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Semester 2 - MSK > 25. Osteology of the scapula, clavicle and proximal humerus > Flashcards

25. Osteology of the scapula, clavicle and proximal humerus Flashcards

1
Q

what type of bone is the scapula?

A

Irregular bone

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2
Q

What does the scapula articulate with?

A
  • It articulates with the humerus at the glenohumeral joint

* with the clavicle at the acromioclavicular joint. In doing so, the scapula connects the upper limb to the trunk

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3
Q

describe the shape of the scapula

A

a triangular, flat bone, which serves as a site for attachment for seventeen different muscles

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4
Q

What is the anterior surface of the scapula referred to as? What is the fossa of this surface called and which muscle originates from this fossa?

A
  • Anterior surface is called the costal surface which faces the rib cage.
  • Has a subscapular fossa(large concave depression over most of its surface), from which the subscapularis (rotator cuff muscle) originates
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5
Q

Where is the coracoid process located on the scapula and in which direction does it project? Where does it lie relative to the clavicle?

A

Arises from the superolateral surface of the scapula and projects anterolaterally
- a hook-like projection, which lies directly below the clavicle

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6
Q

Which muscle attach to the coracoid process?

A
  • Pectoralis minor inserts onto it

- short head of biceps brachii and coracobrachialis originate from it

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7
Q

What are 3 important landmarks of the lateral surface of the scapula?

A

Glenoid fossa (glenoid cavity)
Supraglenoid tubercle
Infraglenoid tubercle

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8
Q

What is the glenoid fossa and where is it located?

A

A shallow cavity, located superiorly on the lateral border. This articulates with the head of the humerus to form the glenohumeral (shoulder) joint.

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9
Q

What is the Supraglenoid tubercle and what attaches to it?

A

A roughening immediately superior to the glenoid fossa. This is the site of origin of the long head of the biceps brachii muscle.

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10
Q

What is the infraglenoid tubercle and what attaches to it?

A

A roughening immediately inferior to the glenoid fossa. This is the site of origin of the long head of the triceps brachii muscle.

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11
Q

what is the lateral surface of the scapula the site of?

A

The lateral surface of the scapula is the site of the glenohumeral joint, and of various muscle attachments

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12
Q

What are 4 important landmarks of the posterior surface of the scapula?

A
  • Spine
  • Acromion
  • Infraspinous fossa
  • Supraspinous fossa
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13
Q

What is the acromion and what does it articulate with?

A

Large projection arising from the lateral end of the scapula spine.
The acromion arches laterally over the glenohumeral joint and articulates with the clavicle at the acromioclavicular joint

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14
Q

What is the infraspinous fossa and what originates from here?

A

A depression below the spine of the scapula. The infraspinatus muscle originates from this area.

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15
Q

What is the supraspinous fossa and what originates from here?

A

A depression above the spine of the scapula. The supraspinous fossa is much smaller than the infraspinous fossa and is more convex in shape. The supraspinatus muscle originates from this area

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16
Q

What is the the posterior surface of the scapula the site of?

A

The posterior surface of the scapula is the site of origin for the majority of the rotator cuff muscles of the shoulder

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17
Q

What is the scapula spine?

A

the most prominent feature of the posterior scapula. It runs

transversely across the scapula.

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18
Q

Where is the Glenohumeral joint and the Acromioclavicular joint?

A

 Glenohumeral joint: between the glenoid fossa (glenoid cavity) of the
scapula and the head of the humerus.
 Acromioclavicular joint: between the acromion of the scapula and the clavicle

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19
Q

What is the scpulothoracic joint and why is it not a true joint?

A

Between the anterior surface of the scapula and the rib cage.
This is not a true joint as it has none of the characteristics of a joint (i.e. union by fibrous, cartilaginous or synovial tissue). Instead, it is an articulation of the scapula with the thorax that itself depends on the integrity of the acromioclavicular and sternoclavicular joints

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20
Q

Why does a fractured scapula usually not require fixation?

A

Tone of the surrounding muscles holds the fragments in place whilst healing occurs

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21
Q

What can cause fractures of the scapula?

A

Fractures of the scapula are relatively uncommon, and if they do occur, they are an indication of severe chest trauma. They are frequently seen in high speed road collisions, crushing injuries, or high-impact sports injuries.

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22
Q

What are the articulation of the clavicle on either side?

A

Laterally: acromion
Medially: manubrium (of the sternum)

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23
Q

What are the 3 main functions of the clavicle?

A
  • Attaches the upper limb to the trunk as part of the ‘shoulder girdle’.
  • Protects the underlying neurovascular structures supplying the upper limb.
  • Transmits force from the upper limb to the axial skeleton.
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24
Q

What is the clavicle classified as?

A

classified as a long bone and has a slight ‘S’ shape

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25
Q

Describe the structure of the clavicle

A

The medial aspect is convex anteriorly, and the lateral aspect concave. The medial end is referred to as the sternal end and the lateral end as the acromial end; between the two ends is the shaft

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26
Q

What does the sternal end of the clavicle contain?

A

contains a large facet for articulation with the manubrium of the sternum at the sternoclavicular joint

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27
Q

What is the inferior surface of the sternal end of the clavicle marked by?

A

Marked by a rough oval depression for the costoclavicular ligament (a ligament of the sternoclavicular joint)

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28
Q

Which muscles attach to the shaft of the clavicle?

A 
The shaft of the clavicle acts a point of origin and insertion for several muscles: 
deltoid, 
trapezius, 
subclavius, 
pectoralis major, sternocleidomastoid
sternohyoid
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29
Q

Which ligament attaches to the acromial end of the clavicle and what does it attach the clavicle to?

A

Coracoclavicular ligament

- attaches clavicle with the coracoid process

30
Q

What does the acromial end of the clavicle contain?

A

The acromial end of the clavicle houses a small facet for articulation with the
acromion of the scapula at the acromioclavicular joint. It also serves as an attachment point for the two parts of the coracoclavicular ligament

31
Q

What are the 2 parts of the coracoclavicular ligament and where do they attach on the clavicle?

A

 Conoid tubercle: attachment point of the conoid ligament, the medial part of the coracoclavicular ligament.
 Trapezoid line: attachment point of the trapezoid ligament, the lateral part of the coracoclavicular ligament.

32
Q

What does the coracoclavicular ligament do?

A

Collectively, the conoid and trapezoid ligaments are known as the coracoclavicular ligament. This is a very strong structure, effectively suspending the
weight of the upper limb from the clavicle.

33
Q

What type of joint is the acromioclavicular joint?

A

synovial plane joint

34
Q

Where is the acromioclavicular joint located?

A

located where the lateral end of the clavicle articulates with the acromion of
the scapula

35
Q

What can be palpated during a shoulder examination?

A

The AC joint can be palpated during a shoulder examination 2-3cm medially from the ‘tip’ of the shoulder (which is formed by the end of the acromion)

36
Q

What are 2 atypical features of the acromioclavicular joint?

A
  • The articular surfaces of the joint are lined with fibrocartilage (as opposed to hyaline cartilage).
  • The joint cavity is partially divided by an articular disc. This is a wedge of fibrocartilage that is suspended from the upper part of the capsule
37
Q

what does the joint capsule consist of?

A

joint capsule consists of a loose fibrous layer which encloses the two articular
surfaces. It also gives rise to the articular disc

38
Q

What is the joint capsule lined by?

A

As would be expected of a synovial joint, the joint capsule is lined internally by a synovial membrane. This secretes synovial fluid into the cavity of the joint.

39
Q

What are the three main ligaments that strengthen the acromioclavicular joint?

A

Intrinsic:
 Acromioclavicular ligament: runs horizontally from the acromion to the
lateral clavicle. It lies superficial to the joint capsule, reinforcing its superior
aspect.
Extrinsic:
 Conoid ligament: runs vertically from the coracoid process of the scapula to the conoid tubercle of the clavicle.
 Trapezoid ligament: runs vertically from the coracoid process of the
scapula to the trapezoid line of the clavicle

40
Q

What movement occurs at the acrimioclavicular joint and what is responsible for this movement?

A

Small degree of axial rotation and anteroposterior movement.
As no muscles act directly on the joint, all movement is passive, and is initiated by movement elsewhere (e.g. rotation of the scapula at the ‘scapulothoracic joint’)

41
Q

Describe the sternoclavicular joint

A

The sternoclavicular joint is a synovial joint between the clavicle and the manubrium of the sternum. It is the only attachment of the upper limb to the axial skeleton so is very strong. Unusually, despite its strength, it is a very mobile joint.

42
Q

Which joint provides the only attachment of the upper limbs to the axial skeleton?

A

Sternoclavicular joint

43
Q

What type of joint is the sternoclavicular joint?

A

Synovial saddle joint

44
Q

describe the location of the sternoclavicular joint and what it contains

A

• between the clavicle and the
manubrium of the sternum
• The sternoclavicular joint consists of the sternal end of the clavicle, the manubrium of the sternum, and the upper medial part of the first costal cartilage

45
Q

What are 3 atypical features of the sternoclavicular joint

A
  • strong and mobile (usually one or the other)
  • The articular surfaces of the joint are lined with fibrocartilage (as opposed to hyaline cartilage).
  • sternoclavicular joint is also separated into two compartments by fibrocartilaginous articular disc.
46
Q

How does the articular disc in the sternoclavicular joint affect the mobility of the joint?

A

Allows the clavicle and the manubrium to slide over each other more freely, allowing for the rotation and movement in a third axis (rather than the two axes usually permitted by saddle-type joints)

47
Q

Which shoulder movements require movement in the sternoclavicular joint?

A
  • Elevation of the shoulder joint e.g. when shrugging the shoulders or when abducting the arm over 90° (which requires rotation of the scapula at the ‘scapulothoracic joint’, so elevates the acromial end of the scapula)
  • Depression of the shoulders e.g. when drooping the shoulders or when extending the arm at the shoulder behind the body
  • Protraction of the shoulders
  • Retraction of the shoulders
  • Rotation: when the arm is raised over the head by flexion at the glenohumeral joint
48
Q

What is protraction and retraction of the shoulder?

A
  • Protraction of the shoulders: moving the shoulder girdle anteriorly
  • Retraction of the shoulders: moving the shoulder girdle posteriorly
49
Q

Why does the clavicle rotate in flexion of the arm above the shoulder joint and what transmits the rotational forces to the clavicle?

A

Rotates passively because the scapula rotates. This rotational force is transmitted to the clavicle by the coracoclavicular ligaments and in turn causes rotation of the sternoclavicular joint.

50
Q

What are the proximal and distal articulations of the humerus?

A

Proximal: with the glenoid fossa of the scapula, forming the glenohumeral joint
Distal: head of the radius and trochlear of ulnar

51
Q

What is the humerus?

A

The humerus is a long bone of the upper limb and extends from the shoulder to the elbow

52
Q

What are the features of the proximal humerus?

A

Head, anatomical neck, surgical neck, greater and lesser tubercles and an intertubercular sulcus

53
Q

Which way does the head of the humerus face and what separates it from the tubercles?

A
  • faces medially, superiorly and posteriorly

- separated from the tubercles by the anatomical neck

54
Q

Which part of the humerus is the greater tubercle found on and what is it the insertion site for?

A
  • located on the posterolateral surface of humerus
  • site of insertion of three of the rotator cuff muscles: supraspinatus, infraspinatus and teres minor, which insert into the superior, middle and inferior facets respectively
55
Q

Which part of the humerus is the lesser tubercle found on and what is it the insertion site for?

A

Smaller, and more medially located. It provides the insertion site for the last rotator cuff muscle: subscapularis

56
Q

What separates the tubercles of proximal humerus?

A

A deep depression called the intertubercular sulcus (intertubercular groove)

57
Q

The tendon of which muscle runs through the intertubercular sulcus?

A

Tendon of the long head of biceps brachii

58
Q

What are the edges of the intertubercular sulcus called?

A

Lips

59
Q

What 3 muscles attach to the intertubercular sulcus and which part of the sulcus attach to it?

A
  • pectoralis major inserts onto the lateral lip
  • teres major onto the medial lip
  • latissimus dorsi onto the floor of the intertubercular sulcus
60
Q

What is a mnemonic to remember the insertion of the muscles at the intertubercular sulcus of the humerus?

A

“A lady between two majors”
Latissimus dorsi inserts between teres major on the medial lip and pectoralis
major on the lateral lip

61
Q

Where is the surgical neck of the humerus located and which structures are in close proximity to it?

A

Between the two tubercles and the shaft of the humerus

Axillary nerve and circumflex humeral vessels are in close proximity to the surgical neck

62
Q

describe the anatomical neck of the humerus

A

The anatomical neck of the humerus is obliquely directed, forming an obtuse angle with the body of the humerus. It is easiest to identify in the lower half of its circumference; in the upper half it is represented by a narrow groove separating
the head of the humerus from the greater tubercle and the lesser tubercle

63
Q

What is the anatomical head of the humerus, the attachment site of?

A

site of attachment of the articular capsule of the shoulder joint. It also marks the region of the epiphyseal growth plate during the growth in length of the humerus in childhood

64
Q

Where is the surgical neck of the humerus located and which structures are in close proximity to it?

A
  • The surgical neck of the humerus is a constriction below the tubercles of the greater tubercle and lesser tubercle and lies between the two tubercles and the shaft of thehumerus.
  • Axillary nerve and circumflex humeral vessels are in close proximity to the surgical neck
65
Q

What are the likely structures to be damaged in a surgical neck fracture of the humerus and what are the consequences of this?

A

Axillary nerve and the posterior circumflex humeral humeral artery

Axillary nerve damage will result in Paralysis of the deltoid and teres minor muscles. The patient will have difficulty performing abduction of the affected limb. This nerve also innervates the skin over insertion of deltoid (regimental badge area), and sensation in this region will be impaired

66
Q

What are the causes of fractures of the surgical neck of the humerus?

A

The surgical neck of the humerus is a frequent site of fracture; usually from blunt trauma to the shoulder or from falling on an outstretched hand

67
Q

Where is the deltoid tuberosity located and what attaches to it?

A

Lateral side of the humeral shaft where the deltoid muscle attaches

68
Q

Where/what is the radial (spiral) groove located and what lies in this groove?

A

Shallow depression that runs diagonally on posterior surface of the humerus at the level of the deltoid tuberosity

The radial nerve and profunda brachii artery lie in this groove

69
Q

Which muscles attach to the humerus along its shaft?

A

Anteriorly: coracobrachialis, deltoid, brachialis, brachioradialis.

Posteriorly: medial and lateral heads of the triceps (the spiral groove demarcates their respective origins)

70
Q

Describe the shape of the shaft of the humerus

A

The shaft of the humerus has a circular cross-section proximally and is more
flattened in cross-section distally.
On the lateral side of the humeral shaft is a roughened surface where the deltoid
muscle attaches. This is known is as the deltoid tuberosity

Semester 2 - MSK (35 decks)

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