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Anatomy and physiology > pectoral girdle, elbow and shoulder > Flashcards

pectoral girdle, elbow and shoulder Flashcards

1
Q

pectoral girdle attachment

A
  • attachment to axial
  • only 1 p.o.a to the axial skeleton at the sternoclavicular joint- medial end of the clavicle articulates w manubrium of the sternum
  • scapula doesn’t directly attach to the axial skeleton via joint but connects to back of the thorax by muscles- allows 4 large range of movement
  • ligs provide stability and support to joints in pec girds
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2
Q

what is pec gird

A

clavicle n scapula

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3
Q

clavicle

A
  • long bone
  • lies horizontally between scapula n sternum
  • 2 joint- ACJ (acromioclavular joint) and SCJ (sternoclaviculr joint)
  • articulates medially with the sternum at SCJ
  • articulates laterally with acromion at ACJ
  • serves as muscular attachment point
  • one of the most fractured bones in body
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4
Q

scapula

A
  • large, triangular flat bone that connects the trunk to the upper limb
  • the posterior bone of pectoral girdle sitting across the back of the thoracic cage, superiorly
  • major features= spine, coracoid process, acromion process and glenoid cavity
  • got 3 borders n angles (it triangle): superior, medial n lateral and superior, inferior and lateral
  • 3 fossas= supraspinous, infraspinous, subscapular
  • has a suprascapular notch
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5
Q

acromion process

A

a continuation of the scapula spine which passes laterally over the shoulder (Glenohumeral) joint
- ACROMION: of the scapula extends from the scapular spine to articulate with the clavicle to form the Acromio-clavicular joint

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6
Q

spine of scapula

A

oblique ridge of bone that passes across the upper posterior part of the scapula

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7
Q

coracoid process

A

small hook-like structure which points laterally forward, on the edge of the superior anterior portion of the scapula
- for muscle attachments

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8
Q

glenoid cavity

A
  • a very shallow articular surface that articulates with the humeral head
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9
Q

sternoclavicular joint

A
  • where pec girdle joins to the axial skeleton
  • Strong synovial saddle joint
  • Contains a fibrocartilaginous articular disc
  • Robust ligamentous and muscular support
    -sternoclavicular ligament= reinforces the joint capsule and prevents forward/ backward movement
  • costoclavicular ligament= connects the clavicle to the first rib and prevent elevation of clavicle
  • interclavicular ligament= runs along top of sternum, connects the 2 clavicle to prervnt excessive downward movement
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10
Q

Acromioclavicular joint

A

Small synovial plane joint

Allows scapula and clavicle to move together during arm movement

Strong ligamentous support

Can have a small fibrocartilaginous disc

Relatively prone to injury

  • acromioclavicular ligament: keeps joint capsule together and connects acromion n clavicle together
  • coracoclavicular ligament: connect coracoid process to the clavicle to prevent displacement
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11
Q

labrum of the shoulder

A

labrum: fibrous cartilage and deepens the socket and provides additional stability = different movement allowed

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12
Q

glenohumeral joint

A
  • synovial joint of the shoulder has a fibrous articular capsule that completely encloses the joint and extends from the glenoid cavity to the neck of the humerus
  • on surface, joint is lined with synovial membrane= provide synovial fluid= lubricates joint and reduce friction
  • it has 5 ligaments, a glenoid labrum, and four bursae (act as cushions) to alleviate friction
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13
Q

humerus

A
  • largest and longest bone in upper limb
  • articulates with scapula at glenohumeral joint + radius and ulna at the elbow joint
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14
Q

major features of humerus

A

head:
- rounded part at the proximal end
- fits into the glenoid fossa of scapula
anatomical neck:
- separates the head of the humerus from the greater and lesser tubercles
tubercles (greater and lesser):
- greater is more lateral and larger
intertubercular groove:
- dep groove between tubercles
- houses the tendon of long head of bicep brachii, provides poa for major muscle groups of shoulder
surgical neck:
- site of fractures that require surgery
shaft:
- cylindrical at proximal end but becomes more triangular as it flattens and broadens at the distal end
- contains a central medullary cavity filled with bone marrow
deltoid tuberosity:
- attachment for deltoid muscles
- on posterior side there is radial groove that contain the radial nerve

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15
Q

distal end of humerus

A

capitulum:
- rounded notch that articulates with radius at the elbow joint
trochlea:
- articulates with the ulna allowing for flexion and extension of elbow
median and lateral epicondyle:
- bony protrusions
- attachment point for muscles n ligaments
olecranon fossa:
- deep indentation on posterior aspect that accommodates the olecranon (bony prominence of the ulna when elbow is extended)
coronoid fossa:
- small indentation on anterior aspect that receives the coronoid process of the ulna during flexion
- large depression on back of humerus

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16
Q

the elbow

A

Essential for bending the arm and rotating the forarm

3 points of articulation:

Humeroradial joint:
Capitulum with radial head

Humeroulnar joint:
Trochlear with trochlear notch

Proximal radioulnar joint:
Head of the radius with the radial notch

17
Q

ligaments of elbow joint

A

median collateral ligament:
- extends from the medial epicondyle of the humerus to the coronoid process and the olecranon of the ulna
- thick triangular ligament
lateral collateral ligament:
- strong triangular ligament
- extends from lateral epicondyle of the humerus to the annular ligament of the radius and the radial notch of the ulna
- annular ligament completely encircles the head of the radius and hold it into eh radial notch of the ulna

18
Q

ligaments of shoulder joint

A

5 ligaments:

Coracohumeral
(to greater tubercle)
- extends from coracoid process in scapula to greater tubercle of humerus= split into anterior and posterior divisions by the biceps tendon

S, M, I glenohumeral
(to lesser tubercle)
- mobile and least stable joint- commonly dislocated synovial joint
- extend from the glenoid cavity to the lesser tubercle and anatomical neck of humerus

Transverse humeral:
- connects greater to lesser tubercle
-keeps the tendon of the long head of the bicep in the bicipital groove

acromioclaviclaular ligament:
- connects acromion to clavicle

coracoclavilcuar ligament:
- connects coracoid process to clavicle

coracoacreomion ligament:
- connects coracoid to acromion

labrum:
- fibrous ring around the glenoid cavity

19
Q

muscles of shoulder

A
  • there are superficial and deep muscles that connect the scapula and clavicle to the trunk
  • also superficial and deep muscles connect the clavicle, scapula and trunk to the proximal end of the humerus
  • four rotator cuff muscles which connect
    the scapula to the humerus (most important)
20
Q

muscles that connect the scapula and clavicle to the trunk

A

function by controlling the movement of the scapula and the humerus:

trapezius:
- superficial, flat and broad
- covers the upper back and part of neck and shoulders
- inserts on the lateral third of the clavicle, the acromion and scapula spine

levator scapulae:
- deep
- lies in posterior triangle of neck
- attaches to medial surface of the scapula and elevates

rhomboid (major and minor):
- deep
- attached to medial border of the scapula
- retract and stabilise the scapula, pulling it towards the spine

21
Q

muscles that connect the clavicle, scapula, and trunk to the proximal end of the humerus

A

3 superficial and 2 deep

superficial:
pectoralis major
deltoids
latissimus dorsi

deep:
pectoralis minor
teres major

22
Q

superficial muscles that connects c,s and t to proximal end of h

A

pectoralis major:
- provide movement and support in the anterior part of the shoulder
- 2 heads: originates from midline of clavicle and sternum
- inserts into humerus and ribs
- allow 4 shoulder flexion (horizontal, upward diag and downward diag

latissimus dorsi:
- originate from lumbar vertebrae and pelvis
- inserts into the Intertubercular groove groove of humerus
- allow 4 shoulder adduction and extension
- keeps the inferior angle of scapula against the chest

deltoid:
- provides the characteristic shape of the shoulder
- originates in 3 portions, anterior, middle, and posterior
- anterior portion originates from anterior superior surface of the clavicle
- middle from the acromion process
- posterior from the lower border of crest of spine of scapula
- these 3 insert into deltoid tuberosity of the humerus

23
Q

deep muscles that connect c,s and t to the proximal end of the h

A

pectoralis minor:
- small deep triangular muscle that passes as 3 muscular slips from the thoracic wall to the coracoid process
- draws scapula forwards and downwards and raises the ribs in inspiration (draw air in lungs)

teres major:
- originate from posterior surface of inferior angle of scapula
- attaches medial lip to the middle lip of the intertubercular groove
- extends and medially rotates the humerus

24
Q

rotator cuff muscles

A
  • muscles that connect the scapula to the humerus
  • muscles and associated tendons surround the shoulder joint and all originate from the scapula and attach either to the greater or lesser tubercle of the humerus
  • stabilises point and allow 4 wide range of movement
  • work together to keep head of humerus within the shoulder socket of the glenoid fossa
  • rotator cuff tendons attach 2 deep rotator cuff muscles
25
Q

describe rotator cuff muscles

A

supraspinatus- originates in supraspinous fossa of scapula/ inserts on the superior facet of the greater tubercle of the humerus / initiates abduction of the arm and stabilises the joint while helping to hold head of humerus in place

infraspinatus- originates and sits in the infraspinatus fossa of scapula (below spine of scapula) / inserts on middle facet of greater tubercle / externally rotates the arms and helps stabilise shoulder joint

teres minor - originates from lateral border of the scapula / inserts into lower facet of the greater tubercle / externally rotates the arm / assists in adduction and stabilisation

subscapularis- originates in subscapularis fossa of scapula (front surface of scapula) / inserts onto lesser tubercle / internally rotates the arm and help w stabilisation

26
Q

vascular supply to pectoral gridle summary

A

intricate network of blood vessels ensures that the shoulder girdle has the necessary blood flow for proper function and muscle activity

Arteries:
- blood supply to the shoulder girdle primarily comes from the subclavian and axillary arteries and their branches, which supply the bones, muscles, and joints of the shoulder

Veins:
- subclavian and axillary veins, along with their tributaries, drain the blood from the shoulder region back to the heart

27
Q

major arties of the shoulder

A
  • oxygenated blood delivered via SUBCLAVIAN (primary source)
  • run under clavicle
  • becomes AXILLARY ARTERY AT THE OUTER BORDER OF THE FIRST RIB
  • continues until the lower border of the teres major muscle where it becomes the BRACHIAL ARTERY

key branches of axillary artery that supply shoulder are: thoracoacromial artery, lateral thoracic artery, subscapular artery, circumflex scapular artery and the thoracodorsal artery

28
Q

major veins of the shoulder

A

veins of the shoulder follow the path of the arteries and drain into larger veins that eventually return blood to the heart.

Subclavian Vein:
- subclavian vein runs parallel to the subclavian artery, draining blood from the arm, shoulder, and neck
- It joins the internal jugular vein to form the brachiocephalic vein, which drains into the superior vena cava.

Axillary Vein:
- primary vein draining the shoulder area
- It is a continuation of the brachial vein, and it runs alongside the axillary artery.

It receives blood from various tributaries, including:
Cephalic vein, Basilic vein and branches from the circumflex humeral veins

29
Q

major arteries of the elbow summary

A
  • provided mostly by the brachial artery (with branches), radial artery, and ulnar artery (forms extensive network of arteries around the joint)
  • blood vessels join together to ensure that the elbow joint receives an adequate blood supply during movement
30
Q

description of major artery of elbow

A

MEDIAL SIDE:
- superior ulnar collateral artery from brachial artery joins with the posterior recurrent artery from the ulnar artery
- inferior ulnar collateral artery joins with the anterior ulnar recurrent artery

LATERAL SIDE:
- radial collateral artery meets with radial recurrent
- medial collateral artery joins with the interosseous recurrent artery

31
Q

major veins in elbow

A

return deoxygenated blood from elbow to heart & drain muscles, bones and other structures around the elbow joint & closely accompany the arteries

SUPERFICIAL:
- cephalic, basilic, median cubital
- join superficial tissue of the elbow
- visible under skin (cannulation)

DEEP:
- brachial, radial, ulnar and interosseous
- join deeper structures
- from primary root venous= drain back to the heart

32
Q

major innervation of the shoulder

A

BRACHIAL PLEXUS
- supply motor and sensory function to the shoulder joint and surrounding structures (forearm and hand)
- gives rise to 7 important nerves

33
Q

description of the major innervation of shoulder

A
  • suprascapular innervates the supraspinatus and the infraspinatus
  • dorsal scapula innervates the rhomboids and levator scapulae
  • long thoracic nerve innervates the serratus anterior muscle
  • thoracodorsal nerve innervates the latissimus dorsi muscle, scapula nerves and the medial and lateral pectoral nerves
  • musculocutaneous nerve innervates the anterior compartment of the arms at the biceps and provides sensory info to the lateral forearm
  • axillary nerve innervates the deltoid
  • radial nerve innervates the extensor muscles
  • median nerve innervates most of the flexor muscles
  • ulnar nerve innervates some of the forearm muscles and most intrinsic hand muscles 2 provide sensation
34
Q

fat pads

A
  • small protective cushions made of adipose tissue located within elbow joint
  • fibrous joint capsule at the side of your membrane
  • reduce friction and assist w smooth movement

3 fat pads in elbow:
- anterior, located in coronoid fossa of humerus
- posterior fat pad located in the olecranon
- supinator fat pad located near the supine muscle in the lateral part of elbow

35
Q

shoulder- dislocation

A
  • 90% of dislocations are anterior
  • Common sports injury
  • Causes lots of soft tissue injury
  • Lots of vulnerable structures nearby including main blood vessels and nerves
36
Q

shoulder- fracture

A
  • can be caused by fall from height/ traffic accident
  • involves humeral head, the greater tuberosity and the lesser tubercle of the humeral shaft
37
Q

clavicle - fracture

A
  • normally treated without surgery dependent on displacement
  • “cyclists” fracture
38
Q

calcific tendonitis

A
  • calcium salts deposited in the tendons, most commonly in rotator cuff
  • ## causes pain and inflammation and can limit range of movement
39
Q

labral tear

A
  • labrum of glenoid cavity can have a tear
  • joint stability can be comprised
  • there are different classifications of labral tear:
    SLAP ; Bankart; Posterior

MRI Arthrogram (contrast injected into the joint) to image the labrum and detect tears

Anatomy and physiology (24 decks)

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