Scapular and Pectoral Regions

Question 1

Anatomical Neck of humerus

Answer 1

Marks the differentiation between the bony epiphysis and diaphysis

Question 2

Surgical Neck of humerus

Answer 2

Thinnest part of the proximal shaft Often injured or fractured

Question 3

Three important joints of/in the shoulder

Answer 3

Sternoclavicular, acromioclavicular, and glenohumeral joints

Question 4

Three ligaments of the acromioclavicular joint. What happens if these ligaments are ruptured?

Answer 4

Acromiolclavicular ligament (1) Coracoclavicular ligaments (2) *Connection between upper limb and clavicle are lost

Question 5

What is the actual term for “separated shoulder”? The clavicle and scapula are pulled in different directions…why?

Answer 5

Acromioclavicular dislocation *Weight of upper limb is pulling the scapula down and away from the clavicle. Trapezius is pulling the clavicle up

Question 6

What are two common ways to separate the shoulder or fracture the clavicle? How will patient present with a clavicle fracture?

Answer 6

1. Fall on outstretched arm 2. Fall on shoulder *Patient will hold arm up because clavicle fracture makes it painful to let weight of arm pull down on fracture

Question 7

What 3 ligaments make up the joint capsule?

Answer 7

Glenohumeral ligaments (superior, middle, and inferior)

Question 8

What ligament reinforces the shoulder joint superiorly

Answer 8

Coracoacromial ligament

Question 9

Structural integrity of the glenohumeral joint is held together by which muscles? (4)

Answer 9

Held together by rotator cuff muscles: supraspinatus, infraspinatus, teres MINOR, and subscapularis

Question 10

What is the most common type of humerus dislocation?

Answer 10

Anterior and inferior dislocation

Question 11

Anterior EXTRINSIC muscles (4) (Take a piss)

Answer 11

Pectoralis major Pectoralis minor Subclavius Serratus anterior

Question 12

Posterior EXTRINSIC muscles (5) (TRL)

Answer 12

Trapezius Latissimus dorsi Levator scapulae Rhomboid major Rhomboid minor

Question 13

INTRINSIC muscles of upper limb (6) 4 of these are the rotator cuff muscles

Answer 13

Deltoid Teres major Teres minor Supraspinatus Infraspinatus Subscapularis

Question 14

Pectoralis Major: Innervation Actions (2)

Answer 14

Innervation: medial and lateral pectoral nerve Actions: primarily an adductor of arm. Whole muscle activation will adduct and medially rotate arm

Question 15

Pectoralis Minor: Innervation Actions (2)

Answer 15

Innervation: medial pectoral nerve Actions: stabilizes scapula against rib cage and elevates rib cage when scapula is fixed. *Accessory muscle of respiration

Question 16

Subclavius Innervation Action (1)

Answer 16

Innervation: nerve to subclavius (seriously…that’s its name) Action: depresses clavicle

Question 17

Serratus Anterior Innervation Actions (2)

Answer 17

Innervation: long thoracic nerve Actions: 1. protracts and stabilizes scapula 2. rotates scapula

Question 18

Long thoracic nerve injury- two things to look for

Answer 18

1. Winged scapula on affected side 2. Patient unable to abduct arm above 90º

Question 19

Trapezius Innervation Actions (4) What is special about trapezius innervation?

Answer 19

Innervation: Accessory nerve Actions: 1. Elevates (superior bit) scapula 2. Retracts (medial) scapula 3. Rotates scapula 4. Depresses (lower) scapula *Only muscle of upper limb NOT innervated by brachial plexus

Question 20

Latissimus dorsi Innervation Actions (3)

Answer 20

Innervation: Thoracodorsal nerve Actions: Adducts, extends, and internally rotates humerus

Question 21

Muscles responsible for ELEVATION of shoulder (4)

Answer 21

1. Trapezius
2. Levator scapulae

3 and 4. Rhomboids

Question 22

DEPRESSION of shoulder

5 muscles and 1 force

Answer 22

1. Gravity
2. Pectoralis major and minor
3. Latissimus dorsi
4. Trapezius
5. Serratus anterior

Question 23

PROTRACTION of shoulder (3)

Answer 23

1. Serratus anterior
2. Pectoralis Major
3. Pectoralis Minor

Question 24

RETRACTION of shoulder (4)

Answer 24

1. Trapezius
2. Rhomboid major and minor
3. Latissimus dorsi

Question 25

SUPERIOR ROTATION of shoulder (2)

Answer 25

**1**. **Trapezius** ## Footnote **2. Serratus anterior**

Question 26

INFERIOR ROTATION of shoulder 6 muscles and 1 force

Answer 26

1. **Latissimus dorsi** 2. Gravity 3. Levator scapulae 4. Rhomboids 6. Pectoralis major and minor

Question 27

Deltoid Innervation Actions

Answer 27

Innervation: axillary nerve Actions: flexes (anterior fibers), abducts (lateral), and extends (posterior) arm at shoulder

Question 28

Teres Major Innervation Actions (3)

Answer 28

Innervation: Lower subscapular nerve Actions: 1. Adducts humerus 2. Internally rotates humerus 3. Assists latissimus dorsi

Question 29

Rotator Cuff: Innervation of supraspinatus and infraspinatus Innervation of teres minor Innervation of subscapularis

Answer 29

Supraspinatus and infraspinatus- suprascapular nerve Teres minor- axillary nerve Subscapularis- upper and lower subscapular nerves

Question 30

Rotator Cuff Actions of supraspinatus- Actions of infraspinatus and teres minor- Actions of Subscapularis-

Answer 30

Supraspinatus- initiates abduction of humerus Infraspinatus and teres minor- laterally/externally rotate humerus Subscapularis- medially/internally rotate humerus

Question 31

How will a patient with supraspinatus injury abduct arm?

Answer 31

The patient will swing arm up until deltoid takes over because the swinging takes pressure off the supraspinatus

Question 32

Why do most arm dislocations occur inferiorly?

Answer 32

Because there is nothing to resist humerus being pulled down except for joint capsule which is weak

Question 33

Branch from 1st part of axillary artery

Answer 33

Superior thoracic artery

Question 34

Branches off 2nd part of axillary artery

Answer 34

1. Thoracroacromial trunk 2. Lateral thoracic artery

Question 35

Branches of thoracoacromial trunk (4)

Answer 35

1. Pectoral br 2. Deltoid 3. Acromial 4. Clavicular

Question 36

Branches of 3rd part of axillary artery

Answer 36

1. Anterior circumflex humeral a. 2. Posterior circumflex humeral a. 3. Subscapular a

Question 37

Branches of subscapular artery (2)

Answer 37

1. Thoracodorsal artery 2. Circumflex artery

Question 38

Triangular Space Borders- lateral, superior, and inferior Contents

Answer 38

Lateral: long head of triceps brachii Superior: teres minor Inferior: teres major Contents: circumflex scapular artery

Question 39

Quadrangular Space Borders- lateral, medial, superior, and inferior Contents (2)

Answer 39

Lateral- surgical neck of humerus Medial: long head of triceps brachii Superior: teres minor Inferior: teres major Contents: axillary nerve and posterior circumflex humeral artery

Question 40

Damage to axillary nerve causes what?

Answer 40

Atrophy of deltoid. Patient will have difficult time elevating arm