position and is held with the sound arm.
If nerves (axillary nerve) are injured, the motor skills and sensitivity of the arm can also be damaged. In most cases, the arm can be repositioned to its normal position without anesthesia and with pain medication. If this is not the case, anesthesia can be performed. However, this is rather rare.

Read more on this topic at: Shoulder dislocation

2. Subacromial bursitis - inflammation of the bursa

Bursitis is inflammation of the bursa. Bursae reduce the friction between bones and soft tissues in the body. Such a bursa is located under the so-called acromion, a bone process of the shoulder blade.
With inflammation, which can be traumatic or infectious, shoulder pain occurs. However, subacromial bursitis is usually traumatic.
But it can also occur in the course of metabolic diseases such as gout or in the context of rheumatoid arthritis. It is characterized by pain in the shoulder and restricted mobility of the shoulder joint. In the acute phase of inflammation, the joint should be spared.
Conservatively, it is treated with physical therapy exercises, glucocorticoid injections, and non-steroidal anti-inflammatory drugs. If conservative treatment fails, the inflamed bursa can be surgically removed.

Read more on this topic at: Bursitis of the shoulder

3. Tendinosis calcarea

The so-called "lime shoulder" is a very painful affair. The tendons of various muscles that secure the shoulder joint (supraspinatus / infraspinatus muscles, more rarely subscapularis / teres minor muscles) have calcium deposits.
Raising the arm and putting pressure on the affected tendons are painful.
The treatment is conservative with the local application of non-steroidal anti-inflammatory drugs and physiotherapy exercises.
If the symptoms do not subside within six months, surgical measures are carried out, which include, for example, arthroscopic removal of the calcium foci or focused orthopedic shock wave therapy.

Read more on this topic at: Lime shoulder

4. Omarthrosis

Omarthrosis is a degenerative change in the joint cartilage of the shoulder joint and usually occurs without an organic cause.
But it can also be the result of frequent dislocations or injuries to the shoulder joint. It is characterized by pain in the shoulder that is aggravated by movement. Restrictions of movement and night pain are the result.

Conservative therapy includes physiotherapy exercises, treatment with non-steroidal anti-inflammatory drugs, but also cryotherapy and ultrasound treatments. In case of doubt, the joint can be artificially replaced in an operation. This is called a total endoprosthesis.

Read more on this topic at: Osteoarthritis of the shoulder

5. Frozen shoulder

The “frozen shoulder” is a form of periarthropathia humeroscapularis. This collective term describes all possible degenerative diseases of the shoulder girdle. This also includes bursitis, tendinitis, signs of wear and tear in the muscles of the shoulder joint (rotator cuff), etc.

The frozen shoulder is a chronic, inflammatory change in the shoulder joint capsule. This leads to the stiffening of the joint, which ultimately results in pain and restricted mobility.
The peculiarity of this disease is that its symptoms run in 3 stages.
In the first stage, the pain is very dominant and very severe, especially at night. However, movement is not restricted.
In the second stage the pain subsides, but movement is increasingly restricted and in the third stage the symptoms subside.

The frozen shoulder is also treated conservatively with non-steroidal anti-inflammatory drugs and physiotherapy exercises.
If the symptoms have not subsided after 6 months, anesthesia mobilization is carried out. The joint is moved in all directions under short anesthesia in order to loosen the degenerative "adhesions".
In extreme cases, the frozen shoulder can also be treated surgically.

Further information can be found under our topic: Frozen shoulder

6. Impingement syndrome

Impingement syndrome is the painful entrapment of the tendon of the supraspinatus muscle. The muscle belongs to the so-called rotator cuff muscle group and secures the shoulder joint. The pain mainly affects the lifting of the arm. 7th

Biceps tendonitis: Tendonitis is inflammation of the tendons. Inflammation of the long biceps tendon is quite common and occurs in old age as a result of wear and tear. The tendon runs in the joint capsule of the shoulder joint.
There is pain when the arm is raised above shoulder level. The pressure on the tendon is also painful.
Nonsteroidal anti-inflammatory drugs and physical therapy exercises can help relieve pain.
If pain persists after 6 months, the long biceps tendon can be shortened in an operation and fixed to the head of the humerus.

Read more on this topic at: Impingement Syndrome

Other causes

Furthermore you can

  • Fractures / breaks
  • Nerve damage
  • degenerative bone changes
  • osteoporosis
  • Osteomyelitis
  • Syndromes such as the cervical spine syndrome

Lead to shoulder pain.

Therapy is based on the underlying causes of the pain. The cause does not always have to be localized in the shoulder joint, and can also lie in the cervical spine, for example, as in the cervical spine syndrome. Symptomatic pain relievers, pain relievers and anti-inflammatory ointments can provide initial relief.

What operations are performed on the shoulder joint?

There are a variety of operations that are performed on the shoulder joint. In the following, the most common operations are discussed in more detail with regard to the surgical techniques and their indication.

1. Arthroscopy of the shoulder joint

Arthroscopy is a minimally invasive procedurewhich can serve therapeutic but also diagnostic purposes.

Small cuts (Athrotomies) an endoscope (Arthroscope) introduced. The Shoulder arthroscopy is a very common procedure as it can be used to treat many shoulder diseases.
By default, it takes place during shoulder mobilization (Arthrolysis), Shoulder joint resection, calcium removal, reconstruction or relocation of the long Biceps tendon, Shoulder stabilization and rotator cuff reconstruction are used.
In addition, the shoulder roof is enlarged arthroscopically (subacromial decompession). Not only the shoulder joint is treated arthroscopically, but also the shoulder joint (acromio-clavicular joint), the subacromial bursa (bursa under the roof of the shoulder) and muscle tendons such as the long biceps tendon.
The advantage of arthroscopy is the comparatively small wounds. In addition, joint structures can also be assessed under dynamic conditions, i.e. in motion.

2. Open surgery on the shoulder

Severe injuries to the shoulder, pronounced shoulder instabilities, Calcifications or very pronounced tendinitis, open surgery on the shoulder may be necessary. This includes all major interventions such as a artificial shoulder joint replacement after a serious accident or an extreme degenerative change. But also a tendon removal, Tenotomy, can be carried out openly.

Cracking shoulder joint

Cracking in the shoulder joint

If the shoulder "cracks" or "crunches", this can have various causes, which do not always include injury or illness. The following are possible causes of shoulder cracking.

1. Impingement

Impingement syndrome is the painful entrapment of the tendon of the Supraspinatus muscle. Movement-induced pain occurs. A cracking and crunching sound can be heard.

2. Degenerative and inflammatory changes in the shoulder joint

These include, for example, bursitis or Tendinosis calcarea. There may be cracking noises, which are accompanied by pain.

3. Injuries to the acromioclavicular joint

The acromioclavicular joint is the shoulder joint and is located between Collarbone and the Acromion, a bony process of the shoulder blade. Injuries to the joint, for example as a result of an accident, lead to pain and a clearly audible crack in the shoulder.

4. Improper loading of the shoulder muscles

A Joint instability the shoulder, which is the result of lack of movement in the Shoulder muscles or a false overstrain can cause the shoulder to crack.

What should you do if you have a shoulder crack?

As long as there are no other complaints, such as pain, you can initially be calm. The shoulder cracking can go through physiotherapeutic and physiotherapy exercises then mostly be eliminated. A doctor can use diagnostic procedures such as the MRI or roentgen Determine the exact cause of the shoulder cracking and then individually determine therapy with those affected.

Bulged shoulder

A Shoulder dislocation is known colloquially as a "dislocated shoulder". It is a dislocation of the shoulder joint.
About 50% of the dislocations affect the shoulder, it is a fairly common orthopedic disease. Due to the special anatomical features of the shoulder joint, a dislocation is very common here.
The Joint capsule is very far and the ligaments at the joint are not particularly tight. The result is a very great freedom of movement.
In addition, the head of the upper arm is too large compared to the joint socket, which can easily lead to a dislocation. A distinction is made between various forms of shoulder joint dislocation, the most common of which is the forward and downward dislocation (Luxatio anterior / subcoacoidea). Such a dislocation is very painful; the affected person hold their arm. The arm can usually be repositioned without major complications. The patient is given pain medication and light sedation to make it easier to put the arm in place. The doctor can do this with a few simple hand movements.
After that, the Motor skills and sensitivity checked.
In the case of injuries to nerves, fractures or in young people with very frequent shoulder dislocations, an operation to tighten the capsule can help.

Inflammation of the shoulder joint

When talking about an inflammation of the shoulder, experts mean the so-called Humeroscapular periarthritis or also "Frozen shoulder“.
The “frozen shoulder” is extensive Joint stiffness with heavy Restrictions on movement, some of which are more or less painful could be. Her is a chronic, inflammatory change in the area of Shoulder joint capsule underlying. Causes can be a Bursitis, Tendonitis, Ruptures or Inflammation in the field of Rotator cuff (Muscles of the shoulder) or a Impingement Syndrome be.
The disease is with the help of roentgen and Sonography diagnosed and can be treated both conservatively and surgically.
Conservative therapy includes oral ingestion of non-steroidal anti-inflammatory drugs and physiotherapy exercises. After 6 months, anesthesia mobilization can be carried out under short anesthesia if the symptoms have not diminished. The joint is moved in all directions. In the extreme case, a Arthroscopy carried out.

Other inflammations of the shoulder: Omarthrosis, Tendinosis calcarea