Quiz 3 Flashcards
What are the 5 muscles that originate on the vertebral column/skull?
- Trapezius
- Rhomboid Major
- Rhomboid Minor
- Levator Scapula
- Latissimus Dorsi
Trap - O
EOP
Superior Nuchal Line
Ligamentous Nuchae - over Cervicals, no Sharpey’s fibers here
Spines of the Thoracic
Trap - I
Clavicle
Acromion Process/Spine of Scapula
Trap - A
- Stabilizes the scapula - holds in anatomical position
- Upper portion - elevates
- Middle/lower portions - adducts (retracts) scapula
What is another term for weakness of the Trapezius and how does it affect the muscle?
Trapezius Palsy
- shoulder drops on affected side
- deepening of shoulder on affected side
Which portion of the trapezius is frequently involved in neck injuries during an auto accident?
Superior portion of the trap
(whiplash injury)
hyperextension/hyperflexion
What is the clinical examination to test for the XI cranial nerve?
Elevate (shrug) shoulders against resistance
test both sides at the same time to evaluate weakness
Rhomb Maj - O
Spines/upper thoracic
Rhomb Minor - O
Spines/lower cervicals and first thoracic
Rhomb Maj and Rhomb Minor - I
Vertebral border of scap
Levator Scap - O
Transverse processes/upper cervicals
Levator Scap - I
Superior angle of scap
Actions of Rhomboid/Levator Scap
- Elevates scap
- Adducts scap
- Stabilizes scap
Damage to the dorsal scapular nerve would affect which muscle(s)?
- Levator Scap
- Rhomboid Maj
- Rhomboid Min
Damage to the DSN results in what?
- Difficulty in adducting scap
2. Scapula on the affected side of further from the midline
What is the largest muscle in the body by area?
Latissimus Dorsi
What helps form the posterior fold/border of the axilla?
The tendon of insertion of the Lat Dorsi and the Teres Major
Lat Dorsi - O
Spines/lower thoracic/lumbar vertebrae
thoracodorsal fascia
crest/ilium
lower ribs
Lat Dorsi - I
Intertubercular groove (lesser tubercle) of humerus
Lat Dorsi - A
- Extends, adducts, & medially rotates humerus
2. Forced expiration
Weakness/damage to the Lat Dorsi results in…
Forward displacement of the shoulder
What makes up the Lumber Triangle?
- Lat Dorsi (depression at lower portion)
- Crest of the ilium
- External oblique musce
Clinical significance of the Lumbar Triangle?
Common site for a hernia of the posterior abdominal wall
What makes up the Triangle of Auscultation?
Found at the superior border of the Lat Dorsi
- Latissimus Dorsi
- Trapezius
- Vertebral Border of scapula
Why is the Triangle of Auscultation significant?
The thin layer of tissue here allows lung sounds to be easily heard with a stethoscope
How can we enlarge the Triangle of Auscultation area on a patient?
Having the patient abduct (protract) scapula. Ask the patient to fold their arms across their chest
What muscles connect the thoracic wall to the upper extremity?
Serratus Anterior, Subclavius, Pectoralis Major/Minor
Serratus anterior - o
Upper ribs
Serratus Anterior - I
Vertebral border of scapula
Serratus Anterior - A
- abducts scapula (prime mover)
- stabilizes scapula
- involved with forced inspiration but only when humerus is abducted
What is another name for Winged Scapula?
Long Thoracic Nerve Palsy
How does LTNP affect the serratus anterior?
Weakens the muscle due to damage of the LTN or its segmental innervation
What is the most important clinical sign of a winged scapula?
- Patient has difficulty keeping vertebral border and inferior angle of scap against the posterior thoracic wall when carrying out abduction against resistance
- Problems raising extremity over their head
- *Pain may or may not occur**
What causes Long Thoracic Nerve Palsy?
- Trauma/subluxation
- Traction injury involving shoulder joint
- Recumbency for a long period of time
What are the 6 scapular muscles?
- Deltoid
- Supraspinatus
- Infraspinatus
- Subscapularis
- Teres Minor
- Teres Major
What are the 4 Rotator Cuff Muscles?
“SITS”
Supra/infraspinatus
Teres Minor
Subscapularis
What two criterion are necessary for a muscle to be considered a rotator cuff muscle?
- Tendon of insertion must form a cuff around the proximal part of the humerus
- They either laterally or medially rotate the humerus
What muscle is a common site for intramuscular injections?
Deltoid
Deltoid - O
Clavicle (anterior portion)
Acromion Process (middle portion)
Spine of scapula (posterior/spinous portion)
Deltoid - I
Deltoid Tuberosity/humerus
Deltoid - A (anteroir)
flexes/medially rotates humerus
Deltoid - A (middle)
abducts humerus
Deltoid - A (posterior)
extends/laterally rotates humerus
What is another name for atrophy of the deltoid?
Crutch Paralysis
What causes Crutch Paralysis?
Due to an injury of the axillary nerve via:
- Dislocation of shoulder joint
- Pressure of a crutch in axilla
- Fracture of surgical neck of humerus
How does atrophy of the deltoid affect the muscle appearance and function?
- Flattened appearance
- Abduction of arm is impaired
- Loss of sensation over lateral aspect of arm
What branch of the axillary nerve is compromised in Crutch Paralysis?
Lateral brachial cutaneous branch
Supraspinatus - O
Supraspinatus Fossa of scap
Supraspinatus - I
Greater tuberosity of humerus
Supraspinatus - A
- Initiates abduction of humerus
- Laterally rotates humerus
- Stabilizes shoulder joint
How is the supraspinatus tendon of insertion separated from the acromion process?
Subacromial and subdeltoid bursa
This is generally more common than tendonitis, but it’s hard to distinguish the two*
What is Rotator Cuff Tendonitis?
Irritation/inflammation of the supraspinatus tendon
Another name for rotator cuff tendonitis?
Shoulder impingement syndrome
Common symptoms of rotator cuff tendonitis?
- “Twinge”, progressing to sharp/aching pain occurring in the anterior/lateral aspect of the shoulder
- Weak shoulder movement
- Hot/burning feeling in shoulder
What causes rotator cuff tendonitis?
- Genetic (due to a hooked acromion process)
- Trauma/Injury
- Excess stress/repetition (mostly in athletes)
- Weakness around rotator cuff (humerus compresses tendons)
- Calcium deposits in tendon (mostly in elderly)
If someone has a rotator cuff tear, where does the tear occur?
Ruptures at or near insertion
Tear may be partial or complete
What test can be performed to check for rotator cuff tears?
Drop test
- Patient slowly lowers abducted limb
- If tendon is torn, arm will drop suddenly at the halfway point
**Tears occur with minor trauma in patients over 50. Under 50, single traumatic injury (dislocation) can cause this injury
Infraspinatus - O
Infraspinatus Fossa of Scap
Infraspinatus - I
Greater tuberosity of humerus
Infraspinatus - A
- Laterally rotates the humerus
- Stabilizes the shoulder joint
Often fused to teres minor
Subscapularis - O
Subscapular Fossa of Scap (ventral surface)
**At muscle lines of attachment (deeper lines = greater muscle development)
Subscapularis - I
Lesser tuberosity
Subscapularis - A
- Medially rotates humerus
2. Stabilizes shoulder joint
Teres Minor - O
Axillary border of scap
Teres Minor - I
Greater tuberosity of scap
Teres Minor - A
- Laterally rotates humerus
2. Stabilizes shoulder joint
Teres Major - O
Inferior angle of Scapula
Teres Major - I
Medial lip of the intertubercular groove of humerus
Terer Major - A
- Adducts/medially rotates humerus
2. Stabilizes shoulder joint
What divides the teres major and teres minor?
Long head of the triceps brachii - divided into two smaller spaces
Quadrilateral Space
More lateral of the two spaces between the teres muscles
Contains the Axillary Nerve & Humeral Circumflex Blood Vessels (artery/vein)
Triangular Space
Medial space containing circumflex scapula branch of the subscapular artery
What are the two categories of ligaments?
Extrinsic (extracapsular) - superficial to capsular ligament
Intrinsic (Intracapsular) - deep to capsular ligament
Prevent movement by acting as either a rope or a wall
Sternoclavicular joint articulations
- Sternal end of clavicle
- Clavicular/costal notches of the sternum (manubrium)
- Medial end of the first rib
What are standout features of the S-C joint?
- Most stable joint of upper extremity
- Where the upper limb articulates with the axial skeleton
What is the articular disc?
Cartilage found in the middle of the S-C joint cavity (divides cavity in half)
What are the functions of the articular disc?
- Prevents clavicle from being displaced at articulation with sternum
- Shock absorber for forces transmitted along clavicle
What type of joint is the S-C joint?
Plane gliding joint (can also act as a ball and socket joint)
This strong ligament acts like a wall and completely surrounds the S-C joint
Capsular Ligament
What movements occur passively at this joint when the scapula moves?
- Elevation
- Depression
- Protraction/Retraction
- Rotation
These ligaments reinforces the capsular ligament
Anterior/Posterior Sternoclavicular Ligament
Costoclavicular Ligament
What ligament associated with the S-C joint is extrinsic and acts like a wall?
Anterior/Posterior Sternoclavicular
What ligament is attached the the sternal ends of both clavicles?
Interclavicular Ligament
What is the fxn of the interclavicular ligament?
Extrinsic and acts like a rope
Prevents displacement of the clavicle when one is carrying a heavy object
What strong ligament is attached to the costal impression of the clavicle and the first rib?
Costoclavicular ligament
What are the fxns of the costoclavicular ligament?
Extrinsic and acts like a rope
Reinforces the capsular ligament
Limits elevation at the medial end of the clavicle (monkey bars)
What causes a dislocation of the S-C joint?
Direct trauma to the anterior aspect of the sternal end of the clavicle
Dislocations are rare due to strength of ligaments
What are the grades of injury to the S-C joint?
Grade 1 - mild sprain
Grade 3 - complete dislocation
Injuries may be life threatening due to damage/compression of the trachea of blood vessels in the neck
How is the acromioclavicular joint classified?
Plane gliding joint
What are the articulations of the a-c joint?
Acromial (lateral) end of the clavicle
Acromion process of the scapula
What is the nerve supply for the A-C joint?
DSN, Axillary, Suprascapular
Are movements of the A-C joint active or passive?
Passive - occur when scapula moves upon the thoracic cage
What ligaments support the A-C Joint?
- Superor Acromioclavicular
- Inferior Acromioclavicular
- Coracoclavicular
How do the superior/inferior a-c ligaments support the A-C joint?
- Reinforce capsular ligament
- Extrinsic/rope
- Prevent the clavicle from losing contact with the acromion process
What does the coracoclavicular ligament connect?
Connects the clavicle with the coracoid process of the scapula
What are the two portions of the coracoclavicular ligament?
Conoid and Trapezoid
Attached respectively to the conoid tubercle and trapezoid line of clavicle
What are the fxns of the coracoclavicular ligament?
- Extrinsic/rope
- Limits protraction, elevation, and rotation of scap
- Holds/Suspends weighe of scap from clavicle
What is another name for a dislocation of the A-C joint?
Shoulder separation
What is a shoulder pointer?
An injury to the A-C joint due to a severe blow to the shoulder
What are some features of an A-C joint dislocation?
- More prominent acromion process (acromion bump)
- lateral end of clavicle is displaced and easily palpable
- Diminished brachial and radial pulse (only happens sometimes, due to subclavian artery compromise)
Which joint has the greatest range of motion (also called the universal joint)
Shoulder (Glenohumeral) Joint
Ball and Socket Joint
This mobility makes it unstable!
What are the articulations of the Glenohumeral joint?
Head of the humerus with the glenoid cavity of the scapula
What is the Glenoid Labrum?
A fibrocartilage rim that deepens the articular surface of the glenoid cavity
What is the nerve supply to the Glenohumeral joint?
Axillary & suprascapular
What are the ligaments of the shoulder joint?
Capsular, Glenohumeral, Transverse Humeral, Coracohumeral, Coracoacromial, Suprascapular
Where is the capsular ligament?
- Surrounds shoulder joint (thin/lax)
- Opens at the inferior lateral portion through which the long head of the biceps brachii passes out of the cavity
- Superiorly, strengthened by ligaments and rotator cuff muscle tendons
Where is the glenohumeral ligament? Fxns?
- Within shoulder cavity
- Strengthens anterior aspect of capsule
- Prevents lateral rotation of humerus at shoulder joint
- Intrinsic/Rope
Where is the transverse humeral ligament? Fxns?
- Spans intertubercular groove (converts into canal)
- Keeps the long head of the biceps brachii in place
Where is the coracohumeral ligament? Fxns?
- Strengthens the capsule from above
- Limits lateral rotation of humerus
- Extrinsic/rope
Where is the coracoacromial ligament? Fxns?
- Attaches to coracoid process/acromion process of scap
- Prevents upward displacement of head of humerus
- Extrinsic/Wall
Where is the suprascapular ligament located?
Scapular notch
What keeps the shoulder joint from dislocating?
Rotator cuff muscles
can occur directly or indirectly
What is the most common type of dislocation of the shoulder joint?
Anterior dislocation - occurs at inferior aspect of capsular ligament
What causes an anterior dislocation?
Excessive extension/lateral rotation of humerus
What is another name for an anterior dislocation?
Subcoracoid dislocation
Head of humerus is forced through the anterior part of the capsular ligament and ends up lying below coracoid process
What are common signs and complaints of a dislocation of the shoulder joint?
- Loss of sensation/numbness along lateral aspect of arm/forearm (musculocutaneous and axillary)
- Loss of rounded appearance of shoulder
- Greater tuberosity cannot be palpated through the deltoid muscle @ lateral proximal aspect of arm
What are the two compartments of the arm (brachium)?
Anterior - flexor
Posterior - extensor
What movements are associated with the elbow joint?
Flexion - bending elbow joint
Extension - A return movement from flexion, increases angle between arm/forearm
Hyperextension - only occurs in some individuals (due to size of olecranon process and fossa)
What movements are associated with the forearm at the superior and inferior radio-ulnar joints?
Supination - lateral rotation of the forearm (palms up). radius/ulna are parallel.
Pronation - medial rotation of forearm (palms down). radius crosses ulna anteriorly
What is another name for the biceps brachii?
“Three joint muscle” - it causes movements at elbow, shoulder, and proximal radio-ulnar joints
Biceps Brachii - O
Short Head (medial) - coracoid process/scap Long Head (lateral) - supraglenoid tubercle/scap
Biceps Brachii - I
Tuberosity/radius
Shaft/ulna (bicipital aponeurosis)
Biceps Brachii - A
- Flexion of forearm at elbow joint
- Supinator of forearm (prime mover)
- Short head: adducts humerus
- Long head: abducts humerus
What muscle completely covers but does not attach to the humerus?
Biceps Brachii
What are symptoms of biceps tendonitis? When does this usually occur?
- Pain at proximal arm/shoulder area
- Crepitus (cracking sound) due to narrow and/or rougher groove that can irritate the tendon
Usually occurs due to excessive flexion at the elbow joint against resistance
What is Popeye Deformity?
- Ruptured belly forms a ball near the center of the anterior aspect of the arm
- Due to tear or rupture of the long head of the biceps tendon (occurs at origin)
What causes Popeye Deformity?
- Chronic tendonitis
- Forceful flexion of the forearm against excessive resistance (e.g. weight lifting)
What is the bicipital reflex? How is this tested?
- Tested in an examination of segmental innervation (C5 and C6)
- Tap the biceps tendon, look for reflex of flexion at the elbow joint
Coracobrachialis - O
Coracoid Process of Scap
Coracobrachialis - I
Shaft of the humerus
Coracobrachialis - A
- Flexion/weak adduction of humerus
2. Helps stabilize shoulder joint
What nerve is always found passing through the belly of the coracobrachialis?
Musculocutaneous
Brachialis - O
Shaft of humerus
Brachialis - I
Coronoid Process of Ulna
Brachialis - A
Flexes forearm at elbow joint
Triceps Brachii - O
Long head: infraglenoid tubercle of humerus
Medial/Lateral: Shaft of humerus
Triceps Brachii - I
Olecranon Process of Ulna
Triceps Brachii - A
Extends forearm at elbow joint
Which head of the Triceps Brachii works all of the time?
Medial Head
Which head(s) of the Triceps Brachii are used only for extra force?
Lateral and Long heads
How can we test the segmental innervation of the triceps brachii?
Tap the muscle’s tendon of insertion and look for extension reflex
When is passive extension of the triceps brachii produced by gravity?
When the muscle is atrophied
Anconeus - O
Lateral epicondyle of the humerus
Anconeus - I
Olecranon Process
Proximal Posterior shaft of Ulna
Anconeus - A
Assists (weakly) in extension of forearm
