Lecture 5--shoulder Arthrology Flashcards
Is the only articulation between the upper limb and axial skeleton
Sc joint
Movements of the shoulder include what joints
Ac joint
Sc joint
Scapulothoracic joint–muscular attachment at the scapula and clavicle to the axial skeleton. It’s a physiological joint not anatomical.
GH joint
The sc joint is a ___ joint
Saddle
What are the ligaments of the sc joint
Inter clavicular ligament,
costoclavicular ligament
Anterior and posterior sternal clavicular ligament
Where the jugular notch sits is the ____. It’s where the superior aspect of the sternal end of one clavicle meets with the superior aspect of the sternal end of the other.
Interclavicular ligament
The Interclavicular ligament strengthens the capsule of the joints ____
Superiorly
____ restrains anterior/posterior movement of the sc joint.
Anterior and posterior sternoclavicular ligaments.
____ inferior surface to the sternal end of the clavicle connected to the upper surface of the 1st rib and costal cartilage.
Costoclavicular ligament
____is one degree stabilizing structure of the sc joint! limiting extremation of all clavicular motion except depression. It is the primary stabilizing structure.
Costoclavicular ligament
Clavicular movements at the ac and sc joints are associated with the
Scapula
The ac joint is a ____ type joint
Plane
A ____ is at the ac joint
Fibrocargilagenous disc
Ligaments of the ac joint
Acromioclavicular ligament
Coracoclavicular ligament
Attaches the acromion of the scapula to the acromial end of the clavicle.
Acromioclavicular ligament
____ strengthens the clavicle superiorly
Acromioclavicular joint
____ consists of two ligaments the conoid and the trapezoid
Coracoclavicular ligament
Attaches the coracoid process of scapula to the inferior surface of the acromial end of the clavicle. It anchors the clavicle to the scapula, maintaining integrity at the ac joint.
Coracoclavicular ligament
What is the function of the st joint
Orientation of the glenoid fossa of the scapula
What type of joint is the GH joint
Ball and socket
Where are the apertures of the GH joint
Between the tubercles of the humerus and inferior to the coracoid process of the scapula. There are two apertures.
What are the ligaments of the GH joint
GH ligament
Glenoid labrum
Coracohuneral ligament
Coracromial arch
Three fibrous bands: superior middle and inferior. They are integrated into the joint capsule.
GH ligaments
Strong broad band. Attaches the base of the coracoid process to the greater tubercle of the humerus.
Coracohuneral ligament
Restrains the inferior and posterior translation in the adducted arm
Coracohuneral ligament
____ is extrinsic to the GH joint. It’s formed by the inferior surface of the acromial and the coracoid process, with the coracromial ligament running between them.
Coracromial arch
____ tendon passes under the arch
Supraspinatus tendon
____prevents superior displacement of the humerus
Coracromial arch
Flexion or abduction occur simultaneously with
Scapular upward rotation
What could limit the motion of scapular upward rotation
Weak serratus or traps
What are the bursa of the scapula called
Subscapular bursa
Sub acromial bursa
____located between the tendon of the subscapulairs and the neck of the scapula. Protects the tendon where it passes beneath the coracoid process and over the neck of the scapula. It communicates with the joint cavity.
Subscapular bursa
____ located inferior to the acromion and the coracromial ligament, between them and the supraspinatus. It facilitates the movement of the supraspinatus tendon under the arch and the deltoid tendon over the capsule over the GH joint and the greater tubercle of the humerus.
Subacromial bursa
How is the GH joint nOrmally dislocated
In an anterior inferior direction
What are the compartments of the arm
They come about through the anterior and posterior compartments by the humerus and medial and lateral intermuscular septa.
Anterior and posterior compartments
What’s in the anterior compartment of the arm
They come about through the anterior and posterior compartments by the humerus and medial and lateral intermuscular septa.
Anterior contents: has a lot of vascular and neural elements. Has elbow flexors, brachial artery, musculocutaneous nerve, median (nothing in the arm, just passing), medial brachial cutaneous (nothing in the arm), and radial nerve (passes through proximally and into distally). The axillary nerve before it goes into the quadrangular space. It’s anterior before it goes posterior.
What’s in the posterior compartment of the arm
Elbow extensor muscles
Profunda brachii artery (passes distally–goes behind the medial epicondyle so it has to pass posteriorly), axillary nerve and radial nerve.
What is the articular disc of the distal radio ulnar joint called in the clinic
Triangular Fibrocartilage complex or TFCC
Where is the supinator crest and fossa located
Lateral side of ulna
What is the fracture of the radius or ulna after 50 referred to
Colles fracture–distal radial fracture from falling on an outstretched hand.
What is the rule for the anterior compartment
All of the muscles of the anterior compartment of the arm are supplied by the musculocutaneous nerve!
Where is the long head of the biceps located
Long head is lateral
What is the major elbow flexor that is usually active always
Brachialis muscle
Rule for the posterior compartment of the arm
All muscles are supplied by the radial nerve!
What runs in the radial groove of the humerus
Radial nerve and profunda brachii artery.
What is the triceps reflex
C7 and c 8
Origin of the brachial artery
Continuation of the axillary artery at the inferior border of the teres major.
Course of the brachial artery
Lies anterior To the triceps and Brachialis and medial to and then anterior to the humerus. As it passes inferolaterally, it accompanies the median nerve. It ends in the cubital fossa by dividing into the radial and ulnar arteries.
Mid humeral fractures out what at risk
Radial nerve
Distal humeral fractures put what at risk
Median nerve
Medial epicondyle fractures out what at risk
Ulnar nerve
What are the branches of the brachial artery
Arising from the medial aspect:
Profunda brachii
Superior ulnar collateral
Inferior ulnar collatoral
Enters the posterior compartment of the arm with the radial nerve and passes the triangular internal and courses the radial groove of the humerus. Inferolaterally on the posterior surface of the medial head of the triceps, giving off the ascending branch.
Profunda brachii artery
Arises near the middle of the arm and accompanies the ulnar nerve posterior to the medial epicondyle of the humerus.
Superior ulnar collatoral
Arises proximal to the elbow joint
Inferior ulnar collatoral
Arterial articular anastomoses can be used to bypass a blockage. Arterial communications around the elbow between what vessels can occur
Radial collateral artery
Middle collateral artery–goes posterior
Superior ulnar collateral artery–posterior
Inferior ulnar collatoral–anterior
Ulnar, interosseous, and radial recurrent arteries.
Where is most of the venal puncture done
Median cubital vein
Is a lateral branch of the 2nd intercostal nerve. It communicates with the medial brachial cutaneous nerve.
Intercostobrachial, t1 or t2 nerve
Distribution of the intercostobrachial nerve
Sensory to the medial aspect of the arm.
Musculocutaneous nerve is motor to
Anterior arm
Initially runs on the lateral side of the brachial artery until it reaches the. Idle of the arm where it crosses to the medial side and contacts the brachialis, it descends through the cubital fossa. No sensory in the arm
Median nerve
Initially runs parallel to the median nerve with the brachial artery and vein between them. At the middle of the arm it pierces the intermuscular septum to continue its course in the posterior compartment. Supplies nothing I’m the arm
Ulnar nerve
Runs along the medial side of the axillary and brachial veins. Communicates with the intercostobrachial nerve. Sensory to the medial aspect of the arm
Medial brachial cutaneous nerve
Initially runs with the ulnar nerve and then goes superficial and enters subcutaneous tissue. No distribution in the arm.
Medial antebrachial cutaneous
Passes to the posterior aspect of the arm through the quadrangular space with the posterior circumflex humeral artery. Winds around the surgical neck of the humerus. Superiolateral aspect for sensory.
Axillary nerve
Runs with the profunda brachii in the radial groove. However, it pierces the lateral intermuscular septa and then sits anterior between the Brachialis and brachioradialis.
Radial nerve
Sensory to the posterior aspect and inferolateral aspect of the arm.
Radial nerve
Posterior cutaneous nerve and inferior lateral cutaneous nerve
What does a dislocated humeral joint or surgical neck fracture injure
Axillary nerve
Mid humeral fracture injures
Radial nerve
Fracture at medial epicondyle injures
Ulnar nerve
Distal humerus fracture injures
Median nerve
When does claw hand happen
When you have lower brachial plexus problem or from the ulnar nerve being injured.
Injury to mid humerus and radial nerve gives
Wrist drop
What causes hand of benediction
No flexion in the first second and third digits. This is a median nerve injury.
What would happen if axillary nerve got injured from a dislocation and or surgical neck fracture
Teres minor and deltoid would have sensory and motor loss.
Borders of the triangular interval of the arm
Superior–teres major
Lateral–lateral head of triceps brachii
Medial–long head of the triceps brachii
Contents of the triangular interval
Radial nerve and the profunda brachii artery.
Describe the brachial fascia
It is continuous superiorly with the pectoral and axillary fascia. The medial and lateral intermuscular septa extend from the deep surfaces to the supracondylar ridges of the humerus. It is attached inferiorly to the epicondyles of the humerus and the olecranon of the ulna. It then becomes continuous with the deep fascia of the forearm (antebrachial fascia).
