4 UE Shoulder + Pectoral Region Flashcards
glenohumeral joint
ball y socket (synovial)
humeral head + glenoid cavity
rotator cuff muscles
(shoulder) ball + socket
highly mobile/movable
- extremely unstable
(shoulder) humeral head + glenoid cavity
made up of:
glenoid labrum articular surfaces (hyaline cartilage)
glenoid labrum
fibrocartilage that extends over glenoid cavity like a rim
- stabilizers
rotator cuff
stablizes shoulder
- holds head in cavity
**1/3 of the round humeral head in cavity (very shallow)
clinical application: GLENOHUMERAL JOINT
labrum stablize + tone of RC muscles keep head in place
easier to dislocate shoulder than the hip
(shoulder) articular capsule is made up of:
fibrous capsule
synovial membrane
fibrous capsule
(shoulder articular capsule) margins of glenoid cavity to anatomical neck of humerus
- loose connective tissue
- allows for mobility
(ie) coracohumeral ligament + glenohumeral ligaments
synovial membrane
part of shoulder articular capsule
- beneath connective tissue
superior glenohumeral reinforcement
coracoacromial ligament coracohumeral ligament (FC) supraspinatus tendon
**very strong
coracoacromial ligament
displaces forces on it onto bones first
- prevents superior displacement
- part of superior glenohumeral reinforcement
supraspinatus tendon
victim of rotater cuff injuries
-part of superior glenohumeral reinforcement
anterior glenohumeral reinforcement
glenohumeral ligaments (FC) subscapularis tendon
clinical application: GLENOHUMERAL REINFORCEMENT / LIGAMENTS
forceful superior thrust of humerus will break clavicle or humerus shaft first before breaking coracoacromial ligament
posterior glenohumeral reinforcement
supraspinatus tendon
infraspinatus tendon
teres minor tendon
**very strong
SIT
inferior glenohumeral reinforcement
lax joint capsule (only parts of fibrous capsule)
laxity is good for
increase mobility + range of mobility
L + M
laxity is bad for
stability
L - S
dislocation of glenohumeral joint
dislocates easily when arm = laterally rotated (head turned out) + adducted
- (ie) throwing ball
torn labrum
- common in athletes who throw
most common rotater cuff problems
impingement syndrome
bone spurs
tears
impingement syndrome
(rotator cuff) tendon, which is usually @ top, rubs against acromion process
- causes tendonitis of supraspinatus
- accompanied by bone spurs
- highly avascular
- must decrease motion
causes of impingement syndrome
poor posture
weak back muscles (trapezius)
weak rotator cuff
bone spurs
(rotator cuff) pieces of bone that peels off inferior aspect of acromion
- sandpaper on tendons/muscles
- common in impingement syndrome
- highly avascular
**need to shave bone spurs + add gel over area + remove inflammed bursa
tears
tear in rotator cuff
- types: partial or full
- highly avascular
- must sew joints together
- may need tendon graft
- long, unpredictable recovery time
- may lead to decreased range of motion
anterior axio-appendicular muscles
connect upper extremity w/ thoracic wall
- pectoralis major
- pectoralis minor
- subclavius
- serratus anterior
pectoralis major
anterior axio-appendicular muscles
O: (clavicular head) clavicle + (sternocostal head) sternum, costal cartilages 1-6, apnoneurosis of external abdominal oblique
I: intertubercular groove of humerus
A: adduct + medially rotate humerus (clavical head: humeral flexion) (sternocostal head: humeral extension from flexed position)
N: lateral pectoral nerve + medial pectoral nerve (C5 - C8, T1)
pectoralis minor
anterior axio-appendicular muscles
O: 3rd-5th ribs
I: coracoid process of scapula
A: draw scapula inferiorily/superiorly + fix scapula against thoracic wall
N: medial pectoral nerve (C8, T1)
subclavius
anterior axio-appendicular muscles
O: junction of 1st rib + costal cartilage
I: middle inferior border of clavicle
A: anchor + depress clavicle (does not do much)
N: subclavius nerve (C5 - C8)
serratus anterior
PA: lateral surface of ribs 1-8
DA: medial border of scapula
A: protract, rotate + fix scapula against thoracic wall
N: long thoracic nerve (C5-C7)
supraspinatus
rotator cuff muscles
O: supraspinous fossa
I: greater tubercle of humerus
A: abducting humerus
N: suprascapular never (C4-C6)
infraspinatus
rotator cuff muscles
O: infraspinous fossa
I: greater tubercle of humerus
A: laterally rotate humerus
N: suprascapular nerve (C5-C6)
teres minor
rotator cuff muscles, beneath infraspinatus
O: lateral scapula
I: greater tubercle of humerus
A: laterally rotate humerus
N: axillary nerve (C5-C6)
subscapularis
rotator cuff muscles
O: subscapular foss
I: lesser tubercle of humerus
A: medially rotate humerus
N: subscapular nerve (C5-C7)
posterior axio-appendicular muscles
extrinsic shoulder muscles that connect upper extremity w/ vertebral column
- trapezius
- latissimus dorsi
- rhomboid major
- rhomboid minor
- levator scapulae
trapezius
posterior axio-appendicular muscle
O: nuchal ligament + spinous process C7 – T12
I: clavicle + medial border of scapula
A: elevate, retract, rotate scapula superiorly
N: CNXI + C3-C4
latissimus dorsi
posterior axio-appendicular muscle
O: spinous process T7 – T12 + iliac crest + thoracolumbar fascia
I: intertubercular groove of + humerus
A: extend, adduct, medially rotate humerus
N: thoracodorsal nerve
rhomboid major
posterior axio-appendicular muscle
O: spinous process T2-T5
I: medial border of scapula
A: retract / rotate scapula inferiorly + fix scapula against thoracic wall
N: dorsal scapular nerve
rhomboid minor
posterior axio-appendicular muscle
O: nuchal ligament + spinous process C7-T1
I: medial border of scapula
A: retract / rotate scapula inferiorly + fix scapula against thoracic wall
N: dorsal scapular nerve
levator scapulae
posterior axio-appendicular muscle
O: transverse process C1 – C4
I: superior angle of scapula
A: elevate + rotate scapula inferiorly
N: dorsal scapular nerve
scapulohumeral muscles
intrinsic shoulder muscles
- rotator cuff (SITS)
- deltoid (3)
- teres major
anterior deltoid
scapulohumeral muscles
**does not stabilize head of humerus
O: clavicle, acromion and spine of scapula
I: deltoid tuberosity of humerus
A: flex + medially rotate humerus
N: axillary nerve (C5-C6)
middle deltoid
scapulohumeral muscles
**does not stabilize head of humerus
O: clavicle, acromion and spine of scapula
I: deltoid tuberosity of humerus
A: abduct humerus
N: axillary nerve (C5-C6)
posterior deltoid
scapulohumeral muscles
**does not stabilize head of humerus
O: clavicle, acromion and spine of scapula
I: deltoid tuberosity of humerus
A: extend + laterally rotate humerus
N: axillary nerve (C5-C6)
teres major
scapulohumeral muscles
**does not stabilize head of humerus
O: inferior angle of scapula
I: intertubercular groove of humerus
A: adduct + medially rotate humerus
N: lower subscapular nerve (C5-C6)
breasts
highly modified sweat glands
- location: sternum to axilla/armpit spanning ribs 2-6
- development starts 6th week of embryo
- rudimentary in males
- highly developed in females
female breast
not fully developed until 5th month of pregnancy
- may have pain while ductwork is being made for lactation
- increase estrogen, increase progesterone
breast anatomy
deep to superficial
- pectoralis fascia
- retromammory space/bursa
- fat
- suspensory ligaments (of Cooper)
- lobules (mammory glands)
- lactiferous ducts
- lactiferous sinuses
- nipple
breast sized determined by
fat
nipple
located near 4th rib space
- deviates in breast cancer
breast cancer
most are adenomas
adenomas
tumor of glandibular origin in the epithelium
ways to diagnosis
palpable mass mammogram (calcifications) dimples OR "peau d'organe" effect nipple deviation unequal breast evaluation enlarged axillary lymph nodes near armpit
palpation of breast
benign cysts normal
- self-exam monthly @ same time of month to decrease hormonal affect on breast
- palpate all the way to armpit
lymphatics + metastases in breast cancer
most commonly to axillary lymph nodes (75% drainage)
- venous drainage (azygos system) to vertebrae, then to skull and brain - blood to bone to brain
- other breast, thorax y abdomen via parasternal, axillary and cervical nodes (lymph nodes)
surgical treatments of breast cancer
lumpectomy
mastectomy (2)
lumpectomy
remove lump
- may have chemo + radiation to be safe
- no physical therapy
types of mastectomy
simple mastectomy
radical mastectomy
simple mastectomy
remove down to retromammory space + leave some lymph nodes
- most common
- don’t always need chemo/radiation
**not any better than lumpectomy
radical mastectomy
remove all breast + glandular tissue pectoralis major
- severe pectroalis minor
- remove fat, fascia + lymph nodes
- need physical therapy for 6-12 months after mastectomy
surgical breast considerations
costocoracoid membrane
long thoracic nerve
costocoracoid membrane
extends from subclavius to pectoralis minor
structures that pass through costocoracoid membrane
(1) thoraco-acromial artery
(2) cephalic vein + deltoid branch of thoraco-acromial artery
(3) lateral pectoral nerve
long thoracic nerve surgical considerations
located along medial wall of axilla
- may be injured during node removal of mastectomy
- injury results in paralysis of serratus anterior
- results in scapular winging
