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MSK anatomy > Pectoral Girdle, Shoulder And Axilla > Flashcards

Pectoral Girdle, Shoulder And Axilla Flashcards

1
Q

Bones of the pectoral girdle

A

Clavicle
Scapula
Humerus

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2
Q

Shape of clavicle

A

Slender, s-shaped bone

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3
Q

What does the clavicle articulate with

A

Manubrium of sternum at its proximal (medial) end- sternoclavicular joint
Acromion of the scapula at its distal (lateral) end - the acromioclavicular joint

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4
Q

What is the most commonly fractured bone

A

Clavicle

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5
Q

What type of joint is the sternoclavicular joint

A

Synovial

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6
Q

What type of joint is the acromioclavicular joint

A

Synovial

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7
Q

What does the word scapula mean

A

Trowel or small shovel

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8
Q

Shape of scapula

A

Mostly flat but some important bony projections

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9
Q

Posterior surface of scapula

A

Ridge of bone called the spine
Easily palpable

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10
Q

Acromion

A

Lateral end of the spine of the scapula which expands to form Acromion
Articulates with the lateral end of the clavicle
Can be easily palpated

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11
Q

Meaning of the word Acromion

A

Highest point of the shoulder

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12
Q

Coracoid process

A

Just inferior to the Acromion on anterior surface of scapula
Site of attachment for several muscles

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13
Q

Meaning of the word coracoid

A

Raven-like

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14
Q

Glenoid fossa

A

Lateral aspect of the scapula has a shallow fossa
Articulates with the proximal humerus to form the shoulder joint

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15
Q

Meaning of the word glenoid

A

Shallow socket

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16
Q

Glenohumeral joint

A

Glenoid fossa is shallow so poor fit for humerus
Increases the range of movement possible at the shoulder but compromises stability of the joint

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17
Q

Supraglenoid and infraglenoid tubercles

A

2 small projections of bone just superior and inferior to the Glenoid fossa
Important sites for muscle attachments

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18
Q

Humerus shape

A

Long bone of the arm
Has a shaft and an expanded proximal and distal end

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19
Q

Head of humerus

A

Articulates with the Glenoid fossa of the scapula

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20
Q

Anatomical neck of humerus

A

Groove in the humerus immediately distal to the smooth head of the humerus

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21
Q

Greater tubercle of humerus

A

Laterally proximal humerus

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22
Q

Lesser tubercle of humerus

A

Smaller anterior projection

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23
Q

Surgical neck of humerus

A

Just distal to the tubercles, bone narrows and becomes continuous with shaft
Commonly fractured especially in elderly

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24
Q

What nerve runs close to the surgical neck of the humerus

A

Ancillary nerve

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25
Q

Deltoid tuberosity

A

Upper lateral aspect of the humeral shaft has a slight protuberance
Site of attachment for the deltoid muscle

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26
Q

What is the site of attachment for the deltoid muscle

A

Deltoid tuberosity

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27
Q

Radial groove

A

Marks the path of the radial nerve over the posterior aspect of the humeral shaft

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28
Q

Parts of the humerus (shoulder to elbow)

A

Head
Anatomical neck
Greater tubercle
Surgical neck
Shaft
Lateral and medial epicondyle

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29
Q

Protraction

A

extends the upper limb, for example, when we stretch out the arm to push open a door.

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30
Q

Retraction

A

squaring’ the shoulders or pulling them backwards.

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31
Q

Elevation

A

shrugging the shoulders

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32
Q

Depression

A

lowering the shoulders

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33
Q

Rotation

A

Scapula tilts the glenoid fossa cranially to aid elevation of the upper limb

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34
Q

What is the key muscle involved in protraction of the scapula

A

Serratus anterior

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35
Q

2 large and superficial muscles of the posterior pectoral girdle

A

Trapezius
Latissimus dorsi

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36
Q

Muscles of anterior pectoral girdle

A

Pectoralis major
Pectoralis minor
Serratus anterior

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37
Q

Shape and location of trapezius and latissimus dorsi

A

Large, flat muscles with extensive attachments to the vertebral column (and skull = trapezius)

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38
Q

What does the latissimus dorsi attach to

A

Anterior aspect of the proximal humerus

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39
Q

3 smaller and deeper muscles of the posterior aspect of the pectoral girdle

A

Levator scapulae
Rhomboid major
Rhomboid mimor

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40
Q

What do the 3 smaller and deeper muscles of the posterior pectoral girdle attach to

A

Medial border of the scapula and to the vertebral column

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41
Q

What movement of the scapula does the trapezius muscle cause

A

Rotation and individually: the upper part elevates, middle part retracts and lower part depresses the scapula

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42
Q

What movement of the humerus does the latissimus dorsi muscle cause

A

Extends
Adducts
Medial rotation

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43
Q

What movement of the scapula does the levator scapulae muscle cause

A

Elevates

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44
Q

What movement of the scapula does the rhomboid major muscle cause

A

Retracts

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45
Q

What movement of the scapula does the rhomboid minor muscle cause

A

Retracts

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46
Q

Origin of the bone

A

More ‘fixed’ or stable bone

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47
Q

Insertion point of a muscle

A

Located on the bone that moves when the muscle contracts

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48
Q

Muscles of the posterior pectoral girdle

A

Trapezius
Latissimus dorsi
Levator scapulae
Rhomboid major
Rhomboid minor

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49
Q

Attachment origin of the trapezius

A

Skull
Cervical and thoracic vertbrae

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50
Q

Attachment origin of the latissimus dorsi

A

Lower thoracic vertebrae

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51
Q

Attachment origin of the Levator scapulae

A

Upper cervical vertebrae

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52
Q

Attachment origin of the rhomboid minor

A

C7 and T1 vertebra

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53
Q

Attachment origin of the rhomboid major

A

Thoracic vertebrae

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54
Q

Attachment insertion of the trapezius

A

Clavicle and scapula (spine and Acromion)

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55
Q

Attachment insertion of the latissimus dorsi

A

Humerus- proximal and anterior

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56
Q

Attachment insertion of the Levator scapulae

A

Scapula- medial border

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57
Q

Attachment insertion of the rhomboid minor

A

Scapula- medial border

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58
Q

Attachment insertion of the rhomboid major

A

Scapula -medial border

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59
Q

What innervates most of the muscles of the posterior pectoral girdle

A

Brachial plexus

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60
Q

What nerve supplies the trapezius

A

Accessory nerve CN XI

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61
Q

What nerve innervates the latissimus dorsi

A

Thoracodorsal nerve - branch of the brachial plexus

62
Q

Movements possible at the shoulder joint

A

flexion, extension, abduction, adduction, internal (medial) and external (lateral) rotation and circumduction

63
Q

What is the most commonly dislocated joint in the body

A

Shoulder joint

64
Q

How many muscles are attached to the scapula

A

6

65
Q

What are the 6 muscles attached to the scapula

A

Deltoid
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
Teres major

66
Q

Which 4 muscles make up the rotator cuff

A

Supraspinatus
Infraspinatus
Subscapularis
Teres minor

67
Q

Function of rotator cuff muscles

A

Provide stability to the shoulder joint

68
Q

Which muscle attached to the scapula does not lie deep to the posterior pectoral girdle

A

Deltoid

69
Q

Deltoid location

A

Large muscle over the lateral aspect of the shoulder
Attaches the humerus to the lateral part of the clavicle and spine of the scapula

70
Q

Deltoid tuberosity

A

Where the deltoid inserts onto the humerus

71
Q

What muscle gives the shoulder its rounded contour

A

Deltoid

72
Q

Function of deltoid muscle

A

Abductor of the shoulder joint- cannot initiate abduction (another muscle initiates first 15 degrees of abduction before deltoid takes over)
Anterior fibres = flexion of shoulder
Posterior fibres = extension of shoulder

73
Q

Which nerve innervates the deltoid muscle

A

Axillary nerve (branch of brachial plexus)

74
Q

Name deltoid

A

Greek
Reference to shape of Greek letter delta- depicted as a triangle

75
Q

Teres major location

A

Arises from posterior aspect of scapula
Tendon slots underneath the humerus and inserts into the anterior aspect of the humerus

76
Q

Teres major function

A

Internal rotator and adductor of the shoulder

77
Q

What type of muscles make up the rotator cuff

A

Short

78
Q

What do the rotator cuff muscle connect

A

Attach the scapula to the tubercles of the humerus

79
Q

Where do the Supraspinatus, infraspinatus, and teres minor muscles originate from

A

Posterior surface of the scapula

80
Q

Where do the Supraspinatus, infraspinatus, and teres minor muscles insert onto

A

Greater tubercle

81
Q

What forms the fibrous capsule that surrounds the shoulder joint

A

The tendons of the Supraspinatus, infraspinatus, and teres minor muscles fuse

82
Q

Why is the Supraspinatus muscle clinically important

A

Travels from, the supraspinous fossa to the greater tubercle under the acromion
Tendon can become inflamed and pinched between the Acromion and humerus during movements of the shoulder causing an impingement

83
Q

Quadrilateral space

A

A square-shaped space bound by the teres minor above
Teres major below
Long head of triceps medially and
Surgical neck of humerus laterally

84
Q

Which nerve innervates the teres minor muscle

A

Axillary nerve

85
Q

Which nerve travels through the quadrilateral space to enter the posterior scapula region

A

Axillary nerve

86
Q

Where does the Subscapularis originate from

A

Anterior surface of the scapula

87
Q

Where does the Subscapularis insert onto

A

Lesser tubercle of humerus

88
Q

Action at the shoulder joint of the deltoid

A

Abduction beyond 15 degrees

89
Q

Action at the shoulder joint of the teres major

A

Internal rotation
Adduction

90
Q

Action at the shoulder joint of the Supraspinatus

A

First 15 degrees of abduction

91
Q

Action at the shoulder joint of the Infraspinatus

A

External rotatiom

92
Q

Action at the shoulder joint of the teres minor

A

External rotatiom

93
Q

Action at the shoulder joint of the Subscapularis

A

Internal rotation

94
Q

Origin on the scapula of the deltoid

A

Spine and acromion of the scapula and the clavicle

95
Q

Origin on the scapula of the teres major

A

Posterior surface
Inferior part of lateral border

96
Q

Origin on the scapula of the Supraspinatus

A

Supraspinous fossa

97
Q

Origin on the scapula of the Infraspinatus

A

Infraspinous fossa

98
Q

Origin on the scapula of the teres minor

A

Lateral border

99
Q

Origin on the scapula of the Subscapularis

A

Subscapular fossa

100
Q

Insertion on the humerus of the deltoid

A

Deltoid tuberosity

101
Q

Insertion on the humerus of the teres major

A

Anterior humerus

102
Q

Insertion on the humerus of the Supraspinatus

A

Greater tubercle- superior facet

103
Q

Insertion on the humerus of the Infraspinatus

A

Greater tubercle- middle facet

104
Q

Insertion on the humerus of the teres minor

A

Greater tubercle- inferior facet

105
Q

Insertion on the humerus of the Subscapularis

A

Lesser tubercle

106
Q

Glenoid labrum

A

A rim of fibrocartilage around the margin of the Glenoid fossa which deepens the shallow fossa and aids stability

107
Q

What structures contribute to stability of the shoulder

A

Rotator cuff
Glenoid labrum
Ligaments
Tendons of biceps brachii

108
Q

Axilla

A

Anatomical term for the armpit- space between the torso and upper arm
Pyramid-shaped and has 6 boundaries formed of various structures

109
Q

Anterior wall of axilla

A

Pectoralis major and minkr

110
Q

Posterior wall of axilla

A

Subscapularis, teres major and latissimus dorsi

111
Q

Lateral wall of axilla

A

Proximal humerus

112
Q

Medial wall of axilla

A

Serratus anterior and thoracic wall

113
Q

Apex of axilla

A

First rib
Clavicle
Scapula

114
Q

Base of axilla

A

Skin and fascia between the thoracic wall and arm (skin of armpit)

115
Q

What does the axilla contain

A

Lymph nodes
Axillary artery and vein
Brachial plexus

116
Q

Number of groups of lymph nodes in axilla

A

5

117
Q

What do the Axillary lymph nodes drain

A

Upper limb
Breast
Chest wall
Scapular region
Abdominal wall as far as the umbilicus

118
Q

Where are the apical nodes located

A

In the apex of axilla (apical nodes)- receive lymph from all other lymph nodes in the axilla

119
Q

What is the axillary artery a continuation of

A

Subclavian artery as it progresses laterally

120
Q

How is the Axillary artery formed

A

Subclavian artery travels over the first rib and under the clavicle and into the axilla
Becomes axillary artery after it passes over the lateral border of the first rib

121
Q

What does the axillary artery become

A

Brachial artery- as it crosses the inferior border of the teres major

122
Q

Axillary vein

A

Continuous with subclavian vein
Drains the upper limb
Travels alongside the axillary artery

123
Q

What forms the axillary vein

A

Union of the brachial veins with the basilic vein
The Cephalic vein also joins the axillary vein in the axilla

124
Q

When does the axillary vein become the subclavian vein

A

Lateral border of the first rib

125
Q

Dislocation of the shoulder

A

In a dislocation of the shoulder, the humeral head moves out of the glenoid fossa. Anterior dislocation, where the humeral head ends up resting anterior to the glenoid fossa, is much more common. It is often caused by blunt force trauma, such as a fall. X-ray imaging confirms the direction of displacement of the humeral head and whether there is an associated fracture. Dislocation can injure the axillary nerve.

126
Q

Rotator cuff injury

A

The rotator cuff can be injured by acute trauma or by repetitive use. The tendons can also degenerate with age. Tears of the rotator cuff are usually painful at rest and on movement, and cause weakness. If the supraspinatus tendon becomes injured and inflamed it may become impinged between the acromion and the humeral head, as the space here is small. The first part of abduction is not painful, but between 60˚– 120˚ of abduction, the inflamed tendon is compressed against the acromion, and this is when patients experience pain. An inflamed tendon may ultimately rupture.

127
Q

Axillary lymph node metastasis

A

Because lymph from the breast drains to the axillary lymph nodes, breast malignancy typically metastasises first to these nodes. A malignant axillary node may be felt as a lump in the armpit and may be noticed before a mass in the breast itself. Axillary lymph nodes can be biopsied to assess whether or not breast malignancy has metastasised and can be removed as part of the patient’s treatment. Because they drain lymph from the upper limb, removal of the nodes can lead to fluid accumulation and swelling in the affected upper limb.

128
Q

Which 2 nerves may be damaged when removing axillary lymph nodes

A

Long thoracic nerve
Thoracodorsal nerve

129
Q

Removing axillary lymph nodes: damage to the long thoracic nerve

A

• The long thoracic nerve innervates serratus anterior and lies superficially on the surface of the muscles in the medial wall of the axilla. Injury to this nerve causes weakness or paralysis of serratus anterior. One of the functions of this muscle is to hold the anterior border of the scapula flat against the posterior thoracic wall. If the muscle is paralysed, the anterior border lifts off the thoracic wall and the scapula appears to ‘stick out’. This is called a ‘winged scapula’.

130
Q

Removing axillary lymph nodes: damage to the Thoracodorsal nerve

A

• The thoracodorsal nerve to latissimus dorsi is also vulnerable to injury as it runs along the subscapularis muscle, which forms part of the posterior wall of the axilla.

131
Q

What nerve innervates the latissimus dorsi

A

Thoracodorsal nerve

132
Q

Which muscles are responsible for shoulder abduction

A

Initiated by Supraspinatus (first 15 degrees)
Deltoid then takes over
Rotation of scapula required to raise arm above the head- requires trapezius

133
Q
  1. Describe the movements of the scapula and the humerus during shoulder abduction.
A

o As the arm rises, the humerus laterally rotates – this keeps the articular surfaces in contact with each other; in full abduction (with the arm above the head) the humerus has rotated 90˚.
o For every 2˚ of abduction at the shoulder joint the scapula rotates 1˚.
o Rotation tilts the glenoid fossa cranially.

134
Q
  1. Which nerve innervates trapezius? How would you test if the nerve was functioning?
A

The accessory nerve / cranial nerve XI (11).
o The most straightforward way to test the function of the nerve is to ask the patient to shrug the shoulders (i.e. elevate the scapula). You would be comparing movement on both sides and looking for symmetry.

135
Q
  1. Which nerve is at risk of injury in shoulder dislocation? What functional deficits would result and how would you examine a patient to test for these deficits?
A

The axillary nerve (C5-C6 fibres).
o Potential function deficits are weakness / paralysis of deltoid and teres minor (motor fibres of the nerve) and impaired sensation / numbness over the skin of the upper lateral shoulder (sensory fibres of the nerve).
o Motor function – tested by asking the patient to abduct the arm; look for weakness compared with the unaffected arm.
o Sensory function – use light touch over the skin of the upper lateral arm and compare sensation with the opposite side; ask the patient if it feels the same or different to the unaffected side.

136
Q
  1. What structures stabilise the shoulder joint?
A

o The rotator cuff is the key stabilising factor.
o The tendon of the long head of biceps and the glenoid labrum also contribute to stability.

137
Q
  1. Which parts of the pectoral girdle and shoulder joint can be palpated on examination?
A

Clavicle, acromion, spine of the scapula and lateral border of the scapula.

138
Q
  1. Which muscles comprise the rotator cuff, and where do they insert on the humerus?
A

supraspinatus (inserts on the superior facet, greater tubercle), infraspinatus (inserts on the middle facet, greater tubercle), teres minor (inserts on the inferior facet, greater tubercle) and subscapularis (inserts on the lesser tubercle).

139
Q
  1. Describe the route of arterial blood through each vessel from the left ventricle to the right axillary artery and from the left ventricle to the left axillary artery.
A

Left ventricle > right axillary artery: Aorta > brachiocephalic trunk > right subclavian > right axillary.

Left ventricle > left axillary artery: Aorta > left subclavian > left axillary.

140
Q

What is the nerve root of the axillary nerve

A

C5-C6

141
Q

For every 2 degree of abduction at the shoulder joint the scapula rotates

A

1 degree

142
Q

What type of joint is the acromio-clavicular joint

A

Plane joint

143
Q

What muscles attach to the coracoid process

A

Biceps brachii
Coracobrachialis

144
Q

What muscles attach to the subscapular fossa

A

Subscapularis

145
Q

What muscles attach to the supraspinous fossa

A

Supraspinatus muscle

146
Q

What muscles attach to the infraspinous fossa

A

Infraspinatus muscle

147
Q

What muscles attach to the medial border of the scapula

A

Levator scapulae
Rhomboid major and minor

148
Q

What muscles attach to the lateral border of the scapula

A

Teres major and minor

149
Q

What muscles attach to the spine of the scapula

A

Deltoid
Trapezius

150
Q

What muscle type is the deltoid

A

Unipennate

151
Q

Innervation of supraspinatus

A

Suprascapular nerve

MSK anatomy (13 decks)

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