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MSK > Shoulder And Arm > Flashcards

Shoulder And Arm Flashcards

1
Q

Name the 3 articulations of the scapula

Which is not a true joint? Why?
What does it depend on

A
  • Glenohumeral
  • Acromioclavicular
  • Scapulothoracic “joint”
  • Scapulothoracic, as it has none of the characteristics of a joint
  • Depends on integrity of the acromioclavicular and sternoclacicular joint
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2
Q

Are scapula fractures common?

What do they indicate?

Do they require fixation? Why?

A

No, are uncommon

Indicate severe chest trauma

Doesn’t typically require fixation, as tone of surrounding muscles holds the fragments in place?

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3
Q

What are the the 2 ends of the clavicle

What is the part between the 2 ends called

A

Sternal End- Manubrium of sternum
Acromial End- Acromion

The shaft

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4
Q

What are the 3 main functions of the clavicle

A
  • Attaches upper limb to trunk
  • Protects underlying neurovascular structures supplying the upper limb
  • Transmits force from upper limb to axial skeleton
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5
Q

What are the attachments of the Costoclavicular ligament

A

Inferior aspect of Sternal end of clavicle

Costal cartilage 1

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6
Q

What are the 2 parts of the Coracoclavicular ligament? Which part is more lateral

Where do they attach?

A

Attach at at the Acromial End of clavicle;

  • Conoid ligament attaches to Conoid tubercle
  • Trapezoid ligament attaches to Trapezoid line
  • Trapezoid ligament is more lateral
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7
Q

What are 2 atypical features of the Acromioclavicular joint?

A
  • Articular surfaces filled with fibrocartilage (Not hyaline cartilage)
  • Joint cavity partially divided by an articular disc (A wedge of fibrocartilage)
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8
Q

What are 3 main ligaments that strengthen the Acromioclavicular joint

A

Intrinsic;
- Acromioclavicular ligament (Superior to joint capsule, which is superior to the articular disc)

Extrinsic;

  • Conoid ligament
  • Trapezoid ligament

*Both extrinsic are part of the Coracoclavicular ligament

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9
Q

Which muscles act directly on the Acromioclavicular joint?

A

No muscles act directly

All movement is passive, initiated by movement elsewhere

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10
Q

Describe the strength and mobility of the ONLY attachment of upper limb to axial skeleton?

What kind of cartilage covers the articular surfaces of this joint

A

Sternoclavicular joint

  • Very strong
  • Very mobile (Unusually)

Fibrocartilage (Like in the acromioclavicular joint)

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11
Q

What bones make up the shoulder girdle?

What do you call anterior and posterior movement of the girdle

A

Clavicle and scapula

Anterior: Protraction
Posterior: Retraction

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12
Q

What are the edges of the Intertubuclar sulcus called?

Which muscles attach and where, in relation to each other?

A

Called lips

A lady between 2 majors

Latissimus Dorsi inserts on the Medial Lip, between Teres major and Pectoralis Major on the Lateral Lip

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13
Q

What are the main neurovascular structures at risk during a fracture to the surgical neck of the humerus

A

Axillary nerve

Posterior circumflex humeral artery

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14
Q

Describe how the Radial/ Spiral groove runs across the humerus?

What nerve and artery lie in the groove?

A

Runs diagonally on posterior surface of humerus, at level of deltoid tuberosity

  • Radial nerve
  • Profunda brachii artery
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15
Q

Name the 3 joints of the shoulder girdle

A
  • Sternoclavicular
  • Acromioclavicular
  • Glenohumeral

(Scapulothoracic joint, is not a true one)

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16
Q

Explain anatomically, why the Glenohumeral joint is the most mobile in the body

Give 2 reasons

A

Humeral head is larger than glenoid fossa

Glenoid fossa is shallow

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17
Q

Why is the inferior aspect of the shoulder the weakest part, relative to the superior, anterior and Posterior parts

A

Inferior part has no rotator cuff muscles providing reinforcement

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18
Q

Name 4 ligaments that provide stability to shoulder joint, preventing dislocation

A
  • Glenohumeral ligaments (Superior, Medial, Inferior)
  • Coroclavicular (Conoid, trapezoid)
  • Coracohumeral
  • Coraco acromial
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19
Q

Where are the Glenohumeral and Coraco-acromial ligaments in relation to the shoulder joint?

What direction of shoulder dislocation do they prevent?

A

Glenohumeral: Anterior, prevent anterior dislocation

Coraco-acromial: Superior, prevent superior dislocation

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20
Q

Which 2 ligaments act as “tunnels” in the shoulder region

What structures pass through?

A
  1. Transverse Humeral Ligament:
    - Allows passage of long head of biceps brachii between greater and lesser tubercles
  2. Coraco acromial Ligament:
    - “Roof” of sub acromial space, through which supraspinatus tendon passes
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21
Q

Compare the 2 groups of shoulder muscles in terms of insertions and origins

A

Extrinsic (Deep or superficial):

  • Originate from torso
  • Insert onto shoulder bones (Clavicle/ scapula/ humerus)

Intrinsic:

  • Originate from Scapula and/ or clavicle
  • Insert onto humerus
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22
Q

Where are the extrinsic shoulder muscles sited?

Which muscles are in each of the 2 layers

A

On back of trunk

Superficial;

  • Latissimus dorsi
  • Trapezius (Most superficial of all back muscles)

Deep (Upper back);

  • Levator Scapulae
  • Rhomboid major
  • Rhomboid minor
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23
Q

How many parts does trapezius have? Name them

Describe the origins and insertions of trapezius

A

Descending part
Transverse part
Ascending part

Origin- External occipital protuberance, Nuchal ligament, C7-T12 spinous processes

Insertion- Clavicle, Acromion and Spine of scapula

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24
Q

State the innervation of Trapezius

State the actions of the 3 parts of trapezius

A

Innervation: Accessory nerve (Cranial nerve 9)

Descending part;
- Elevate scapula and rotate it during arm abduction> 90 degrees

Transverse part;
- Retract scapula

Ascending part;
- Pull scapula inferiorly

25
Q

How do you test trapezius power of a patient

A

Ask patient to shrug shoulders while attempting to push them back down

26
Q

Identify the 4 origins of Latissimus Dorsi

Identify the insertion

A

Spinous process of T6-T12
Iliac crest
Thoracolumbar fascia
Ribs 10,11,12

Insertion: Intertubucular sulcus (Converge into a single tendon)

27
Q

Identify the Innervation and Actions of Latissimus Dorsi

A

Innervation: Thoracodorsal nerve

Actions: Arm Extension, Adduction, Medial Rotation

28
Q

Identify the Origins, Insertion, Innervation and Action of Levator Scapulae

A

Origin: C1-C4 transverse processes

Insertion: Medial border of scapula, above spine (above rhomboid minor)

Innervation: Dorsal scapular nerve

Action: Elevates scapula

29
Q

Identify the Origins, Insertion, Innervation and Action of Rhomboid Minor

A

Origin: C7-T1 spinous processes
Insertion: Medial border of scapula, at level of spine

Innervation: Dorsal scapular nerve

Action: Retracts scapula, rotates medial border so that glenoid fossa is rotated inferiorly

30
Q

Identify the Origins, Insertion, Innervation and Action of Rhomboid Major

A

Origin: T2-T5 spinous processes

Insertion: Medial border of scapula, below spine (Below R Minor)

Innervation: Dorsal scapular nerve

Action: Retracts scapula, rotates medial border so that glenoid fossa is rotated inferiorly

31
Q

What is the combined function of Rhomboid Major and Minor

A

Return of glenoid fossa to anatomical position after arm abduction> 90 degrees

32
Q

What are the Intrinsic Shoulders muscles also called?

Name all 6 of them

4 of the muscle are in one category. What is this category?

A

Scapulohumeral group of muscles

  • Deltoid
  • Teres Major

Rotator Cuff Muscles; (SITS)

  • Teres Minor
  • Infraspinatus
  • Supraspinatus
  • Subscapularis
33
Q

Identify the Origin, Insertion, Innervation and Actions of Teres Major

A

Origin: Inferior angle of Infraspinatus fossa

Insertion: (Medial lip of) Intertubucular sulcus

Innervation: Lower subscapular nerve (C5-C7)

Actions: Medial rotation, Adduction, Extension of arm

34
Q

Compare the paths of Teres Minor and Teres Major in reference to Long Head of Triceps Brachii

A

Teres Major passes anteriorly to Triceps Long Head

Teres Minor passes posteriorly to Triceps Long Head

35
Q

What is the collective function of the 4 Rotator Cuff muscles

A

Their resting tone acts to pull humeral head into the glenoid fosaa

36
Q

Identify the Origin, Insertion, Innervation and Actions of Supraspinatus

A

Origin: Supraspinatous fossa
Insertion: Greater tubercle (Above Infraspinatus)

Innervation: Suprascapular nerve (C5, C6)

Action: Arm abduction up to 15 degrees, then assists Deltoid

37
Q

Identify the Origin, Insertion, Innervation and Actions of Infraspinatus

A

Origin: Infraspinatous fossa

Insertion: Greater tubercle (Between Supraspinatus and Teres Minor)

Innervation: Suprascapular nerve

Action: Lateral rotation of arm

38
Q

Identify the Origin, Insertion, Innervation and Actions of Subscapularis

A

Origin: Subscapular Fossa
Insertion: Lesser tubercle

Innervation: Upper and lower subscapular nerves

Action: Medial rotation of arm

39
Q

Identify the Origin, Insertion, Innervation and Actions of Teres Minor

A

Origin: Lateral border of Infraspinatus fossa (Above T Major)

Insertion: Greater tubercle (Below Infraspinatus)

Innervation: Axillary nerve

Action: Lateral rotation

40
Q

What muscles are in each compartment of the arm

A

Anterior compartment;

  • Biceps brachii
  • Brachialis
  • Coracobrachialis

Posterior Compartment;
- Triceps brachii

41
Q

Identify the innervation and blood supply of the Anterior Compartment muscles of the arm

A

Innervation: Musculocutaenous nerve

Blood supply: Muscular branches of brachial artery

42
Q

Describe the origins, insertion and actions of Biceps Brachii

A

Origins;

  • Long head from Supraglenoid tubercle
  • Short head from Coracoid process

Insertion;
- Radial tuberosity and deep fascia of forearm

Actions;

  • Supination
  • Arm flexion at elbow joint
  • Arm flexion at shoulder joint
43
Q

Describe the Biceps Tendon Reflex Test

A

Biceps brachii tendon is stretched briefly by tapping with a hammer

Normally, this causes elbow Flexion

44
Q

Where may the Long head of Biceps Brachii rupture?

What will a patient hear?

A

Near its scapular origin
OR
Near its insertion in weight lifters

Will hear a snap whilst lifting

45
Q

What causes Popeye sign? Describe the sign

Does the cause result in a lot of weakness in arm

A

Rupture of biceps tendon

A firm lump in lower arm during elbow flexion

Not much weakness after a rupture (Brachialis and Supinator are still intact)

46
Q

Describe the origin, insertions and action of Brachialis

What are its 2 Innervations

A

Origin: Distal half of humerus

Insertion: Coronoid process of ulna and ulnar Tuberosity

Action: Elbow Flexion

Innervtions;

  • MSC nerve
  • Radial nerve (C5, C6 only)
47
Q

What are the heads of Triceps Brachii?
Which is deeper?

What is the arterial supply to the posterior compartment of the arm?

A

Medial head lies deeper than Lateral and Long Heads

Profunda Brachii artery

48
Q

Describe the origins and insertion of Triceps Brachii

A

Origins;

  • Long head: Infraglenoid tubercle
  • Lateral head: Humerus shaft, above Radial groove
  • Medial Head: Humerus shaft, below Radial groove

Insertion:
- Olecranon of of ulna

49
Q

State the Innervation and Action of Triceps Brachii

A

Innervation: Radial nerve

Action: Elbow extension

50
Q

Stare the 4 borders of the Quadrangular Space

A

Superior: Teres minor
Inferior: Teres major
Medial: Long head of triceps brachii
Lateral: Surgical neck of humerus

(Axillary nerve and Posterior Circumflex Humeral Artery pass through)

51
Q

Stare the 3 borders of the Triangular Space

Which nerves and vessels pass through

A

Superior: Teres minor
Inferior: Teres Major
Lateral: Long head of Triceps Brachii

No nerves pass through
Circumflex Scapular Vessels

52
Q

Stare the 3 borders of the Triangular Interval

Which nerves and vessels can be seen at the base, as they wind around humerus in the radial groove?

A

Superior: Teres major
Medial: Long head of Triceps Brachii

Lateral: Humerus shaft OR Lateral head of triceps brachii

  • Radial nerve
  • Profunda brachii artery
53
Q

Describe the 2 main Bursae at the shoulder joint

A

Subacromial bursa;
- Between Supraspinatus and Coraco-acromial ligament, Acromion, Coracoid process and deltoid muscle

Subscapular bursa;
- Between Subscapularis and Neck of Scapula

54
Q

What is the Subacromial space

Wha are 4 contents in this space

A

Space between Head of Humerus and Coraco-acromial arch (CA ligament, C process and Acromion)

Subacromial bursa
Joint capsule
Supraspinatus
Long head of Biceps Trachii

55
Q

What do the insertions of the rotator cuff muscles combine into?

What does this fuse with?
What is the effect?

A

Combine-> a “Tendinous cuff”

Fuses with the joint capsule, strengthening it

56
Q

Identify 8 stabilisers of the shoulder joint

A

Static stabilisers (Stability at rest);

  • Congruency of humeral head and glenoid fossa
  • Glenoid labrum
  • Joint capsule
  • Glenohumeral ligaments
  • Extracapsular ligaments
  • Negative intra-Articular pressure

Dynamic stabilisers (Stability during motion);

  • Rotator cuff muscles
  • Extrinisc muscles that cross the shoulder joint
57
Q

Which 3 arteries are involved in the anastomosis around the margin of the scapula

A
  • Subscapular artery (Below spine)
  • Suprascapular artery (Above spine)
  • Transverse Cervical/ Dorsal Scapular artery (Medial border of scapula)
58
Q

From which 3 arteries is the shoulder joint’s arterial supply derived?

A
  • Posterior and anterior circumflex humeral arteries

- Suprascapular artery

59
Q

Which artery provides the main supply to arm and forearm

What happens to this artery immediately distal to Teres Major

Which part of arm does this supply?

A

Brachial artery, gives off Profunda Brachii (Deep brachial artery)

Profunda Brachii supplies posterior arm

MSK (21 decks)

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