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Year 2 Term 1 Movement > Lecture 2: Shoulder > Flashcards

Lecture 2: Shoulder Flashcards

1
Q

What are the 5 anatomical regions of the upper limb?

A

1) Axilla (armpit)
2) Arm/Brachium (upper arm)
3) Cubital Fossa
4) Forearm
5) Hand

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2
Q

What are the 5 joints of the upper limb?

A

1) Sternoclavicular
2) Shoulder
3) Elbow
4) 2 Radioulnar (where radius and ulna meet near the elbow and the wrist)
5) Wrist

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3
Q

What makes up the pectoral girdle?

A

Clavicle, scapula and manubrium

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4
Q

What is the anatomical name for the shoulder joint?

A

The glenohumeral joint

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5
Q

Where is the glenohumeral joint located?

A

Between the glenoid fossa of the scapula and the head of the humerus

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6
Q

What is meant by the word girdle?

A

Circle of bone

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7
Q

Is the pectoral girdle a complete bony circle?

A

Anteriorly completed by the manubrium

Posteriorly incomplete

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8
Q

The pectoral girdle is incomplete posteriorly, how is it stabilised?

A

By 4 muscles attaching to the scapula

1) Rhomboids, major and minor
2) Levator scapulae
3) Trapezius
4) Serratus anterior

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9
Q

Where does the acromioclavicular joint lie?

A

Between the clavicle and the acromion of the scapula

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10
Q

Where does the sternoclavicular joint lie?

A

Between the clavicle and the manubrium

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11
Q

What are the 3 movements of the pectoral girdle?

A

1) Elevation/Depression
2) Protraction/Retraction
3) Upward rotation/Downward rotation (for abduction and adduction of the arm)

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12
Q

Which nerve provides motor innervation to the trapezius muscle?

A

Accessory nerve CN IX

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13
Q

What sections can the trapezius muscle be divided into?

A

Upper fibres
Middle fibres
Lower fibres

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14
Q

What is the origin of the upper fibres of the trapezius muscle? 4

A

1) External occipital protuberance
2) Superior nuchal line
3) Ligamentum nuchae
4) Spinous processes of the 7th cervical vertebrae

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15
Q

What is the insertion of the upper fibres of the trapezius?

A

Lateral 1/3 of the clavicle

Acromium process

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16
Q

What is the function of the upper fibres of the trapezius muscle?

A

Elevate the scapula

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17
Q

What is the origin of the middle fibres of the trapezius muscle?

A

Spinous process of the 1st to 5th thoracic vertebrae

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18
Q

What is the insertion of the middle fibres of the trapezius?

A

The lateral 2/3 of the superior border of the spine of the scapula

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19
Q

What is the function of the middle fibres of the trapezius muscle?

A

Retract scapula

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20
Q

What is the origin of the lower fibres of the trapezius muscle?

A

Spinous process of 6th to 12th thoracic vertebrae

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21
Q

What is the insertion of the lower fibres of the trapezius muscle?

A

Medial 1/3 of the spine of the scapula

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22
Q

What is the function of the lower fibres of the trapezius muscle?

A

Depress scapula

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23
Q

In which movement of the upper limb are all fibres of the trapezius muscle involved in?

A

Rotating scapula during abduction of the humerus above horizontal

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24
Q

What are the 3 deep dorsal muscles?

A

1) Levator scapulae
2) Rhomboid major
3) Rhomboid minor

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25
Q

Where do the deep dorsal muscles lie?

A

Deep to the trapezius muscle

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26
Q

What is the origin of the levator scapulae muscle?

A

Transverse processes of C1 to C4

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27
Q

What is the insertion of the levator scapulae muscle?

A

Medial border of scapula superior to the root of the spine

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28
Q

What is the function of the levator scapulae muscle?

A

Elevate the scapula and rotate the scapula medially (downwards)

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29
Q

What is the origin of the rhomboid major?

A

Spinous processes T2-T5

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30
Q

What is the insertion of the rhomboid major?

A

Medial border of the scapula inferior to the level of the spine

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31
Q

What is the function of the rhomboid major and minor?

A

Retract the scapula medially and superiorly , used in squaring the shoulders

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32
Q

What is the origin of the rhomboid minor?

A

Spinous processes C7 to T1

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33
Q

What is the insertion of the rhomboid minor?

A

Medial border of the scapula at the level of the spine

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34
Q

What is the innervation of the deep dorsal muscles?

A

Dorsal scapula nerve - C5

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35
Q

What is the origin of the serratus anterior muscle?

A

Ribs 1-8

36
Q

What is the insertion of the serratus anterior muscle?

A

Medial border of the scapula

37
Q

What are the 2 functions of the serratus anterior?

A

1) Protracts scapula - (with pectoralis minor) so sometimes called boxers muscle
2) Rotates the scapula laterally

38
Q

Other than its movement functions what is the other important function of the serratus anterior?

A

Essentially holds scapula flat against the thoracic wall (because its insertion is the medial border of the scapula)

39
Q

What is the innervation of the serratus anterior?

A

Long thoracic nerve C5-C7

40
Q

What is winged scapula and why does it occur?

A

Medial border and inferior angle of the scapula pull away from the posterior thoracic wall
Innervated by the long thoracic nerve which descends from the brachial plexus and lies superficial to the serratus anterior - if this becomes damaged then the serratus anterior becomes paralysed and cannot hold the medial border of the scapula against the thoracic wall

41
Q

What are 3 possible causes of winged scapula?

A

1) Penetrating injuries when arm abducted eg. knife wound
2) Iatrogenic eg. insertion of a chest drain, during breast surgery
3) Neuritis (inflammation of the nerve)

42
Q

What kind of joint in the glenohumeral joint?

A

Ball and socket joint

43
Q

Why is the glenohumeral joint not a particularly stable joint?

A

The synovial joint surfaces are incongruent (badly fitting)

Joint capsule is thin and lax

44
Q

Which 4 things increase the stability of the glenohumeral joint?

A

1) Glenoid labrum
2) Ligaments
3) Biceps tendon
4) Rotator cuff muscles

45
Q

What is the glenoid labrum?

A

Ring of cartlidge around the glenoid fossa which aims to improve the fit of the head of the humerus

46
Q

At which point is the glenohumeral joint weakest?

A

Inferiorly

47
Q

What are the 3 ligaments which help to improve the stability of the glenohumeral joint?

A

1) Glenohumeral
2) Coracohumeral
3) Transverse humeral

48
Q

What is the coracoacromial arch and what is its function?

A

Made up of the acromion process, the coracoid process and the coracoacromial ligament
Prevents superior displacement of the humerus

49
Q

What is a bursa?

A

A synovial fluid filled sac which reduces friction between tissues of the body

50
Q

What are the 2 bursae of the glenohumeral joint?

A

1) Subscapular bursa

2) Subacromial bursa

51
Q

What is subacromial bursitis and what does it cause?

A

Inflammation of the subacromial bursa, causes pain and limits movement of the joint

52
Q

What can chronic inflammation of the bursa lead to?

A

Can lead to calcification of the bursa, calcific bursitis

53
Q

What is painful arc syndrome?

A

Caused by calcific bursitis
Pain when upper limb is abducted between 50 and 130 degrees
Caused by inflammation usually after excessive use of the glenohumeral joint
Because subacromial bursa is in contact with inferior surface of the acromium at this point

54
Q

What are the 4 rotator cuff muscles?

A

1) Supraspinatus
2) Infraspinatus
3) Teres minor
4) Subscapularis

55
Q

What do the tendons of the rotator cuff muscles do?

A

Act as ligament, keeping the head of the humerus pressed into the glenoid fossa

56
Q

What do the 4 rotator cuff muscles attach to on the head of the humerus?

A

Supraspinatus, Infraspinatus and teres minor attach to the greater tubercle
Subscapularis attaches to the lesser tubercle

57
Q

What is the origin, insertion and innervation of the supraspinatus muscles?

A

Origin - Supraspinous fossa of the scapula
Insertion - Greater tubercle of head of humerus
Innervation - Suprascapular nerve

58
Q

What is the action of the supraspinatus muscle and what is the test for its function?

A

Action: initiates abduction of the arm (first 15 degrees) and stabilizes the glenohumeral joint
Test: Abduct the arm against resistance (from 0 degrees)

59
Q

What is the origin, insertion and innervation of the infraspinatus muscle?

A

Origin: Infraspinous fossa of the scapula
Insertion: Greater tubercle of the head of the humerus
Innervation: Suprascapular nerve

60
Q

What is the action of the infraspinatus muscle and what is the test for its function?

A

Action: Lateral rotator of the humerus and stabilizers the glenohumeral joint
Test: Laterally rotate the arm against resistance

61
Q

What is the origin, insertion and innervation of the teres minor muscle?

A

Origin: Middle part of lateral border of the scapula
Insertion: greater tubercle of the head of the humerus
Innervation: Axillary nerve

62
Q

What is the action of the teres minor muscle and what is the test for its function?

A

Laterally rotates and adducts the humerus (with infraspinatus) and stabilises the glenohumeral joint
Test: Laterally rotate the arm against resistance

63
Q

Which of the rotator cuff muscles are anterior and which are posterior?

A 
Posterior = Supraspinatus, Infraspinatus, Teres Minor
Anterior = subscapularis
64
Q

What is the origin, insertion and innervation of the subscapularis muscle?

A

Origin: Subscapular fossa
Insertion: Lesser tubercle of the head of the humerus
Innervation: Upper and lower subscapular nerves (C5 - 6)

65
Q

What is the action of the subscapularis muscle and what is the test for its action?

A

Action: Medial rotator and adductor of the humerus and stabilises the glenohumeral joint
Test: Place the dorsum of the hand to the mid lumbar spine then lift the dorsum of the hand off the back

66
Q

Does the teres major muscle contribute to the rotator cuff?

A

No

67
Q

What is the origin, insertion and innervation of the teres major?

A

Origin: inferior angle of the scapula
Insertion: Medial lip of intertubercular of humerus
Innervation: Lower subscapular nerve (C5-6)

68
Q

What is the function of the teres major muscle?

A

Adducts and medially rotates the humerus

69
Q

What tendon is most commonly torn in rotator cuff tears?

A

One or more may be torn, supraspinatous tendon is most commonly torn

70
Q

What are the symptoms of a rotator cuff tear?

A

Pain when arm is overhead and weakness

71
Q

What is the test for a rotator cuff tear?

A

Abduct arm fully, lower arm slowly with control and at about 90 degrees the arm will fall suddenly to the side

72
Q

What is the most common cause of dislocation of the glenohumeral joint and who is it most common in?

A

Most often seen in young adults

Usual cause is excessive extension and lateral rotation of the humerus

73
Q

In which direction do 95% of dislocations of the glenohumeral joint occur?

A

Anteroinferior direction as the inferior aspect is the weakest point

74
Q

Why can inferior dislocation of the glenohumeral joint cause damage to the axillary nerve?

A

The axillary nerve passes inferior to the humeral head and winds round the surgical neck of the humerus

75
Q

What 4 things does a patient with a damaged axillary nerve following dislocation of the gelnohumeral joint typically present with?

A

1) Prominent acromion process
2) Flattened shoulder
3) Prominent humeral head (deltoid atrophy as this is supplied by the axillary nerve)
4) Area of anaesthesia on the upper arm as this skin is also supplied by the axillary nerve

76
Q

What are the 4 movements of the glenohumeral joint?

A

1) Flexion and extension
2) Abduction (away) and adduction (back towards)
3) Circumduction
4) Medial and lateral rotation

77
Q

Which muscles are involved in abduction of the upper limb?

A

Supraspinatus initiates the first 15 degrees

Deltoid then takes over and is a powerful abductor at the glenohumeral joint

78
Q

In abduction of the upper limb above 90 degrees muscles other than the supraspinatus and deltoid are involved, what are they and what is there action?

A

Teres minor - laterally rotates the humerus
Trapezius and serratus anterior rotate the scapula laterally
This has to occur as at 90 degrees the humerus and the scapula come into contact

79
Q

If the supraspinatus muscles becomes paralyzed then this can impair abduction, why is this, how does it occur and how can the pt compensate?

A 
Suprascapular nerve (C5,6) innervates the supraspinatus muscle, this can become damaged in a scapula fracture
Supraspinatus is soley responsible for the first 10-15 degrees of abduction, following that the deltoid takes over
Pt can facilitate abduction in this case by leaning to allow gravity to initiate abduction where the supraspinatus cant
80
Q

How can the deltoid muscle become paralysed and what is the consequence of this?

A

Innervated by the axillary nerve C5,6 (terminal branch)
This nerve can be damaged by shoulder dislocation and fracture of the surgical neck of the humerus (because this is what is wraps round)
If the deltoid becomes paralyzed the arm cannot be lifted above 90 degrees

81
Q

What important structures travel through the quadrangular/quadrilateral space? 3

A

1) Axillary nerve

2) Posterior circumflex humeral artery and vein

82
Q

What are the boundaries of the quadrangular/quadrilateral space?

A

Lateral - surgical neck of the humerus
Medial - Long head of triceps brachii (muscle)
Superior - Teres minor
Inferior - Teres major

83
Q

What is quadrangular space syndrome?

A

Transient blockage of the posterior humeral circumflex artery and axillary nerve
Often occurs when the arm lies in a position of abduction, extension and external rotation

84
Q

What symptoms do patients report in quadrangular space syndrome, what is it often associated with and who does it commonly occur in?

A

Symptoms - Shoulder pain and paraesthesia down the arm
Often associated with fibrotic bands in the quadrangular space
Uncommon but most often affects athletes who perform overhead movements eg. tennis

85
Q

What is meant by the term paraesthesia?

A

An abnormal sensation typically prickling or tingling (pins and needles) chiefly caused by pressure or damage to the peripheral nerves

86
Q

What are the attachments and innervation of the deltoid muscle?

A

Origins: Inferior edge of the crest of the spine of the scapula, lateral margin of the acromion, anterior border of the lateral 1/3 of the clavicle
Insertions: Deltoid tuberosity of the humerus
Innervation: Axillary nerve C5,6

87
Q

What are the actions of the anterior and posterior fibres of the deltoid and the deltoid as a whole?

A

Anterior fibres - flexing the arm at the gleno humeral joint
Posterior fibres - extending the arm at the glenohumeral joint
Deltoid as a whole - major abductor of the arm above the initial 15 degrees

Year 2 Term 1 Movement (8 decks)

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