Exam 2 flashcards-1
Trapezius (Origin/ Insertion)
Origin: External Occipital Protuberance (EOP), Superior Nuchal Line, Ligamentum Nuchae, Spines of the Thoracic Vertebrae, Insertion: Clavicle, Acromion Process and Spine of Scapula
Trapezius (Actions)
Actions:* Stabilizes the scapula, * Upper portion: elevates the scapula,* Middle and Lower portions: adducts the scapula
Trapezius (Nerve Supply)
Nerve Supply: Motor Innervation: Spinal Accessory Nerve (C.N. XI), Sensory Innervation: C4 and C5”
Trapezius Palsy
A deepening of the shoulder on the affected side. The shoulder drops on the affected side.
Whiplash Injuries (to Trapezius)
The superior portion of the muscle is frequently involved in neck injuries during an auto accident.
Cranial Nerve XI (Clinical Test)
The clinical test for this nerve is to ask the patient to elevate their shoulders (shrug) against resistance. Both sides should be tested at the same time, so weakness of one side can be evaluated relative to the other side.
Rhomboid Major (Origin/Insertion)
Origin: Spine of Upper Thoracic Vertebrae, Insertion: Vertebral/Medial Border of Scapula
Rhomboid Minor (Origin/ Insertion)
Origin: Spines of Lower Cervicals and T1, Insertion: Vertebral/Medial Border of Scapula
Levator Scapula (Origin/Insertion)
Origin: Transverse Processes of Upper Cervicals, Insertion: Superior Angle of Scapula
Rhomboid Major, Rhomboid Minor, and Levator Scapula (Actions )
Actions: * Elevates the scapula, * Adducts the scapula, * Stabilizes the scapula
Rhomboid Major, Rhomboid Minor, and Levator Scapula (Nerve Supply)
Nerve Supply: Dorsal Scapula Nerve (C5)
(Damage to) Dorsal Scapula Nerve or C5
Damage results in difficulty in completely adducting the scapula and the scapula on the affected side is further from the midline.
Latissimus Dorsi (Origin/Insertion)
Origin: Spines of Lower Thoracics and Lumbars, Thoracodorsal Fascia, Crest of the Ilium, Lower Ribs, Insertion: Intertubercular Groove of Humerus
Latissimus Dorsi (Actions)
Actions:* Extends, adducts, and medially rotates the humerus, * Involved with forced expiration
Latissimus Dorsi (Nerve Supply)
Nerve Supply: Thoracodorsal Nerve (C6, C7, and C8)
(Damage to) Latissimus Dorsi
Damage results in forward displacement of the shoulder.
Lumbar Triangle
A depression found at the lower portion of the latissimus dorsi and is bounded by the: latissimus dorsi, crest of the ilium, and the external oblique muscle. A hernia of the posterior wall of the abdomen may develop here.
Triangle of Auscultation
A depression found at the superior portion of the latissimus dorsi bounded by the: latissimus dorsi, trapezius, and the vertebral/medial border of the scapula. The area is a relatively thin layer of tissue allowing for lungs sounds to be more easily heard with a stethoscope. The area can be enlarged by abducting the scapula.
Serratus Anterior (Origin/Insertion)
Origin: Upper Ribs, Insertion: Vertebral/Medial Border of Scapula
Serratus Anterior (Actions)
Actions: * Abducts the scapula (prime mover), * Stabilizes the scapula, * Involved with forced inspiration but only when the humerus is abducted
Serratus Anterior (Nerve Supply)
Nerve Supply: Long Thoracic (C5, C6, and C7)
Serratus Anterior (AKA)
AKA: Boxer’s Muscle
Winged Scapula (Long Thoracic Nerve Palsy)
A condition in which the serratus anterior is weakened due to damage to the long thoracic nerve or its segmental innervation. Patient will experience difficulty abducting their scapula and thus have problems with raising their extremity over their head. The patient will have difficulty keeping the vertebral border and inferior angle of their scapula against the posterior thoracic wall, and will have shoulder pain.
Winged Scapula weakened serratus anterior (Common Causes)
- Trauma and/or subluxation, * Traction injuries involving the shoulder joint, * Recumbency for a long period of time
Rotator Cuff Muscle (Criteria)
Criteria: 1. The muscle’s tendon of insertion must contribute to forming a cuff around the proximal end of the humerus. 2. The muscle participates in either lateral or medial rotation of the humerus.
Rotator Cuff Muscles
This group of muscles is collectively known as {this}: supraspinatus, infraspinatus, subscapularis, and teres minor.
Deltoid (Origin/Insertion)
Origin: Clavicle (anterior portion), Acromion Process (middle portion), Spine of Scapula (posterior portion), Insertion: Deltoid Tuberosity of Humerus
Deltoid (Actions)
Actions: * Anterior portion: flexes and medially rotates the humerus, * Middle portion: abducts the humerus, * Posterior portion: extends and laterally rotates the humerus
Deltoid (Nerve Supply)
Nerve Supply: Axillary Nerve (C5 and C6)
Atrophy of Deltoid (Crutch Paralysis)
Injury due to the axillary nerve. Caused by: * Fracture of the surgical neck of the humerus (injury to nerve may be immediate or occur during healing), * Dislocation of the shoulder joint, * Pressure of a crutch in the axilla
Atrophy of Deltoid (Problems)
Problems: * The shoulder has a flattened appearance; the rounded contours of the shoulder disappear, * Loss of sensation may occur over the lateral aspect of the arm, * Abduction of the arm is greatly impaired
Deltoid
Common site for intramuscular injection of drugs.
Supraspinatus (Origin/Insertion)
Origin: Supraspinous Fossa of Scapula, Insertion: Greater Tuberosity of Humerus
Supraspinatus (Actions)
Actions: * Initiates abduction of the humerus, * Laterally rotates the humerus, * Stabilizes the shoulder joint
Supraspinatus (Nerve Supply)
Nerve Supply: Suprascapular (C5 and C6)
Rotator Cuff Tendinitis
An irritation and inflammation of the supraspinatus tendon and one of the most common causes of shoulder pain. Also known as shoulder impingement syndrome. * Pain may be sharp or aching and usually occurs in the anterior and/or lateral aspects of the shoulder,* At first it may feel like a “twinge” in your shoulder but can progress to pain during and after activity, * Usually the result of overuse due to repetitive motions which cause microtrauma to the tendon’s collagen fibers, * In elderly individuals it may be due to calcium deposits in the tendon
Rotator Cuff Tears
If the tendon is weakened by a combination of multifactorial it may lead to {this}. * The tendon usually ruptures at or near its insertion and the tear may be partial or complete, * A complete tear in younger individuals are almost always from trauma or after a shoulder dislocation, * Small tears can result from repetitive microtrauma or from a severe case of tendinitis, but large or complete tears are from a single episode of trauma, * Over the age of 50, tears can occur with only minor trauma, * Symptoms are similar to tendinitis, but with a significant tear patient will have difficulty carrying out abduction of the arm
Drop Test
Test used to evaluate rotator cuff tears or for degenerative tendinitis. The patient is asked to lower the fully abducted limb slowly, the limb will fall suddenly to the side in an uncontrolled manner if the tendon is torn or diseased.
Shoulder Bursitis
Shoulder pain and discomfort may be due to inflammation of the subacromial and deltoid brusae. This may in fact be more common than rotator cuff tendinitis, but is difficult to distinguish one from the other. Commonly seen in swimmers, tennis players, and gymnasts.
Subacromial and Deltoid (Bursae)
The supraspinatus tendon is separated from the acromion process by these bursae.
Infraspinatus (Origin/Insertion)
Origin: Infraspinous Fossa of Scapula, Insertion: Greater Tuberosity of Humerus
Infraspinatus (Actions)
Actions: * Laterally rotates the humerus, * Stabilizes the shoulder joint
Infraspinatus (Nerve Supply)
Nerve Supply: Suprascapular (C5 and C6)
Subscapularis (Origin/Insertion)
Origin: Subscapular Fossa of Scapula, Insertion: Lesser Tuberosity of Humerus
Subscapularis (Actions)
Actions: * Medially rotates the humerus, * Stabilizes the shoulder joint
Subscapularis (Nerve Supply)
Nerve Supply: Upper and Lower Subscapular Nerves (C5 and C6)
Teres Minor (Origin/Insertion)
Origin: Axillary/Lateral Border of Scapula, Insertion: Greater Tuberosity of Humerus
Teres Minor (Actions)
Actions: * Laterally rotates the humerus, * Stabilizes the shoulder joint
Supraspinatus, Infraspinatus, and Teres Minor (SIT) Muscles
The rotator cuff muscles that attach to the greater tuberosity of the humerus.
Teres Major (Origin/Insertion)
Origin: Inferior Angle of Scapula, Insertion: Intertubercular Groove (Medial Lip) of Humerus
Teres Major (Actions)
Actions: * Adducts and medially rotates the humerus* Stabilizes the shoulder joint
Teres Major (Nerve Supply)
Nerve Supply: Lower Subscapular (C6)
Quadrilateral Space
The more lateral space between the teres major and teres minor where the axillary nerve and humeral circumflex arteries are found.
Triangular Space
The more medial space between the teres major and teres minor where the circumflex scapular branch of the subscapular artery is found.
Sternoclavicular Joint
The joint by which the upper limb articulates with the axial skeleton. Most stable joint in the upper extremity. Articulations: sternal end of the clavicle, clavicular notch of the sternum, and the cartilage of the first rib. The articulating surfaces are poorly adapted to one another overcome by a piece of cartilage called the articular disc.
Articular Disc (of Sternoclavicular Joint)
Divides the sternoclavicular joint into separate cavities and functions to: prevent the clavicle from being displaced at its articulation with the sternum, and as a shock absorber of forces being transmitted along the clavicle.
Plane Gliding (Sternoclavicular Joint Classification)
Sternoclavicular joint classification.
Sternoclavicular Joint (Capsular Ligament)
Very strong ligament that completely surrounds the joint.
Anterior and Posterior Sternoclavicular Ligaments
These ligaments reinforce the capsular ligament and prevent excessive forward (protraction) and backward (retraction) displacement of the clavicle. Extrinsic/Wall
Interclavicular Ligament
This ligament is attached to the sternal ends of both clavicles across the jugular notch of the sternum. It functions to prevent displacement of the clavicle, as when one is carrying a heavy object. Extrinsic/Rope
Costoclavicular Ligament
A strong ligament which is attached from the costal tubercle of the clavicle to the first rib. The ligament reinforces the joint capsule and limits elevation of the medial end of the clavicle. Extrinsic/Rope
Sternoclavicular Joint (Nerve Supply)
Joint Nerve Supply: Supraclavicular and Nerve to the Subclavius
Sternoclavicular Joint (Movements)
Although the joint is very strong and stable it is mobile enough to allow movements of the pectoral girdle and upper limb. Elevation, depression, protraction and retraction occur at the joint but much of the movement is passive and occurs when the scapula moves.
Acromioclavicular Joint (Articulations)
Articulations: Acromion process of the scapula and the lateral end of the clavicle.
Plane Gliding (Acromioclavicular Joint Classification)
Acromioclavicular joint classification.
Acromioclavicular Joint (Capsular Ligament)
A thin, weak capsular ligament that cannot maintain the integrity of the joint without reinforcing ligaments.
Superior and Inferior Acromioclavicular Ligaments
Ligaments that reinforce the capsule and prevent the clavicle from losing contact with the acromion process. Extrinsic/Rope
Coracoclavicular Ligament
Ligament which connects the clavicle with the coracoid process of the scapula. The ligament is divided into a conoid and trapezoid portion, which are attached respectively to the conoid tubercle and trapezoid line of the clavicle. The ligament is largely responsible for holding and suspending the weight of the scapula from the clavicle and also limits protraction, elevation, and rotation at the joint. Extrinsic/Rope
Acromioclavicular Joint (Nerve Supply)
Joint Nerve Supply: Suprascapular and Axillary Nerves
Acromioclavicular Joint (Movements)
At this joint the acromion of the scapula rotates on the acromial end of the clavicle, but no muscles attach to either bones to carry out this movement. all movement at the joint occurs by movements of the scapula which than cause it to move upon the clavicle.
Dislocation of the Acromioclavicular Joint (Shoulder Separation)
Although a very strong ligament, it is very vulnerable to injury in contact sports (e.g. football, rugby, and hockey). Injuries often occur by a severe blow to the shoulder which is known as a shoulder pointer. Both the acromioclavicular and coracoclavicular ligaments are damaged and the scapula will separate from the clavicle and falls because of the weight of the upper limb. The lateral end of the clavicle is displaced and easily palpable and the acromion process is more prominent than normal. This type of dislocation may compress the subclavian artery indicated by a diminished brachial or radial pulse.
Glenohumeral (Shoulder) Joint (Articulations)
Articulations: Head of Humerus with the Glenoid Cavity of the Scapula
Glenoid Labrum
The fibrocartilage rim that deepens the glenoid cavity of the scapula.
Ball and Socket (Glenohumeral (Shoulder) Joint Classification)
Glenohumeral (Shoulder) joint classification.
Glenohumeral (Shoulder) Joint (Capsular Ligament)
Capsular ligament surrounds the joint and is thin and lax. The long head of the biceps brachii passes out of the joint cavity. The capsule is not strong enough to keep the two bones in contact with each other allowing for tremendous freedom of movement.
Glenohumeral Ligament
A ligament which is found within the shoulder joint cavity. It strengthens the anterior aspect of the capsule and helps prevent lateral rotation of the humerus. Intrinsic/Rope
Transverse Humeral Ligament
A ligament that spans the intertubercular groove, converting it into a canal. The long head of the biceps is held in place by the ligament.
Coracohumeral Ligament
A ligament that strengthens the capsule from above and limits lateral rotation of the humerus. Extrinsic/Rope
Coracoacromial Ligament
A ligament that attaches the coracoid process to the acromion process. It prevents upward displacement of the head of the humerus. Extrinsic/Wall
Suprascapular Ligament
A small ligament which spans the scapular notch and may ossify.