Exam II Flashcards
Muscles that originate on the vertebral column or skull
Trapezius, Rhomboid major, rhomboid minor, levator scapula, and latissimus dorsi
What is the origin of the trapezius
External occipital protuberance, superior nuchal line, ligamentous nuchae, and spines of the thoracic vertebrae
What is the insertion of the trapezius?
Clavicle and acromion process of the scapula
What are the actions of the trapezius?
Stabilizes the scapula. Upper portion elevates the scapula. The middle and lower portions adduct the scapula
What is the nerve supply of the trapezius?
Motor: spinal accessory nerve
Sensory: C4 and C5
What is the clinical condition characterized by a deepening of the shoulder on the affected side?
Trapezius Palsy
This type of injury frequently occurs during an auto accident and most often injures the superior portion of the trapezius.
Whiplash injury
What is the clinical test for the spinal accessory nerve?
Have the patient shrug their shoulders against resistance and see if there is any weakness on a particular side
What is the origin of the rhomboid major?
Spines of the upper thoracic vertebrae
What is the insertion of the rhomboid major?
Vertebral border of the scapula
This muscle is rhomboid in shape and lies deep to the trapezius
Rhomboid major
This muscle lies superior and parallel to the rhomboid major
Rhomboid minor
What is the origin of the rhomboid minor?
Spines of the lower cervicals and first thoracic vertebrae
What is the insertion of the rhomboid minor?
Vertebral border of the scapula
This muscle is found on the side of the neck, deep to the superior portion of the trapezius
Levator scapula
What is the origin of the levator scapula?
Transverse processes of the upper cervical vertebrae
What is the insertion of the levator scapula?
Superior angle of the scapula
What are the actions of the rhomboids and levator scapula?
Elevation, adduction, and stabilization of the scapula
What nerve innervates the rhomboids and levator scapula?
Dorsal scapular nerve
What complications arise when you have damage to the dorsal scapular nerve?
Difficulty in completely adducting the scapula. The scapula is also further from the midline on the affected side
This muscle is found over the lower posterior thoracic and lumbar region and is the widest muscle of the back region
Latissimus Dorsi
What is the origin of the latissimus dorsi?
Spines of the lower thoracic and lumbar vertebrae, thoracodorsal fascia, crest of the ilium, and lower ribs
What is the insertion of the latissimus dorsi?
The intertubecular groove (lesser tubercle) of the humerus
What is the action of the latissimus dorsi?
Extends, adducts, and medially rotates the humerus. Also involved with forced expiration
What is the nerve supply of the latissimus dorsi?
Thoracodorsal nerve (C6, C7, and C8)
What complications arise when there is a weakness or damage to the latissimus dorsi?
It results in forward displacement of the shoulder
This feature is a depression found at the lower portion of the latissimus dorsi and bounded by the latissimus dorsi, crest of the ilium and the external oblique muscle. Clinical significance: hernia of the posterior abdominal wall may develop here.
Lumbar triangle
This feature is a depression found at the superior border of the latissimus dorsi and bounded by the latissimus dorsi, trapezius, and vertebral border of the scapula. Clinical significance: the lungs can be hear much more easily with a stethoscope in this location
Triangle of Auscultation
What is the origin of the serratus anterior?
Upper ribs
What is the insertion of the serratus anterior?
Vertebral border of the scapula
What are the actions of the serratus anterior?
Abducts the scapula (prime mover), stabilizes the scapula, and is involved with forced inspiration when the humerus is abducted
What is the nerve supply of the serratus anterior?
Long thoracic (C5, C6, and C7)
What muscle is affected in long thoracic nerve palsy (winged scapula)?
Serratus anterior
This is a condition in which the serratus anterior muscle is weakened due to damage to the long thoracic nerve or its segmental innervation.
Long thoracic nerve palsy (Winged scapula)
What are some common causes for long thoracic nerve palsy (winged scapula)?
Trauma (subluxation), traction injuries involving the shoulder joint, and recumbence for a long period of time
What muscles compose the scapular muscles?
Deltoid, supraspinatus, infraspinatus, subscapularis, teres major, and teres minor
The suprasinatus, infraspinatus, subscapularis, and teres minor muscles compose what structure?
Rotator cuff muscles
What is the origin for the three portions of the deltoid?
Anterior portion: clavicle
Middle portion: acromion process
Posterior portion: spine of the scapula
What is the insertion of the deltoid?
Deltoid tuberosity of the humerus
What are the actions of the deltoid?
Anterior portion: flexes and medially rotates the humerus
Middle portion: abducts the humerus
Posterior portion: extends and laterally rotates the humerus
What is the nerve supply of the deltoid?
Axillary nerve (C5-C6)
This clinical condition can occur through an injury to the axillary nerve through a fracture of the surgical neck of the humerus, dislocation of the shoulder joint, or pressure of a crutch in the axilla.
Crutch paralysis or atrophy of the deltoid
What are some physical manifestations of crutch paralysis?
Atrophy of the deltoid gives the shoulder a flattened appearance, loss of sensation may occur over the lateral aspect of the arm, and abduction of the arm is greatly impaired
The tendon of insertion for the supraspinatus is separated from the acromion process by what structures?
Subacromial and subdeltoid bursa
What is the origin of the supraspinatus?
Supraspinatus fossa of the scapula
What is the insertion of the supraspinatus?
Greater tuberosity of the humerus
What are the actions of the supraspinatus?
Initiates abduction of the humerus, laterally rotates the humerus, and stabilizes the shoulder joint
What is the nerve supply of the supraspinatus?
Suprascapular nerve (C5-C6)
What are some clinical aspects of the supraspinatus?
Rotator cuff tendonitis, rotator cuff tears, and bursitis
It is the most common cause of shoulder pain, also known as shoulder impingement syndrome, and is characterized by an irritation and inflammation of the supraspinatus tendon. It can be caused by calcium deposits, trauma/injury, excess stress and repetition, weakness around the rotator cuff or genetics.
Rotator cuff tendonitis
What is the drop test and what is it testing?
It is used to test a rotator cuff tear. The patient is asked to lower their fully abducted arm slowly and if it drops suddenly in an uncontrolled manner, their tendon is torn
This condition is due to an inflammation of a bursa.
Bursitis
What is the origin of the infraspinatus?
Infraspinatus fossa of the scapula
What is the insertion of the infraspinatus?
Greater tuberosity of the humerus
What is the action of the infraspinatus?
Laterally rotates the humers and stabilizes the shoulder joint
What is the nerve supply to the infraspinatus?
Suprascapular (C5-C6)
What is the origin of the subscapularis?
Subscapular fossa of the scapula
What is the insertion of the subscapularis?
Lesser tuberosity of the humerus
What is the action of the subscapularis?
Medially rotates the humerus and stabilizes the shoulder joint
What is the nerve supply of the subscapularis?
Upper and lower subscapular nerves (C5-C6)
What is the origin of the teres minor?
The axillary border of the scapula
What is the insertion of the teres minor?
Greater tuberosity of the humerus
What is the action of the teres minor?
Adducts and medially rotates the humerus and stabilizes the shoulder joint
What is the nerve supply of the teres minor?
Axillary nerve (C5-C6)
What is the origin of the teres major?
Inferior angle of the scapula
What is the insertion of the teres major?
medial lip of the intertubercular groove of the humerus
What is the action of the teres major?
Adducts and medially rotates the humerus. Also stabilizes the shoulder joint
What is the nerve supply of the teres major?
Lower subscapular nerve (C6)
What is the quadrilateral space?
This space is more lateral than the triangular space and contains the axillary nerve and humeral circumflex blood vessels (artery and vein)
What is the triangular space?
This space is more medial than the quadrilateral space and contains the circumflex scapular branch of the subscapular artery
What are the two classifications of ligaments?
Extrinsic (found superficial to the capsular ligament) and Intrinsic (found deep to the capsular ligament)
What two things can ligaments act as?
A rope or a wall
This joint by which the upper limb articulates with the axial skeleton and is the most stable joint.
Sternoclavicular joint
What are the articulations of the sternoclavicular joint?
Sternal end of the clavicle, clavicular and costal notches of the sternum (manubrium) and the medial end of the first rib
What is an articular disc of the sternoclavicular disc and what does it do?
It is a piece of cartilage that is found in the middle of the joint cavity. It prevents the clavicle from being displaced at its articulation with the sternum and acts as a shock absorber for forces being transmitted along the clavicle
What type of joint is the sternoclavicular joint classified as?
Plane gliding joint
What is the nerve supply of the sternoclavicular joint?
Supraclavicular and nerve to the subclavius
What are the ligaments associated with the sternoclavicular joint?
Anterior and posterior sternoclavicular, interclavicular, costoclavicular ligaments
What do the anterior and posterior sternoclavicular ligaments do? What type of ligament is it?
Reinforce the capsular ligament, prevent excessive forward and bacward movement of the joint. It is an extrinsic ligament and acts as a wall.
What does the interclavicular ligament do? What type of ligament is it?
Functions to prevent displacement of the clavicle when one is carrying a heavy object. It is extrinsic and acts like a rope
What does the costoclavicular ligament do? What type of ligament is it?
Reinforces the capsular ligament and limits the elevation at the medial end of the clavicle. It is extrinsic and acts like a rope
What usually causes a sternoclavicular joint dislocation?
Direct trauma to the anterior aspect of the sternal end of the clavicle. This injury is rare, but can be life threatening due to compression of the trachea and blood vessels
What are the articulations of the acromioclavicular joint?
The acromion process of the scapula and the lateral end of the clavicle
What type of joint is the acromioclavicular joint classified as?
A plane gliding joint
What is the nerve supply of the acromioclavicular joint?
Suprascapular and axillary nerves
What ligaments are associated with the acromioclavicular joint?
Superior and inferior acromioclavicular ligaments and the coracoclavicular ligament
What is the function of the superior and inferior acromioclavicular ligaments? What type of ligaments are they?
Reinforces the capsular ligament, prevents the clavicle from losing contact with the acromion process. It is extrinsic and acts like a rope
What is the function of the coracoclavicular ligament? What type of ligament is it?
It is largely responsible for holding and suspending the weight of the scapula from the clavicle. Also limits protraction, elevation, and rotation of the scapula. It is extrinsic and acts like a rope
How does a dislocation of the acromioclavicular joint occur? What is it typically characterized by?
It usually occurs through a severe blow to the shoulder, known as a shoulder pointer. When a grade III dislocation occurs both the acromioclavicular and coracoclavicular ligaments rupture and the clavicle will separate from the scapula.
What are the articulations of the shoulder or glenohumeral joint?
Head of the humerus with the glenoid cavity of the scapula.
What is the glenoid labrum?
It is a fibrocartilage rim that that deepens the glenoid cavity for the head of the humerus.
What type of joint is the glenohumeral joint?
Ball and socket joint
What is the nerve supply of the glenohumeral joint?
Axillary and suprascapular
What are the ligaments of the glenohumeral joint?
Capsular ligament, Glenohumeral, transverse humeral, coracohumeral coracoacromial, and the suprascapular
What muscle passes through the capsular ligament of the glenohumeral joint?
The long head of the biceps brachii
What does the glenohumeral ligament do? What type of ligament is it?
It strengthens the anterior aspect of the capsule, helps prevent lateral rotation of the humerus at the shoulder joint. It is intrinsic and acts like a rope
What does the transverse humeral ligament do?
It keeps the long head of the biceps brachii in place
What does the coracohumeral ligmanet do? What type of ligament is it?
Strengthens the capsule from above, limits lateral rotation of the humerus. It is extrinsic and acts like a rope
What does the coracoacromial ligament do? What type of ligament is it?
It prevents upward displacement of the humerus. It is extrinsic and acts like a wall
What is the suprascapular ligament?
It is a small ligament that spans the scapular notch
What type of dislocations can occur with the glenohumeral joint?
Anterior dislocation and Subcoracoid dislocation
What nerves can be damaged with a shoulder dislocation?
Musculocutaneous and axillary nerves
What is the origin of the biceps brachii?
Long head: supraglenoid tubercle of the scapula
Short head: Coracoid process of the scapula
What is the insertion of the biceps brahii?
Radial tuberosity and the shaft of the ulna
What are the actions of the biceps brachii?
Flexion of the forearm at the elbow joint, supinator of the forearm, and adduction (short head)/abduction (long head) of the humerus
What is the innervation of the biceps brachii?
Musculocutaneous nerve
This clinical condition occurs when the biceps tendon moves back and forth in the intertubecular groove to the point that wear and tear can inflame it and cause pain.
Biceps tendonitis
This clinical condition occurs when the long head of the biceps tendon ruptures.
Popeye Deformity
What segmental innervations are being tested with the biciptial reflex?
C5 and C6
What is the origin of the coracobrachialis?
Coracoid process of the scapula
What is the insertion of the coracobrachialis?
Shaft of the humerus
What are the actions of the coracobrachialis?
Flexion and weak adduction of the humerus. Helps to stabilize the shoulder joint
What is the innervation of the coracobrachialis?
Musculocutaneous nerve
What is the origin of the brachialis?
Shaft of the humerus
What is the insertion of the brachialis?
Coronoid process of the ulna
What is the action of the brachialis?
Flexion of the forearm at the elbow joint
What is the innervation of the brachialis?
Musculocutaneous nerve
What is the origin of the triceps brachii?
Long head: infraglenoid tubercle of the humerus
Lateral and medial heads: shaft of the humerus
What is the insertion of the triceps brachii?
Olecranon process of the ulna
What is the action of the triceps brachii?
Extension of the forearm at the elbow joint
What is the segmental innervation being tested by tapping the triceps brachii’s tendon of insertion?
C7 and C8
If the triceps brachii is atrophied, passive extension can be produced through what?
Gravity
What is the origin of the anconeus?
Lateral epicondyle of the humerus
What is the insertion of the anconeus?
Olecranon process and proximal posterior shaft of the ulna
What is the action of the anconeus?
To assist (weakly) in the extension of the forearm
This artery is the continuation of the axillary and splits into the ulnar and radial arteries.
Brachial artery
Where can a pulse of the brachial artery be taken?
Bicipital furrow
What are the branches of the brachial artery?
Deep brachial (brachial profundus), superior and inferior ulnar collaterals
Why is blood pressure taken at the location of the brachial artery?
It is approximately at the level of the heart and the muscle mass of the arm can effectively transmit the pressure in the cuff to the blood vessels
What tool do you use to take blood pressure?
Sphygomomanometer
When taking blood pressure, the point at which blood flow resumes and is audible through a stethoscope is known as what?
Systolic pressure
When taking blood pressure, the point at which the sound can no longer be heard is what?
Diastolic pressure
What are the veins that compose the cutaneous (superficial) veins of the upper extremity?
Dorsal venous arch, cephalic vein (terminates in the axillary veins), basilic vein (joins with the brachial veins to form the axillary vein, median cubital vein.
Where is blood sampling commonly performed?
At the median cubital vein of the upper extremity