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Block 4 > Pectoral Girdle and Upper Limb > Flashcards

Pectoral Girdle and Upper Limb Flashcards

1
Q

Where is the acromion palpable?

A

Above the shoulder

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2
Q

Where is the coracoid process palpable?

A

Below lateral clavicle

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3
Q

What does regional tenderness around the intertubercular (bicipital) groove indicate?

A

Biceps tendon inflammation

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4
Q

What is the lesser tubercle an attachment point for?

What does regional pain indicate?

A
  • Rotator cuff muscles
  • Regional pain =damage to rotator cuff muscles
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5
Q

What muscle attaches to the supraspinatus fossa?

A

Supraspinatus muscle

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6
Q

What muscle attaches to the infraspinatus fossa?

A

Infraspinatus muscle

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7
Q

What sits medially to the inferior angle of the scapula?

A

Auscultation triangle

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8
Q

Which vertebral levels are marked by the scapula?

A

Superior angle: T2

Medial spine: T3

Inferior angle: T7

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9
Q

On abduction of the upper limbs, what does the medial scapula border roughly align with?

A

Oblique fissure of the lung

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10
Q

What is the role of the clavicle?

A

Keeps scapula away from the axial skeleton and allows its free movement around the thoracic wall

Transmits forces from upper limb to axial skeleton

Protects underlying neurovasculature:

  • Subclavian vein
  • Subclavian artery
  • Axillary nerve
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11
Q

How could the clavicle be damaged?

A

Fall onto outstretched limb or onto lateral shoulder

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12
Q

Where does the axillary artery run to/from?

A

From the 1st rib to teres major

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13
Q

What type of joint is the acromioclavicular joint?

Can it be dislocated?

A

Synovial plane joint

Dislocation possible

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14
Q

What type of joint is the sternoclavicular joint?

Is dislocation possible?

A

Synovial ball and socket joint

Dislocation unlikely

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15
Q

Which ligaments support the acromioclavicular joint?

How can they be damaged?

A

Coracoclavicular ligaments:

  • Trapezoid
  • Conoid

Can be torn by acromioclavicular joint disclocation

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16
Q

What do the coracoacromial ligaments support?

How can they be damaged?

What can they impinge?

A

Support the shoulder joint superiorly

Can be ruptured by superiorly directed forces

Can impinge supraspinatus & subacromial bursa

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17
Q

Why must injection/aspiration of the sternoclavicular joint be done under ultrasound guidance?

A

Due to its proximity with other important structures:

  • Apex of the lung (risk of pneumothorax)
  • Brachiocephalic veins
  • Internal jugular vein
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18
Q

How should a normal AC joint appear on x-ray?

A

Should have space betwen clavicle and acromion due to hyaline cartilage of synovial joint.

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19
Q

Which ligaments support the sternoclavicular joint?

A

Costoclavicular joints support from below

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20
Q

How do separated parts of a fractured clavicle move? Why?

A

Move in opposite directions due to gravity and muscle contraction (sternocleidomastoid muscle)

(picture indicates multi-fragmented, convoluted fracture)

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21
Q

Which parts of the clavicle are most easily fractured?

A

In order of frequency:

  • Middle 1/3
  • Lateral 1/3
  • Medial 1/3

The weakest point of the clavicle is between the lateral and middle 3rds

22
Q

What can a mid shaft fracture through the spiral groove of the humerus damage?

A

Profunda brachii artery

Radial nerve

23
Q

What can fractures of the surgical neck of the humerus damage?

What can this cause, how would it present?

A

Axillary nerve

Damage to axillary nerve causes paralysis of deltoid and teres minor:

  • Difficulty abducting limb
  • Sensory impairment to regimental badge area
24
Q

What is the shoulder joint formed from?

How is it supported?

A

Head of humerus and glenoid fossa of the scapula.

Supported by 3 glenohumeral ligaments:

  • Extend from margins of the glenoid to the humerus
  • Support shoulder anteriorly.
25
Q

What does the inferior laxity of the shoulder joint capsule allow?

What is the clinical relevance of this?

A

Allows free movement, however reduced stability of shoulder joint and increased risk of inferior dislocation.

26
Q

How can the shoulder be dislocated?

Which nerve is most at risk of damage?

A

Inferior dislocation: downward forces on abducted arm

Axillary nerve most at risk

27
Q

Why are superior dislocations of the shoulder rare?

A

The shoulder joint is supported superiorly by the coracoacromial arch

28
Q

What is the glenoid labrum?

A

Fibrocartilage rim around the glenoid fossa

Deepens socket and stabilises joint

29
Q

What are the actions and innervation of the trapezius?

A

Elevates, retracts and depresses the scapula

Accessory nerve (CNXI)

30
Q

What are the actions and innervatons of latissimus dorsi?

A

Extension, adduction and medial rotation of the humerus

Can raise the trunk to the arm (e.g. climbing)

Thoracodorsal nerve

31
Q

What are the actions and innervations of levator scapulae?

A

Elevation and rotation of the scapula

Dorsal scapula nerve and C3-4 spinal nerves

32
Q

What are the actions and innervations of rhombdoid major and minor?

A

Retract and fix position of the scapula

Dorsal scapula nerve

33
Q

What are the actions and innervations of teres major?

A

Adduction and medial rotation of the humerus

Lower subscapula nerve

34
Q

What are the actions and innervation of pectoralis major?

What are its attachment points?

A

Adducts and medially rotates the shoulder

Acts as an accessory breathing muscle

Medial and lateral pectoral nerve

Attaches to clavicle, sternum, adjacent costal cartilages and lateral side of intertubercular groove of humerus

35
Q
A
36
Q

What are the actions and innervations of the pectoralis minor?

What are its attachment points?

A

Depresses and protracts the scapula

Divides axillary artery into 3 parts

Attaches to ribe 3-5 and corocoid process

Medial pectoral nerve

37
Q

What are the actions and innervations of the deltoid muscle?

What are its attachment points?

A

All shoulder movements except adduction

Axillary nerve

Attaches to lateral clavicle, acromion, scapula spine and humerus

38
Q

What can damage to the axillary nerve in shoulder discloation cause?

A
  • Paralysis and wasting of deltoid and teres minor
  • Limb can hang limp by side
  • Loss of shoulder contour
  • Sensory loss over lateral shoulder (regimental badge area)
39
Q

What are the 4 rotator cuff muscles?

What are their actions and innervations?

A

Supraspinatus

  • Assists with initial part of arm abduction (first 20 degrees)
  • Suprascapular nerve

Infraspinatus

  • Lateral shoulder rotation
  • Suprascapular nerve

Teres minor

  • Lateral shoulder rotation
  • Axillary nerve

Subscapularis

  • Medial shoulder rotation
  • Upper and lower subscapular nerve
40
Q

What can injury to rotator cuff muscles cause?

A

Pain on movement

Shoulder instability

41
Q

What are the actions and innervations of serratus anterior muscle?

What are its attachment points?

How can its innervation be damaged? What is the result of this?

A

Protracts scapula and holds it close to the thoracic wall

Attaches to ribs 1-8 and medial scapula border

Long thoracic nerve:

  • Can be damaged by breast surgery with axillary node clearance

Damage causes winging of the scapula: detaches from thoracic wall

42
Q

What is the axilla? What are its borders?

A

Fat filled region superior to armpit skin.

Borders:

  • Anterior: anterior axillary fold and pectoral muscles
  • Posterior: posterior axillary fold, subscapularis muscle and scapula
  • Medial: Serratus anterior and lateral thoracic wall
  • Lateral: Intertubercular groove
43
Q

What important structures are in the axilla?

Which structures drain lymph to this region?

A

Contains:

  • Axillary artery (parts medial and posterior to teres minor) and branches
  • Axillary vein and tributaries
  • Brachial plexus
  • Short head of biceps brachii
  • Coracobrachialis
  • Axillary lymph nodes

Axillary nodes drain lymph from the upper limb and pectoral region. (enlargement is a non-specific indicator of breast cancer)

44
Q

What are the axillary lymph nodes?

What is their drainage route?

A
  • Humeral: drains the arm
  • Subscapula: drains the posterior thoracic wall and scapula region
  • Pectoral: drains the anterior thoracic wall and pectoral region (including breast tissue)

All 3 of these drain into the central lymph nodes which drain to the apical.

45
Q

Which muscles are contained in the anterior compartment of the arm?

What are their actions and innervations?

What are their attachment points?

A

Biceps Brachii:

  • 2 headed muscle:
    • Long head originates from supraglenoid tubercle of scapula (tendon passes through intertubercular groove)
    • Short head originates from coracoid process
    • Both insert into radial tuberosity and bicipital aponeuroses
  • Musculocutaneous nerve
  • Flexes shoulder and elbow, supinates forearm

Brachialis:

  • Sits deep to biceps brachii
  • Flexes the elbow
  • Attaches to the ulna
  • Musculocutaneous and radial nerve

Coracobrachialis:

  • Adducts arm
  • Musculocutaneous nerve
46
Q

What does tapping the biceps tendon test?

A

C5-6 reflex

47
Q

What muscles are in the posterior compartment of the arm?

What are their actions and innervations?

A

Triceps Brachii:

  • 3 headed muscle: long, medial and lateral
  • Shoulder and elbow extension
  • Radial nerve
48
Q

What are the quandrangular and triangular spaces?

What passes through them?

A

Quadrangular space:

  • Axillary nerve and circumflex arteries pass through and around surgical neck of humerus

Triangular space:

  • Circumflex and subscapula artery pass through
49
Q

What is the venous drainage of the arm?

A

Veins of the upper limb (brachial veins) drain into the basilic vein which becomes the axillary vein as it moves proximally.

Axillary vein is joined by the cephalic vein which continue on to become the subclavian vein.

50
Q

What is the arterial supply to the arm?

A

Subclavian artery→axillary artery (after crossing rib 1)→brachial artery (below teres major)→Profunda brachii artery branches off→Brachial artery continues down the arm with median and ulnar nerves.

Subclavian and axillary arteries form rich anastamoses surrounding the scapula.

51
Q

What would be the consequence of a blockage of the brachial artery at the level of the mid-humerus?

A

Block 4 (20 decks)

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