Orthopedic clinical exam (Cleland) Basic Anatomy of TMJ and Shoulder Flashcards
1
Q
TMJ: Ligaments (3)
A
- Temporomandibular
- Sphenomandibular
- Stylomandibular
2
Q
Attachment and function of temporomandibular ligament
A
- Temporomandibular- thickening of anterior joint capsule extending from neck of mandibe to zygomatic arch (strengthens the TMJ laterally)
3
Q
Attachment an function of Sphenomandibular ligament (TMJ)
A
- Sphenoid bone to mandible (serve as a fulcrum and reinforcement to TMJ motion)
4
Q
Attachment and function of Stylomandibular ligament (TMJ)
A
- Styloid process to angle of the mandible
5
Q
Temporalis muscle (TMJ)
A
- Prox- temporal fossa
- Dist- Coronoid process and anterior ramus of mandible
- Nerve and segmental level- Deep temporal branches of mandiular nerve
- Action- Elevate mandible
6
Q
Masseter
A
- Prox- Inferior and medial aspects of zygomatic arch
- Dist- Coronoid process and lateral ramus of mandible
- Nerve and segmental level- Mandibular nerve via masseteric nerve
- Action- Elevate and protrude mandible
7
Q
Medial Pterygoid (TMJ)
A
- Prox- Medial surface of lateral pterygoid plate and tuberosity of maxilla
- Dist- Medial aspect of mandibular ramus
- Nerve and segmental level- Mandibular nerve via medial pterygoid nerve
- Action- Elevate and protrude mandible
8
Q
Lateral Pterygoid (TMJ)
A
- Prox- (Superior head) Lateral surface of greater wing of sphenoid bone/ (Inferior head) Lateral surface of lateral pterygoid plate
- Dist- Neck of mandible, articular disc, and TMJ capsule
- Nerve and segmental level- Mandibular nerve via lateral pterygoid nerve
- Action- Acting bilaterally: protrude and depress mandible. Acting unilaterally: laterally deviate mandible
9
Q
Digastric muscle (TMJ)
A
- Prox- (Anterior belly) Digastric fossa of mandible/ (Posterior belly) Mastoid notch of temporal bone
- Dist- Intermediate tendon of hyoid bone
- Nerve and segmental level- Mylohyoid nerve (anterior) and Facial nerve (posterior)
- Action- Depresses mandible, raises and stabilizes hyoid bone
10
Q
TMJ nerves
A
- Mandibular (motor-temporalis, masseter, lateral and medial pterygoid, digastric, mylohyoid/sensory-skin of inferior third of face)
- Nerve to mylohyoid (motor- mylohyoid/no sensory)
- Buccal (no motor/ sensory-cheek lining of gingiva))
- Lingual (no motor/ sensory- anterior tounge and floor of mouth)
- Maxillary (no motor/ sensory- skin of middle third of face)
- Opthalmic (no motor/ sensory-skin of superior third of face)
11
Q
TMJ Exam History:
Jaw crepitus and pain during mouth opening and closing
A
- OA
- Capsulitis
- Internal derangement consisting of anterior disc displacement without reduction
12
Q
TMJ Exam History:
Patient reports jaw clicking and pain during opening and closing of the mouth
A
- Internal deragement consiting of anterior disc displacement with reduction
13
Q
TMJ Exam History:
Patient reports limited motion to about 20 mm with no joint sounds
A
- Capsulitis
- Internal deragement consiting of an anterior disc displacement without reduction
14
Q
Shoulder joints (4)
A
- Glenohumeral
- Sternoclavicular
- AC
- Scapulothoracic
15
Q
Shoulder:
Closed packed positions
A
- GH- Full abduction and ER
- SC- Arm abducted to 90 degrees
- AC- Arm abducted to 90 degrees
- ST- NA
16
Q
Shoulder:
Capsular Patterns
A
- GH- ER <abd>
</abd><li>SC- NR</li><li>AC- NR</li><li>ST- NR</li>
</abd>
17
Q
Shoulder:
Ligaments (8)
A
- Glenohumeral
- Coracohumeral
- Coracoclavicular (trapezoid & conoid)
- Acromioclavicular
- Coracoacromial
- Sternoclavicular
- Interclavicular
- Costoclavicular
18
Q
Glenohumeral igament (shoulder)
A
- Attach- glenoid labrum of humerus
- Function- reinforce anterior GH joint capsule
19
Q
Coracohumeral ligament (shoulder)
A
- Attach- Corocoid process to greater tubercle of humerus
- Function- strengthen superior glenohumeral joint capsule
20
Q
Coracoclavicular ligament (shoulder)
A
- Attach- (trapezoid) superior aspect of coracoid process to inferior aspect of clavicle/ (conoid) coracoid process to conoid tubercle on inferior clavicle
- Function- Anchor clavicle to corocoid process
21
Q
Acromioclavicular ligament (shoulder)
A
- Attach- acromion to clavicle
- Function- Strengthen AC joint superiorly
22
Q
Coracoacromial ligament (shoulder)
A
- Attach- coracoid process to acromion
- Function- Prevent superior displacement of humeral head
23
Q
Sternoclavicular ligament (shoulder)
A
- Attach- clavicular notch of manubrium to medial base of clavicle anteriorly and posteriorly
- Function- reinforce SC joint anteriorly and posteriorly
24
Q
Costoclavicular ligament (shoulder)
A
- Attach- superior aspect of costal cartilage of 1st rib to inferior border of medial clavicle
- Function- Anchor medial end of clavicle to 1st rib
25
Upper trapezius
26
Middle trapezius
27
Lower trapezius
28
Levator scapulae
29
Rhomboids
30
Latissimus Dorsi
31
Serratus anterior
32
Deltoid
33
Pectoralis Major
34
Pectoralis Minor
35
Supraspinatus
36
Infraspinatus
37
Teres minor
38
Subscapularis
39
Teres major
40
Radial nerve
**Segmental levels**- C5-T1
**Sensory**- Posterior aspect of forearm
**Motor**- Triceps brachii, anconeus, brachioradialis, extensor mm of forearm
41
Ulnar nerve
**Segmental levels-** C7, C8, T1
**Sensory-** Medial hand including medial half of 4th digit
**Motor-** Flexor carpi ulnaris, medial half of flexor digitorum profundus, and most of small muscles in hand
42
Musculocutaneous nerve
**Segmental levels-** C5, C6, C7
**Sensory-** Becomes lateral antebrachial cutaneous nerve
**Motor-** Coracobrahialis, biceps brachii, brachialis
43
Axillary nerve
**Segmental levels-** C5, C6
**Sensory-** Lateral shoulder
**Motor-** Teres minor, deltoid
44
Suprascapular nerve
**Segmental levels-** C4, C5, C6
**Sensory-** No sensory
**Motor-** Supraspinatus, Infraspinatus
45
Dorsal scapular nerve
**Segmental levels-** ventral rami, C4, C5
**Sensory-** No sensory
**Motor-** Rhomboids, levator scapulae
46
Lateral pectoral nerve
**Segmental levels-** C5, C6, C7
**Sensory-** No sensory
**Motor-** Lateral and Medial pectoralis
47
Medial pectoral nerve
**Segmental levels-** C8, T1
**Sensory-** No sensory
**Motor-** Pectoralis minor
48
Long thoracic nerve
**Segmental levels-** Ventral rami, C5, C6, C7
**Sensory-** No sensory
**Motor-** No serratus anterior
49
Upper subscapular nerve
**Segmental levels-** C5, C6
**Sensory-** No sensory
**Motor-** Subscapularis
50
Lower subscapular nerve
**Segmental levels-** C5, C6
**Sensory-** No sensory
**Motor-** Teres major, Lower subscapularis
51
Medial cutaneous nerve of forearm
**Segmental levels-** C8, T1
**Sensory-** Medial arm
**Motor-** No motor
52
**Shoulder exam history:**
Patient reports lateral/anterior shoulder pain with overhead activities or deomonstration of a painful arc
* possible subacromial impingement
* possible tendonitis
* possible bursitis
53
Shoulder exam history:
Patient report of instability, apprehension, and pain with activities most often when shoulder is abducted and externally rotated
* shoulder instability
* possible labral tear if clicking present
54
Shoulder exam history:
Decreased ROM and pain with resistance
* possible rotator cuff or long head of the biceps tendonitis
55
Shoulder exam history:
Patient reports of pain and weakness with muscle loading, night pain, age \>60
* possible rotator cuff tear
56
Shoulder exam history:
Patient complaints of poorly located shoulder pain with occasional radiation into elbow. Pain is usually aggravated by movement and relieved by rest. Age \>45. Females often affected more than males.
* possible adhesive capsulitis
57
Shoulder exam history:
Patient reports of a fall on the shoulder followed by pain over AC joint
* possible AC sprain
58
Shoulder exam history:
Patient complaints of UE heaviness or numbness with prolonged postures and when lying on involved side
* possible TOS
* possible cervical radiculopathy
