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ESA2 > MSK - Clinical Arm Shoulder > Flashcards

MSK - Clinical Arm Shoulder Flashcards

1
Q

What could be injured with a stab wound to the axilla?

A 
Artery
Vein
Lymph
Nerves - brachial plexus
Lymph nodes
Biceps brachia and coracobreachialis muscle
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2
Q

Which is easier to tell on an X-ray anterior or posterior dislocated shoulder?

A

Anterior

Posterior may need CT

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3
Q

Why are some clavicle fractures displaced inferomedially? What is the worry with this?

A

Inferior due to weight of arm
Medially displaced lateral segment due to action of pectoralis major

Damage to axilla - e.g. upper brachial plexus injury and Erbs palsy

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4
Q

What might cause injury to the upper brachial plexus and what symptoms/clinical signs? Which nerve and roots?

A

Clavicle fracture or squashed baby from birth canal
Erbs palsy

C5 C6 axillary nerve

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5
Q

What might cause injury to the lower brachial plexus and what is the symptoms clinical signs? Which nerve(s) and roots?

A

Falling from a tree

Klumskis palsy - claw like a monkey - due to ulna and sometimes median damage C8-T1

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6
Q

How is abduction achieved of the shoulder?

A

First 15 degrees by supraspinatus

15- 90 by middle fibres of deltoid helped by supraspinatus

Above 90 degrees scapular needs to be rotated by trapezius and serrates anterior

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7
Q

What do the supra scapular nerves innervate and why is this relevant in a clavicle fracture?

A

Supra scapular nerves do the lateral rotator muscles

So damage to these may cause medial rotation - waiters tip

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8
Q

What is the arms best supinator?

A

Biceps brachii

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9
Q

What are the three muscles in the arm supplied by the musculocutaneous nerve

A

BBC

Brachialis
Biceps brachii
Coracobrachialis

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10
Q

What is the function of these three muscles BBC

A

Biceps brachii - supinates, flexion of arm at shoulder and elbow

Brachialis - flexion of arm at elbow

Coracobrachialis - Flexion of arm at shoulder and wear adduction as attaches to coracoid process of the scapula.

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11
Q

What muscle in the arm are inverted by the radial nerve?

A

Triceps brachii

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12
Q

What is the functions of triceps brachii?

A

Extension of the arm at the elbow

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13
Q

What are the two muscles in the arm innervated by the axillary nerve?

A

Teres minor - lateral (external) rotation of the arm at the shoulder

Deltoid - 15-90 degree abduction (middle) Posterior extension
Anterior flexion

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14
Q

How many deltoids are there? What do they do?

A

3
Anterior - flexes the arm at the shoulder
Middle - abduction of the shoulder
Posterior - extends the arm at the shoulder

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15
Q

What are the 4 rotator cuff muscles?

A

SITS

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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16
Q

What are the 6 intrinsic muscles of the shoulder (from scapular and/or clavicle and attach to humerus)

A

1) Infraspinatus
2) Supraspinatus
3) Subscapularis
4) Teres minor
5) Teres Major
6) Deltoids

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17
Q

What are the 4 extrinsic muscles of the shoulder?

A

1) Trapezius
2) Latissimus dorsi
3) Levator scapulae
4) Rhomboids - major/minor

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18
Q

What do the subscapular and suprascapular nerves supply?

A

Subscapular

  • Lower - subscapularis
  • Upper subsapularis and theres major

Suprascapular - infraspinatus supraspinatus

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19
Q

What is the resting function of the rotator cuff muscles?

A

Their resting tone helps pull the humeral head into the glenoid fossa

20
Q

What is the glenoid fossa?

A

Shallow depression in the scapular where the humerus can fit

21
Q

What injuries can occur with the rotator cuffs?

A
  • Tendonitis - most commonly the supraspinatus tendon due to repetitive overhead movements.
  • Rotator cuff tears - either acute or degenerative.
22
Q

What are the signs that you might have a rotator cuff tear?

A

Impingement signs, weak internal rotation, weak external rotation and external rotation lag

23
Q

What artery are you worried about in a humeral neck vs humeral shaft fracture?

A

Head - posterior circumflex artery (comes off radial)

Shaft - Radial - profunda brachii

24
Q

What are the 5 distinguishing features of a synovial joint?

A

1) Articular cartilage
2) Synovial membrane
3) Synovial fluid
4) Articular (fibrous) capsule
5) Joint cavity

25
Q

What are the 4 joints of the shoulder/upper limb?

A

Glenohumeral
Sternoclavicular
Acromioclavicular
Scapulothoracic

26
Q

What type of joint is the sternoclavicular and between what bones?

A

Synovial

Between the clavicle and the manubrium of the sternum

27
Q

What is calcific supraspinatus tendonitis? What can you get with it? Why could an Xray be normal after a few weeks?

A

Deposits of calcium hydroxyapatite crystals between the humeral head and the acromium

Can get impingement in subacromial space - 10/10 pain - normally resolves and gets absorbed by white cells so good give normal Xray

28
Q

What is the role of the ligaments of the shoulder?

A

Stabilise the bones

29
Q

What are the 4 major ligaments - which one prevents superior displacement of the humeral head?

A

Coracohumeral
Coracoacromial
Transverse humeral ligament (between two tubercles of the humerus)
Glenohumeral

The corachoachromial ligament is the corachoachromial arch that prevents superior displacement of the humeral head.

30
Q

What is a ‘popeye’ arm a clinical feature of?

A

Long head of biceps brachii rupture

Long head goes to the supraglenoid tubercle of the scapula

31
Q

Where does the short head of the biceps brachii go

A

To the coracoid process of the scapula

32
Q

Which two muscles go through the axilla?

A

Biceps brachi

Coracobrachialis

33
Q

What is the space between the two tubercles on the humerus called and why?

A

Bicipital groove as the tendon of the long head of the biceps brachii runs here.

34
Q

Where does the levator scapulae originate and insert into? What’s its role?

A

from transverse process of C1-C14 to the medial border of the scapula.

Elevates the scapula

35
Q

Which 3 muscles attach to and which tendon runs through the intertubecular groove of the humerus

A

Biceps brachii long arm runs through the bicipital groove

Teres major and Pectoralis major attach to either lip of the bicipital groove and the latissimus doors tendon attaches to the bicipital groove

36
Q

Which muscles insert into the the greater tubercle of the humerus?

A

Infraspinatus
Supraspinatus
Teres minor

37
Q

Which muscles inset into the less tubercle of the humerus?

A

Subscapularis

38
Q

Where do the deltoids originate and insert into?

A

Originate from the scapula and the clavicle and insert in to the deltoid tuberosity of the humerus

39
Q

Where does the serratus anterior originate and insert into? What is the role (2)?

A

From ribs 1-8 to the medial aspect of the anterior scapular.

They rotate the scapula allowing the arm to be raised over 90 degrees and it also holds the scapula against the ribcage

40
Q

Name 5 muscles that move the scapula

A 
Trapezius
Latissimus dorsi 
Levator scapulae 
Rhomboids
Pectoralis minor
41
Q

What are the functions of the three different fibre types of the trapezius?

A

Upper - elevate scapula and rotate during abduction of the arm

Middle - Retract scapula (backwards towards midline)

Lower - pulls scapula interiorly e.g. if you were carrying heavy bags and your shoulders move down.

42
Q

Where does the trapezius originate from and insert?

A

Originates from the nuchal ligament, skull and spinous processes of C1-T12

Insert into the clavicle, scapula spine, and acromion

43
Q

What are the functions of the latissimus dorsi?

A

Extends adducts and medially rotates the arm.

44
Q

Which muscle rotates the gelnoid cavity upwards? And which downwards?

A

Upwards - upper fibres of the trapezius

Downwards - rhomboids

45
Q

What is the origin and insertion of the rhomboids? is major or minor above? What is their function?

A

Minor is above

Originate from C7-T5
Insert into the medial border of the scapula

Rotate and retract the scapula

ESA2 (37 decks)

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