m4: shoulder and elbow Flashcards
● 20 muscles
● 3 bony articulations
● 3 soft tissue moving surface (functional joints)
● Permit the greatest mobility of any joint area found in the body
● 16,000 different positions (hand placement)
● stabilizes the upper extremity for hand motions
● lifts and pushes objects
● elevates the body
● assists with forced respiratory inspirations and expirations
● bears weight when walking with crutches or performing handstands
● Mobility > Stability
shoulder
only bony attachment of UE to trunk.
sternoclavicular joint
primary support and stabilizer of the shoulder
muscles and ligaments
● ___ joint = glenohumeral joint
● Shoulder ___ = all structures which make up the shoulder.
shoulder ; complex
4 bones of shoulder
manubrium
clavicle
scapula
humerus
● Shoulder girdle
○ Manubrium
○ Right and left ____
○ Right and left ____
● ___ girdle (does not have bony connection posteriorly)
clavicles
scapulaes
incomplete
● Clavicular facet
● Sternal/jugular notch
● Facets for attachment of the first ribs
manubrium
● Lateral strut to the scapula and the humerus.
● This increases glenohumeral mobility to permit greater motion in reaching and climbing activities.
● Medial end
● Costal facet
● Costal tuberosity
● Acromial end
clavicle
● a flat, triangular-shaped bone
● 3 sides and 3 angles
● sits against the posterior thorax.
● Lies on the posterior ribs
● Conforms to the upper thorax
● Does not lie in a pure frontal plane
● Inferior angle (T7)
● Vertebral border (medial border)
● Axillary border (lateral border)
● Glenoid fossa (the most lateral aspect of the scapula) ● Supraglenoid tubercle (attachment for LH of biceps) ● Infraglenoid tubercle (attachment for LH of triceps) ● Superior border
● Scapular spine (T3)
● Supraspinatus fossa
● Infraspinatus fossa
● Acromion process
● _____ (crow’s beak)
scapula
coracoid process
● Dense fibrous connective tissue rim that surrounds the glenoid fossa.
● Increase joint congruence.
● Tilted _ ° upward relative to the scapular vertebral border.
● Teardrop or pear-shaped appearance
● Orientation: _ , _ , _
● (Concave)
glenoid labrum
5°
LAS
● Head of humerus
○ Convex
○ 1/3 to 1⁄2 sphere
○ Orientation: _
● Humeral neck (anatomic neck)
● Humeral shaft
● Angle of inclination = humeral head is angled at _° to the long axis of the humeral shaft
● Angle of torsion = _°
● Resting position of the humeral head in posterior rotation relative to the distal condyles of the humerus allows the head to be aligned in the scapular plane while maintaining proper elbow joint alignment; this relative position of posterior rotation = _
● Greater tubercle
● Lesser tubercle
● _ (intertubercular groove)
○ through which the LH of biceps runs from its proximal insertion on the supraglenoid tubercle.
humerus
medial, superior, posterior (PMS)
135
30
Retroversion
Bicipital groove
● Circumferential area on the proximal humerus.
● Distal to the _ _
● Common site for humeral fractures, especially in the elderly, when a fall occurs and the individual lands on an outstretched arm.
surgical neck
bicipital groove
synovial joints of shoulder
● Sternoclavicular joint
● Acromioclavicular joint
● Glenohumeral joint
● Scapulothoracic joint
a joint responsible for the majority of the scapular movement.
sternoclavicular joint
provides minimal movement and acts more as a fine tuner of scapular motion than a producer of its motion.
acromioclavicular joint
the result of sternoclavicular and acromioclavicular joint movements.
scapulothoracic motions
Shoulder Girdle Movements
● Elevation
● Depression
● Protraction
● Retraction
● Upward Rotation
● Downward Rotation ● Scapular Tilting
○ A-P
○ M-L
● The only joint that acts as a strut to connect the upper extremity directly with the axial skeleton.
● Medial end of the clavicle connects with the manubrium of the sternum and the medial first rib.
sternoclavicular joints
_____ has
○
○ 3 strong stabilizing ligaments
1
2
3
sternoclavicular joint ligaments
Fibrocartilaginous articular disc
anterior SC ligament
posterior SC ligament
superior SC ligament
2 Coracoclavicular Ligaments
● Conoid
● Trapezoid
____ Joint
● Plane synovial joint
● 3 DOF
○ Elevation/Depression
○ Abduction/Adduction
○ UR/DR
● Medial margin of the acromion and the lateral end of the clavicle
● Lined with fibrocartilage
● Superior AC ligament
● Inferior AC ligament
Acromioclavicular
● no bony articulations
● False joint/pseudo joint/functional joint
● Separating the scapula from the thorax are soft tissue structures, including a large subscapular bursa.
scapulothoracic joint
● Increasing the range of motion of the shoulder to provide greater reach
● Maintaining favorable length-tension relationships for the deltoid muscle to function above _ ° of glenohumeral elevation to allow better shoulder joint stability throughout a greater motion
● Providing glenohumeral stability through maintained glenoid and humeral head alignment for work in the overhead position
● Providing for injury prevention through shock absorption of forces applied to the outstretched
scapulothoracic function
90
● Shoulder joint
● Ball-and-socket
● 3 DOF
● Little bony stability
○ Convex:
○ Concave:
● Labrum
○ From neck of glenoid
○ To anatomic neck of humerus
● 10 to 15 mL
● Axillary pouch
Glenohumeral Joint
Humeral head (PMS)
Glenoid fossa (small/shallow) (LAS)
● Ligaments and tendons blend with and reinforce the glenohumeral joint capsule for added stability.
○ Coracohumeral ligament
○ Superior, Middle, Inferior GH ligament
Capsular Reinforcement (GH)
● coracoid process of the scapula → greater and lesser tubercles of the humerus
● where it forms a tunnel for the tendon of the long head of the biceps brachii.
Coracohumeral Ligament
● Capsular ligaments
● From the glenoid and its labrum, form capsular thickenings, and attach to the humeral neck and lesser tubercle.
Superior, Middle and Inferior GH Ligaments
● Support the dependent (hanging down) arm and limit lateral rotation in the lower ranges of abduction
Coracohumeral, Superior and Middle GH Ligaments
● Forms a hammock-like sling with anterior and posterior bands around the lower portion of the humeral head and is part of the axillary pouch.
● Main stabilizer of the abducted shoulder
Inferior Glenohumeral Ligament
Deep Muscles of the Shoulder
1.
2.
3.
● Tendon of the LH biceps brachii
○ Intra-articular and extrasynovial
● LH of triceps brachii
○ Blends with posterior capsule
● Tendons of 4 short rotator cuff muscles (S IT S)
● anterior acromion → lateral coracoid process
● osteoligamentous arch
● roof of the glenohumeral joint
Coracoacromial Arch
Subacromial Space
● Contains:
○
○
○
○
○ supraspinatus muscle and tendon,
○ long head of the biceps tendon
○ subacromial bursa
○ superior capsule
● Area under the coracoacromial
● Formed by the neck of the scapula, the acromion process, the rigid coracoacromial ligament, and the coracoid process
Supraspinatus Outlet
reduces friction between two structures.
● 8 bursae within the shoulder area
○ Subacromial bursa
○ Subdeltoid bursa
bursa
● Scapular plane glenohumeral abduction
● Occurs _ ° to _° anterior to the frontal plane
scaption
30 & 40
● LH of biceps tendon
● Retained by the coracohumeral ligament and by the transverse humeral ligament
bicipital groove
● They found that the early phase of abduction was individually variable.
● This early stage of motion was termed the “____.” After about 30° of abduction, a 2:1 ratio occurred: For every 2° of glenohumeral motion, 1° occurred at the scapulothoracic joint.
Scapulohumeral Rhythm
setting phase
5 Scapular Stabilizers of the Shoulder Complex
● Serratus anterior
● Trapezius
● Rhomboids major and minor
● Pectoralis minor ● Levator scapulae
● Primary scapular protractor
● “saw muscle”
● lowest five digitations is the strongest portion of the muscle
● XXX: ___ winging of the scapula
Serratus Anterior
medial
● superficial muscle of the neck and upper back
● “Shawl” muscle or “musculus cucullaris”
● Full abduction with scapular rot: All fibers
○ Mid = ret
○ Upper and Lower = upward
rot.
● XXX: ___ winging of the scapula
○ Elevation is limited to \ degrees (only by GH)
Trapezius
lateral
120
● connect the scapula with the vertebral column lie under the trapezius.
● The more cranial portion is known as rhomboid ____
● The larger, more caudal portion is the rhomboid ____
● XXX: scapula in protracted position
● scapula positioned farther laterally from the thoracic spinous processes
● than the normal 6 cm from the thoracic spinous processes
rhomboid major and minor
cranial- minor
caudal- major
● located anteriorly on the upper chest by the pectoralis major.
● XXX: Weakness of this muscle results in reduced strength during scapular depression and downward rotation of the scapula against resistance.
Pectoralis Minor
● An elevator of the scapula, an action it shares with the upper trapezius and with the rhomboids.
● Elevation + DR
● XXX: reduced ability to elevate and downwardly rotate the scapula.
Levator Scapulae
5 Glenohumeral Stabilizing Muscles in the
Shoulder
● Rotator Cuff
● Biceps brachii
● Triceps brachii
● Teres major
● Coracobrachialis
○ provide glenohumeral stability as well as glenohumeral motion.
Rotator cuff
● located above the spine of the scapula.
● capable of performing the total motion of abduction without the assistance of the deltoid.
Supraspinatus
● Infraspinatus @ ____
● Teres minor @ ____
● External rotators of the shoulder
● Different innervations
Infraspinatus and Teres Minor
infra @ infraspinatus fossa
tm @ lateral border of the scapula
● located on the anterior scapula.
● ___ = primary medial rotation function
● But can also flex, extend, adduct, or abduct the glenohumeral joint
Subscapularis
IR =
● Lies distal to the teres minor on the lateral scapula border
● It acts in most pulling activities when the the shoulder is extended or adducted against resistance.
Teres Major
2 muscles that also stabilize the GH joint
Biceps Brachii and Triceps Brachii