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ANP402 > 4 UE Shoulder + Pectoral Region > Flashcards

4 UE Shoulder + Pectoral Region Flashcards

1
Q

glenohumeral joint

A

ball y socket (synovial)

humeral head + glenoid cavity

rotator cuff muscles

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2
Q

(shoulder) ball + socket

A

highly mobile/movable

- extremely unstable

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3
Q

(shoulder) humeral head + glenoid cavity

A

made up of:

glenoid labrum
articular surfaces (hyaline cartilage)
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4
Q

glenoid labrum

A

fibrocartilage that extends over glenoid cavity like a rim

- stabilizers

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5
Q

rotator cuff

A

stablizes shoulder
- holds head in cavity

**1/3 of the round humeral head in cavity (very shallow)

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6
Q

clinical application: GLENOHUMERAL JOINT

A

labrum stablize + tone of RC muscles keep head in place

easier to dislocate shoulder than the hip

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7
Q

(shoulder) articular capsule is made up of:

A

fibrous capsule

synovial membrane

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8
Q

fibrous capsule

A

(shoulder articular capsule) margins of glenoid cavity to anatomical neck of humerus

  • loose connective tissue
  • allows for mobility

(ie) coracohumeral ligament + glenohumeral ligaments

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9
Q

synovial membrane

A

part of shoulder articular capsule

- beneath connective tissue

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10
Q

superior glenohumeral reinforcement

A 
coracoacromial ligament
coracohumeral ligament (FC)
supraspinatus tendon

**very strong

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11
Q

coracoacromial ligament

A

displaces forces on it onto bones first

  • prevents superior displacement
  • part of superior glenohumeral reinforcement
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12
Q

supraspinatus tendon

A

victim of rotater cuff injuries

-part of superior glenohumeral reinforcement

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13
Q

anterior glenohumeral reinforcement

A 
glenohumeral ligaments (FC)
subscapularis tendon
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14
Q

clinical application: GLENOHUMERAL REINFORCEMENT / LIGAMENTS

A

forceful superior thrust of humerus will break clavicle or humerus shaft first before breaking coracoacromial ligament

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15
Q

posterior glenohumeral reinforcement

A

supraspinatus tendon
infraspinatus tendon
teres minor tendon

**very strong

SIT

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16
Q

inferior glenohumeral reinforcement

A

lax joint capsule (only parts of fibrous capsule)

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17
Q

laxity is good for

A

increase mobility + range of mobility

L + M

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18
Q

laxity is bad for

A

stability

L - S

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19
Q

dislocation of glenohumeral joint

A

dislocates easily when arm = laterally rotated (head turned out) + adducted
- (ie) throwing ball

torn labrum
- common in athletes who throw

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20
Q

most common rotater cuff problems

A

impingement syndrome
bone spurs
tears

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21
Q

impingement syndrome

A

(rotator cuff) tendon, which is usually @ top, rubs against acromion process

  • causes tendonitis of supraspinatus
  • accompanied by bone spurs
  • highly avascular
  • must decrease motion
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22
Q

causes of impingement syndrome

A

poor posture
weak back muscles (trapezius)
weak rotator cuff

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23
Q

bone spurs

A

(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

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24
Q

tears

A

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
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25
Q

anterior axio-appendicular muscles

A

connect upper extremity w/ thoracic wall

  • pectoralis major
  • pectoralis minor
  • subclavius
  • serratus anterior
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26
Q

pectoralis major

A

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)

27
Q

pectoralis minor

A

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)

28
Q

subclavius

A

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)

29
Q

serratus anterior

A

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)

30
Q

supraspinatus

A

rotator cuff muscles

O: supraspinous fossa
I: greater tubercle of humerus
A: abducting humerus
N: suprascapular never (C4-C6)

31
Q

infraspinatus

A

rotator cuff muscles

O: infraspinous fossa
I: greater tubercle of humerus
A: laterally rotate humerus
N: suprascapular nerve (C5-C6)

32
Q

teres minor

A

rotator cuff muscles, beneath infraspinatus

O: lateral scapula
I: greater tubercle of humerus
A: laterally rotate humerus
N: axillary nerve (C5-C6)

33
Q

subscapularis

A

rotator cuff muscles

O: subscapular foss
I: lesser tubercle of humerus
A: medially rotate humerus
N: subscapular nerve (C5-C7)

34
Q

posterior axio-appendicular muscles

A

extrinsic shoulder muscles that connect upper extremity w/ vertebral column

  • trapezius
  • latissimus dorsi
  • rhomboid major
  • rhomboid minor
  • levator scapulae
35
Q

trapezius

A

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

36
Q

latissimus dorsi

A

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

37
Q

rhomboid major

A

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

38
Q

rhomboid minor

A

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

39
Q

levator scapulae

A

posterior axio-appendicular muscle

O: transverse process C1 – C4
I: superior angle of scapula
A: elevate + rotate scapula inferiorly
N: dorsal scapular nerve

40
Q

scapulohumeral muscles

A

intrinsic shoulder muscles

  • rotator cuff (SITS)
  • deltoid (3)
  • teres major
41
Q

anterior deltoid

A

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)

42
Q

middle deltoid

A

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)

43
Q

posterior deltoid

A

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)

44
Q

teres major

A

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)

45
Q

breasts

A

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
46
Q

female breast

A

not fully developed until 5th month of pregnancy

  • may have pain while ductwork is being made for lactation
  • increase estrogen, increase progesterone
47
Q

breast anatomy

A

deep to superficial

  • pectoralis fascia
  • retromammory space/bursa
  • fat
  • suspensory ligaments (of Cooper)
  • lobules (mammory glands)
  • lactiferous ducts
  • lactiferous sinuses
  • nipple
48
Q

breast sized determined by

A

fat

49
Q

nipple

A

located near 4th rib space

- deviates in breast cancer

50
Q

breast cancer

A

most are adenomas

51
Q

adenomas

A

tumor of glandibular origin in the epithelium

52
Q

ways to diagnosis

A 
palpable mass
mammogram (calcifications)
dimples  OR "peau d'organe" effect
nipple deviation
unequal breast evaluation
enlarged axillary lymph nodes near armpit
53
Q

palpation of breast

A

benign cysts normal

  • self-exam monthly @ same time of month to decrease hormonal affect on breast
  • palpate all the way to armpit
54
Q

lymphatics + metastases in breast cancer

A

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)
55
Q

surgical treatments of breast cancer

A

lumpectomy

mastectomy (2)

56
Q

lumpectomy

A

remove lump

  • may have chemo + radiation to be safe
  • no physical therapy
57
Q

types of mastectomy

A

simple mastectomy

radical mastectomy

58
Q

simple mastectomy

A

remove down to retromammory space + leave some lymph nodes

  • most common
  • don’t always need chemo/radiation

**not any better than lumpectomy

59
Q

radical mastectomy

A

remove all breast + glandular tissue pectoralis major

  • severe pectroalis minor
  • remove fat, fascia + lymph nodes
  • need physical therapy for 6-12 months after mastectomy
60
Q

surgical breast considerations

A

costocoracoid membrane

long thoracic nerve

61
Q

costocoracoid membrane

A

extends from subclavius to pectoralis minor

62
Q

structures that pass through costocoracoid membrane

A

(1) thoraco-acromial artery
(2) cephalic vein + deltoid branch of thoraco-acromial artery
(3) lateral pectoral nerve

63
Q

long thoracic nerve surgical considerations

A

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

ANP402 (19 decks)

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