Shoulder Flashcards
Trapezius origin and insertion
Origin - C7-T12 spinous process
Insertion - Clavicle, acromion, spine of scapula
Trapezius innervation
Accessory nerve (CN XI)
Trapezius action
Elevate and rotate scapula
Latissimus dorsi origin and insertion
Origin - T7-T12, iliac crest
Insertion - Humerus (intertubercular groove)
Latissimus dorsi innervation
Thoracodorsal nerve
Latissimus dorsi action
Adduct, extend and IR arm
Levator scapulae origin and insertion
Origin - C1-C4 spinous processes
Insertion - Superior medial scapula
Levator scapulae innervation
Dorsal scapular (C3-C4)
Levator scapulae action
Elevate scapula
Rhomboid minor origin and insertion
Origin - C7-T1
Insertion - medial scapula (at spine)
Rhomboid minor innervation
Dorsal scapular
Rhomboid minor action
Adduct scapula
Rhomboid major origin and insertion
Origin - T2-T5
Insertion: Medial scapula
Rhomboid major innervation
Dorsal scapular
Rhomboid major action
Adduct scapula
What happens if there is weakness of the trapezius?
Lateral winging
What muscles connect the UE to the spine
Levator Scapulae
Rhomboid major
Rhomboid minor
Triangular space borders
Teres minor
Teres major
Triceps long head
What structure(s) are in the triangular space?
circumflex scapular artery
Quadrangular space borders
Teres minor
Teres major
Long head triceps
Medial border of humerus
What structure(s) are in the quadrangular space?
Axillary nerve
Posterior circumflex humeral artery
Borders of triangular interval
Triceps long head
Triceps lateral head
Teres major
What structure(s) are in the triangular interval?
Deep artery of the arm
Radial nerve
Supraspinatus origin and insertion
O: supraspinatus fossa
I: great tubercle (superior)
Supraspinatus innervation
suprascapular nerve
Supraspinatus action
Abduct FF arm
Stability
Infraspinatus origin and insertion
O: Infraspinatus fossa
I: greater tubercle (middle)
Infraspinatus action
ER arm
Stability
Teres minor origin and insertion
O: Lateral scapula
I: greater tubercle (inferior)
Teres minor innervation
axillary nerve
infraspinatus innevervation
suprascapular
Teres minor action
ER arm
stability
Subscapularis origin and insertion
O: subscapular fossa
I: lesser tubercle
Subscapularis innervation
upper and lower subscapular nerve
Subscapularis action
IR
adduct arm
stability
Deltoid origin and insertion
O: Clavicle, acromion, spine of scapula
I: deltoid tuberosity of humerus
Deltoid innervation
axillary
Deltoid action
abduct arm
Teres major origin and insertion
O: inferior angle of scapula
I: Humerus (intertubercular groove)
Teres major innervation
lower subscapular
Teres major action
IR
Adduct arm
which muscle is trapped in shoulder impingement
supraspinatus
which rotator cuff tendon is most commonly torn
supraspinatus
where would you see most atrophy in axillary nerve damage?
deltoid
what muscle protects the radial nerve in posterior approach for shoulder repair
teres major
Pectoralis major origin and insertion
O: clavicle, sternum
I: Humerus (intertubercular groove)
Pectoralis major innervation
medial and lateral pectoral
Pectoralis major action
adduct arm
IR humerus
Pectoralis minor origin and insertion
O: ribs 3-5
I: coracoid process
Pectoralis minor innervation
medial pectoral nerve
Pectoralis minor action
stabilizes scapula
what muscle divides the axillary artery into 3 parts
Pectoralis minor
Serratus anterior origin and insertion
O: ribs 1-8
I: antero-medial border of scapula
Serratus anterior innervation
long thoracic
Serratus anterior action
holds scapula to chest wall
Paralysis of what muscle causes medial winging of scapula
serratus anterior
Subclavius origin and insertion
O: Rib 1 (and costal cartilage)
I: Clavicle (inferior border/mid 3rd)
Subclavius innervation
nerve to subclavius
Subclavius action
depresses clavicle
What is pathognomonic for a rotator cuff tear on MRI
communication between the shoulder joint and subdeltoid bursa (subacromial space)
pathogenesis of external impingement
repeated arm abduction causes repeated impingement of the supraspinatus tendon between the greater tubercle and acromion causing degeneration and inflammation of the tendon, secondary inflammation of bursa, and pain
3 stages of adhesive capuslitis
pain, stiffness, resolving (thawing)
what is adhesive capsulitis
synovial inflammation leads to capsular fibrosis and loss of joint space
which tests test for biceps tenditinits?
speed and yergason’s test
what is biceps tendinitis associated with?
impingement, rotator cuff tear (esp. subscapularis), and tendon subluxation
what tests test for external impingement?
Neers and Hawkins test
Name +test for rotator cuff tear
SS: FF, +empty can test
IS: ER, +hornblower’s
Subscapularis: IR, +lift off, +belly press, increased ER
What is TUBS?
Traumatic anterior shoulder instability
(Traumatic Unilateral dislocations with a Bankart lesion requiring Surgery)
- Result of dislocation (Trauma)
- Most often UNILATERAL
- Labral tear (BANKART lesion) results from the dislocation
- SURGERY is most often needed (90% recurrence rate)
What is AMBRI?
Glenohumeral joint instability
- ATRAUMATIC
- MULTIDIRECTIONAL
- BILATERAL
- Responds to REHAB
- INFERIOR capsular shift may help
what is SLAP lesion?
tear of superior labrum from anterior to posterior
what tests would be positive for SLAP lesion
O’brien’s
Crank test
imaging for labral tears
MR arthrogram
condition with small, undescended scapula; omovertebral bone connects C-spine to scapula
that is associated with Klippel-Field syndrome, scoliosis and kidney disease
neck appears short/full, often decreased ROM
Sprengel’s deformity
what is a bankart lesion
is an avulsion of the anterior labrum and anterior band of the IGHL from the anterior inferior glenoid.
Bony bankart lesion - is a fracture of the anterior inferior glenoid
what is Hill-Sachs defect
is a chondral impaction injury in the posterosuperior humeral head secondary to contact with the glenoid rim.
is present in 80% of traumatic dislocations and 25% of traumatic subluxations
is not clinically significant unless it engages the glenoid
What nerves make up the brachial plexus?
C5-T1
Which nerves make up the cervical plexus?
C1-C4
What CN is axillary nerve?
C5, C6
What CN is radial nerve
C5-8, T1
What CN makes up median nerve
C5-8, T1
What CN makes up ulnar nerve
C7, C8, T1