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מסקולוסקלטל ליד > Anatomy of Shoulder > Flashcards

Anatomy of Shoulder Flashcards

0
Q

Sternoclavicular Joint

  • classification
  • articular surfaces (2)
  • ligaments and fibrous capsule (4 ligaments)
  • movements (df, types)
  • resting position
  • closed packed position
  • capsular pattern
A
  1. classification: complex joint (disk)
    - -mechanically bi-axial saddle joint
    - -anatomically ball-and-socket joint (lax capsule and flexible disk)
  2. articular surfaces
    - -clavicle (sternal end): convex vertically and slightly concave anterior-posteriorly
    - -sternum: clavicular notch/facet of manubrium: concave vertically and convex anterior-posteriorly
  3. ligaments and fibrous capsule: disk, SCM reinforces it
    - -anterior sternoclavicular ligaments
    - -posterior sternoclavicular ligaments
    - -interclavicular ligaments:
    - -costoclavicular ligament
  4. movements: 3 degrees of freedom [elevation with retraction, depression with protraction]
  5. resting position: arm at side
  6. closed packed position: arm abducted to 90 degrees
  7. capsular pattern: pain with extrenes of motion
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1
Q

Shoulder Complex/girdle Joints

8

A
  1. Sternoclavicular (SC)
  2. Acromioclavicular (AC)
  3. Scapulothoracic (ST)
  4. Glenohumeral (GH)
  5. Suprahumeral
  6. Costosternal
  7. Costovertebral
  8. Bicipital Groove
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2
Q

SC Joint Classification

A

classification: complex joint (disk)
- -mechanically bi-axial saddle joint
- -anatomically ball-and-socket joint (lax capsule and flexible disk)

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3
Q

SC Joint Articular Surfaces

A

articular surfaces

  • -clavicle (sternal end): convex vertically and slightly concave anterior-posteriorly
  • -sternum: clavicular notch/facet of manubrium: concave vertically and convex anterior-posteriorly
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4
Q

SC joint: ligaments and fibrous capsule

4

A

ligaments and fibrous capsule: disk, SCM reinforces it

  • -anterior sternoclavicular ligaments
  • -posterior sternoclavicular ligaments
  • -interclavicular ligaments:
  • -costoclavicular ligament (clavicle to 1st rib, important)
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5
Q

SC joint Movement

  • -DF
  • -caudal and cranial
  • -dorsal and ventral
  • -rotation
A

movements: 3 degrees of freedom [elevation with retraction, depression with protraction

movement of the clavicle

  • clavicle moves with its convex surface for caudal and cranial directions about a sagittal axis
  • —elevation 45-60 degrees
  • —depression 5 degrees
  • clavicle and disk move with concave surface for ventral and dorsal directions about a vertical axis
  • —protraction 15 degrees
  • —retraction 15 degrees

rotation of clavicle about its own longitudinal axis: 30-50 degrees (to elevate the arm)

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6
Q

SC resting position

A

resting position: arm at side

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7
Q

SC closed packed position

A

closed packed position: arm abducted to 90 degrees

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8
Q

SC Capsular Pattern

A

capsular pattern: pain with extrenes of motion

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9
Q

SC joint Disk

A

disk subdivides joint into 2 secondary cavities

  • -attachment above to the upper and posterior borders of articular surface of clavicle
  • -below to the cartilage of the 1st rib near its junction with the sternum and circumferentially to the fibrous capsule
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10
Q

what muscle helps to reinforce the SC joint?

A

SCM

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11
Q

Anterior sternoclavicular ligaments

A

above to upper and front part of sternal end of clavicle, passes obliquely downwards and medially

below to the front of upper part of manubrium sterni and more laterally to the first costal cartilage

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12
Q

posterior sternoclavicular ligament

A

attached posterior aspect of sternal end of clavicle

passes obliquely downwards and medially to back of the upper part of the manubrium sterni

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13
Q

interclavicular ligament

A

unites upper part of the sternal ends of both clavicles with some fibers attached to the upper margin of the manubrium

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14
Q

costoclavicular ligament

A

consists of anterior and posterior laminae attached below to the upper surface of the 1st rib and the adjacent part of its cartilage and above to the margins of the impression on the inferior surface off the medial end of the clavicle;

fibers of anterior laminae directed upward and laterally

fibers of posterior lamina directed upwards and medially

bursa between the two laminas

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15
Q

degrees of freedom at SC joint

A

3 degrees of freedom functionally

–usually: elevation with retraction; depression with protraction

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16
Q

Degrees of Movement at SC Joint: Clavicle

A

Caudal and Cranial Direction: clavicle moves with its convex surface about sagittal axis; elevation 45-60 degrees; depression 5 degrees

Ventral and Dorsal Direction: clavicle moves with concave surface about vertical axis; protraction 15 degrees; retraction 15 degrees

rotation: rotation of clavicle around its own longitudinal axis: 30-50 degrees

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17
Q

AC Joint

  • classification
  • articular surfaces
  • ligaments and fibrous capsule
  • movements
  • resting position
  • closed packed position
  • capsular pattern
A
  1. AC joint classification: anatomically simple joint, mechanically compound plane gliding joint, functionally a ball and socket joint (because of lax capsule and disk when present)
  2. articular surfaces: acromion, clavicle, articular disk
  3. fibrous capsule surrounds the articular margins, a. acromioclavicular ligament, b. coracoclavicular ligament
  4. movements: abduction/adduction (sagittal axis), winging (vertical axis), tilting of inferior angle away from chest wall as in protraction (long axis through clavicle)
  5. resting position: arm at side
  6. closed packed position: upwards rotation of scapula with arm abduction-narrows thoracic inlet as does horizontal adduciton of the arm
  7. capsular pattern: pain with elevating arm or with horizontal adduction, limited full extension
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18
Q

AC joint classification

A

anatomically simple joint

mechanically compound plane gliding joint

functionally ball and socket joint because of lax capsule and disk

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19
Q

AC Joint Articular Surfaces

A

antero-medial border of acromion: flat and slightly convex (authors disagree), facing anteriorly/medially/and superiorly

inferior aspect of clavicle: flat and slightly convex facing inferiorly, posteriorly and laterally

articular disc (1/3 of population): occupies upper part of articulation and only partially separates the articular surfaces, rarely divides the joint completely

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20
Q

Acromioclavicular ligament

A

of SC joint

covers superior part of joint, extends between upper part of acromial end of clavicle and adjoining part of upper surface of acromion

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21
Q

AC Joint Biomechanics

ASK

A

Sagittal Axis: abduction/adduction (upward/downward rotation) of lower end of scapula around the chest wall = 20-30 degrees

Vertical Axis: winging scapula: vertebral border of scapula moves away from the chest wall = 30-50 degrees

Long Axis through clavicle: tilting of inferior angle away from the chest wall as in protraction = 30 degrees

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22
Q

coracoclavicular ligament

A

Primary supported of the AC joint (acromioclavicular joint)
2 parts separated by fat or bursa

trapezoid: attached below to upper surface of coracoid process and above to trapezoid line on inferior surface of clavicle
conoid: (triangle shape): attached at its apex to medial and posterior edge of root of coracoid process just in front of scapular notch; base is attached to conoid tubercle on inferior surface of clavicle and to a short length of clavicle medial to conoid tubercle

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23
Q

Scapulothoracic Movements (3)

A

Elevation and Depression

Retraction and Protraction

Downward and Upward Rotation

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24
Q

AC Joint Resting Position

A

arm at side

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25
Q

AC Joint Closed Packed Position

A

upward rotation of the scapula with arm abduction narrows the thoracic inlet, as does horizontal adduction of the arm

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26
Q

AC Capsular Pattern

A

pain with elevating arm or with horizontal adduction, limited full extension

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27
Q

Scapulothoracic joint vs articulation

A

not a true joint/ ST articulation riding of scapula on posterior thoracic wall

ST doesnt have a capsular pattern or a closed packed position, but its resting position is arm at side

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28
Q

Ligaments of ST Joint

A

coracoacromial ligament: apex attached to the edge of the acromion, just in front of the articular surface for the clavicle and base is the whole length of the lateral border of the coracoid process

superior transverse (scapular) ligament: converts the scapula notch into a foramen and sometimes is ossified, attached to base of coracoid process and medial end of scapular notch [if ossify can get nerve conduction issue-rotator cuff issues bc suprascapular nerve]

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29
Q

coracoacromial ligament

A

arch over humeral head, block superior translation

apex attached to the edge of the acromion, just in front of the articular surface for the clavicle
and base is the whole length of the lateral border of the coracoid process

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29
Q

transverse humeral ligament

A

forms roof over bicipital groove to hold long head of biceps tendon into the groove

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31
Q

superior transverse scapular ligament

A

converts scapular notch into a foramen and is sometimes ossified

attach to base of coracoid process and medial end of scapular notch

This notch is converted into a foramen by the superior transverse scapular ligament, and serves for the passage of the suprascapular nerve, sometimes the ligament is ossified. (can cause issue)

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32
Q

GH Joint

  1. classification
  2. articular surfaces
  3. ligaments
  4. biomechanics
  5. resting position
  6. closed packed position
  7. capsular pattern
A
  1. classification: anatomically and mechanically: simple ball and socket joint (multiaxial, synovial, ball and socket joint)
  2. articular surfaces: head of humerus, glenoid cavity (glenoid labrum),
  3. ligaments: capsule, superior band, middle band, inferior band, coracohumeral ligament, transverse humeral ligament
  4. movements: 3 degrees of freedom
    - -flexion/extension
    - -abduction/adduction
    - -external rotation/internal rotation
  5. resting position: position of maximal laxity: 55 degrees abduction, 30 degrees horizontal adduction
  6. closed packed position: full abduction and external rotation
  7. capsular pattern: external rotation > abduction > internal rotation
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33
Q

GH Joint Type

A

anatomically and mechanically a simple ball and socket joint

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34
Q

GH Joint Articular Surfaces

A

head of humerus–covered with hyaline cartilage faces superiorly, medially, and posteriorly convex ovoid surface that approximates a spherical shape much larger than glenoid cavity

glenoid cavity (glenoid labrum) 
glenoid cavity of scapula: hyaline cartilage faces laterally, anteriorly, slightly superiorly, biconcave transversely and vertically but irregular.

glenoid
glenoid labrum fibrocartilagenous _ attach to margin _ glenoid cavity to slightly widen and appreciably deepen cavity

glenoid is 1/2 as long and 1/3 as wide as head of humerus. lit more than 1/3 of the humerus contacts cavity at any one time. stability achieved through muscles, tendons, and capsule.

read netter on ball and plate joint vs ball and socket joint

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35
Q

head of the humerus

  • what direction it faces
  • shape of surface
A
  • faces superiorly, medially, and posteriorly
  • convex ovoid surface
  • when relaxed the humerus sits centered in the glenoid cavity, when contracted of rotator cuff muscles it translates anteriorly, posteriorly, inferiorly, superiorly based on the movement.
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36
Q

glenoid cavity of scapula

  • which way does it face?
  • concave or convex?
A

hyaline cartilage faces laterally, anteriorly and slightly superiorly
biconcave transversly and vertically but irregular

40
Q

Glenoid Labrum

  • -what is it
  • -its significance
A

1-ring of fibrocartilage that surrounds (slightly widens) and deepens the glenoid cavity of the scapula about 50%
2-only part of the humeral head is in contact with the glenoid at any given time

41
Q

capsular pattern at the GH joint

A

external rotation most limited > abduction > internal rotation

42
Q

how does the size of the glenoid fossa compare to the head of the humerus?

how much is in contact?

what provides stability?

A

the glenoid fossa is 1/2 as long and 1/3 as wide as the head of the humerus

1/3 of the head of the humerus contacts the cavity at any one time

stability is achieved through muscles, tendons, and capsule

43
Q

GH joint capsule

  • type, amount of motion
  • attach: medial, superior, lateral, inferior
  • what is least supported
A
  • fibrous capsule with laxity–allows motion
  • attached medially to circumference of glenoid cavity and beyond labrum
  • above to coracoid process (includes long head bicep in joint)
  • laterally to anatomical neck of humerus (close to articular margin except medial side where it descends to shaft of humerus)
  • inferior least supported and subject to GREATEST STRAIN, it has redundant fold, axillary recess
44
Q

what ligaments support GH capsule: superior, inferior, anterior, posterior

A

Superior: supraspinatus

inferior: long head of triceps
anterior: subscapularis tendon
posterior: infraspinatus and teres minor

tendons of rotator cuff muscles blend with fibrous capsule for reinforcement and active support

45
Q

middle glenohumeral ligament

A

limit external rotation

46
Q

inferior glenohumeral ligament

A

most important, has an anterior and posterior band with a thin pouch in between so it acts like a hammock or sling

supports the humeral head above 90 degrees of abduction: limits inferior translation

anterior band tightens on internal rotation
(anterior can get stretched with too much external rotation)

47
Q

coracohumeral ligament

A

coracoid process to greater tubercle of humerus

blends with supraspinatus tendon (unites it to the superior border of the subscapularis tendon

limit inferior translation and help limit external rotation (below 60 degrees of abduction)

48
Q

superior glenohumeral ligament

A

limit inferior translation and adduction

it also restrains anterior translation and lateral rotation up to 45 degrees of abduciton

49
Q

Primary Ligaments of the GH joint:

A

superior, inferior and middle glenohumeral ligaments stabilize the shoulder
1. superior glenohumeral ligament:

50
Q

GH Capsule

  • laxity/motion
  • attached: medial, superior, lateral, inferior
A

fibrous capsule, laxity, high degree motion

medial: glenoid cavity circumference/labrum
superior: coracoid process (include longhead biceps)
lateral: humerus (anatomical neck-close to articular margin except for at the medial side descend to shaft of humerus)

inferior: LEAST supported and this subject to greatest strain, has redundant fold, axillary recess
* **pain if bicep tendinitis or adhesive capsulitis under redundant fold

51
Q 
What reinforces the GH capsule
anterior
posterior
superior
inferior
A

anterior: subscapularis tendon
posterior: infraspinatus, teres minor
superior: supraspinatus
inferior: long head of triceps

tendons of rotator cuff muscles blend with capsule for reinforcement and support

52
Q

glenohumeral ligament: superior band

  • where is it
  • when is it taut
A

pass along medial edge of biceps tendon and attach above lesser tubercle

taut in inferior translation and adduction

53
Q

glenohumeral ligmament medial band

A

to lower part of lesser tubercle

limit ER

54
Q

glenohumeral ligament inferior band

A

to lower part of anatomical neck of humerus

limits inferior translation

anterior band of it is tait on IR

55
Q

glenohumeral ligaments

A

attached at scapular end to upper part of medial margin of glenoid cavity and are blended with labrum

superior band
middle band
inferior band

56
Q

GH joint, degrees of freedom

A 
3:
flexion (120)
extension (55)
abduction (120)
adduction (neutral)
internal rotation (60-70)
external rotation (90)
57
Q

GH flexion degrees

A

120

58
Q

GH extension degrees

A

55

59
Q

GH Internal Rotation Degrees

A

60-70

60
Q

GH External Rotation

A

90 degrees

61
Q

GH Abduction Degrees

A

120

62
Q

GH Adduction Degrees

A

Return to Normal

63
Q

GH Joint Capsular Pattern

A

external rotation > abduction > internal rotation

64
Q

GH Resting Position

A

Position of maximum laxity (assessment and joint mobilization)

55 degrees ABDUCTION

30 degrees HORIZONTAL ADDUCTION

65
Q

GH Closed Packed Position

A

maximum abduction and external rotation

66
Q

is suprahumeral joint a real joint?

A

NO

humerocoracoacromial joint: coracoacromial arch: acromion and coracoacromial ligament

67
Q

costosternal joint

-why we watch it

A

sternal and spinal joint substitutions

68
Q

what joint is innervated by the subscapular and lateral pectoral nerve?

A

AC Joint

69
Q

what joint is innervated by the anterior supraclavicular nerve and the nerve to the subclavius muscle?

A

the SC joint

70
Q

Bursa Shoulder Region (8)

A
  1. between subscapularis and joint capsule*
  2. between infraspinatus and capsule
  3. summit of acromion
  4. between coracoid and capsule
  5. behind coracobrachialis
  6. between teres major and longer head of triceps
  7. anterior to and posterior to tendon of latissiumus dorsi (2)
  8. subdeltoid (subacromial)*
  • Palpate course of muscle, when you get point of attachment, see if that is causing cardinal pain of the patient – differentiate from cuff tear
  • subacromial, subdeltoid bursa – most problematic if doing abduction without ER arm
71
Q

3 Groups of Muscles at the Shoulder Region

A

scapulothoracic–axioscapular

thoracohumeral–axiohumeral

scapulohumeral–scaoulohumeral

72
Q

Scapulothoracic (axialthoracic)

A
  • elevation depression of scapula upward and downward rotation of scapula ab/adduction
  • pectoralis minor, serratus anterior, rhomboids levator scapulae
73
Q

Thoracohumeral (axiohumeral)

A
  • latissimus dorsi – extension and internal rotation of humerus
  • pectoralis major – horizontal adduction of humerus, internal rotation, flexion (clavicular head)
74
Q

Scapulohumeral (scapulohumeral)

A
  • flexion/extension of humerus
  • abduction/adduction
  • internal/external rotation
  • subscapularis, teres major, teres minor, supraspinatus, infraspinatus, coracobrachialis, deltoid
75
Q

Nervous Tissue: Shoulder Region

A

• Brachial plexus – capsule C5 structure, can have referred pain out into deltoid
o Palpate to find source of problem
o Comes underneath clavicle – be careful during palpation
• Dermatome: Sensory: C4,C5, C6, C7
• Myotome: Motor

76
Q

Vascular Structures Shoulder Region

A

Vascular structures support the tissues
o posterior humeral circumflex artery ad suprascapular arteries
o anterior humeral circumflex artery
o thoraco-acromial artery (sometimes absent)
o suprahumeral and subscapular arteries (often absent)

77
Q

Biomechanics of the shoulder

  • degrees of freedom
  • motions
A
  1. TRANSVERSE AXIS: flexion-extension
  2. ANTEROPOSTERIOR AXIS: abduction-adduction
  3. VERTICAL AXIS: horizontal abduction/horizontal adduction
  4. LONGITUDINAL AXIS: external rotation/internal rotation (due to movement at the other 3 axes)
78
Q

What three true joints and three virtual joints make up the shoulder complex?

A

SC, AC, GH,
scapulothoracic, subdeltoid/coracoacromial arch/suprahumeral, substernal
costovertebral

bicipital groove is not a true jt

79
Q

what do we have to be careful about in palpating the clavicle?

A

brachial plexus comes under it

80
Q

Articulations of the shoulder complex
three true joints
three virtual joints
two not real joints

A

• Articulations – shoulder complex is made up of three true joints and three virtual joints
o sternoclavicular

o acromioclavicular

o glenohumeral

o scapulothoracic

o subdeltoid/coracoacromial arch/suprahumeral

o substernal

‘o NOT TRUE JOINTS: costovertebral, biciptal groove

81
Q

What can cause pain/referred pain to the shoulder region?

A

compressive or tensile forces on neurovascualar structures

referred pain to shoulder region: cervical spine, thoracic spine, viscera, myocardium

82
Q

True Shoulder related joints

A

SC
AC
GH

83
Q

Not true joints shoulder

A 
ST
subdeltoid space
coracoachromial arch
substernal
bicipital groove
84
Q

SC: elevation, depression, protraction, retraction (3 axis of movement, not true x, y, z

the 3 movement axes

A

a. Elevation will be more than depression
b. Movements on a disc at the SC joint
c. Saddle joint:

AP axis : Elevation and depression: convex on concave:

Vertical axis: Protraction retraction: concave on convex

Longitudinal axis: Rotation: clavicle

85
Q

AC joint:

scapular motions

A

a. Clavicle on acromion or visa versa

Saggital plane, upward and downward rotation along that A-P axis

Winging: Pulling away from spine and rib cage or going towards—Vertical axis, horizontal plane adjustments

Tipping: bring inferior angle of scapula backwards or forwards—Pivot on a Medial to lateral type of axis

86
Q

. Scapulathoracic joint (not true joint) (we can look at these as translations at this joint)

what motions (2)

A

a. Elevation, depression

b. Abduction, adduction towards and away from the spine

87
Q

SC and AC joint working together:

explain protraction and retraction
what does clavicle do to the scapula at SC and at AC

A

Protraction and retraction: Newman picture: clavicle on sternum at SC: the protraction of clavicle will drag along the scapula, the pivot point at the SC joint

Thorax bumps out as do protraction and retraction—winging (bumping out) helps scapula bump out around rib cage—bumping out from the AC joint

88
Q

Upward rotation at scapula: how much SC how much AC?

what about GH?

A

Upward rotation: 50% SC (30 degrees), 50% AC (30 degrees)

i. Pivot point at the AC joint upward rotation
ii. Clavicular elevation at SC joint
iii. ST elevation and upward rotation
iv. GH 2:1 ratio

89
Q

GH joint motions

vertical axis
AP axis
transverse axis
long bone axis

A

vertical axis: Horizontal Adduction/abduction

A-P Axis: abduction, aduction

Transverse axis: flexion, extension

Long bone is the axis: internal rotation, external rotation

90
Q

GH Joint Motion–what are the osteokinematics

Flexion
Extension
Abduction
Adduction
IR 
ER
A

flexion–Anterior
extension—Posterior
abduction—Superior

IR—Anterior
ER—Posterior

91
Q

GH Joint Motion–what are the Arthrokinematics

Flexion
Extension
Abduction
Adduction
IR 
ER
A

flexion–Posterior glide
extension—Anterior glide
abduction—Inferior glide

IR—Posterior glide
ER—Anterior glide

92
Q 
SC joint Motion
Elevation 
Depression
Protraction
Retraction
A

SC joint Motion— Osteokinematics— Arthrokinematics
1. Elevation —Superior— Inferior glide

  1. Depression —Inferior — Superior glide
  2. Protraction —Anterior— Anterior glide
  3. Retraction —Posterior— Posterior glide
93
Q

AC separation—AC ligament would go first if fall or have a trauma to that area due to a loose capsule with some give, it is the furthest from axis

3 grades

A

I. Grade 1 AC separation: may be too small to see on xray—probably stretch the AC ligament and may have a partial tear

II. Grade 2 AC separation: some more separation and completely tear the AC ligament, may not be seen at rest on xray. Increased laxity on mobility test

III. Grade 3 AC separation: rupture AC ligament and still have trauma and energy that will need to dissipate and may tear some or all of the coracoclavicular ligament and clavicle will be popping up, and have an anatomical abnormality.

94
Q

X axis = transverse axis

Y axis = vertical axis

Z axis = anteroposterior axis

A

X axis = transverse axis

Y axis = vertical axis

Z axis = anteroposterior axis

מסקולוסקלטל ליד (14 decks)

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