Shoulder and arm Flashcards
bones of the upper limb
- Pectoral girdle: Clavicle; Scapula - Arm: Humerus - Forearm:Radius; Ulna - Wrist: Scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate - metacarpals (5) - phalanges (thumb only has 2)
where does the supraspinatus sit?
supraspinous fossa
where does the infraspinatus sit?
infraspinous fossa
where do the teres major and minor muscles sit?
lateral border of scapula
where does the subscapularis sit?
subscapular fossa
where does the short head of the biceps, coracobrachilias and pec major originate from?
corocaid process
where does the long head of the biceps originate from?
supraglenoud tubercle
where does the long head of the triceps originate from?
infraglenoid tubercle
structures to identify on humerus
Deltoid tuberosity Radial groove Medial and lateral epiondyles Olecranon fossae Trochlea, capitulum
what are the joints of the pectoral girdle
Sternoclavicular joint
Acromioclavicular joint
Glenohumeral joint
Scapulothoracic joint
what separates the sternum and the clavicle?
articular disk
what stabilises the sternoclavicular joint?
stern-clavicular and costoclavicular ligaments
what does the sternoclavicular joint enable?
movement of the pectoral girdle
what is the acromio-clavicular joint?
Synovial joint between the clavicle, acromion and coracoid process
what are the important ligaments of the acromio-clavicular joint?
- Acromioclavicular
- Coracoclavicular (Composed of the conoid and trapezoid ligaments)
- Coracoacromial
what can be torn in the acromio-clavicular joint in a dislocation?
Commonly injured by falls onto outstretched hand and can tear the ligaments
Minor: Tearing of the acromio-clavicular
Major: Tearing of the coraco-clavicular
what is the glenohumeral joint?
Joint between the glenoid process of the scapula and head of the humerus
what deepens the glenoid socket?
glenoid labrum
Subacromial bursa
capsule extends above the humeral head to form a bursa
what tendon passes through the glenohumeral joint?
tendon of the long head of the biceps
comes from under the transverse humeral ligament
what is the common site for pathology for impingement of the shoulder?
The acromion, coracoid and acromio-coracoid ligament form an arch above the joint and this is the site
This is trapping of a tendon (usually supraspinatus) when raising the arm resulting in pain
which ligaments make the capsule that surrounds the GH joint?
Gleno-humeral (x3)
Coraco-humeral
Transverse-humeral
what does inflammation of the GH joint lead to?
frozen shoulder
what are the movement facilitated by the GH joint?
Flexion and extension
- Abduction and adduction
- Internal and external rotation
- Circumduction (combination of movements)
what are the two functions of the rotator cuff muscles?
- Hold the humerus in the glenoid cavity
- Depress the humeral head to minimise risk of dislocation
what does anterior dislocation of the humerus lead to?
Tearing of the glenoid labrum
what is the result of compression of the axillary nerve?
Limited abduction due to reduced function of the deltoid muscle
what are the rotator cuff muscles?
Supraspinatus
Infraspinatus
teres minor
subscapularis
what is the scapulothoracic joint?
This is a virtual joint between the scapula, and the thoracic wall immediately anterior to it.
what are the possible movements of the ST joint?
- Elevation and depression of the scapula
- Protraction and retraction
- Rotation whereby the glenoid cavity either moves upwards or downwards
These movements are separate and independent of movements at the gleno-humeral joint
what spinal nerves make up the somatic brachial plexus?
C5-T1.
what is the brachial plexus responsible for?
innervation of the entire upper limb except trapezius
what is the sensory innervation provided by the brachial plexus?
sensory innervation to joints and skin and motor innervation to the muscles.
As well as providing sympathetic fibres to the vessels for vasoconstriction.
structures of the brachial plexus
Roots, trunks, divisions, cords, branches.
roots of peripheral nerves : Musculoskeletal Axillary nerve Ulnar nerve Radial nerve Median nerve
Musculoskeletal (C5, C6) Axillary nerve (C5, C6) Ulnar nerve (C8, T1) Radial nerve (C5 – T1) Median nerve (C6 – T1)
what does the musculocutaneous nerve supply?
Supplies the anterior compartment of the arm
Lies close to the subscapularis tendon
Continues as the lateral cutaneous nerve
roots of musculocutaneous nerve
C5, C6
what does the axillary nerve supply?
course of the nerve
Supplies the deltoid and teres minor muscle
Emerges from the posterior cord of the brachial plexus alongside the radial nerve
what are the roots of the axillary nerve?
C5, C6
What does the ulnar nerve supply?
course of the nerve
No branches in the upper arm
Supplies the hand and the anterior compartment of the forearm
- Upper arm in the anterior compartment initially but pierces the intermuscular septum and distally runs in the posterior compartment
- Lies posterior to the medial epicondyle and can be damaged
what does the radial nerve supply?
course of the nerve
Supplies the posterior compartments of the arm and forearm
It lies on the humerus in the radial groove and can be damaged there by fractures
It descends between the medial and lateral heads of the triceps brachii
what are the roots of the ulnar nerve?
C8, T1
what does the radial nerve divide into, above the elbow?
Superficial radial nerve
Posterior interosseous nerve
what are the roots of the radial nerve?
C5-T1
what does the medial nerve supply?
course of the nerve
Supplies the anterior compartments of the arm and forearm
It passes through the upper arm via the anterior compartment.
It begins anterior to the brachial artery
But at the level of the elbow it lies medial to the brachial artery and can be damaged there at any time
what are the roots of the median nerve?
C6-T1
what are the intrinsic shoulder muscles?
Deltoid
Teres Major
what are the four rotator cuff muscles?
Supraspinatus
Infraspinatus
Subscapularis
Teres Minor
what are the muscles of the anterior compartment of the arm?
Biceps brachii
Brachialis
Coracobrachialis
what are the muscles of the posterior compartment of the arm?
Triceps
Anconeus
what are the anterior pectoral muscles?
Pectoralis Major
Pectoralis Minor
Subclavius
Serratus Anterior
what are the posterior pectoral muscles?
Levator Scapulae
Rhomboids Major and Minor
Trapezius
Latissimus Dorsi
what is the proximal attachment of pec major?
Medial 1/3 clavicle
Sternum
Costal cartilages I – VII
what is the distal attachment of pec major?
Lateral lip of the intertubercular groove
what is the function of pec major?
Flexion
Adduction
Internal rotation
at GHJ
what is the innervation to the pec major?
Lateral and medial pectoral nerves
what is the proximal attachment of pec minor?
Ribs III – VI
what is the distal attachment of pec minor?
Coracoid process of the scapula
what is the function of pec minor?
protraction of STJ
what is the innervation to pec minor?
Medial pectoral nerve only
what is the function of subclavian?
Anchors the clavicle
Stabilises the sternoclavicular joint
what is the proximal attachment of serratus anterior?
Lateral surface of ribs I - VIII
what is the distal(insertion) attachment of serratus anterior?
Medial border to the scapula
what is the function of the serratus anterior?
Protraction at STJ
Rotation: Can elevate the glenoid fossa
responsible for centring the scapula on the thoracic wall
what is the innervation to the serratus anterior?
Long thoracic nerve (C5-C7)
what does injury to long thoracic nerve lead to?
scapular winging occurs
in what procedure may the thoracodorsal nerve be damaged?
mastectomies when looking for lymph nodes
what is the proximal attachment of the trapezius?
The ligamentum nuchae and the thoracic spine
Technically: External occipital protuberance, ligamentum nuchae, vertebra C1-T12
what is the distal attachment of the trapezius?
Posterior 1/3 clavicle
Acromion
Scapular spine
what is the function of the trapezius?
Multiple movements of the STJ
Elevation/rotation/retraction/depression
what is the function of the rhomboids?
Rotation
Retraction
what is the function of the levator scapula?
Elevation
what is the innervation to the rhomboids and lev scapulae?
dorsal scapular nerve
proximal attachment of lat dorsi
Vertebral column from T7 to ileum
distal attachment of lat dorsi
Floor of intertubercular groove of humerus
what is the function of lat dorsi?
Adduction (same as pec major)
Medial rotation (same as pec major)
Extension (opposite to pec major)
what is the innervation to the lat dorsi?
thoracodorsal nerve
proximal attachment of deltoid
Posterior 1/3 clavicle
Acromion
Scapular spine
(same as the distal attachments for the trapezius)
distal attachment of deltoid
Deltoid tuberosity of the humerus
function of deltoid
Abduction beyond 15⁰ (GHJ)
innervation to deltoid
axillary nerve
proximal attachment of teres major?
Inferior angle of the scapula
distal attachment of teres major?
Medial lip of intertubercular groove
function of teres major
Medial rotation
Adduction
Extension (tiny bit)
innervation to teres major
Inferior subscapular
proximal attachment of supraspinatus
Supraspinous fossa
function of supraspinatus
Abduction to 15⁰
innervation of supraspinatus
Suprascapular
proximal attachment of infraspinatus
Infraspinous fossa
function of infraspinatus
Lateral rotation
innervation to infraspinatus
Suprascapular
proximal attachment of teres minor
Infraspinous fossa
function of teres minor
Lateral rotation
innervation to teres minor
Axillary
proximal attachment of scapularis
Medial border of scapula
distal attachment of scapularis
Lesser tubercule
function of subscapularis
Medial rotation
innervation to subscapularis
Upper and lower subscapular nerves
distal attachment of rotator cuff muscles
onto the greater tubercule
except for subscapularis (lesser tubercle)
causes medial rotation
how do you test muscles e.g. at GH?
oppose the movement
which muscles cause flexion at GHJ?
Pectoralis Major
Anterior fibres of Deltoid
Coracobrachialis
Biceps Brachii also helps.
which muscles cause extension at GHJ?
Latissimus Dorsi
Posterior fibres of Deltoid
which muscles cause abduction at GHJ?
First 15 degree – Supraspinatus
Later – Central fibres of Deltoid
which muscles cause adduction at GHJ?
Pectoralis Major
Latissimus Dorsi
Teres Major
which muscles cause external rotation at GHJ?
Infraspinatus
Teres Minor
which muscles cause internal rotation at GHJ?
Subscapularis
which muscles help resist dislocation?
Deltoid, Rotator Cuff, tendon of long head of biceps, short head of biceps, coracobrachialis
what are the boundaries of the axilla?
- Apex: Formed by rib 1
- Anterior wall: Pectoralis major
- Posterior wall: subscapularis, teres major and latissimus dorsi
- Medial wall: Ribs I – IV and serratus anterior
- Lateral wall: Humerus
- Base: skin, subcutaneous tissue and fascia
what connect the humerus to the deep fascia of the arm on either side?
Medial and lateral intermuscular septa
what is the anterior compartment of the arm innervated by?
musculocutaneous nerve
what is the posterior compartment of the arm innervated by?
radial nerve
when does the axillary artery become the brachial artery?
inferior border of the teres major
what is near the brachial artery?
median nerve (artery is lateral to it)
what branch comes of the brachial artery and what nerve runs nearby?
The profunda brachii- runs alongside the radial nerve
what happens to the brachial artery at the elbow?
Brachial artery divides at the elbow into the radial and ulnar arteries
what does the profunda brachii supply?
Supplies blood to the posterior compartment of the arm.
what is the superficial venous drainage for the arm?
Basilic – draining medial part
Cephalic – draining lateral part
what is the deep venous drainage of the arm?
The venae comitantes of the profunda brachii (VCPB)
when does the basili vein become deep? what does it join and where?
Basilic pierces deep fascia midway up arm to become deep and joins the VCPB to form the axillary vein at the inferior border of the teres major
cephalic vein also joins the axillary vein
what is the superificial lymphatic drainage of the arm?
Cubital lymph nodes
Delto-pectoral lymph nodes
what is the deep lymphatic drainage of the arm?
Lymph nodes running alongside the deep veins
where do the breast drain?
axillary lymph nodes,
where the arm systems also drain
what are the 5 groups of axillary lymph nodes?
Central Humeral Apical Pectoral Subscapular
[CHAPS]
where do the axillary lymph nodes drain?
subclavian lymphatic trunk
what nerves can be damaged during surgery near the axillary lymph nodes?
Long thoracic and thoracodorsal
Results in winging of the scapula
