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Yr 2 - Movement > Pectoral Girdle and Shoulder > Flashcards

Pectoral Girdle and Shoulder Flashcards

1
Q

What are the 4 anatomical regions of the upper limb?

A
  1. Shoulder (pectoral) 2. Arm 3. Forearm 4. Hand
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2
Q

What are the 3 large joints in the UL?

A

Shoulder, elbow, wrist

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3
Q

What are the 3 ‘spaces’ / neurovascular regions in the UL?

A
  1. Axilla (armpit) 2. Cubital fossa (anterior to elbow) 3. Carpal tunnel (wrist/hand)
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4
Q

What region in the UL is often used in venepuncture?

A

Cubital fossa

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5
Q

What is the most commonly dislocated joint in the body?

A

Shoulder

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6
Q

What 2 bones does the ‘pectoral girdle’ refer to?

A
  1. Clavicle (collar bone)
  2. Scapula (shoulder blade)
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7
Q

What does the pectoral girdle connect the upper limb to?

A

The thorax (axial skeleton)

  • Clavicle attached to sternum (sternoclavicular joint)
  • Scapula anchored to posterior chest wall by muscles and soft tissues
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8
Q

What does the head of the humerus articulate with? What is this called?

A

Proximal part of the humerus articulates with a socket on the scapula called the glenoid fossa

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9
Q

What is the joint between the glenoid fossa and the humerus called?

A

The glenohumeral joint

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10
Q

How is the UL securely anchored to the thorax?

A

Via the glenohumeral joint

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11
Q

What are the borders and angles of the anterior surface of the scapula?

A
  1. Superior border
  2. Medial border
  3. Lateral border
  4. Superior angle
  5. Inferior angle
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12
Q

What is the coracoid process?

A

An attachment point on scapula for several muscles of the UL

Projects anteriorly

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13
Q

When looking at the scapula from its anterior surface, does the coracoid process project anteriorly or posteriorly? Does the acromion project anteriorly or posteriorly?

A

Coracoid process –> anteriorly

Acromion –> posteriorly

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14
Q

What is the subscapular fossa?

A

Anterior surface of scapula –> hollowed out middle bit

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15
Q

Posterior view of scapula

A
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16
Q

What feature majorly marks the posterior surface of the scapula?

A

Spine of scapula

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17
Q

What is the spine of the scapula continuous with? What does it divide the posterior surface of the scapula into?

A

Acromion

Divides it into 2 regions: smaller region above and larger region below

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18
Q

What is the region above the spine of the scapula called?

A

Supraspinous fossa (hollow)

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19
Q

What is the region below the spine of the scapula called?

A

Infraspinous fossa

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20
Q

Lateral view of scapula

A
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21
Q

Anterior view of glenohumeral joint

A

(bones have been separated)

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22
Q

What is the ‘anatomical neck’ of the humerus?

A

Separates the head of the humerus from tubercles

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23
Q

Name the highlighted bony landmark

A

Glenoid fossa

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24
Q

Name the highlighted bony landmark

A

Coricoid process

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25
Q

Name the highlighted bony landmark

A

Acromion

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26
Q

Which part of the humerus articulates with the glenoid fossa?

A

Head of humerus

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27
Q

How is the head of the humerus separated from the tubercles?

A

By the anatomical neck

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28
Q

What 2 tubercles are found on the proximal humerus?

A

Greater & lesser tubercles

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29
Q

Describe the greater tubercle

A
  • Located laterally on humerus and has anterior and posterior surfaces
  • Attachment site of 3 of the rotator cuff muscles
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30
Q

Name the highlighted bony landmark

A

Greater tubercle

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31
Q

Describe the lesser tubercle

A
  • Anterior to greater tubercle (located more medially) with only an anterior surface
  • Attachment site for last rotator cuff muscle
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32
Q

Name the highlighted bony landmark

A

Lesser tubercle

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33
Q

What is the ‘surgical neck’ of the humerus?

A

Region where head blends down to shaft of bone

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34
Q

Why is surgical neck an important landmark?

A

Is commonly fractured

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35
Q

Name the highlighted bony landmark

A

Spine of scapula

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36
Q

Name the highlighted bony landmark

A

Supraspinous fossa

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37
Q

Name it

A

Infraspinous fossa

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38
Q

Name

A

Anatomical neck

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39
Q

Name

A

Posterior aspect of greater tubercle

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40
Q

Posterior view of humerus

A
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41
Q

What type of joint is the shoulder joint? Is it a good fit?

A

Ball and socket joint but glenoid cavity is shallow so joint surfacesare poor fit –> ‘incongruent’

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42
Q

What is it called in anatomy when joints aren’t a good fit?

A

Incongruent

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43
Q

What is advantages to compromised stability of shoulder joint?

A

Increased range of movement

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44
Q

What features act to increase stability at shoulder joint?

A
  1. Surronding muscles
  2. Tendon of biceps
  3. Glenoid labrum - a rim of cartilage around the edge of the glenoid which deepens the glenoid fossa (improves fit for humoral head)
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45
Q

What are the movements of the scapula?

A
  1. Protraction (forward) –> putting your arm out in front of you (e.g. pushing open a door)
  2. Retraction (backward) –> ‘squaring the shoulders’
  3. Elevation (shrugging) and depression
  4. Rotation –> this moves the scapula so that the inferior angle is pointed either more medially or more laterally
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46
Q

Describe the origin and insertion of pectoralis major?

A

2 parts of pec major: clavicular and sternocostal parts

Clavicular part: originates from anterior surface of medial half of clavicle

Sternocostal part: originates from the anterior surface of sternum and the anterior aspects of the costal cartilages of ribs 1-6

Inserts: Both clavicular and sternocostal parts have same insertion point –> inserts on the (bicipital groove and deltoid tuberosity of the) humerus

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47
Q

What movement does the pectoralis major allow?

A

Adduction and medial rotation of shoulder by pulling humerus

  1. Flexion of humerus (e.g. throwing ball underhand)
  2. Adduction of humerus (e.g. flapping arms)
  3. Rotates humerus medially (e.g. arm wrestling)

Also keeps arm attached to trunk of body

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48
Q

What is the origin and insertion of the pectoralis minor?

A

Origin: ribs 3-5 (anterior surface)

Inserts: on coracoid process of scapula

I.e. ribs to shoulder

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49
Q

What movement does the pectoralis minor allow?

A

Stabilises the scapula and assists in protraction by contracting and pulling on attachment at coracoid process

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50
Q

Origin and insertion of serratus anterior?

A

Origin: Lateral surfaces of ribs 1-8/9

Inserts: Costal srufaces of medial border of scapula

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51
Q

What movement does serratus anterior allow?

A

PROTRACTOR of scapula –> draws scapula forwards and lengthens upper limb (e.g. punching)

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52
Q

What are the muscles of the anterior pectoral girdle?

A

Pectoralis major and minor, serratus anterior

53
Q

What is the axial skeleton?

A

The part of the skeleton that consists of the bones of the head and trunk of a vertebrate. In the human skeleton, it consists of 86 bones and is composed of six parts; the skull (22 bones), the ossicles of the middle ear, the hyoid bone, the rib cage, sternum and the vertebral column.

54
Q

What do the muscles of the posterior pectoral girdle attach the bones of the pectoral girdle to?

A

The axial skeleton

55
Q

What are the 2 layers of the muscles of the posterior pectoral girdle?

A

Superficial and deep layer

56
Q

What muscles make up the superficial layer of the posterior pectoral girdle?

A

Trapezius and latissimus dorsi

N.B. Lat dorsi considered pectoral girdle muscle, although originates from the axial skeleton and inserts directly onto the humerus

57
Q

What movement does the lat dorsi allow?

A

Adducts, medially rotates and extends the shoulder

58
Q

Describe the direction of muscle fibres in the trapezius? How does this affect the movement of the scapula?

A

Fibres run in different directions: superior, middle and inferior fibres

When these fibres work independently they can move scapula in different directions: elevate, retract or depress scapula

59
Q

Describe insertion of lat dorsi

A

Sweeps across lower back and inserts onto anterior aspect of humerus (posterior origin and anterior insertion)

60
Q

What movement does lat dorsi allow?

A

Posterior origin and anterior insertion –> extend arm, medially rotate and adduct arm

61
Q

What muscles make up the deep layer of the posterior pectoral girdle?

A

Levator scapulae, rhomboid minor and rhomboid major (but the rhomboids work together)

62
Q

What movement does levator scapulae cause when it contracts?

A

Levator scapulae contracts and elevates scapula towards neck

63
Q

Insertion and origin of rhomboids?

A

Origin: thoracic vertebrae

Insertion: onto medial border of scapula

64
Q

What movement do the rhomboids allow when they contract?

A

Pull medial border of scapula towards the vertebral column (retraction)

65
Q

What bone does the anterior/posterior pectoral girdle muscles work on?

A

Scapula

66
Q

What bone does the deltoid and teres major work on?

A

Shoulder

67
Q

What do the deltoid and teres major connect?

A

Connect the humerus to the pectoral girdle

68
Q

Where does the teres major originate and insert?

A

Origin: posterior scapula

Inserts: anteriorly on humerus

69
Q

What movement does the teres major allow? What enables it to do this?

A

The orientation of the muscle (from posterior to anterior) allows it to medially rotate and adduct the shoulder (pulls humerus in towards body)

70
Q

What is the largest muscle of the shoulder?

A

Deltoid

71
Q

Describe location of deltoid muscle

A

Sits over shoulder joint

72
Q

Origin and insertion of deltoid?

A

Origin: clavicle and spine of scapula

Inserts: on anterior humerus (deltoid tuberosity)

73
Q

What is effect of of deltoid muscle when it contracts?

A

Pulls on deltoid tuberosity on humerus and pulls arm out laterally –> medially rotates and adducts shoulder

Also contributes to flexion (anterior fibres) and extension (posterior fibres) of shoulder joint

Abduction –> from 20-90 degrees

74
Q

What is the rotator cuff?

A

a group of muscles and tendons that surround the shoulder joint –> act to stabilise joint

75
Q

Origin and insertion of rotator cuff muscles?

A

Origin: scapula

Insert: humerus

76
Q

How many rotator cuff muscles are there? What are they?

A

4

  1. Supraspinatus
  2. Infraspinatus
  3. Teres minor
  4. Subscapularis
77
Q

Name highlighted muscle (posterior view)

A
78
Q

Where does supraspinatus muscle sit?

A

In supraspinous fossa (above spine of scapula from posterior view)

79
Q

Describe location and insertion of supraspinatus

A

Muscle and tendon of supraspinatus travel from supraspinous fossa, travel underneath acromion and insert on top of the greater tubercle of humerus

80
Q

What movement does supraspinatus muscle give when it contracts?

A

Gives first few degress of abduction (starts it off, approx 20 degrees)

81
Q

After the first few degrees of abduction of arm, what muscle then takes over from supraspinatus?

A

Deltoid

82
Q

Where is infraspinatus and teres minor found?

A

On posterior aspect of scapula

83
Q

Which muscle is highlighted in blue? In yellow?

A

Blue: infraspinatus

Pink: teres minor

84
Q

Origin and insertion of teres minor and infraspinatus?

A

Originate from posterior scapula and insert on greater tubercle of humerus

They act on shoulder joint in similar way due to similar orientation

85
Q

What movement does teres minor and infraspinatus allow?

A

Laterally rotate shoulder

86
Q

Where is subscapularis found?

A

On anterior aspect of scapula in subscapularis fossa

87
Q

How is rotator clinically relevant?

A

Commonly injured - tendons can be torn or inflamed

88
Q

Origin and insertion of subscapularis?

A

Origin: medial border and subscapular fossa

Insert: LESSER tubercle of humerus (different to others)

89
Q

What movement does subscapularis allow when it contracts?

A

Adducts and medially rotates shoulder

90
Q

What can injury/disease of shoulder cuff lead to?

A

Impaired movement, instability, pain

91
Q

What are the main vessels of the upper limb?

A

Subclavian artery and vein

92
Q

Describe path of subclavian vessels

A

Travel under clavicle (subclavian) and enter axilla (armpit)

93
Q

What are subclavian vessels called once they enter axilla?

A

Axillary artery and vein

94
Q

What branches does the axillary artery give off?

A

Anterior and posterior humeral circumflex artery

95
Q

Is there a corresponding vein to circumflex humeral arteries?

A

NO - this area drained by axillary vein

96
Q

What does the brachial plexus innervate?

A

Provides branches that innervate upper limb

97
Q

Where are the terminal branches of the brachial plexus found?

A

In the axilla

98
Q

What is the axillary nerve a branch of?

A

Is a terminal branch of the brachial plexus

99
Q

Describe pathway of axillary nerve

A

Runs posteriorly, close to surgical neck of humerus

100
Q

What does the axillary nerve supply?

A

Deltoid and teres minor

101
Q

What is the cephalic vein? What does it drain into?

A

A major superficial vein that runs up lateral side of arm –> once it enters the axilla it drains into the axillary vein

102
Q

Where does cephalic vein lie?

A

Lies superficially between deltoid and pectoralis major in deltopectoral groove

103
Q

What is osteomyelitis?

A

Bone infection

104
Q

What is osteoarthritis?

A

Osteoarthritis is the most common form of arthritis. It occurs when the protective cartilage that cushions the ends of your bones wears down over time

105
Q

What is tendonitis?

A

Inflammation of tendon

106
Q

What is it called when muscle or tendon becomes trapped?

A

Impingement

107
Q

Normal left shoulder X-ray. Find the:

  • Medial, lateral, superior borders of scapula
  • Acromion
  • Coracoid process
  • Glenoid fossa
  • Greater tubercle
  • Anatomical neck
  • Surgical neck
A

There appears to be a gap due to tissues not showing up

108
Q

What has been fractured here?

A
  • Fracture at greater tubercle
109
Q

What is problem with this shoulder joint?

A

Osteoarthritis of shoulder bone; outgrowths of bone called osteocytes, also get joint space narrowing

110
Q

What is abnoramlity here?

A
  • AC (clavicle and acromion) joint dislocation
  • Normally in common with rupture of supporting ligament
111
Q

Which bone is fractured? How do these fractures differ?

A
  • Left –> clavicle fracture
  • Right –> comminuted fracture
    • Danger of piercing subclavian vessels
      • Could cause ischaemia of upper limb
      • Could cause life-threatening bleeding
    • Danger of damaging brachial plexus
112
Q

What joint is dislocated? Which direction has the dislocation occured?

A

Anterior dislocation of glenohumeral joint (humerus moves inferiorly and medially)

113
Q

What is the most common problem of the rotator cuff?

A

The supraspinous tendon getting trapped (impinged) between the humeral head and the acromion and becoming inflamed

114
Q

What is ‘winged scapula’? What movement would a person with this conditon have trouble with?

A

A skeletal medical condition in which the shoulder blade protrudes from a person’s back in an abnormal position

Would have trouble with protraction and getting arm about head (serratus anterior wouldn’t be able to rotate scapula properly)

115
Q

What is winged scapula caused by?

A

Injury to the long thoracic nerve which innervates the serratus anterior

116
Q

If the long thoracic nerve is injured, how can it affect the serratus anterior?

A

Can paralyse it so cannot hold scapula on posterior chest wall anymore so medial border appears to lift off from ribs –> ‘winged scapula’

In picture –> problem with right scapula

117
Q

What is the brachial plexus?

A

Network of nerves that innervates the upper limb

118
Q

Where does the brachial plexus originate?

A

From spinal cord

119
Q

Where is the brachial plexus located?

A

In neck, travels under clavicle and into axilla

120
Q

How many major branches does the brachial plexus give rise to?

A

5 –> these provide motor and sensory innervation of upper limb

121
Q

Branches of brachial plexus diagram

A

5 terminal branches:

  1. Musculocutaneous
  2. Axillary
  3. Median
  4. Radial
  5. Ulnar
122
Q

What are the 5 major branches of the brachial plexus?

A
  1. Musculocutaneous
  2. Axillary
  3. Median
  4. Radial
  5. Ulnar
123
Q
A
124
Q

What is the glenohumeral joint?

A

BETWEEN SCAPULA AND HUMERUS

Joint between head of humerus and glenoid fossa on scapula

125
Q

What muscles make up the posterior pectoral girdle?

A

Trapezius, lat dorsi, rhomboids, levator scapulae

126
Q

What nerve innervates serratus anterior? What can damage to this nerve cause?

A

Long thoracic nerve

Can cause paralysis of scapula: winged scapula

127
Q

What muscle starts abduction of arm/shoulder?

A

Supraspinatus

128
Q

What is the quadrilateral/quadrangular spance?

A

The ‘gap’ that the axillary nerve and posterior circumflex humeral artery pass through to reach the posterior scapula region.

129
Q

What forms the borders of the quadrilateral space?

A

Inferior: Teres major

Medial: long head of the bicep

Posterior: Teres minor

Anterior: Subscapularis

Lateral: Surgical neck of humerus

Yr 2 - Movement (39 decks)

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