54: Scapular and Pectoral Regions Flashcards by E B

only bony attachment of the upper limb to the thorax

sternoclavicular joint

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end of the clavicle distal by the shoulder

acromial end

the sternal end is obvi by the sternum

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what structures are contained withing the suprascapular notch on the scapula?

the notch is for the suprascapular artery and nerce

the superior transverse ligament of scapula covers the notch, artery is above and nerve is below

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the _________ degrees of elevation of the upper limb can occur without movement of the scapula

first 30

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full abduction (180) of the arm is 60 degrees _______- and 120 degrees ______________

120 degrees occurs at the glenohumeral joint and 60 degrees from scapular rotation

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morphology of the sternoclavicular joint

saddle joint but functionally it is a ball and socket

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three ligaments of the acromioclavicular joint

acromioclavicular ligament
cracoclavicular ligament
coracoacromial ligament

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movements of the scapula

elevation/depression
protraction/retraction
rotation

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what type of joint is the glenohumeral joint?

ball and socket joint

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fibrocartilaginous ring surrounding the glenoid cavity

glenoid labrum

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where is the shoulder joint capsule weakest?

the capsule is weakest inferiorly where it is not reinforced by the coracoacromial arch or the rotator cuff muscles &laquo_space;anterior dislocation&raquo_space;

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what provides most of the support and stability to the shoulder joint?

rotator cuff muscles

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holds the long tendon of the biceps brachii between within the biciptal groove

transverse humeral ligament

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reinforces superior border of glenohumeral joint preventing superior dislocation

coracoacromial ligament

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movements at the glenohumeral joint

medial/lateral rotation
abduction/adduction
flexion/extension

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extrinsic muscles attaching the upper limb to the thorax

axio-appendicular muscles

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proximal attachment pectoralis major

clavicular and sternal head

clavicular: anterior medial shaft of the clavicle
sternal: anterior surface of the sternum

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distal attachment pectoralis major

lateral lip of the intertubercular groove of the humerus

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innervation pectoralis major

lateral and medial pectoral nn.

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actions pectoralis major

adducts, medially rotates, and flexes the humerus. Can EXTEND the humerus from a flexed/elevated position

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proximal attachment pectoralis minor

3rd-5th ribs

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distal attachment pectoralis minor

medial border of the coracoid process (scapula)

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N pectoralis minor

medial pectoral n.

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actions of pectoralis minor

stabilizes the scapula; elevates ribs (accessory muscle of respiration)

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proximal attachment subclavius

junction of the first rib and manubrium

distal attachment subclavius

inferior center of the clavicle

innervation subclavius

nerve to the subclavius

actions subclavius

anchors and depresses clavicle

proximal attachment serratus anterior

lateral parts or ribs 1-8

distal attachment serratus anterior

medial anterior border of the scapula

innervation serratus anterior

long thoracic n.

actions serratus anterior

protracts, rotates, and stabilizes scapula on thorax (also abduction > 90)

"winged scapula"

damage to serratus anterior or long thoracic nerve

proximal attachment trapezius

occipital bone, spinous processes of C1-T12

distal attachment trapezius

lateral third of clavicle, acromion, superior border of scapular spine

innervation trapezius

accessory n. (CN XI)

action trapezius

elevates, retracts, rotates, and depresses scapula

proximal attachment levator scapulae

transverse processes of C1-4

distal attachment levator scapulae

superior angle of scapula

innervation levator scapulae

dorsal scapular n.

action levator scapulae

elevates scapula

proximal attachment rhomboideus major

spinous processes of T1-4

proximal attachment rhomboideus minor

spinous processes of C6-7

distal attachment rhomboideus major

medial border of scapula below scapular spine

distal attachment rhomboideus minor

medial border of scapula above scapular spine

innervation rhomboideus major and minor

dorsal scapular n.

action rhomboideus major and minor

retract and elevate scapula

proximal attachment latissimus dorsi

spinous processes of T7-T12, thoracolumbar fascia, iliac crest

distal attachment latissimus dorsi

floor of the intertubercular groove on humerus

innervation latissimus dorsi

thoracodorsal n.

action latissimus dorsi

adducts, extends, and medially rotates humerus

intrinsic muscles connecting the scapula to the humerus

scapulohumeral muscles

proximal attachment deltoid

lateral third of clavicle, acromion, and scapular spine

distal attachment deltoid

deltoid tuberosity of humerus

innervation deltoid

axillary n.

actions deltoid

anterior part flexes and medially rotates arm, middle part abducts the arm, and the posterior part extends and laterally rotates the arm

proximal attachment teres major

posterior surface of inferior angle of scapula

distal attachment teres major

medial lip of the intertubercular groove of humerus

innervation teres major

lower subscapular n.

actions teres major

adduction and medial rotation of arm

muscles of the rotator cuff

supraspinatus infraspinatus teres minor subscapularis

proximal attachment supraspinatus

supraspinous fossa of scapula

distal attachment supraspinatus

superior aspect of the greater tubercle of the humerus

innervation supraspinatus

suprascapular n.

actions supraspinatus

initiates abduction (deltoid takes over), stabilization of glenohumeral joint

proximial attachment infraspinatus

infraspinatus fossa of the scapula

distal attachment infraspinatus

greater tubercle of the humerus

innervation infraspinatus

suprascapular n.

actions infraspinatus

lateral rotation, stabilization of glenohumeral joint

only two lateral rotators of humerus

infraspinatus | teres minor

proximal attachment teres minor

lateral border of scapula

distal attachment teres minor

greater tubercle of humerus

innervation teres minor

axillary n.

actions teres minor

lateral rotation, stabilization of glenohumeral joint

proximal attachment subscapularis

subscapular fossa

distal attachment subscapularis

lesser tubercle of humerus

innervation subscapularis

upper and lower subscapular nn.

actions subscapularis

medial rotation, stabilization of glenohumeral joint

what arteries branch off the thyrocervical trunk?

dorsal scapula a. suprascapular a. (the thyrocervical trunk itself comes off of the subclavian)

as the subclavian passes under the clavicle it changes names to ________-

the axillary | the axillary artery is divided into three parts relative to pectoralis minor

branches of part 1 of axillary a. proximal to pectoralis minor

superior thoracic a.

branches of part 2 of axillary a. deep to pectoralis minor

thoracoacromial trunk | lateral throacic a.

branches off of the thoracoacromial trunk

acromial pectoral clavicular deltoid

branches of part 3 of axillary a. distal to pectoralis minor

anterior circumflex humeral a. posterior circumflex humeral a. subscapular a.

branches off of subscapular a.

circumflex scapular a. | thoracodorsal a.

scapular anastomoses

subclavian - thyrocervical trunk - transverse cervical - dorsal scapular - thoracodorsal - subscapular - axillary

humeral anastomosis

anterior circumflex humeral - posterior circumflex humeral

"venae comitantes"

accompanying veins

what vein travels in the deltopectoral groove?

cephalic v. drains into the axillary v.

what vein passes through basilic hiatus

basilic v.

what connects the cephalic and basilic veins in cubital foss

median cubital v.

node located lateral wall of axillary fossa medial and posterior to axillary v.

humeral

node located posterior wall of axillary fossa along posterior axillary fold and subscapular blood vessels

subscapular

node located medial wall of axilla, surrounding lateral thoracic vein and inferior border of pectoralis minor

pectoral

node located deep to pectoralis minor

central node

node located at apex of axillary fossa along medial side of axillary vein and 1st part of axillary a.

apical node

basilic v. drainage enters which nodes more often?

cubital nodes > humeral axillary nodes cephalic v. drainage enters apical axillary nodes

what are the levels of the axillary nodes? what is the significance?

level 1: lateral to pectoralis minor *** level 2: deep to pectoralis minor** level 3: medial to pectoralis minor* level 3 metastasis has 0% 5 year cancer survival rate (1-65%, 2-31%)

what does the triangular space contain?

scapular circumflex artery

borders of the triangular space

lateral: long head of the triceps superior: teres minor inferior: teres major

what does the quadrangular space contain?

axillary n. and post. humeral circumflex a.

borders of quadrangular space

lateral: humerus medial: long head of triceps brachii superior: teres minor inferior: teres major

fracture of the surgical head of the humerus can damage the ...

contents of the quadrangular space, including axillary n. and post. humeral circumflex a. ---> paralysis and atrophy of the deltoid and teres minor