54: Scapular and Pectoral Regions Flashcards
only bony attachment of the upper limb to the thorax
sternoclavicular joint
end of the clavicle distal by the shoulder
acromial end
the sternal end is obvi by the sternum
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
the _________ degrees of elevation of the upper limb can occur without movement of the scapula
first 30
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
morphology of the sternoclavicular joint
saddle joint but functionally it is a ball and socket
three ligaments of the acromioclavicular joint
acromioclavicular ligament
cracoclavicular ligament
coracoacromial ligament
movements of the scapula
elevation/depression
protraction/retraction
rotation
what type of joint is the glenohumeral joint?
ball and socket joint
fibrocartilaginous ring surrounding the glenoid cavity
glenoid labrum
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 «_space;anterior dislocation»_space;
what provides most of the support and stability to the shoulder joint?
rotator cuff muscles
holds the long tendon of the biceps brachii between within the biciptal groove
transverse humeral ligament
reinforces superior border of glenohumeral joint preventing superior dislocation
coracoacromial ligament
movements at the glenohumeral joint
medial/lateral rotation
abduction/adduction
flexion/extension
extrinsic muscles attaching the upper limb to the thorax
axio-appendicular muscles
proximal attachment pectoralis major
clavicular and sternal head
clavicular: anterior medial shaft of the clavicle
sternal: anterior surface of the sternum
distal attachment pectoralis major
lateral lip of the intertubercular groove of the humerus
innervation pectoralis major
lateral and medial pectoral nn.
actions pectoralis major
adducts, medially rotates, and flexes the humerus. Can EXTEND the humerus from a flexed/elevated position
proximal attachment pectoralis minor
3rd-5th ribs
distal attachment pectoralis minor
medial border of the coracoid process (scapula)
N pectoralis minor
medial pectoral n.
actions of pectoralis minor
stabilizes the scapula; elevates ribs (accessory muscle of respiration)
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