[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Upper limb](https://durgical.com/en/anatomy/region/upper-limb/) › Shoulder capsule [Joints and ligaments](https://durgical.com/en/anatomy/system/joints-and-ligaments/) · [Upper limb](https://durgical.com/en/anatomy/region/upper-limb/) # Shoulder capsule The shoulder capsule is the loose sleeve that seals the ball-and-socket joint; its looseness lets the shoulder move more than any other joint. Official name: Shoulder (glenohumeral) joint capsule [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=upper_limb&select=shoulder_capsule&side=r) Opens in the Durgical app, no sign-up needed. ## What it is The loose bag of tissue around the shoulder ball and socket; its thick parts are the glenohumeral ligaments. ## What it does Seals the joint and holds its fluid; its looseness lets the shoulder move more than any other joint. ## Key points - The inferior capsule (axillary pouch) is the loosest and weakest part: most dislocations go anterior-inferior through it, and the axillary nerve runs just below it - Capsular pattern of the shoulder (frozen shoulder): external rotation is lost most, then abduction, then internal rotation - Rotator interval: the gap between the [supraspinatus](https://durgical.com/en/anatomy/supraspinatus/) and [subscapularis](https://durgical.com/en/anatomy/subscapularis/) tendons, closed by capsule, the [coracohumeral ligament](https://durgical.com/en/anatomy/coracohumeral-ligament/) and [superior glenohumeral ligament](https://durgical.com/en/anatomy/superior-glenohumeral-ligament/); it thickens early in frozen shoulder ## Key facts **Attaches** Glenoid rim and labrum to the anatomical neck of the [humerus](https://durgical.com/en/anatomy/humerus/) (further down medially) **Function** Loose for range; reinforced by the glenohumeral ligaments and rotator cuff; axillary pouch below; thickens and shrinks in frozen shoulder; supplied by the axillary and suprascapular nerves and the circumflex humeral and suprascapular arteries ## Relations **Above** [Supraspinatus tendon](https://durgical.com/en/anatomy/supraspinatus-tendon/), which blends with it; above that, the [subacromial bursa](https://durgical.com/en/anatomy/subacromial-subdeltoid-bursa/) and the coracoacromial arch **In front** [Subscapularis tendon](https://durgical.com/en/anatomy/subscapularis-tendon/) and the subscapular recess; the glenohumeral ligaments thicken it from the inside **Behind** [Infraspinatus tendon](https://durgical.com/en/anatomy/infraspinatus-tendon/) and [teres minor tendon](https://durgical.com/en/anatomy/teres-minor-tendon/), which blend with it **Below** The axillary recess; below it the [axillary nerve](https://durgical.com/en/anatomy/axillary-nerve/) and posterior circumflex humeral artery pass back through the quadrangular space **Contents** Humeral head and glenoid with the [labrum](https://durgical.com/en/anatomy/glenoid-labrum/); the [long biceps tendon](https://durgical.com/en/anatomy/tendon-of-the-long-head-of-biceps/) crosses inside the joint but stays outside the synovial membrane ## How to find it It cannot be felt as a structure. The joint line lies below and in front of the acromion; aspiration or injection uses a posterior entry below the posterolateral corner of the acromion, aiming at the coracoid, or an anterior entry lateral to the coracoid. ## Examination - Passive external rotation with the elbow at the side: loss compared with the other side, with normal X-rays, points to frozen shoulder rather than a cuff tear (which keeps passive motion) - Apprehension and relocation tests: fear in abduction and external rotation that eases when the humeral head is pushed back suggests anterior capsulolabral laxity - Sulcus sign: downward pull on the arm opens a gap below the acromion, a sign of a lax inferior capsule (multidirectional instability) ## On imaging MR arthrography shows capsular volume, labral tears and capsular tears from the humerus (HAGL). In frozen shoulder MRI shows a thick capsule in the axillary recess and scarring in the rotator interval; ultrasound shows a thick coracohumeral ligament. Joint fluid tracks into the biceps sheath and subscapular recess. ## Common problems - Frozen shoulder (adhesive capsulitis): the capsule becomes inflamed, thick and tight, so the shoulder hurts and stiffens. - Stretched or torn in a dislocation; a loose capsule lets the shoulder slip. - Frozen shoulder is more common in people with diabetes and thyroid disease. ## How it is diagnosed Loss of both active and passive motion, especially outward rotation, with normal X-rays. MRI may show a thick capsule. ## Treatment - Gentle stretching, pain control and time: most frozen shoulders improve over months. - Steroid injection or hydrodilatation in the painful phase. - Arthroscopic capsular release or manipulation under anesthesia when stiffness persists. ## Clinical notes - Anterior dislocation or its reduction can stretch the axillary nerve: numbness over the lateral deltoid (regimental badge area) and weak abduction, checked before and after reduction - A stretched capsule in recurrent instability is tightened by capsular shift or arthroscopic plication, usually with labral repair - Septic arthritis of the shoulder may be subtle in infants and older adults; aspiration of the joint settles the diagnosis - Frozen shoulder passes through freezing (painful), frozen (stiff) and thawing phases over months; options include physiotherapy, hydrodilatation and capsular release - Anterior dislocation squares off the shoulder (epaulette sign): the acromion juts out, the rounded deltoid contour is lost and the humeral head is felt below the coracoid ## Anatomical variants - Sublabral foramen and Buford complex (no anterosuperior labrum, with a thick cord-like [middle glenohumeral ligament](https://durgical.com/en/anatomy/middle-glenohumeral-ligament/)): normal variants that can be mistaken for labral tears on MRI ## Development From week 6 the joint forms between the cartilage models of the humerus and [scapula](https://durgical.com/en/anatomy/scapula/): the centre of the interzone breaks down into the cavity while the mesenchyme around it becomes the capsule; its thicker bands are the glenohumeral ligaments. ## Related conditions - [Ehlers–Danlos syndrome](https://durgical.com/en/conditions/ehlers-danlos-syndrome/) - [Polymyalgia rheumatica](https://durgical.com/en/conditions/polymyalgia-rheumatica/) - [Shoulder dislocation](https://durgical.com/en/conditions/shoulder-dislocation/) - [Frozen shoulder (adhesive capsulitis)](https://durgical.com/en/conditions/frozen-shoulder/) ## Test yourself Think of the answer, then tap the question to see it. ## What is the weakest part of the shoulder capsule, and what runs below it? The inferior capsule (axillary pouch); most dislocations go anterior-inferior through it, and the axillary nerve runs just below. ## What is the capsular pattern of the shoulder in frozen shoulder? External rotation is lost most, then abduction, then internal rotation. ## What closes the rotator interval of the shoulder capsule? Capsule, the coracohumeral ligament and the superior glenohumeral ligament, between the supraspinatus and subscapularis tendons; it thickens early in frozen shoulder. ## What is the sulcus sign of the shoulder capsule? Downward pull on the arm opens a gap below the acromion, a sign of a lax inferior capsule (multidirectional instability). [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anatomy/shoulder-joint-capsule/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** capsula articularis articulationis glenohumeralis TA2 1536 **Official Spanish (DeCS)** Cápsula articular de la articulación glenohumeral **English (TA2)** Shoulder (glenohumeral) joint capsule **Also called** shoulder joint capsule ## Related - [IGHL](https://durgical.com/en/anatomy/inferior-glenohumeral-ligament/) - [MGHL](https://durgical.com/en/anatomy/middle-glenohumeral-ligament/) - [Coracohumeral ligament](https://durgical.com/en/anatomy/coracohumeral-ligament/) - [Axillary nerve](https://durgical.com/en/anatomy/axillary-nerve/) - [Circumflex humeral arteries](https://durgical.com/en/anatomy/anterior-and-posterior-circumflex-humeral-arteries/) - [Humerus](https://durgical.com/en/anatomy/humerus/) - [Scapula](https://durgical.com/en/anatomy/scapula/) Sources: Terminologia Anatomica (TA2); [Anatomy, Shoulder and Upper Limb, Glenohumeral Joint](https://www.ncbi.nlm.nih.gov/books/NBK537018/); [Anatomy, Shoulder and Upper Limb, Shoulder](https://www.ncbi.nlm.nih.gov/books/NBK536933/); [9.7 Development of Joints](https://openstax.org/books/anatomy-and-physiology-2e/pages/9-7-development-of-joints) (OpenStax (Rice University), 2022) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/); Anatomy of the Human Body (20th ed.): Development of the Joints (Lea & Febiger (Gray's Anatomy, 1918), 1918) · adapted, Public domain; Anatomía humana (4.ª ed.), tomo 1, cap. 55: Cintura escapular. ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/shoulder-joint-capsule/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/shoulder-joint-capsule/