Pembahasan Kuis Sendi Acromioclavicular Pra OSPE Genome Bimbel
Channel: M. Rifki Al Ikhsan, MD
Date: 2021-01-26

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Penunjang Sistem Pembelajaran Daring
Joints and ligament connections of the
shoulder
girdle
A distinction is made between 2 joints on the shoulder girdle:
• Medial clavicular joint (Articulatio sternoclavicularis)
• Lateral clavicular joint (Articulatio acromioclavicularis)
Medial clavicular joint
The Articulatio sternoclavicularis is the only truly articulated connection
between the upper extremity and the torso (› Fig. 4.9 ).
The joint surfaces of the Extremitas sternalis of the Clavicula and
the Incisura clavicularis of the Manubrium sterni are both slightly
saddle-shaped but functionally they are ball joints. A Discus articularis
divides the joint almost completely. Because of the very
strong ligaments, luxation of the joint is extremely rare.
The following ligaments secure the medial clavicular joint:
• Ligg. sternoclavicularia anterius and posterius on the front
and back of the joint
• Lig. interclaviculare, which connect both clavicles with each
other along the top of the breastbone
• Lig. costoclaviculare, which stretches from the cartilage of the
first rib to the medial end of the Clavicula.
Also, the M. subclavius, which stretches from the first rib to the
Clavicula, supports the fixation of the Clavicula to the thorax and
thus acts as an active ligament.
Lateral clavicular joint
The lateral clavicular joint (Articulatio acromioclavicularis) is a
plane joint and connects the lateral end of the Clavicula with the acromion
of the Scapula (› Fig. 4.10 ). It is stabilised by 3 ligaments:
• Lig. acromioclaviculare, which constitutes a reinforcement of
the joint capsule
• Lig. trapezoideum from the Linea trapezoidea of the Clavicula
to the Proc. coracoideus
• Lig. conoideum from the Tuberculum conoideum of the Clavicula
to the Proc. coracoideus.
The Ligg. trapezoideum (lateral) and conoideum (medial) are merged
into the Ligg. trapezoideum (lateral) and conoideum (medial).
Three other ligament connections have no direct relation to the
clavicular joints:
• The Lig. coracoacromiale connects the Proc. coracoideus and
Acromion and together with them forms the so-called roof of
the shoulder.
• The Lig. transversum scapulae superius bridges the Incisura
scapulae.
• The Lig. transversum scapulae inferius is only inconsistently
formed and is located directly below the lateral end of the Spina
scapulae.
Clinical remarks
In contrast to injuries to the medial clavicular joint, trauma to
the Articulatio acromioclavicularis (clinical: dropped shoulder)
is common. Typically they arise through a fall onto the
shoulder with an outstretched arm, often through sports accidents.
A distinction is made according to TOSSY, between 3
levels of severity:
• TOSSY I: strain or partial rupture of the Lig. acromioclaviculare
(1 ligament affected)
• TOSSY II: additional partial rupture of the Lig. coracoclaviculare
(2 ligaments affected)
• TOSSY III: complete tear of the Lig. acromioclaviculare and
the Lig. coracoclaviculare (all 3 ligaments torn)
Especially in the case of TOSSY III the lateral end of the Clavicula
is higher than the Acromion. The clear step formation can
be pushed back into the normal position (‘piano key phenomenon’,
› Fig. 4.11 ).
Clinically, a classification by ROCKWOOD based on that by
TOSSY is now primarily used, as this is more suitable for
whether an operation is indicated.
4.3.3 Shoulder girdle mechanics
The Clavicula can be dislocated in the sternoclavicular joint
around the sagittal and longitudinal axes (› Fig. 4.12 , › Table
4.1 ). Thereby the Clavicula moves in the form of a cone with the
tip in the sternoclavicular joint and the base in the acromioclavicular
joint (‘circles of the shoulder’). In addition, due to the relatively
weakly developed saddle form of the articular surfaces of the sternoclavicular
joint, light rotational movements of the Clavicula
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