iRA/tRA- Shoulder Complex Anatomy and Kinematics Review Flashcards
The scapula lies in a plane ___ degrees to the back, and __ degrees to the clavicle. It extends from the _nd to _th rib.
- 30 degrees, 60 degrees
- 2nd and 7th
The superior angle of the scapula corresponds to T_ spinous process and the medial lip of the spine corresponds to T_ spinous process.
- T1
- T3
What are the 3 morphologies of the acromion?
- Type I: Flat
- Type II: Curved
- Type III: Hooked
Type __ acromion is a negative prognostic factor for conservative management, while Type __ acromion is a good prognostic indicator for conservative management.
- Type III (hooked)
- Type I (flat)
What type of acromion has the greatest correlation with subacromial impingement syndrome?
Type III (hooked)
What are the 3 ligaments of the scapula?
- Coracoacromial ligament
- Superior Transverse Scapular ligament
- Inferior Transverse Scapular ligament
The coracoacromial ligament is a strong triangular band with a ____________ deep to this to allow movement of deeper supraspinatus tendon.
subacromial bursa
The superior transverse scapular ligament completes the scapular ______ to make foramen.
notch
The inferior transverse scapular ligament arches over the _________ nerve.
suprascapular
- What is the glenoid labrum?
- What does the glenoid labrum do?
- Ring of fibrocartilage attached to the margin of the glenoid fossa.
- Deepens the glenoid cavity for congruency of articular surfaces.
For the Glenohumeral Joint (GHJ), the head of the humerus faces superiorly, medially, and _________.
posteriorly
The angle of inclination of the GHJ is ____ degrees and ___ degrees of retroversion.
- 135 degrees
- 30 degrees
The GHJ capsule is weakest where?
Over the anterior aspect of the capsule between the bands of the glenohumeral ligament.
What does the coraco-humeral ligament connect?
corocoid process to greater tuberosity
- How many bands of the GH ligament are there?
- The GH ligament is taut in __ and slackened in __.
- 3 (superior, middle, inferior)
- ER, IR
When we are positioned in 90 degrees of abduction there is a tightening of the ______ and ______ fibers of the GH ligament. The _______ GH ligament resists anterior and posterior humeral head translation by cupping the joint.
- middle and inferior
- inferior
The scapulothoracic joint is a _____ joint between the scapula and thoracic wall.
false
The clavicle is ______ shaped (convex medial 2/3s, concave lateral 1/3). It transmits UE weight to ______.
- sigmoid
- axial skeleton
How do females clavicles differ from males?
Shorter, thinner, less curved, smoother, acromial end lower than sternal end.
What are the 3 parts of the sternum?
- Manubrium
- Mesosternum (body)
- Xiphoid process
The sternoclavicular (SC) joint is _______ shaped and is divided by a ________.
- saddle
- meniscus
What are the articulating surfaces of the SC joint?
- Sternum
- Clavicle
- Superior surface of 1st costal cartilage
What are the stabilizing ligaments of the SC joint?
- Anterior SC joint
- Posterior SC joint
- Interclavicular ligament
- Costoclavicular ligament
The SC joint has two axes. The first corresponds to the ________ sternocostal on _____ clavicular, allowing movement of the clavicle in the vertical plane. The second corresponds to the ________ sternocostal on _________ clavicular, allowing movement of the clavicle in the horizontal plane.
- concave, convex
- convex, concave
The SC joint also undergoes axial rotation of ___ degrees.
30
The acromioclavicular joint is a _____ joint and is subject to dislocation, why?
- plane
- absence of interlocking articular surfaces, weakness of ligaments
The acromion has a slightly _______ surface facing _____________. The clavicular surface faces inferior, _________, and laterally.
- convex, anteriomedially
- posteriorly
What are 2 extra-articular ligaments that support the AC joint?
- Conoid ligament
- Trapezoid ligament
What is the resting position of the GHJ?
55 degrees abduction, 30 degrees horizontal adduction, slight ER
What is the close-packed position of the GHJ?
Max abduction and ER
What is the close-packed position of the SCJ?
Full elevation
What is the close-packed position of the ACJ?
90 degrees abduction
What are the boundaries of the quadrilateral space?
- Teres major
- Teres minor
- Long head of triceps
- Surgical neck of humerus
What are the contents of the quadrilateral space?
- Axillary nerve
- Posterior circumflex humeral artery
What motions can close the quadrilateral space down?
- Extension
- Abduction
- ER
What is the rotator cuff interval?
- Triangular portion of glenohumeral capsule that lies between the supraspinatus and subscapularis tendons.
- Reinforced by superior glenohumeral and coracohumeral ligaments.
- Adhesions in this area with adhesive capsulitis, causes anterior seating of humeral head.
Adhesions in the rotator cuff interval with adhesive capsulitis causes ________ seating of the humeral head.
anterior
The biceps pulley is a tendoligamentous sling formed by what structures?
- Superior GH ligament
- Coracohumeral ligament
- Distal attachment of the subscapularis tendon
What does the biceps pulley do?
Stabilizes the long head of the biceps in the bicipital groove.
SHOULDER COMPLEX MUSCULATURE
SHOULDER COMPLEX MUSCULATURE
What are the muscles of the rotator cuff?
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
The rotator cuff is the primary ___________ of the GH joint. It can provide _____ stability in response to external __________.
- stabilizer
- rapid
- perturbation
What are other muscles that act on the shoulder complex?
- Teres Major
- Deltoid
- Trapezius
- Biceps Brachii
- Coracobrachialis
- Pectoralis Major and Minor
- Latissimus Dorsi
- Rhomboid Major and Minor
- Serratus Anterior
- Levator Scapulae
- Triceps Brachii
KINEMATICS
KINEMATICS
During elevation, what motions should occur at the scapula? What muscles are involved?
- Upward rotation (upper trap, lower trap, serratus anterior)
- Posterior tilting (serratus anterior)
- Internal rotation
- There is a : ratio of GH:Scapular motion during shoulder abduction.
- With shoulder abduction, we get a contralateral thoracic spine _____________.
- 2:1
- lateral flexion
Describe the 3 phases of shoulder abduction:
Phase I (0°-60°)
- ________ and ___________
- “Locking” at 90° from greater tuberosity impacting superior margin of glenoid; lateral ________ and __________ of the humerus to delay lock.
Phase II (60°-120°)
- 60° rotation of scapula to orient glenoid superior and anterior, axial rotation of ___ and ____ joints
- _________ (upper and lower) and _______________
- Checked by _________________ and inferior ___________
Phase III (120°-180°)
- Lateral flexion of _______
- ________, ________, inferior ________, and _____________ elevate UE
- deltoid and supraspinatus
- rotation and flexion
- AC and SC
- trapezuis and serratus anterior
- latissimus dorsi and inferior pec minor
- T-spine
- deltoid, supraspinatus, inferior trapezius, serratus anterior
Describe the 3 phases of shoulder flexion:
1
The rhomboids and possibly levator scap are innervated by the ___________ nerve at root C_.
- dorsal scapular nerve
- C5
The serratus anterior is innervated by the __________ nerve at root C_,C_, and C_*.
- long thoracic
- C5, C6, and C7*
The subclavius is innervated by the _____________ at root C_ and C_.
- nerve to subclavius
- C5 and C6
The supraspinatus and infraspinatus are innervated by the _________ nerve at root C_ and C_.
- suprascapular
- C5 and C6
The long thoracic nerve innervates the serratus anterior which is essential for what?
Keeping the scapula stable on the thorax (winged scapula)
The pec major and pec minor are innervated by both the __________ nerve (C_, C_, C_) and ____________ nerve (C_, T_).
- lateral pectoral nerve (C5, C6, C7)
- medial pectoral nerve (C8, T1)
The upper subscapularis is innervated by the _____________ nerve at root C_ and C_.
- upper subscapular nerve
- C5 and C6
The lower subscapularis and teres major are innervated by the _____________ nerve at root C_ and C_.
- lower subscapular nerve
- C5 and C6
The latissimus dorsi is innervated by the ____________ nerve at root C_-C_.
- thoracodorsal nerve
- C6-C8
The deltoid and teres minor are innervated by the ________ nerve at root C_ and C_. The nerve also has a sensory distribution to where?
- axillary nerve
- C5 and C6
- lateral proximal upper arm
The triceps is innervated by the _______ nerve at root C_-T_. The nerve also has a sensory distribution to where?
- radial nerve
- C5-T1
- posterior aspect of digits 1-3 and lateral half of digit 4
The extensors of the wrist and long extensors of the fingers are innervated by the __________ nerve at root C_ and C_.
- posterior interosseous nerve
- C7 and C8
The coracobrachialis, biceps, and brachialis are innervated by the __________ nerve at root C_-C_. The nerve also has a sensory distribution to where?
- musculocutaneous nerve
- C5-C7
- lateral cutaneous nerve of forearm
The wrist flexors, thenar muscles, and radial lumbricals are innervated by the ________ nerve at root C_-T_. The nerve also has a sensory distribution to where?
- median nereve
- C6-T1
- palmar lateral hand and digits 1-3 and radial 4th digit
The ____________ nerve is a branch of the median nerve from roots C_ and C_ that innervates the pronator quadratus, FDP, and FPL.
-anterior interosseous nerve
The FCU and FDP (medial hald) are innervated by the ________ nerve at root C_-T_. The nerve also has a sensory distribution to where?
- ulnar nerve
- dorsal cutaneous branch (palmar digit 5 and medial half of digit 4)
