M Upper limb 1 - The shoulder Flashcards
What is the forearm?
elbow to wrist
What is the arm?
shoulder to elbow
What is the role of the sternoclavicular joint?
attaching the heavy upper limb to the rest of the body
Where do you take blood?
cubital fossa
What is the glenoid fossa a part of?
flat part of scapula
What are the 2 components of the shoulder?
- Pectoral girdle
2. Shoulder joint
What makes up the pectoral girdle?
Clavicle and the scapula (shoulder blade)
What makes up the shoulder joint?
glenohumeral joint
Where is the glenohumeral joint?
between glenoid fossa and head of humerus
What does the pectoral girdle do?
hold the upper limb and attaches it to the rest of the body
What are the important joints of the pectoral girdle?
- acromioclavicular joint
2. sternoclavicular joint
How is stability of the pectoral girdle maintained? (4)
muscles 1. rhomboids - major and minor 2, levator scapulae 3. trapezius 4. serratus anterior
What are the three movements of the pectoral girdle?
- elevation/ depression
- protraction/retraction
- abduction/ adduction
What muscles are involved in elevation/depression? (5)
- trapezius
- levator scapulae
- rhomboids
- pec major
- latissimus dorsi
What muscles are involved in protraction and retraction? (4)
- trapezius - inferior
- serratus anterior
- pec major
- pec minor
What muscles are involved in abduction and adduction? (1)
- trapezius - middle
GRAVITY
What is winged scapula?
happens when the long thoracic nerve which innervates the serratus anterior is damaged.
Serratus anteiror is paralysed and the scapula sticks out
This is because the role of the serratus anterior is to hold the scapula in place.
Where does the long thoracic nerve come from?
brachial plexus
What can cause winged scapula? (3)
- penetrating injuries
- iatrogenic
- neuritis
What type of joint is the glenohumeral (shoulder) joint?
ball and socket joint
between head of humerus and glenoid fossa of scapula
What helps the stability of the joint? (4)
- glenoid labrum
- ligaments
- biceps tendon
- rotator cuff muscles
Where is the glenohumeral joint weakest?
inferiorly
Why is the glenohumeral joint prone to dislocation?
only in contact with 1/3 of humerus therefore unstable
incongruency
What are the ligaments of the glenohumeral joint? (3)
- glenohumeral - sup, mid and inf
- coracohumeral
- transverse humeral
What is the coraco-acromial arch made up of?
- acromion
- coracoid process
- coracoacromial ligament
What does the coraco-acromial arch prevent?
superior displacement of the humerus
What are the bursae of the glenohumeral joint? (2)
- subscapular
2. subacromial
What is calcific bursitis?
When inflammation of the bursa leads to calcification of the bursa
Which bursa of the glenohumeral joint is commonly affected?
subacromial
subacromial bursitis
What age group and gender does calcific bursitis develop in?
males
over 50 yrs
What is a key sign of calcific bursitis?
painful arch syndrome
What is painful arch syndrome and when with the pain disappear?
pain during 50-130 degrees of abduction
abduction after 130 degrees - pain will disappear
What are the rotator cuff muscles? (4)
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
What do the tendons of the rotator cuff muscles act as?
ligament - keeping the head of the humerus pressed into the glenoid fossa
What tendon is most commonly torn in rotator cuff tears?
supraspinatous tendon
What is the symptom of the rotator cuff tear?
- pain and weakness when arm is overhead
2. supraspinatous damage - can’t initiate fist 15 degrees
What is the test for rotator cuff tear and which muscle does it mainly test for?
- abduct arm fully
- lower arm slowly with control
Supraspinatus
If damaged will fall suddenly to the side at 90 degrees
Which age group is dislocation of the glenohumeral joint most commonly seen in?
young adults
What is the most usual cause of a glenohumeral joint dislocation and why is the case? (2)
- excessive extension
- lateral rotation
both of humerus
due to inferior instability
Where does the axillary nerve wrap around?
surgical neck of humerus
What nerve can inferior dislocation of the gelnohumeral joint damage?
axillary - 3% of people
How does a patient with damage to the axillary nerve present? (2)
- atrophy of deltoid muscle
2. anaesthesia of deltoid muscle
What nerves make up the brachial plexus? (5)
- musculocutaneous
- median
- ulnar
- axillary
- radial
What is the nerve root of musculocutaneous nerve?
C5-C7
What is the nerve root of median nerve?
C6-T1
What is the nerve root of ulnar nerve?
C7-T1
What is the nerve root of axillary nerve?
C5-C6
What is the nerve root of radial nerve?
C5-T1
What is the movement of the shoulder joint?
- flexion/extension
- medial/lateral rotation
- circumduction - flexion/extension/adduction/abduction
- adduction/abduction
What muscle initiates abduction?
supraspinatous
first 15 degrees
What takes over the supraspinatous after the initiation of abduction?
deltoid
What is a powerful abductor of the shoulder joint?
deltoid
What can cause impairments of abduction?
paralysed supraspinatus and deltoid
What causes the supraspinatus to be paralysed?
damage to subscapular nerve (C5,6)
in scapular fracture
What causes the deltoid o be paralysed?
damage to axillary nerve (C5,6)
shoulder dislocation or fracture of surgical neck of humerus
what are the boundaries of the quadrangular space?
lateral - surgical neck of humerus
medial - long head of triceps brachia
inferior - trees major
superior - teres minor
What are the contents of the quadrangular space?
axillary nerve
posterior circumflex artery and vein
What is quadrangular space syndrome?
transient blockage of the posterior humeral circumflex artery and axillary nerve
At what position does quadrangular space syndrome occur at?
- abduction
- extension
- external rotation
What symptoms do the patients experience in quadrangular space syndrome?
- shoulder pain
2. parasthesia - down arm
What is quadrangular space syndrome often associated with?
fibrotic bands develop in quadrangular space
compress posterior circumflex artery and axillary nerve
Who does quadrangular space syndrome often affect?
atheletes who perform overhead movements
Tennis players