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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
How do you test trapezius power of a patient
Ask patient to shrug shoulders while attempting to push them back down
26
Identify the 4 origins of Latissimus Dorsi Identify the insertion
Spinous process of T6-T12 Iliac crest Thoracolumbar fascia Ribs 10,11,12 Insertion: Intertubucular sulcus (Converge into a single tendon)
27
Identify the Innervation and Actions of Latissimus Dorsi
Innervation: Thoracodorsal nerve Actions: Arm Extension, Adduction, Medial Rotation
28
Identify the Origins, Insertion, Innervation and Action of Levator Scapulae
Origin: C1-C4 transverse processes Insertion: Medial border of scapula, above spine (above rhomboid minor) Innervation: Dorsal scapular nerve Action: Elevates scapula
29
Identify the Origins, Insertion, Innervation and Action of Rhomboid Minor
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
Identify the Origins, Insertion, Innervation and Action of Rhomboid Major
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
What is the combined function of Rhomboid Major and Minor
Return of glenoid fossa to anatomical position after arm abduction> 90 degrees
32
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?
Scapulohumeral group of muscles - Deltoid - Teres Major Rotator Cuff Muscles; (SITS) - Teres Minor - Infraspinatus - Supraspinatus - Subscapularis
33
Identify the Origin, Insertion, Innervation and Actions of Teres Major
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
Compare the paths of Teres Minor and Teres Major in reference to Long Head of Triceps Brachii
Teres Major passes anteriorly to Triceps Long Head Teres Minor passes posteriorly to Triceps Long Head
35
What is the collective function of the 4 Rotator Cuff muscles
Their resting tone acts to pull humeral head into the glenoid fosaa
36
Identify the Origin, Insertion, Innervation and Actions of Supraspinatus
Origin: Supraspinatous fossa Insertion: Greater tubercle (Above Infraspinatus) Innervation: Suprascapular nerve (C5, C6) Action: Arm abduction up to 15 degrees, then assists Deltoid
37
Identify the Origin, Insertion, Innervation and Actions of Infraspinatus
Origin: Infraspinatous fossa Insertion: Greater tubercle (Between Supraspinatus and Teres Minor) Innervation: Suprascapular nerve Action: Lateral rotation of arm
38
Identify the Origin, Insertion, Innervation and Actions of Subscapularis
Origin: Subscapular Fossa Insertion: Lesser tubercle Innervation: Upper and lower subscapular nerves Action: Medial rotation of arm
39
Identify the Origin, Insertion, Innervation and Actions of Teres Minor
Origin: Lateral border of Infraspinatus fossa (Above T Major) Insertion: Greater tubercle (Below Infraspinatus) Innervation: Axillary nerve Action: Lateral rotation
40
What muscles are in each compartment of the arm
Anterior compartment; - Biceps brachii - Brachialis - Coracobrachialis Posterior Compartment; - Triceps brachii
41
Identify the innervation and blood supply of the Anterior Compartment muscles of the arm
Innervation: Musculocutaenous nerve | Blood supply: Muscular branches of brachial artery
42
Describe the origins, insertion and actions of Biceps Brachii
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
Describe the Biceps Tendon Reflex Test
Biceps brachii tendon is stretched briefly by tapping with a hammer Normally, this causes elbow Flexion
44
Where may the Long head of Biceps Brachii rupture? What will a patient hear?
Near its scapular origin OR Near its insertion in weight lifters Will hear a snap whilst lifting
45
What causes Popeye sign? Describe the sign Does the cause result in a lot of weakness in arm
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
Describe the origin, insertions and action of Brachialis What are its 2 Innervations
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
What are the heads of Triceps Brachii? Which is deeper? What is the arterial supply to the posterior compartment of the arm?
Medial head lies deeper than Lateral and Long Heads Profunda Brachii artery
48
Describe the origins and insertion of Triceps Brachii
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
State the Innervation and Action of Triceps Brachii
Innervation: Radial nerve Action: Elbow extension
50
Stare the 4 borders of the Quadrangular Space
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
Stare the 3 borders of the Triangular Space Which nerves and vessels pass through
Superior: Teres minor Inferior: Teres Major Lateral: Long head of Triceps Brachii No nerves pass through Circumflex Scapular Vessels
52
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?
Superior: Teres major Medial: Long head of Triceps Brachii Lateral: Humerus shaft OR Lateral head of triceps brachii - Radial nerve - Profunda brachii artery
53
Describe the 2 main Bursae at the shoulder joint
Subacromial bursa; - Between Supraspinatus and Coraco-acromial ligament, Acromion, Coracoid process and deltoid muscle Subscapular bursa; - Between Subscapularis and Neck of Scapula
54
What is the Subacromial space Wha are 4 contents in this space
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
What do the insertions of the rotator cuff muscles combine into? What does this fuse with? What is the effect?
Combine-> a “Tendinous cuff” Fuses with the joint capsule, strengthening it
56
Identify 8 stabilisers of the shoulder joint
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
Which 3 arteries are involved in the anastomosis around the margin of the scapula
- Subscapular artery (Below spine) - Suprascapular artery (Above spine) - Transverse Cervical/ Dorsal Scapular artery (Medial border of scapula)
58
From which 3 arteries is the shoulder joint’s arterial supply derived?
- Posterior and anterior circumflex humeral arteries | - Suprascapular artery
59
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?
Brachial artery, gives off Profunda Brachii (Deep brachial artery) Profunda Brachii supplies posterior arm

MSK (21 decks)

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