Often done for blood collection or intravenous fluid/drug administration Commonly done through the median cubital vein (MCV) MCV connects the basilic vein to the cephalic vein

Lecture 21 - Pectorial Girdle and Shoulder Flashcards by Katherine Nicholls

Upper limb functions

Proximal (larger) muscles position hand - for example bringing closer to body when eating or for when throwing a ball
Note how mobile the upper limb is as compared to the lower limb

Distal (smaller) muscles for fine motor movements

Locomotion - when you are younger this is crawling, as you are older this is for climbing for example

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Upper limb

shoulder
arm
forearm
hand

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Area between shoulder joint and elbow joint is

the arm

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Are between the elbow joint and the wrist joint is

the forearm

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Muscles anterior in the upper limb do

flexion

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Muscles posterior in the upper limb do

extension

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Arteries of the upper limb

Aorta to subclavian to axillary (which passes through the medial part of the arm) to brachial (brachial means arm) and goes through the cubital fossa and the brachial artery divides into 2 to form the radial and ulnar artery

Deep veins run parallel with the arteries, and have the same name as the arteries

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Superificial palmar arch and deep palmar arch

Superficial palmer arch is formed by ulnar artery and superficial branch of radial artery

Deep palmar arch is formed by the radial artery and deep branch of the ulnar artery

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Superficial veins of the upper limb

Located at the superficial fascia

Dorsal venous arch to basilic (on the medial side) to cephalic (runs along lateral part of arm and forearm)

Cephalic and basilic connection at the median cubital vein (blood test common place for it)

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Supinated =

palm up

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Pronated =

palm down

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Venepuncture

Often done for blood collection or intravenous fluid/drug administration
Commonly done through the median cubital vein (MCV)
MCV connects the basilic vein to the cephalic vein

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Pulse locations for upper limb…

Axillary pulse 
Brachial pulse in midarm 
Brachial pulse in the cubital fossa (needs extension of elbow because it means that the tendon moves out of the way, tendon is in the way during flexion) 
Radial pulse in distal forearm 
Ulnar pulse in distal forearm 
Radial pulse in the anatomical snuffbox

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3 Plexuses in the body …

Cervical – supplying the neck
Brachial – supplying upper limb
Lumbosacral – supplying lower limb (lumbar plexus and sacral plexus grouped together)

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Brachial plexus innervates

the upper limb

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Brachial plexus is formed from

the anterior rami of C5-T1 spinal nerves

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Main branches of the brachial plexus

Axillary
Radial
Musculocutaneous
Median
Ulnar

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Axillary branch of brachial plexus

Axillary: supplies deltoid + teres minor

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Radial branch of brachial plexus

Radial: supplies posterior arm and forearm muscles

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Musculocutaneous branch of brachial plexus

Musculocutaneous: supplies biceps
brachii, brachialis, coracobrachialis (BBC)

MC supplies BBC

On the anterior side

Median + Ulnar branch of brachial plexus

Median+Ulnar:supply anterior forearm and hand muscles

Both run on medial side

Median - supplies most of the forearm muscles and some of the hand muscles (runs under the carpal tunnel)

Ulnar - supplies some of the forearm and most of the hand muscles (pinched when you hit your ‘funny bone’

Pectoral girdle made of

scapula and clavicle

Function of the pectoral girdle

Connect axial skeleton to the appendicular skeleton //Attach the upper limb to axial skeleton

Ligaments of the pectoral girdle

Limit movement

Provide stability

Pectoral girdle provides

protection for deep structures - VAN

Sternal end of clavical

medial | attaches to the sternum which is a bone in the middle of the rib cage

Subclavian groove

for muscle called subclavius

Conoid tubercle

For conoid ligament

Trapezoid line

Trapezoid ligament attaches here

Clavicle fracture

* Commonly due to force from falling onto outstretched limb * (usually) Medial fragment is pulled superiorly by sternocleidomastoid (muscle) * Lateral fragment drops because of gravity (may also be pulled medially by pectoralis major)

Glenoid fossa

Comes in contact with the humerus to form the shoulder joint

Subcapsular fossa

For subscapularis | SMooth surface

Superior angle

for levator scapulae | Function of this muscle is to help elevate the scapula

Spine of scapula

splits scapula into 2 regions - supraspinous fosaa and infraspinous fossa

Supraspinous fossa

for supraspinatus | Above spine of scapula

Infraspinous fossa

For infraspinatus | Below the spine of the scapula

Medial border

for rhomboids which is a muscle that is involved with retraction of the scapula

Scapula movement =

Elevation Depression Upward rotation - inferior angle is moving up Downward rotation - moving back to the medial side Protraction - move scapula forward Retraction - move scapula back

When do we protract scapula?

Protraction is when you are moving the scapula forward Push ups, pushing against something/someone you are protracting your scapula

Joints of the pectoral girdle

Sternoclavicular joint

* Saddle synovial joint, allowing biaxial movement (saddle shaped heads allows movement in two different planes) * Has an articular disc Inflammation at this joint will impact on arm movements

Sternoclavicular joint

Synovial joint with a fibrocartilage disc that seperates the joint into 2 compartments

Sternal angle

Important landmark for clinicians

Acromioclavicular joint

* Synovial plane joint, allowing sliding movement * Has an incomplete articular disc * Extrinsic ligaments help stabilize the joint - lots of ligament support - acromioclavicular, coracoclavicular (coronid and trapezoid), coracoacromial Plane joints usually uniaxial permit gliding or sliding movements

Key ligaments of pectoral girdle

Coracoclavicular Acromioclavicular Coracoacromial

Dislocation of the acromioclavicular joint

Common in contact sports (e.g., hockey, martial arts) or fall on shoulders Ligament can rupture

Glenohumeral joint

Synovial ball and socket joint • Head of the humerus • Glenoid fossa of the scapula Wide range of movement - flexion, extension, adduction, abduction, circumduction, medial rotation, lateral rotation Relatively unstable and requires external stabilization from: • Ligaments and muscles • Glenoid labrum ( increases concavity) - helps increase concavity of joint, increase surface area so it can help to stabilise the humerus in this area • Capsule (taut superiorly)

Dislocation of glenohumeral joint

Dislocation mostly happens inferiorly Tends to because ... 1 - Bony structures above humerus (acromion and clavicle, therefore easier to occur inferiorly), tendon of the biceps is also above the humerus 2 - Muscles anteriorly, muscles and bone (scapula) posteriorly 3 - thinner and weaker capsule inferiorly This prevents the humerus from going anteriorly and posteriorly so therefore dislocaiton happens inferiorly