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Anatomy of the limbs > Shoulder and arms > Flashcards

Shoulder and arms Flashcards

1
Q

What is the glenoid cavity?

A

The socket for the shoulder joint on the scapula

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2
Q

What is the costal surface of the scapula?

A

The front of the scapula - pressed against the posterior chest wall

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3
Q

What does the spine of the scapula divide the scapula into?

A

The supraspinous and infraspinous fossae

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4
Q

What is the name of the tubercle of the scapula?

A

deltoid tubercle of scapula

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5
Q

What is the name of the bony process on the end of the scapula?

A

acromion

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6
Q

What is the coracoid process?

A

the hook like structure of the scapula

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7
Q

What are the 2 articulations of the clavicle?

A

acromial end

sternal end

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8
Q

What does the acromial end of the clavicle articulate with?

A

the acromial end of the scapula

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9
Q

What causes the impressions on the posterior surface of the clavicle?

A

muscle attachments

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10
Q

What are the three main bones of the shoulder?

A

clavicle, humerus and scapula

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11
Q

What are the 2 necks of the humerus?

A

Anatomical - real head

Surgical - most commonly damaged

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12
Q

What is the deltoid tuberosity of the humerus?

A

It is a bump halfway down the humerus where the deltoid muscle attaches

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13
Q

What are the main parts of the humerus?

A

head, shaft, distal region with articulating surfaces (trochloea and capitulum)

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14
Q

What are the compartments of the shoulder and arm?

A

Anterior pectoral girdle muscles

Posterior pectoral girdle muscles

Intrinsic shoulder muscles

Anterior compartment of the upper arm

Posterior compartment of the upper arm

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15
Q

What does proximal attachment (of a muscle ) mean?

A

closer to the trunk

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16
Q

What is the arm (anatomically not when talking to patients)?

A

Between the elbow and shoulder

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17
Q

What are the anterior pectroral girdle muscles?

A
  • pec major
  • pec minor
  • sublcavius
  • serratus anterior
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18
Q

What are the proximal and distal attachments of pectoralis major?
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A

proximal - on the medial third of the clavicle, sternum and costal cartilages (hence two heads; sternal, clavicular and also has an abdominal part)

distal - lateral lip of the intertubercular sulcus (groove in humerus)

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19
Q

What does the pectoralis major do?

A

Adducts and medially rotates the humerus (punching muscle), little extension
Less effects on the scapula

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20
Q

What are the attachments of pectoralis minor?

A

Originates at the caracoid process of the scapula and

attaches to ribs 2,3,4,5

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21
Q

What is the role of pectoralis minor?

A

Moves scapula forward and down maintaining the mobility of the shoulder joint

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22
Q

What are the attachments of the subclavius?

A

Attaches from the first rib the the under surface of the clavicle

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23
Q

What does the subclavius do?

A

Stabilises the clavicle and SCJ

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24
Q

What are the attachments of serratus anterior?

A

Attaches up to 9 ribs and comes posteriorly from the medial edge of the scapula. The muscle runs around the side of the chest and divides into finger like parts

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25
Q

What is the role of serratus anterior?

A

Holds and stabilises the scapula, protraction at STJ and elevate the glenoid fossa

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26
Q

What are the posterior pectoral girdle muscles?

A

trapezius, latissimus dorsi, levator scapulae and rhomboids

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27
Q

What are the attachments of the trapezius?

A

A triangular muscle that attaches to the base of the skull (supeior nuchal line) and at all of cervical and thoracic vertebrae. Has an attachment from the spine of the scapula. It goes anteriorly onto the lateral/posterior third of the clavicle, acromion and scapular spine

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28
Q

What nerve innervates the trapezius?

A

spinal accessory nerve

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29
Q

What is the role of the trapezius muscle?

A

Acts on the scapula - different fibres of muscle contract to have different effects

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30
Q

What are the proximal and distal attachments of the latissimus dorsi?

A

Big triangular muscle that attaches from T8 to connective tissue in posterior pelvic region. Fibres from the distal attachment form a trap which attaches to the floor of the intertubercular groove.

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31
Q

What are the roles of latissimus dorsi?

A
  • Extends, adducts and rotates the humerus
  • Pulls the body up to the arms during climbing and also important in rowing
  • In 4 legged animal important in running
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32
Q

What is the nerve supplying the latissimus dorsi?

A

Thoracodorsal nerve

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33
Q

What are the attachments of the rhomboids?

A

2 muscles (major and minor)

  • Minor is one strap
  • They attach to the medial border of the scapula and spinous process at lower end of neck and upper part of thorax
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34
Q

What nerve supplies the rhomboids?

A

The dorsal scapular nerve

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35
Q

What are the roles of the rhomboid?

A

Retracts the scapula and stabilises it

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36
Q

What are the attachments of levator scapulae?

A

Comes from the transverse processes of C1-4 and attaches to superior angle of the scapula (top corner)

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37
Q

Which nerve innervates levator scapulae?

A

Dorsal scapula nerve and C3/4

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38
Q

What are the roles of levator scapulae?

A

It is involved in retracting and elevating and rotating the scapula (e.g. shrugging your shoulders upwards).

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39
Q

What are the different parts of the trazpezius?

A

superior (descending), middle and inferior (ascending)

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40
Q

What are the intrinsic shoulder muscles?

A

deltoid, teres major and rotator cuff muscles

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41
Q

What are the attachments of the deltoid muscle?

A
  • Posteriorly attaches to the scapular spine, and also the acromial region and the clavicle
  • The deltoid therefore has a clavicular part, a middle part and a posterior, spinous part
  • The fibres coming from these converge onto the deltoid tuberosity
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42
Q

What is the nerve supplying the deltoid?

A

Axillary nerve

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43
Q

What is the role of the deltoid muscle?

A
  • Adduction of arm
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44
Q

What is included in the rotator cuff muscles?

A

supraspinatus, infraspinatus, teres minor and subscapularis

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45
Q

What are the attachments of the rotator cuff muscles?

A

They come off at the scapula in different places and cross the shoulder joint to attach around the head of the scapula. Muscles on posterior and anterior surface of scapula.

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46
Q

What are the roles of the rotator cuff muscles?

A
  • Involved in holding the head of humerus into the socket -as socket is shallow so lots of muscle needed to stabilise joint
  • They fix the head of the humerus into glenoid fossa.
  • Supraspinatus is involved in abduction of arm for first 15 degrees
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47
Q

What are the attachments of teres major?

A
  • Comes off the inferior angle of the scapula
  • It passes laterally and inserts (along with latissimus dorsi) into the floor and medial lip of intertubercular sulcus of humerus
48
Q

Which nerve innervates teres major?

A

lower subscapular nerve

49
Q

What does teres mean?

A

straight

50
Q

What does teres major do?

A

Medial rotator and adductor of the humerus

It also helps stabilise the humeral head in the glenoid cavity

51
Q

What is included in the anterior compartment of the arm?

A

biceps, brachialis and corabrachialis

52
Q

What is the biceps and what are the attachments?

A
  • Two-headed muscle of the arm

short head from the coracoid prcoess and long head from the supraglenoid tubercle to the tuberosity on the radius

53
Q

Which nerve supplies the anterior compartment of the arm?

A

musculocutaneous nerve

54
Q

What are the attachments of the brachialis?

A

It has an attachment at the middle and distal parts of the humeral shaft. It attaches to the coronoid process of the ulna.

55
Q

What is the role of the brachialis muscle?

A

Major contributor to flexion of the elbow joint

56
Q

What are the attachments of the coracobrachialis muclse?

A

Comes from the carcoid process and attaches to shaft of humerus

57
Q

What is the role of the coracobrachialis muscle?

A

Involved in flexion of the shoulder join

58
Q

What is included in the posterior compartment of the arm?

A

triceps and anconeus

59
Q

Which nerve supplies the posterior compartment of the arm?

A

radial nerve

60
Q

What is the structure of the triceps?

A

Triceps have a long head, a lateral head and a medial head

61
Q

What are the attachments of the triceps?

A

The long head covers the other heads (it crosses the shoulder group, towards the infraglenoid tubercle). The other proximal attachments are posterior to the shaft of the humerus. These heads converge to form the triceps tendon, which crosses over the elbow joint and attaches to the olecranon process of the ulna.

62
Q

What are the attachments of the anconeus muscle?

A

Anconeus is a small muscle that attaches from the lateral epicondyle of the humerus, to the upper part of the posterior of the ulna bone

63
Q

List the joints of the shoulder and arm

A
  • sternoclavicular
  • acromioclavicular
  • gleno-humeral
  • scapulothoracic (virtual)
  • elbow
64
Q

What kind of joint is the sternoclavicular joint?

A

pivot joint

65
Q

What kind of joint is the gleno-humeral joint?

A

synovial

66
Q

What is the rim of cartilage that deepens the glenoid fossa?

A

glenoid labrum/lip

67
Q

What are the names of the ligaments associated with the clavicle and scapula?

A

capsular ligaments

68
Q

What does the intertubercular groove refer to?

A

The space between the two tubercles of the heads of the humerus

69
Q

What is the subacromial bursa?

A

synovial cavity located just below the acromion - bursas are found at joints with lots of movement to cushion them (can become inflamed and painful)

70
Q

What is the main function of the rotator cuff muscles?

A

To hold the humeral head in the glenoid

71
Q

Where are the supraspinatus and infraspinatus muscles?

A

supra - in the supraspinous fossa

infra - infraspinous fossa

72
Q

Where does the teres minor come off from?

A

the inferior part of the scapula

73
Q

Where does the subscapularis come off?

A

deep surface of scapula

74
Q

What are the different movements of the scapulothoracic joint?

A
  • Elevation/Depression of the scapula
  • Protraction/Retraction of the scapula
  • Rotation of the scapula
75
Q

What is found in the axilla?

A
  • pyramid shaped
  • arteries (axilla and branches)
  • veins (axillary and tributaries)
  • lymphatic vessels and nodes
  • nerves (brachial plexus)
76
Q

What are the arteries of the shoulder and arm?

A
  • subclavian artery
  • axillary artery
  • brachial artery
  • ulnar and radial arteries
77
Q

Describe venous drainage in the limbs

A

superficial and deep (deep mirrors the arterial supply, often venae comitantes)

78
Q

What are the superficial veins in the arm?

A
  • Cephalic vein runs up lateral border of arm
  • Basilic vein runs up the medial border of arm
  • The cephalic and basilic veins are often joined by a median cubital vein
79
Q

How do the superficial veins in the arm drain into the subclavian vein?

A
  • Basilic veins joins the venae comitantes (a bit deeper) to form the axillary vein in the arm
  • Cephalic vein continues up the arm into the delto-pectoral groove and joins the axillary vein in the axilla
  • Axillary vein becomes the subclavian vein at the level of the first rib
80
Q

Describe the venous drainage of the arm into the subclavian vein

A
  • Axillary vein (deep v) is formed as basilic vein passes through the deep fascia to join the brachial veins at the level of the lower border of teres major
  • The axillary vein receives a large number of tributaries, including the cephalic vein and the lateral thoracic vein.
  • The axillary vein becomes the subclavian vein at the level of the 1st rib
81
Q

What are some lymph nodes of the shoulder and arm?

A
  • Superficial and deep systems, run with veins
  • Cubital lymph nodes
  • Delto-pectoral lymph nodes
  • Axillary lymph nodes – particularly important in breast cancer
  • Subclavian lymph trunk
82
Q

Where does the brachial plexus pass under?

A

clavicle

83
Q

Describe the brachial plexus and what the terminal branches are

A
  • The nerves mix and swap and branch off
  • Some branches come off early and some later
  • The terminal branches include the radial nerve, ulna nerve, median nerve, axillary nerve and musculocutaneous nerve
84
Q

What are some nerves that are more prone to damage?

A

Funny bone
When you bang the funny bone, you are banging the ulna nerve (where it’s quite superficial) wrapping around the medial epicondyle of the humerus.

Axillary nerve
Similarly, the axillary nerve is just below the shoulder joint. This can be damaged in shoulder dislocation.

Radial nerve
The radial nerve wraps very closely is opposed to the shaft of the humerus. If this is broken, we may see radial nerve damage.

85
Q

Explain the aterial supply of the arm from the subclavian artery

A

Subclavian artery -> in axilla become axillary artery (divides into 3 parts in relation to pex minor: superior, deep and inferior) -> in upper arm becomes brachial artery (major branch is profunda brachii artery coming off) -> at elbow divides into ulnar and radial artery -> main branch of ulnar artery is the common interosseous artery -> anterior and posterior branch -> ulnar and radial anastamose in the end at superficial and deep palmar arch to give off metacarpal and digital arteries to fingers

  • extensive anastomosis at the elbow
  • extensive collateral circulation around scapula
  • extensive anastomosis in the axilla
86
Q

What are some ligaments of the acromio-clacivular joint?

A

Acromio-clavicular ligament

Coraco-clavicular ligament: runs from the coracoid process of the scapula to the clavicle. There are two main sections to this ligament, the conoid and the trapezoid ligaments.

Coraco-acromial ligament: this is not particularly strong, but it is clinically important in that it is often a cause of impingement of the gleno-humeral joint.

87
Q

How is the ACJ often injured?

A

fall onto outstretched hands

88
Q

What are the extensions of the shoulder joint capsule? (ligaments encapsulating the joint)

A
  • from glenoid to humerus
  • subacromial bursa (capsule extends above humeral head to form bursa between the humeral head and acromial process)
  • extends around long head of biceps
89
Q

What is the coraco-acromial arch?

A
  • It consists of the acromion, the coracoid process and a strong ligament running between the two
  • This ligament is the coraco-acromial ligament
  • Arch prevents the humerus rising above acromion
90
Q

What are some ligaments blending in with the capsule of the gleno-humeral joint?

A
  • Gleno-humeral
  • Coraco-humeral
  • Transverse-humeral
91
Q

Which muscle cause which movements at the gleno-humeral joint?

A

Flexion – clavicular head of pectoralis major, anterior fibres of deltoid, coracobrachialis, biceps

Extension – latissimus dorsi

Abduction – supraspinatus (first 15 degrees), central fibres of deltoid (after 15 degrees)

Adduction – pectoralis major, latissimus dorsi

Internal rotation – subscapularis

External rotation – infraspinatus, teres minor

Circumduction – i.e. a combination of movements

92
Q

Which muscles resist dislocation at the gleno-humeral joint?

A
  1. Rotator cuff muscles – hold the humeral head against the glenoid cavity
  2. Deltoid
  3. Coracobrachialis
  4. Short head of biceps
  5. Long head of bicep
93
Q

What are the main movements of the scapula at scapulo-thoracic joint?

A
  1. Elevation and depression of the scapula
  2. Protraction of the scapula i.e. forward and lateral movement of the scapula against the chest wall
  3. Retraction of the scapula i.e. backward and medial movement of the scapula against the chest wall
  4. Rotation of the scapula
94
Q

What forms the borders of the axilla?

A
  • The base is composed of skin, subcutaneous tissue and fascia extending from the arm to the chest
  • The apex lies between the first rib, the clavicle and the superior border of the subscapularis muscle
  • The anterior wall is formed by pectoralis major and pectoralis minor
  • The posterior wall is formed by the scapula and subscapularis (superiorly) and the teres major and latissimus dorsi (inferiorly)
  • The medial wall is formed by the chest wall (1st to 4th ribs) and the serratus anterior
  • The lateral wall is formed by the intertubercular groove of the humerus
95
Q

What are the 5 axillary lymph nodes?

A

Apical, pectoral, subscapular, humeral and central - all drain to apical which goes into subclavian lymphatic duct into the right/left duct

96
Q

Describe the lymphatic drainage of the arm

A
  • Lymph drains from the hand via superficial lymphatics, which run alongside the cephalic and basilic veins
  • Some lymphatics pass directly and superficially up the arm
  • But there are also some cubital lymph nodes at the elbow
  • Similarly there are some delto-pectoral lymph nodes alongside the cephalic vein
  • Ultimately lymph from the superficial system drains to the axillary lymph nodes
97
Q

Which nerves are at risk of damage during axillary node dissections?

A

long thoracic and thoracodorsal

98
Q

Why is the clavicle unusual?

A

It is the first long bone to ossify (5th week of intra uterine life) in humans. It does so by intramembranous ossification rather than endochondral ossification that is common to most long bones.

99
Q

Which nerves can be damaged during fractures or dislocations of the humerus?

A
  • axillary
  • radial
  • ulnar
  • median
100
Q

Where can the subclavian artery pulse be found?

A

The subclavian artery pulse is just above and behind the medial end of the clavicle

101
Q

Superior/inferior angle and medial end of the scapula are at which vertebral levels?

A

superior- T2
medial - T3
inferior - T7

102
Q

Delto-pectoral groove landmarks

A

Is a triangle bounded by the clavicle superiorly, the deltoid laterally and the pectoralis major medially

103
Q

What is a prime mover or agonist?

A

Main muscle responsible for a specific movement

104
Q

How can the sternocleidomastoid be tested and which nerves are responsible?

A

turn the head against resistance

spinal accessory nerve, C3, C4

105
Q

How can the trapezius be tested and which nerves are responsible?

A

raise both shoulders against resistance

spinal accessory nerve, C3, C4

106
Q

How can pec major be tested and which nerves are responsible?

A

adduct the abducted arm against resistance

lateral and medial pectoral C5-8, T1

107
Q

How can serratus anterior be tested and which nerves are responsible?

A

both arms of subject are outstretched with palms against wall, and asked to press forward strongly
long thoracic nerve, C5, C6

108
Q

How can teres major be tested and which nerves are responsible?

A

adduct arm against resistance

lower subscapular nerve, C5, C6

109
Q

How can latissimus dorsi be tested and which nerves are responsible?

A

abduct arm to 90 degrees, then adduct against resistance

thoracodorsal nerve, C6-8

110
Q

How can the deltoid be tested and which nerves are responsible?

A

abduct the upper arm against resistance

axillary nerve, C5, C6

111
Q

What is circumduction

A

combination of flexion/extension and abduction/adduction so that the distal part of the upper limb moves in a circle

112
Q

What is opposition?

A

OPPOSITION: Bringing the pad of the thumb towards the pad of another digit.

113
Q

What is protraction and retraction?

A

PROTRACTION: an anterior movement of a body part.

RETRACTION: a posterior movement of a body part.

114
Q

What is pronation and supination?

A

PRONATION: rotation of the forearm along its long axis so that the palm faces posteriorly.

SUPINATION: rotation of the forearm along its long axis so that the palm faces anteriorly.

115
Q

Which muscles cause elevation, depression, protraction, retraction, rotation of the scapulo-thoracic joint?

A

Elevation: Superior trapezius, levator scapulae, rhomboids

Depression: Inferior trapezius, pectoralis minor, serratus anterior

Protraction: Pectoralis minor, serratus anterior

Retraction: Rhomboids, middle trapezius, latissimus dorsi

Rotation: Glenoid fossa faces upwards or downwards as scapula rotates

Rotation-up: Superior trapezius, inferior trapezius, serratus anterior

Rotation down: Pectoralis minor, latissimus dorsi, rhomboids and levator scapulae

116
Q

What is the scapulo-thoracic joint?

A

Convex surface of the posterior thoracic cage and the concave surface of the anterior scapula (at the back)

117
Q

What causes flexion and extension of the elbow joint?

A

Flexion:s Biceps, brachialis, brachioradialis (pronator teres)

Extension: Triceps (anconeus

Anatomy of the limbs (5 decks)

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