Exam 2 Flashcards
These nerves are from the cervical plexus, C3-4, and supply the skin over the clavicle and over the superior-lateral aspect of pectorals major.
Supraclavicular nerves
These nerves penetrate deep and superficial back muscles, and supply the skin on either side of midline of back.
Cutaneous branches of dorsal rami
The sternoclavicular joint articulates what bones?
Sternal end of clavicle; Articular notch on sternum; First costal cartilage
What is the structural type of the sternoclavicular joint?
Synovial (shallow, saddle; articular disc)
The articular disc in the sternoclavicular joint is made up of what? What does it attach to?
Fibrocartilage meniscus; Attaches to clavicle superiorly and manubrium and first costal cartilage inferiorly
What is the functional type of the sternoclavicular joint?
Diarthrotic (synovial); Triaxial
Name the 3 ligaments involved with the sternoclavicular joint.
1) Anterior/Posterior sternoclavicular ligaments
2) Costoclavicular ligament
3) Interclavicular ligament
What do the anterior/posterior sternoclavicular ligaments do?
Check anterior/posterior movements of clavicular head
What does the costoclavicular ligament do?
Axis for elevation and depression; Axis for protraction and retraction; Main check for elevation
What 2 bones are involved in the acromioclavicular joint?
Acromion process on scapula (concave facet) and the Lateral end of clavicle (convex facet)
What type of joint is the acromioclavicular structurally?
Synovial; Plane
What type of joint is the acromioclavicular functionally?
Triaxial; Diarthrotic; Scapula glides and rotates on clavicle
What are the movements involved in the acromioclavicular joint?
Scapular rotation; Winging of vertebral border of scapula; Tipping of inferior angle of scapula
Name the 2 ligaments involved in the acromiclavicular joint.
Acromiclavicular ligaments (Superior and inferior) Coracoclavicular ligament (consists of Trapezoid (lateral) and Conoid (medial))
What bones are involved with the glenohumeral joint?
Glenoid fossa on scapula and head of humerus
What is the structural type of the glenohumeral joint?
Synovial; Ball-and-socket
What is the functional type of the glenohumeral joint?
Triaxial; Diarthrotic; Flex/Extend; Abduct/Adduct; Circumduction; Lateral/medial rotation
Name the 3 ligaments involved with the glenohumeral joint.
Glenohumeral (Superior; Middle; Inferior)
Coracohumeral
Coracoacromial
What is the trapezium muscle innervated by?
CN XI and ventral rami of 3rd & 4th cervical nerves
What is the proximal attachment of the upper part of the trapezius?
External occipital protuberance, Superior nuchal line and ligamentum nuchae and spinous process of CV 7
What is the proximal attachment of the middle part of the trapezius?
Spinous processes of TV 1-6
What is the proximal attachment of the lower part of the trapezius?
Spinous process of TV 7-12
What is the distal attachment of the upper part of the trapezius?
Lateral third of clavicle
What is the distal attachment of the middle part of the trapezius?
Acromion and crest of scapular spine
What is the distal attachment of the lower part of the trapezius?
Tubercle of scapular spine
What action does the upper trapezius perform?
Elevates scapula (shrugs shoulder)
What action does the middle trapezius perform?
Adducts (retracts) scapula
What action does the lower trapezius perform?
Depresses scapula
What action do the upper and lower parts of the trapezius perform together?
Upward rotation of scapula
What supplies blood to the trapezius?
Dorsal scapular artery
What innervates the latissimus dorsi muscle?
Thoracodorsal nerve (C6-8)
What is the proximal attachment for the latissimus dorsi muscle?
Spines of TV 7-12 and lumbar and sacral vertebrae via thoracolumbar fascia; Posterior iliac crest and ribs 9-12
What is the distal attachment for the latissimus dorsi?
Floor of intertubercular (bicipital) groove
What actions does the latissimus dorsi perform?
Extends, adducts, and internally rotates the humerus
What supplies blood to the latissimus doris?
Thoracodorsal artery and a branch of the subscapular artery
What innervates the levator scapulae muscle?
Cervical nerves C3-5 and dorsal scapular nerve (C5)
What is the proximal attachment for the levator scapulae?
Transverse processes of CV 1-4
What is the distal attachment for the levator scapulae?
Medial border of scapula at level of and above the spine
What actions do the levator scapulae perform?
Elevates the scapula at the superior (medial) angle and assists in the downward rotation of the scapula
What supplies blood to the levator scapulae?
Dorsal scapular artery
Which muscle is the detached cranial edge of the serratus anterior?
Levator scapulae
What innervates the rhomboid muscles (minor and major)?
Dorsal scapular nerve
What is the proximal attachment of the rhomboid minor muscle?
Spines of CV 7 and TV 1 and lower end of ligaments nuchae
What is the proximal attachment of the rhomboid major muscle?
Spines of TV 2-4 (sometimes TV 5)
What is the distal attachment for the rhomboid muscles?
Medial border of scapula from level of spine inferiorly to the inferior angle (Rhomboid minor is superior to Rhomboid major)
What actions do the rhomboid muscles perform?
Adducts scapula; Rotates glenoid fossa downward; Fixes scapula to thoracic wall
What supplies blood to the rhomboid muscles?
Dorsal scapular artery
What is the origin (proximal attachment) of the subclavius muscle?
Junction of first rib and costal cartilage 1
What is the insertion (distal attachment) of the subclavius muscle?
Inferior surface of middle third of clavicle
What action does the sublcavius perform?
Anchors and depresses the clavicle
What innervates the sublcavius muscle?
Subclavian nerve (C5, C6 — branch from superior trunk)
What is the innervation for the pectoralis major?
Lateral and medial pectoral nerves; Clavicular head (C5, C6); Sternal head (C7, C8, T1)
What is the origin for the pectoralis major?
Anterior surface of the medial half of the clavicle (clavicular head); Anterior surface of the manubrium and body of the sternum (sternal head); Costal cartilages 2-6 (sternal head); Aponeurosis of the external oblique (sternal head)
What is the insertion for the pectoralis major?
Lateral lip of the intertubercular groove (bicipital groove) = crest of greater tubercle
What actions does the pectoralis major perform?
Adducts and medially rotates arm (humerus); Flexes arm (clavicular head); Extends arm (sternal head) from flexed position; Draws scapula anteriorly and inferiorly
What innervates the pectoralis minor?
Medial pectoral nerve (C8, T1)
What is the origin of the pectoralis minor?
Ribs 3-5 near costal cartilages
What is the insertion for the pectoralis minor?
Coracoid process
What is the action performed by the pectoralis minor?
Draws scapula inferiorly and anteriorly against thoracic wall (stabilizes scapula)
These muscles are considered the “scapulohumeral musculature” and attach the scapula to the humerus. They move the humerus at the shoulder joint and contribute to the stabilization of this joint. All innervated by brachial plexus.
Deltoid; Teres major; Serratus anterior; SITS (rotator cuff muscles) = Supraspinutus; Infraspinatus; Teres minor; Subscapularis
What innervates the serratus anterior muscle?
Long thoracic nerve (C5, C6, C7)
What is the proximal attachment for the serratus anterior?
External surface of lateral parts of ribs 1-8 (9)
What is the distal attachment of the serratus anterior?
Anterior surface of medial border of scapula
What actions does the serratus anterior perform?
Protracts scapula; Fixes scapula to thoracic wall; Rotates scapula
What is the blood supply to the serratus anterior?
Lateral thoracic artery
What innervates the deltoid muscle?
Axillary nerve (C5, C6)
What is the proximal attachment for the deltoid?
Lateral 1/3 of clavicle, acromion, and spine of scapula
What is the distal attachment for the deltoid?
Deltoid tuberosity of humerus
What actions does the deltoid perform?
Flexes, medially rotates, abducts, extends, and laterally rotates the humerus
What supplies blood to the deltoid?
Deltoid branch of thoracoacromial artery
The deltoid is sometimes divided into 3 sections, these 3 sections are called…
Spinodeltoid (posterior on spine of scapula)
Acromiodeltoid (middle on acromion)
Clavodeltoid (anterior on clavicle; also called cleidodeltoid)
What innervates the teres major muscle?
Lower subscapular nerve (C5, C6)
What is the proximal attachment for the teres major?
Posterior surface of inferior angle of scapula
What is the distal attachment for the teres major?
Medial lip of intertubercular (bicipital) groove of humerus
What actions does the teres major perform?
Adducts and medially rotates humerus
What supplies blood to the teres major?
Circumflex scapular artery
This “joint” is not a true anatomic joint, but it consists of the sliding of scapula on the thoracic cage.
Scapulothoracic joint
What is involved with the coracoacromial arch?
Acromion process; Coracoid process; Coracoacromial ligament (Arch prevents superior dislocation of the humeral head and protects head of humerus from a downward directed blow)
The “Quadrilateral Space” has what as its boundaries? What is contained within this space?
Inferior glenohumeral capsule; Teres major; Triceps longus; Surgical neck of humerus
Contents = Axillary nerve & Posterior circumflex humeral artery
What are the 4 muscles involved with the rotator cuff?
Supraspinatus; Infraspinaturs; Teres minor; Subscapularis (SITS)
What innervates the supraspinatus?
Suprascapular nerve (C4, C5, C6)
What is the proximal attachment for the supraspinatus?
Supraspinous fossa of scapula
What is the distal attachment for the supraspinatus?
Superior facet of greater tubercle of humerus
What action does the supraspinatus perform?
Works with deltoid in abduction of humerus; Acts with other rotator cuff muscles in stabilizing shoulder joint
What supplies blood the supraspinatus?
Suprascapular artery
What innervates the infraspinatus?
Suprascapular nerve (C5, C6)
What is the proximal attachment for the infraspinatus?
Infraspinous fossa of scapula
What is the distal attachment for the infraspinatus?
Middle facet of greater tubercle of humerus
What actions do the infraspinatus perform?
Laterally rotates the humerus; Helps hold humeral head in place; Stabilizes shoulder joint
What supplies blood to the infraspinatus?
Suprascapular artery
What innervates the teres minor?
Axillary nerve (C5, C6)
What is the proximal attachment for the teres minor?
Middle part of lateral border of scapula (Superior to teres major)
What is the distal attachment for the teres minor?
Inferior facet of greater tubercle of humerus
What actions does the teres minor perform?
Laterally rotates humerus; Helps hold humeral head in place; Stabilizes shoulder joint
What supplies blood to the teres minor?
Circumflex scapular artery
What innervates the subscapularis?
Upper and lower subscapular nerves (C5, C6, C7)
What is the proximal attachment for the subscapularis?
Subscapular fossa of scapula (anterior surface)
What is the distal attachment of the subscapularis?
Lesser tubercle of humerus
What actions does the subscapularis perform?
Medially rotates and adducts humerus; Helps hold humeral head in place; Stabilizes shoulder joint
What supplies blood to the subscapularis?
Suprascapular artery
Two parallel forces, equal in magnitude but opposite in direction, acting on different points of the body a distance apart from each other can be defined as a ______ _____.
Force couple
Give an example of a force couple.
Upper trapezius and lower trapezius working together to upwardly rotate the scapula
The glenohumeral joint has a glenoid labrum which consists of a _________ meniscus and it deepens the articulating surface of glenoid fossa.
Fibrocartilage
The glenohumeral joint capsule is very (TIGHT/LOOSE) and has up to a(n) (INCH/CM) of passive distraction (i.e., how far head of humerus can be pulled away from glenoid fossa)
LOOSE; INCH
In the scapulohumeral rhythm, it refers to the relatively uninterrupted movement of upper extremity from dependent position to full abduction. For full abduction, how many degrees of movement occur?
180 degrees
In scapulohumeral rhythm, how many degrees of movement are contributed by the glenohumeral joint and how many by the scapulothoracic movement?
120 degrees; 60 degrees
In the 60 degrees contributed by the scapulothoracic movement, 40 degrees is from the ________ joint and 20 degrees is from the _______ joint.
Sternoclavicular; Acromioclavicular
Put the following steps in arm abduction in order from first to last:
A. External rotation of humerus (infraspinatus)
B. Snubbing of head of humerus into glenoid fossa (Rotator cuff muscles)
C. Movement (searching) of scapula (serratus anterior clamps scapula to thoracic wall)
D. First few degrees of abduction (supraspinatus)
- C
- B
- D
- A
How can deltoid paralysis occur?
By damaging the axillary nerve
How can serratus anterior paralysis (winging of scapula) occur?
By damaging the long thoracic nerve
When there are tears in the rotator cuff, which muscle is most often torn?
Supraspinatus
What 3 arteries branch off of the aortic arch?
Left subclavian; Left common carotid; Brachiocephalic trunk (which turns into right subclavian & Right common carotid)
The right subclavian artery has 3 “divisions”. Part 1 is ____ the anterior scalene muscle, Part 2 is _____ to the anterior scalene muscle, and Part 3 is ______ to the anterior scalene muscle.
Medial; Posterior; Lateral
What are the anastomosing arterial branches involved with the scapula?
Suprascapular artery (from thyrocervical trunk)
Dorsal scapular artery (deep branch of transverse cervical a. from subclavian a.)
Posterior Intercostal arteries (from thoracic aorta)
Circumflex Scapular artery (division of subscapular artery from axillary artery)
Thoracodorsal artery (division of subscapular artery from axillary artery)
The artery that runs along the vertebral border of the scapula is always referred to as the ______ _____ artery.
Dorsal scapular
The cephalic vein runs along the (MEDIAL/LATERAL) side of the ante brachium in (SUPERFICIAL/DEEP) fascia, and dumps into the axillary vein.
Lateral; Superficial
The basilic vein runs along the (MEDIAL/LATERAL) side of the ante brachium in (SUPERFICIAL/DEEP) fascia.
Medial; Deep
What does the basilic vein join with to form the axillary vein?
Vena comitantes
The axillary vein is renamed to what after it passes under the clavicle?
Subclavian vein
There are ___ brachiocephalic vein(s) and ___ brachiocephalic artery(ies).
2; 1
The 2 brachiocephalic veins come together to form what?
Superior vena cava
These lymph nodes lie medial to the humerus near axillary artery and vein.
Brachial lymph nodes
These lymph nodes lie behind pectoralis minor with lateral thoracic artery and drain the mammary gland.
Pectoral lymph nodes
These lymph nodes lie along the lower border of scapula with subscapular artery and drain the back.
Subscapular lymph nodes
These lymph nodes are in axillary fat and receive lymph from the brachial, pectoral, and subscapular nodes. It drains to the apical nodes behind the clavicle.
Central lymph nodes
What are the muscles in the anterior brachial compartment?
Biceps brachii; Corachobrachialis; Brachialis
What action does the biceps brachii perform?
Flexes arm and forearm; Main supinator of forearm
What action does the coracobrachialis perform?
Flexes arm
What action does the brachialis perform?
Flexes forearm
What innervates the anterior brachial compartment?
Musculocutaneous nerve (C5-C6)