Arm and Shoulder Joint Flashcards
_____ for attachment of the long head of the biceps
Supraglenoid tubercle
_______ for attachment of the long head of the triceps
Infraglenoid tubercle
Distal humerus has two articular surfaces:
- Capitulum (lateral) for articulation with the head of the radius
- Trochlea (medial) for articulation with the ulna
______ receives the coronoid process of ulna during flexion of elbow
Coronoid fossa
_____ receives radial head during flexion of elbow
Radial fossa
_______ located on the posterior surface for passage of the radial nerve and the deep brachial artery
Radial groove
_______ on posterior aspect of the medial epicondyle for the passage of the ulnar nerve (common site for ulnar nerve impingement)
Ulnar groove
_____ are incorporated into these veins at regular intervals to increase the efficiency of venous return
Valves
_____ are located within the subcutaneous tissues (easily visible)
Superficial veins
Cephalic Vein- ascends the anterior lateral aspect of the arm- courses through the _____ where it joins the axillary vein (a deep vein)
Deltopectoral Triangle
_____ ascends the anterior medial aspect of arm- then pierces the deep (brachial) fascia in the middle of arm to join the brachial veins (which are deep veins)
Basilic vein-
Both superficial veins communicate via the _____ anterior to the elbow- a common site for phlebotomy
median cubital vein
Sheath of deep fascia that encloses the arm like a sleeve- continuous from the deltoid, pectoral, and axillary fascia proximally
Brachial Fascia
The brachial fascia continues distally into the forearm as _____
antebrachial fascia
Strong septa arise from this brachial fascia and attach to the shaft of the humerus and …
These medial and lateral intermuscular septa divide the arm into an anterior (flexor) and posterior (extensor) compartments
These compartments share muscles with similar function and innervation
muscles of the anterior arm compartment and what they are innervated by
biceps, brachialis, coracobrachialisis; muscuolocutanous nerve
The Biceps Brachii orginates from two heads
- short head from the coracoid process of scapula
- long head from the supraglenoid tubercle of scapula (tendon courses in the intertubercular sulcus or bicpital groove)
The biceps brachii inserts into the _____ and the ______ via the bicipital aponeurosis
proximal radius (radial tuberosity); antebrachial fascia
Bicep muscles crosses two joints (shoulder and elbow)…hence it acts on both joints
- Flexes the shoulder joint
- Powerful supinator of the forearm but also a flexor of forearm (elbow joint)
Ruptured Biceps
Rupture of the long head of the biceps generally occurs due to “wear and tear” or prolonged tendonitis (baseball pitchers, weight lifters) or chronic arthritis (i.e. rheumatoid arthritis) within the joint
Tendon commonly tears from the supraglenoid tubercle of the scapula (audible “snap or pop” can often be heard)
Detached muscle belly forms a prominent “ball” near the center of the anterior arm
Hence the description… “Popeye deformity”
Located deep to the Biceps
Originates from distal ½ of the humerus
nInserts into the proximal ulna (tuberosity of the ulna)
Prime flexor of the forearm (elbow)
Innervated by (C5 & C6) of the musculocutaneous nerve
Brachialis
Coracobrachialis orginates from the
ncoracoid process
Coracobarchiallis inserts in the
middle 1/3rd of the humerus
coracobrachiallis motion
nBoth a flexor and adductor of the arm
Musculocutaneous Nerve arises from ___ and innervates anterior/posterior compartments of the anterior arm and continues as the ____
Arises from the lateral cord of the brachial plexus; anterior; Continues as the lateral cutaneous nerve of the forearm (aka the lateral antebrachial cutaneous nerve)
Subclavian artery passes the 1st rib it becomes the _____
axillary artery
Axillary traverses the teres major muscles it becomes the ____
brachial artery
The axillary artery which turns into the brachial artery accompanies the ___ nerve
median nerve
It is clinically significant in that the brachial artery can sometimes be ligated (tied-off) just above the elbow (i.e. to control heavy post traumatic bleeding) because of the _______
extensive collateral branches can continue to perfuse the forearm and hand
_____ artery -largest branch and accompanies the radial nerve through the radial groove
Deep (Profunda) Brachial Artery
Superior Ulnar Collateral Artery- accompanies the _____ nerve posterior to medial epicondyle of humerus
ulnar
Collateral vessels provide also
important anastomoses
(alternate route for blood
flow) around the elbow joint during flexion/extension
during limb flexion
only one muscle located in posterior compartment of the arm
Triceps Brachii
the three heads of the triceps brachii; and which ones in respect to radial groove
1.Long head originates from the infraglenoid tubercle of scapula
2.Lateral head originates from the posterior surface of humerus superior to radial groove
3.Medial head originates from the posterior surface of humerus inferior to radial groove
all three heads of the tricep brachii insert into the
olecranon process of ulna
motion of the tricep brachii
Prime extensor of the forearm
innervation of tricep brachii
Innervated by (C6, C7 & C8) of the radial nerve
________ nerve courses through the posterior compartment in the radial groove beside the profunda (deep) brachial artery (triangular interval)
radial nerve
Radial nerve then gives rise to the __________ of the arm and forearm which supply sensation to the skin along the posterior (dorsal) aspect of the upper limb
Posterior cutaneous nerves
Mid Shaft Humeral Fractures
Frequently result from direct trauma (auto accidents)
Proximal fragment often displaces laterally due to pull of the deltoid muscle
Radial nerve can be stretched or transected along the radial groove leading to permanent damage and loss of function
As you will soon learn, the radial nerve ALSO innervates all the muscles that “extend” the wrist…patients typically present with wrist drop due to loss of innervation of the extensors muscles of the forearm and hand
“Saturday Night Palsy”…compression of radial nerve against the humerus can cause a temporary wrist drop
Surgical
Neck Fractures
nSurgical neck located just distal to the tuberosities
nThese fractures an be associated with injure to the axillary nerve
nAxillary nerve damage can result in paralysis and atrophy of deltoid-loss of rounded shoulder contour
______ vessels drain lymph fluid from the skin and subcutaneous tissues and converge to follow the cephalic and basilic veins (superficial veins)
Superficial lymphatic
_______ drain lymph fluid from joints, muscles, and bones and accompany _______ veins
Deep lymphatic vessels; deep
Lymph from these nodes then joins the venous system via the _______ or the _________ which both convey the lymph fluid into the venous system (via the subclavian veins)
right lymphatic duct (right upper limb); thoracic duct (left upper limb)
Glenohumeral Joint
nBall-and-socket type synovial joint
nExtremely mobile joint-but relatively unstable
nLarge humeral head articulates with the small, shallow glenoid cavity
______ a fibrocartilagenous “ring” that surrounds and deepens the glenoid cavity- providing greater stability
Glenoid Labrum
_______ helps stabilize and hold the humeral head within glenoid cavity
Musculotendinous Rotator Cuff
___________ holds long head of bicep tendon in the bicipital groove
Transverse humeral ligament
_______ lines the inside of the joint capsule and reflects/surrounds the tendon of the long head of the biceps
Synovial membrane
Shoulder Dislocations
The glenohumeral joint is extremely mobile- providing a wide range of movements at the expense of stability
For this reason- it is the most frequently dislocated major joint in the body
Structurally- the inferior aspect of the joint is the weakest
Dislocations due to trauma are most common in the anterior-inferior direction…often tearing the labrum and anterior joint capsule/subscapularis tenson
Humeral head often ends up beneath the coracoid process (sub-coracoid)
Once dislocated, the joint is susceptible to frequent dislocations
Other cutaneous nerves arise directly from the major branches of the plexus:
Lateral cutaneous nerve of the forearm (from the musculocutaneous nerve)
Superior lateral cutaneous nerve (from the axillary nerve)
Some of these “cutaneous nerves” arise directly from the medial cord of the plexus:
Medial cutaneous nerve of the arm
Medial cutaneous nerve of the forearm
nSimilarly, most of the cutaneous nerves on the posterior aspect of the upper limb arise from the radial nerve:
nPosterior cutaneous nerve of the arm
nPosterior cutaneous nerve of the forearm
nSuperficial branch of the radial nerve
___ are relatively common and tend to occur in an anterior-inferior direction
nShoulder dislocations
nShoulder dislocations can tear/damage the _______ which results in a high incidence of recurrence
glenoid labrum
Mid-shaft fractures of the humerus can injure the ______ resulting in loss of function (wrist drop)
radial nerve
______ is susceptible to tendonitis and subsequent tears due to its course thru the bicipital groove and intra-articular position within the shoulder
Long head of the bicep
Beatrice Long, a 77 year-old female with a 20 year history of rheumatoid arthritis presents to the
orthopedic clinic. She has been on steroid medication for ~ 10 years to help control chronic
arthritis in her joints. 3 months ago, she had a cortisone injection into her right shoulder to
help alleviate serve pain and inflammation.
Beatrice explains to her orthopedic physician that while attempting to lift a heavy box yesterday,
she felt something “give-way” in her right shoulder area. She also complains that now she feels
a “lump’ in the middle of her upper arm.
Which of the following is likely to have occurred?
A. Torn acromioclavicular ligament
B. Torn rotator cuff muscle
C. Torn deltoid muscle
D. Torn biceps muscle
D. Torn biceps muscle
Whalen, a 30 year-old man is inebriated and falls asleep on a park bench on Franklin
Street in Chapel Hill. When he awakes, he realizes he had been sleeping there
for nearly 6 hours.
Which of the following nerves was most likely compressed/damaged with his arm
lying against the hard wooden bench for 6 hours? Think…Pair…and Share
A.Axillary
B.Musculocutaneous
C.Radial
D.Median
E.Ulnar
C.Radial
Imaging: Physician orders X-rays to evaluate osseous and/or ligamentous damage
Diagnosis: Traumatic left subcoracoid dislocation of the glenohumeral joint
Treatment: Under sedation, the dislocation is reduced (X-rays confirm), Sheryl is placed in a
splint for several weeks followed by rehabilitation physical therapy
Sheryl returns 3 months post reduction. She denies any pain in the shoulder joint…
but she mentions that she is still experiencing some tingling sensations along her left forearm.
Based on these new symptoms, which nerve could she have damaged? Think…Pair..and Share
A.Axillary
B.Radial
C.Long Thoracic
D.Musculocutaneous
E.Suprascapular
D.Musculocutaneous
radial nerve
Surgical
Neck Fractures
Mid Shaft Humeral Fractures
